As of April 2021, cannabis, or marijuana, is legal for recreational use in 16 states and the District of Columbia (medical marijuana is legal in 36 states), with several others attempting to follow suit.1 Despite its prevalence and increasing legalization, however, marijuana remains classified by the U.S. Drug Enforcement Administration as a Schedule I drug, along with heroin and LSD, due to its high potential for abuse and the absence of currently accepted medical use. As such, marijuana is still federally illegal and, according to research on substance abuse disorders, potentially dangerous.

“Cannabis use disorders are often associated with dependence—in which a person feels withdrawal symptoms when not taking the drug. People who use marijuana often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort that peak within the first week after quitting and last up to two weeks,” explains Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).

“When dependence and other factors escalate to cannabis use disorder, a person cannot stop using the drug even though it interferes with many aspects of his or her life,” Dr. Volkow continues. “Some studies suggest that nine percent of people who use marijuana will become dependent on it, with higher rates in those who start using in their teens.” Other studies show even higher rates.

What Is Cannabis Use Disorder?

 Among other substance abuse disorders, cannabis use disorder (CUD) is classified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) using a series of criteria that determine a user’s patterns of behavior. These criteria include:

  • Cannabis is often taken in larger amounts or over a longer period than 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 to use cannabis
  • Recurrent cannabis use results in failure to fulfill 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 continues 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: (1) a need for markedly increased cannabis to achieve intoxication or desired effect or (2) a 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 or (2) cannabis is taken to relieve or avoid withdrawal symptoms.

CUD is defined as either mild (two to three symptoms present), moderate (four to five symptoms present) or severe (six or more symptoms present). According to NIDA, in 2015 roughly 4 million people in the United States met the criteria for cannabis use disorder.

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Treatments For Cannabis Use Disorder

According to NIDA, CUD is similar to other substance abuse disorders in that people with the disorder often suffer from other psychiatric disorders or substance abuse problems. For that reason, treating underlying mental health concerns may help treat the marijuana use disorder. Behavioral health treatments include:

  • Cognitive-behavioral therapy, which teaches people strategies to identify and correct behaviors that lead to substance abuse
  • Contingency management, which monitors target behaviors and rewards positive behavior changes
  • Motivational enhancement therapy, which is designed to mobilize a person’s internal motivations for change

Is Any Amount of Marijuana OK?

 Cannabis has long had the reputation of being non-addictive, unlike other “harder” drugs. Scientists, however, disagree–particularly in today’s environment that produces stronger strains. Simply stated, this isn’t your parents’ weak weed.

“The potency of cannabis products used to be much weaker, perhaps contributing to the impression that marijuana is not addictive,” explains Deborah Hasin, Ph.D., professor of epidemiology at Columbia University, in New York City. “However, potency has increased greatly over the last few decades. Updated figures show that 20 to 30 percent of cannabis users develop CUD, so the risk for addiction is real.” It is for that reason that Dr. Hasin feels that marijuana consumption of any amount can be cause for concern.

“I think the very idea that there is a ‘healthy’ amount of any psychoactive substance is problematic,” says Dr. Hasin. “Some people can use marijuana without harm, just as some people can drink without harm, especially if use is infrequent, but others run the risk of adverse consequences, including CUD, impaired social or operational functioning, respiratory problems, motor vehicle crashes and cannabis reactions requiring visits to the emergency room.”

Although somewhat controversial, cannabis use has also been linked to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorder.

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Last Updated: Jul 13, 2021