Cannabis use disorder

Cannabis use is sometimes comorbid with other mental health problems, such as mood and anxiety disorders, and discontinuing cannabis use is difficult for some users. Psychiatric comorbidities are often present in dependent cannabis users including a range of personality disorders. Based on annual survey data, some high school seniors who report smoking daily (nearly 7%, according to one study) may function at a lower rate in school than students who do not. The sedating and anxiolytic properties of tetrahydrocannabinol (THC) in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders. Cannabis users have shown decreased reactivity to dopamine, suggesting a possible link to a dampening of the reward system of the brain and an increase in negative emotion and addiction severity. Cannabis users can develop tolerance to the effects of THC. Tolerance to the behavioral and psychological effects of THC has been demonstrated in adolescent humans and animals. The mechanisms that create this tolerance to THC are thought to involve changes in cannabinoid receptor function. Cannabis dependence develops in about 9% of users, significantly less than that of heroin, cocaine, alcohol, and prescribed anxiolytics, but slightly higher than that for psilocybin, mescaline, or LSD. Symptoms may include dysphoria, anxiety, irritability, depression, restlessness, disturbed sleep, gastrointestinal symptoms, and decreased appetite. It is often paired with rhythmic movement disorder. Most symptoms begin during the first week of abstinence and resolve after a few weeks. Furthermore, a study on 49 dependent cannabis users over a two-week period of abstinence proved most prominently symptoms of nightmares and anger issues. Cause Cannabis addiction is often due to prolonged and increasing use of the drug. Increasing the strength of the cannabis taken and increasing use of more effective methods of delivery often increase the progression of cannabis dependency. Approximately 17.0% of weekly and 19.0% of daily cannabis smokers can be classified as cannabis dependent. In addition to cannabis use, it has been shown that co-use of cannabis and tobacco can result in an elevated risk of cannabis use disorder. Susceptibility to cannabis addiction can also stem from genetic predispositions or environmental influences that make certain individuals inherently more vulnerable to substance dependence. Moreover, prenatal exposure to cannabis—where the mother uses cannabis during pregnancy—can predispose offspring to an increased risk of developing cannabis use disorder later in life, highlighting a possible transgenerational transmission of vulnerability. Risk factors Certain factors are considered to heighten the risk of developing cannabis dependence. Longitudinal studies over a number of years have enabled researchers to track aspects of social and psychological development concurrently with cannabis use. Increasing evidence is being shown for the elevation of associated problems by the frequency and age at which cannabis is used, with young and frequent users being at most risk. The frequency of cannabis use and duration of use are considered to be major risk factors for development of cannabis use disorder. The strength of cannabis used, with higher THC content conferring a heightened risk, is also thought to be a risk factor. Adolescents The endocannabinoid system is directly involved in adolescent brain development. Adolescent cannabis use is associated with increased cannabis misuse as an adult, issues with memory and concentration, long-term cognitive complications, and poor psychiatric outcomes including social anxiety, suicidality, and addiction. There are several reasons why adolescents start a smoking habit. According to a study completed by Bill Sanders, influence from friends, difficult household problems, and experimentation are some of the reasons why this population starts to smoke cannabis. This segment of the population seems to be one of the most influenceable group there is. They want to follow the group and look "cool", "hip", and accepted by their friends. The authors observed a high correlation between adolescents that knew about the mental and physical harms of cannabis and their consumption. In a 2023 national inpatient study, researchers found that adolescents with Cannabis Use Disorder (CUD) were at a significantly higher risk for suicide attempts and self-harm tendencies. They observed 807,105 adolescents who were hospitalized from January 1, 2016, to December 31, 2019, of which 6.9% had CUD. The study showed the majority of adolescents with CUD that were hospitalized were more likely to be older and have depression, emphasizing the association between CUD and suicide attempts/self-harm. Adolescents who were diagnosed with CUD had 2.4 times the odds of suicide attempt/self-harm. Interventions should occur early on to attempt to prevent the development of CUD and any related actions. Pregnancy The American College of Obstetricians and Gynecologists advises against cannabis use during pregnancy or lactation. There is an association between smoking cannabis during pregnancy and low birth weight. Smoking cannabis during pregnancy can lower the amount of oxygen delivered to the developing fetus, which can restrict fetal growth. In a study conducted by Reproductive Health, the use of cannabis during pregnancy may also alter the neurotransmission system of the infant. Prenatal exposure to cannabis could harm their brain areas such as the "prefrontal cortex, the mesolimbic system, the striatum and the hypothalamic-pituitary axis." These areas are involved in executive functions such as the reinforcement and regulation of emotions. Thus, the consequences of exposure to maternal cannabis use could cause executive dysfunction to the emotional system that will remain present even in early adulthood. == Diagnosis ==

Cannabis use disorder is recognized in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which also added cannabis withdrawal as a new condition. In the 2013 revision for the DSM-5, DSM-IV abuse and dependence were combined into cannabis use disorder. The legal problems criterion (from cannabis abuse) has been removed, and the craving criterion was newly added, resulting in a total of eleven criteria: hazardous use, social/interpersonal problems, neglected major roles, withdrawal, tolerance, used larger amounts/longer, repeated attempts to quit/control use, much time spent using, physical/psychological problems related to use, activities given up and craving. For a diagnosis of DSM-5 cannabis use disorder, at least two of these criteria need to be present in the last twelve-month period. Additionally, three severity levels have been defined: mild (two or three criteria), moderate (four or five criteria) and severe (six or more criteria) cannabis use disorder. Cannabis use disorder is also recognized in the eleventh revision of the International Classification of Diseases (ICD-11), adding more subdivisions including time intervals of pattern of use (episodic, continuous, or unspecified) and dependence (current, early full remission, sustained partial remission, sustained full remission, or unspecified) compared to the 10th revision. A 2019 meta-analysis found that 34% of people with cannabis-induced psychosis transitioned to schizophrenia. This was found to be comparatively higher than hallucinogens (26%) and amphetamines (22%). To screen for cannabis-related problems, several methods are used. Scales specific to cannabis, which provides the benefit of being cost efficient compared to extensive diagnostic interviews, include the Cannabis Abuse Screening Test (CAST), Cannabis Use Identification Test (CUDIT), and Cannabis Use Problems Identification Test (CUPIT). Scales for general drug use disorders are also used, including the Severity Dependence Scale (SDS), Drug Use Disorder Identification Test (DUDIT), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). == Treatment ==

Clinicians differentiate between casual users who have difficulty with drug screens, and daily heavy users, to a chronic user who uses multiple times a day. In the US, , cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities. Demand for treatment for cannabis use disorder increased internationally between 1995 and 2002. In the United States, the average adult who seeks treatment has consumed cannabis for over 10 years almost daily and has attempted to quit six or more times. No medications have been found effective for cannabis dependence, but psychotherapeutic models hold promise. The most commonly accessed forms of treatment in Australia are 12-step programmes, physicians, rehabilitation programmes, and detox services, with inpatient and outpatient services equally accessed. In the EU approximately 20% of all primary admissions and 29% of all new drug clients in 2005, had primary cannabis problems. And in all countries that reported data between 1999 and 2005 the number of people seeking treatment for cannabis use increased. Psychological Psychological intervention includes cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), contingency management (CM), supportive-expressive psychotherapy (SEP), family and systems interventions, and twelve-step programs. Evaluations of Marijuana Anonymous programs, modelled on the 12-step lines of Alcoholics Anonymous and Narcotics Anonymous, have shown small beneficial effects for general drug use reduction. In 2006, the Wisconsin Initiative to Promote Healthy Lifestyles implemented a program that helps primary care physicians identify and address marijuana use problems in patients. Medication No medication has been proven effective for treating cannabis use disorder; research is focused on three treatment approaches: agonist substitution, antagonist, and modulation of other neurotransmitter systems. More broadly, the goal of medication therapy for cannabis use disorder centers around targeting the stages of the addiction: acute intoxication/binge, withdrawal/negative affect, and preoccupation/anticipation. For the treatment of the withdrawal/negative affect symptom domain of cannabis use disorder, medications may work by alleviating restlessness, irritable or depressed mood, anxiety, and insomnia. Bupropion, which is a norepinephrine–dopamine reuptake inhibitor, has been studied for the treatment of withdrawal with largely poor results. It is possible that venlafaxine use actually exacerbated cannabis withdrawal symptoms, leading people to use more cannabis than placebo to alleviate their discomfort. Vilazodone, which has both SRI and 5-HT1A receptor agonism properties, also failed to increase abstinence rates in people with cannabis use disorder. The CB1 receptor antagonist rimonabant has shown efficacy in reducing the effects of cannabis in users, but with a risk for serious psychiatric side effects. Lower-risk cannabis use Recommendations by the Lower-Risk Cannabis Use Guidelines (LRCUG) for strategies to reduce the risks associated with cannabis use include: - Delaying use until after adolescence to lower the risk of cognitive impairment and dependence - Avoiding high-potency cannabis to reduce the likelihood of Cannabis Use Disorder - Limiting frequency of use - Avoiding high-risk methods of consumption such as deep inhalation and combusted cannabis - Avoid simultaneous substance use such as tobacco and alcohol to prevent compounding effects on health and dependence ==Epidemiology==

According to the 2022 National Survey on Drug Use and Health, cannabis is one of the most widely used drugs in the world. Research by the Pew Research Center from 2012 claims 42% of the US population have claimed to use cannabis at some point. An estimated 9% of those who use cannabis develop dependence. In the United States, cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities. Of Australians aged 14 years and over, 34.8% have used cannabis one or more times in their life. In the European Union (data as available in 2018, information for individual countries was collected between 2012 and 2017), 26.3% of adults aged 15–64 used cannabis at least once in their lives, and 7.2% used cannabis in the last year. The highest prevalence of cannabis use among 15 to 64 years old in the EU was reported in France, with 41.4% having used cannabis at least once in their life, and 2.17% used cannabis daily or almost daily. Among young adults (15–34 years old), 14.1% used cannabis in the last year. Among adolescents (15–16 years old) in a European school based study (ESPAD), 16% of students have used cannabis at least once in their life, and 7% (boys: 8%, girls: 5%) of students had used cannabis in the last 30 days. Globally, 22.1 million people (0.3% of the world's population) were estimated to have cannabis dependence. == Research ==

Medications such as SSRI antidepressants, mixed-action antidepressants, bupropion, buspirone, and atomoxetine may not be helpful as cannabis use disorder treatments, but the evidence is very weak and further research is required. == See also ==