Cannabis Use Disorder: Symptoms, Risks, and Treatment Options

Introduction

Cannabis use disorder (CUD) is becoming increasingly prevalent as cannabis consumption rises worldwide. While many individuals use cannabis recreationally or for medical purposes, some develop a problematic pattern of use that leads to significant distress or impairment in their daily lives. Although cannabis has been used for centuries, its potential for addiction has only recently gained widespread recognition. This article aims to help patients understand what cannabis use disorder is, its causes, and how it can be managed. It will cover risk factors, symptoms, diagnosis, treatment options, and self-care strategies for managing CUD symptoms.

Definition

Cannabis use disorder is a medical condition characterized by problematic cannabis use. This article will explore its risk factors, symptoms, diagnostic tests, medications, procedures, and self-care strategies.

What is Cannabis Use Disorder?

Cannabis use disorder (CUD) occurs when a person becomes dependent on cannabis, leading to significant physical, psychological, and social challenges. Individuals with CUD often struggle to control their cannabis use, even when it negatively impacts their health, relationships, or responsibilities. The condition typically develops gradually, beginning with occasional use that becomes more frequent and compulsive over time.

As cannabis use increases, the brain adapts to the drug, resulting in tolerance (needing more cannabis to achieve the same effect) and withdrawal symptoms when not using it. Over time, this can create a cycle of dependence, where the person feels compelled to use cannabis to avoid withdrawal symptoms or to function normally.

According to the National Institute on Drug Abuse (NIDA), approximately 9% of cannabis users develop CUD, with this number rising to 17% for those who begin using during adolescence. As cannabis legalization expands, understanding and addressing CUD is becoming increasingly important for public health.

Risk Factors for Developing Cannabis Use Disorder

Lifestyle Risk Factors

Several lifestyle factors can increase the risk of developing cannabis use disorder. Frequent cannabis use is one of the most significant. The more often a person uses cannabis, the more likely they are to develop dependence. Additionally, using cannabis in social settings where it is normalized or encouraged can lead to regular use.

Other lifestyle factors include stress, peer pressure, and easy access to cannabis. People who use cannabis to cope with stress or emotional difficulties may be at higher risk of developing CUD. Similarly, individuals surrounded by friends or family members who frequently use cannabis may be more likely to start using it and eventually develop a disorder.

Medical Risk Factors

Individuals with certain medical conditions may be more vulnerable to developing cannabis use disorder. For example, those with mental health conditions such as anxiety, depression, or post-traumatic stress disorder (PTSD) may use cannabis to self-medicate, which can lead to dependence and exacerbate their mental health symptoms.

Additionally, people with a history of substance use disorders, including alcohol or other drugs, are more likely to develop CUD. Cannabis use can sometimes act as a gateway to other substances or worsen existing substance use problems.

Genetic and Age-Related Risk Factors

Genetics also play a role in the development of cannabis use disorder. Research indicates that individuals with a family history of substance use disorders may be more likely to develop CUD, suggesting a genetic predisposition to addiction.

Age is another important factor. People who begin using cannabis at a younger age, particularly during adolescence, are at a higher risk of developing CUD. The adolescent brain is still developing, and early cannabis exposure can interfere with normal brain development, increasing the likelihood of dependence later in life. Studies suggest that individuals who start using cannabis before age 18 are four to seven times more likely to develop CUD compared to those who begin in adulthood.

Clinical Manifestations

Increased Tolerance

Increased tolerance to cannabis occurs in about 70-80% of individuals with cannabis use disorder (CUD). Tolerance means needing more cannabis over time to achieve the same effects. This happens because the body becomes accustomed to THC (the active ingredient in cannabis) and requires larger amounts to achieve the same high or symptom relief. Tolerance is a hallmark of substance use disorders and can lead to more frequent or higher doses of cannabis, increasing the risk of dependence.

Withdrawal Symptoms

Withdrawal symptoms are observed in about 50-95% of individuals with cannabis use disorder, especially when they try to reduce or stop using cannabis. Symptoms can include irritability, anxiety, insomnia, decreased appetite, and physical discomfort. These occur because the brain and body have become dependent on regular cannabis intake, and when it is no longer available, the body reacts negatively. Withdrawal symptoms are often more severe in individuals who have been using cannabis heavily or for a long time.

Cravings

Cravings for cannabis are reported by 60-80% of people with cannabis use disorder. Cravings are strong urges to use cannabis, often triggered by environmental cues, stress, or emotions. These cravings can be difficult to resist and are a common reason for relapse after quitting. Cravings are a central feature of addiction and can persist even after a person has stopped using cannabis for a significant period.

Unsuccessful Attempts to Cut Down

About 40-60% of individuals with cannabis use disorder report unsuccessful attempts to reduce or quit cannabis use. Despite wanting to cut down, they find it difficult due to cravings, withdrawal symptoms, or habitual use. This pattern of failed attempts to stop is a key indicator of addiction and highlights the need for professional support in managing the disorder.

Significant Time Spent Using

In about 50-70% of cases, individuals with cannabis use disorder spend a significant amount of time obtaining, using, or recovering from the effects of cannabis. This can interfere with daily responsibilities and activities. The time spent on cannabis use becomes a dominant aspect of their lives, often at the expense of work, school, or family obligations.

Neglecting Responsibilities

Neglecting responsibilities is common in 40-60% of individuals with cannabis use disorder. This occurs when cannabis use takes priority over important obligations, such as work, school, or family duties. As cannabis use becomes more central to the individual’s life, they may miss deadlines, important events, or perform poorly in daily tasks.

Continued Use Despite Problems

About 60-80% of individuals with cannabis use disorder continue using cannabis despite experiencing physical, psychological, or social problems related to their use. This could include issues like anxiety, depression, or relationship conflicts. Continued use despite these negative consequences is a clear sign of addiction, as the individual is unable to stop even when it causes harm.

Social or Interpersonal Issues

Social or interpersonal issues related to cannabis use are reported by 30-50% of individuals with cannabis use disorder. These issues can include conflicts with family members, friends, or colleagues due to the individual’s cannabis use. Relationships may become strained as the individual prioritizes cannabis over social interactions or responsibilities, leading to isolation or tension.

Loss of Interest in Activities

Loss of interest in previously enjoyable activities is seen in 40-60% of individuals with cannabis use disorder. As cannabis use becomes the primary focus, individuals may lose interest in hobbies, social events, or other activities they once found fulfilling. This can lead to a reduced quality of life and contribute to feelings of depression or isolation.

Using in Hazardous Situations

Using cannabis in hazardous situations, such as driving or operating machinery, occurs in about 20-40% of individuals with cannabis use disorder. Cannabis impairs judgment, coordination, and reaction times, making these activities dangerous. Despite the risks, individuals with cannabis use disorder may continue using cannabis in these situations, putting themselves and others at risk.

Diagnostic Evaluation

The diagnosis of cannabis use disorder is made through a comprehensive evaluation that includes a clinical interview, symptom assessment, and specific diagnostic tools. During the clinical interview, healthcare providers will ask about the patient’s cannabis use patterns, including frequency, duration, and any related problems. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria are often used to assess whether the patient meets the criteria for cannabis use disorder. Additionally, tests like urine drug screening, blood tests, and psychological evaluations may be used to confirm the diagnosis and assess the severity of the disorder.

Clinical Interview

The clinical interview is a conversation between the patient and the healthcare provider to gather detailed information about the patient’s cannabis use. This interview may cover topics such as the frequency of use, the amount of cannabis consumed, and any negative consequences the patient has experienced. The healthcare provider will also ask about the patient’s attempts to quit or reduce use, as well as any withdrawal symptoms or cravings they may have experienced. This information helps create a comprehensive picture of the patient’s relationship with cannabis and is essential for making an accurate diagnosis.

DSM-5 Criteria Assessment

The DSM-5 is a manual used by healthcare professionals to diagnose mental health disorders, including substance use disorders. The DSM-5 criteria for cannabis use disorder include symptoms like increased tolerance, withdrawal symptoms, cravings, and continued use despite problems. To be diagnosed with cannabis use disorder, a patient must meet at least two of these criteria within a 12-month period. The DSM-5 assessment helps healthcare providers determine the severity of the disorder, which can range from mild (2-3 symptoms) to moderate (4-5 symptoms) to severe (6 or more symptoms).

Urine Drug Screening

Urine drug screening is a common test used to detect the presence of THC, the active compound in cannabis, in the body. The test involves collecting a urine sample, which is then analyzed for THC metabolites. These metabolites can remain in the body for several days to weeks after cannabis use, depending on the frequency and amount of use. Urine drug screening is important for confirming recent cannabis use and can help healthcare providers determine whether the patient is currently using cannabis.

Results that Indicate Cannabis Use Disorder

If the urine drug screening shows the presence of THC metabolites, it confirms recent cannabis use. However, a positive result alone does not diagnose cannabis use disorder. The healthcare provider will consider the test results alongside the patient’s symptoms and history to make a diagnosis. If the test comes back negative, it may indicate that the patient has not used cannabis recently, but it does not rule out a history of cannabis use disorder. In such cases, the provider will rely more heavily on the clinical interview and DSM-5 criteria to make a diagnosis.

Blood Tests

Blood tests can also be used to detect the presence of THC in the body. Unlike urine tests, which detect THC metabolites, blood tests measure active THC in the bloodstream. This test is typically used to assess recent cannabis use, as THC is quickly metabolized and may only be detectable in the blood for a few hours to days after use. Blood tests are often used in situations where recent impairment is a concern, such as in cases of suspected intoxication while driving.

Results that Indicate Cannabis Use Disorder

A positive blood test for THC indicates recent cannabis use, but like urine tests, it does not diagnose cannabis use disorder on its own. The healthcare provider will interpret the results in the context of the patient’s symptoms and history. If the blood test is negative, it may suggest that the patient has not used cannabis recently, but it does not rule out a history of cannabis use disorder. In cases where the test is negative but symptoms persist, the provider may explore other diagnostic tools or consider other potential causes for the symptoms.

What if All Tests are Negative but Symptoms Persist?

If all tests come back negative but you are still experiencing symptoms of cannabis use disorder, it is important to continue working with your healthcare provider. They may recommend further evaluation, including additional psychological assessments or behavioral evaluations, to explore other potential causes of your symptoms. In some cases, symptoms may be related to another underlying condition, such as anxiety or depression, which can co-occur with cannabis use disorder. Your healthcare provider can help guide you through the next steps and develop a treatment plan tailored to your needs.

Treatment Options for Cannabis Use Disorder

Medications for Cannabis Use Disorder

N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is a supplement that helps restore glutamate levels, a key neurotransmitter in the brain. It may help reduce cravings and ease withdrawal symptoms in individuals with cannabis use disorder.

NAC is often recommended for those experiencing cravings or withdrawal, particularly in the early stages of treatment. It is considered a first-line option due to its safety profile and availability over the counter.

Many patients report reduced cravings and an improved ability to abstain from cannabis within a few weeks of starting NAC, though results can vary depending on the severity of the disorder.

Gabapentin

Gabapentin, commonly used to treat seizures and nerve pain, has shown potential in alleviating withdrawal symptoms associated with cannabis use disorder.

It is typically prescribed for individuals experiencing significant withdrawal symptoms, such as anxiety, irritability, or insomnia. While not a first-line treatment, gabapentin may be used alongside other therapies in more severe cases.

Patients may begin to feel relief from withdrawal symptoms within a few days to a week of starting gabapentin, and it may also help reduce cravings over time.

Baclofen

Baclofen, a muscle relaxant, has been studied for its potential to reduce cravings and withdrawal symptoms in cannabis use disorder.

It is generally considered when other treatments have not been effective or when patients experience severe withdrawal symptoms. Baclofen is not a first-line treatment but may be an option in more advanced cases.

Some patients notice a reduction in cravings and withdrawal symptoms within a few weeks of starting baclofen, though its effectiveness can vary.

Topiramate

Topiramate, a medication commonly used for epilepsy and migraines, has been studied for its ability to reduce cravings and improve abstinence rates in cannabis use disorder.

Topiramate is typically considered when other medications have not been effective or in patients with co-occurring conditions such as epilepsy or migraines. It is not usually a first-line treatment.

Patients may experience reduced cravings and an increased ability to abstain from cannabis use within a few weeks of starting topiramate.

Cannabidiol (CBD)

Cannabidiol (CBD), a non-psychoactive compound found in cannabis, has been studied for its potential to reduce cravings and anxiety in individuals with cannabis use disorder.

CBD is often used as a complementary treatment, particularly for patients experiencing anxiety or stress related to cannabis withdrawal. It is generally considered safe and is available over the counter.

Patients may experience reduced anxiety and cravings within a few days to weeks of starting CBD, though individual results can vary.

Disulfiram

Disulfiram, traditionally used to treat alcohol use disorder, has been studied for its potential to reduce cannabis use.

It is typically used in more advanced cases of cannabis use disorder, especially when patients also struggle with alcohol use disorder. Disulfiram is not a first-line treatment for cannabis use disorder alone.

Patients may experience a gradual reduction in cannabis use over time, though the effectiveness of disulfiram for cannabis use disorder is still under investigation.

Mirtazapine

Mirtazapine, an antidepressant, has been studied for its potential to reduce withdrawal symptoms and improve sleep in individuals with cannabis use disorder.

Mirtazapine is often prescribed to patients experiencing significant anxiety, depression, or sleep disturbances related to cannabis withdrawal. It is typically used in combination with other treatments.

Patients may notice improvements in mood and sleep within a few days to weeks of starting mirtazapine, which can support long-term abstinence from cannabis.

Varenicline

Varenicline, a medication commonly used to help people quit smoking, has been studied for its potential to assist individuals with cannabis use disorder.

It is typically considered when other treatments have not been effective, particularly in patients who are also trying to quit smoking. Varenicline is not usually a first-line treatment for cannabis use disorder alone.

Patients may experience reduced cravings and an increased ability to abstain from cannabis use within a few weeks of starting varenicline.

Fluoxetine

Fluoxetine, an antidepressant, has been studied for its potential to reduce anxiety and depression in individuals with cannabis use disorder.

Fluoxetine is often prescribed to patients experiencing significant mood disturbances related to cannabis withdrawal. It is typically used in conjunction with other treatments.

Patients may experience improved mood and reduced anxiety within a few weeks of starting fluoxetine, which can support long-term abstinence from cannabis.

Clonidine

Clonidine, a medication commonly used to treat high blood pressure, has been studied for its ability to reduce withdrawal symptoms in cannabis use disorder.

Clonidine is typically prescribed for patients experiencing significant withdrawal symptoms, such as irritability, anxiety, or insomnia. It is not usually a first-line treatment but may be used in more severe cases.

Patients may experience relief from withdrawal symptoms within a few days of starting clonidine, which can support long-term abstinence from cannabis.

Improving Cannabis Use Disorder and Seeking Medical Help

In addition to medical treatments, several lifestyle changes and home remedies can help manage cannabis use disorder. These include:

1. Exercise: Regular physical activity can help reduce stress and improve mood, making it easier to manage cravings and withdrawal symptoms.
2. Meditation: Mindfulness and meditation practices can help reduce anxiety and improve focus, aiding in resisting the urge to use cannabis.
3. Support groups: Joining a support group provides encouragement and accountability, helping individuals stay on track with their recovery.
4. Journaling: Writing down thoughts and feelings can help process emotions and identify triggers for cannabis use.
5. Healthy diet: A balanced diet supports overall well-being and helps the body recover from cannabis dependence.
6. Hydration: Staying hydrated can help alleviate physical withdrawal symptoms such as headaches and fatigue.
7. Mindfulness: Practicing mindfulness helps individuals stay present and focused on their recovery goals.
8. Setting goals: Establishing clear, achievable goals provides motivation and a sense of purpose during recovery.
9. Avoiding triggers: Identifying and avoiding situations or people that trigger cannabis use can help prevent relapse.
10. Establishing a routine: A structured daily routine helps individuals stay focused on recovery and reduces the likelihood of relapse.

If you are struggling with cannabis use disorder, seeking medical help is essential. Telemedicine offers a convenient way to access care from the comfort of your home. Our primary care practice provides comprehensive support, including medication management, counseling, and lifestyle recommendations.

Living with Cannabis Use Disorder: Tips for Better Quality of Life

Living with cannabis use disorder can be challenging, but there are steps you can take to improve your quality of life:

1. Stay connected: Maintain strong relationships with family and friends who support your recovery.
2. Practice self-care: Prioritize activities that promote mental and physical well-being, such as exercise, relaxation, and healthy eating.
3. Seek professional help: Don’t hesitate to reach out to a healthcare provider for guidance and support.
4. Stay engaged in treatment: Whether through medication, therapy, or support groups, staying committed to your treatment plan is key to long-term recovery.

Conclusion

Cannabis use disorder is a serious condition that can impact both your physical and mental health. However, with the right treatment and support, recovery is possible. Early diagnosis and intervention are crucial for improving outcomes and preventing complications. If you or a loved one is struggling with cannabis use disorder, our telemedicine practice is here to help. We offer convenient, compassionate care from the comfort of your home, so you can take the first step toward recovery today.

James Kingsley

Learn More