Marijuana is the most used drug in the U.S. after alcohol and tobacco. About 4.2 million people in 2014 (age 12 and up) were believed to have met the criteria for having a substance use disorder based on marijuana use. Marijuana’s immediate effects include distorted perception, difficulty with thinking and problem solving, and loss of motor coordination. Long-term use of the drug can contribute to respiratory infection, impaired memory, and exposure to cancer-causing compounds. Signs of cannabis use include red eyes, chronic cough, cannabis odor on clothing, yellowing of finger tips (from smoking joints), burning of incense (to hide odor), and exaggerated craving and impulse for specific foods. Heavy marijuana use in youth has also been linked to increased risk for developing mental illness and poor cognitive functioning.
Cannabis use disorder criteria are met if 2 of the following symptoms occur during a 12 month period. Severity of the disorder is defined as follows:
Mild = 2-3 symptoms present
Moderate = 4-5 symptoms present
Severe = 6 or more symptoms present
- Cannabis is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
- A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
- Craving, or a strong desire or urge to use cannabis.
- Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
- Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
- Recurrent cannabis use in situations in which it is physically hazardous.
- Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
- Tolerance, as defined by either a (1) need for markedly increased cannabis to achieve intoxication or desired effect or (2) markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis- irritability, anger or aggression; nervousness or anxiety; insomnia or disturbing dreams; decreased appetite or weight loss; restlessness; depressed mood; at least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache. These withdrawal symptoms typically don’t require medical attention; however, they make quitting cannabis difficult or (2) cannabis is taken to relieve or avoid withdrawal symptoms
The onset of cannabis use disorder is seen in teens and young adults, but can be in pre-teens as well. There is a genetic component to the risk factors for the disorder that includes impulsiveness and novelty-seeking. Males are more apt to develop the disorder than females. Generally speaking, those who start smoking marijuana earlier (early adolescence) and smoke heavily are more likely to experience negative consequences. This may in turn lead to mental health problems, but also lead to more general life problems, like conflict at home, school or work, financial problems and memory problems. Psychologically, chronic use of marijuana has been associated with a loss of ambition known as the “amotivational syndrome.”
Treatment options for individuals with cannabis-related disorders are identical to those available for people with alcohol and other substance abuse disorders. The goal of treatment is abstinence. Treatment approaches range from in-patient hospitalization, drug and alcohol rehabilitation facilities, and outpatient counseling such as cognitive-behavioral therapy. Twelve-step programs such as Narcotics Anonymous are also treatment options. For heavy users suffering from withdrawal symptoms, treatment with anti-anxiety and/or antidepressant medication may assist in the treatment process.