Cannabis use disorder
Cannabis use disorder, also known as cannabis addiction or marijuana addiction, is a psychiatric disorder defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders and ICD-11 as the continued use of cannabis despite clinically significant impairment.
There is a common misconception that cannabis use disorder does not exist, as people describe cannabis as non-addictive. Cannabis use disorder is the clinical name for cannabis addiction. Cannabis is one of the most widely used drugs globally. According to the National Survey on Drug Use and Health, in 2024, nearly 7% of US teens and adults met the criteria for cannabis use disorder. Among those aged 18–25, this rate is nearly 16%.
Cannabis use is linked to a range of mental health issues, including mood and anxiety disorders, and in some individuals, it may act as a form of self-medication for psychiatric disorders. Long-term use can lead to dependence, with an estimated 9–20% of users—particularly daily users—developing cannabis use disorder. Risk factors for developing CUD include early and frequent use, high THC potency, co-use with tobacco or alcohol, adverse childhood experiences, and genetic predispositions. Adolescents are especially vulnerable due to their stage of neurodevelopment and social influences, and CUD in youth is associated with poor cognitive and psychiatric outcomes, including a heightened risk of suicide attempts and self-harm.
Cannabis withdrawal, affecting about half of those in treatment, can include symptoms like irritability, anxiety, insomnia, and depression. There are no FDA-approved medications for CUD. Current evidence for medication in the setting of CUD is weak and inconclusive. Psychological treatments, such as cognitive behavioral therapy, motivational enhancement therapy, and twelve-step programs show promise. Diagnosis is based on DSM-5 or ICD-11 criteria, and screening tools like CAST and CUDIT are used for assessment. Treatment demand is rising globally, and despite limited pharmacological options, structured psychological support can be effective in managing cannabis dependence.
Signs and symptoms
Cannabis use is sometimes comorbid for 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 may function at a lower rate in school than students that do not. The sedating and anxiolytic properties of tetrahydrocannabinol in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders.
Dependence
Prolonged cannabis use produces both pharmacokinetic changes and pharmacodynamic changes to the body. These changes require the user to consume higher doses of the drug to achieve a common desirable effect, reinforcing the body's metabolic systems for eliminating the drug more efficiently and further down-regulating cannabinoid receptors in the brain.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.
One study has shown that between 2001–2002 and 2012–2013, the use of cannabis in the US doubled.
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. Of those who use cannabis daily, 10–20% develop dependence.
Withdrawal
Cannabis withdrawal symptoms occur in half of people being treated for cannabis use disorder. 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. About 12% of heavy cannabis users showed cannabis withdrawal symptoms as defined by the DSM-5, and this was associated with significant disability as well as mood, anxiety, and personality disorders. 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. Concomitant alcohol or tobacco use, a history of adverse childhood experiences, depression or other psychiatric disorders, stressful life events and parental cannabis use may also increase the risk of developing cannabis use disorder.The main factors in Australia, for example, related to a heightened risk for developing problems with cannabis use include frequent use at a young age; personal maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using peers; moving away from home at an early age; daily cigarette smoking; and ready access to cannabis. The researchers concluded there is emerging evidence that positive experiences to early cannabis use are a significant predictor of late dependence and that genetic predisposition plays a role in the development of problematic use.
High risk groups
A number of groups have been identified as being at greater risk of developing cannabis dependence and, in Australia have been found to include adolescent populations, Aboriginal and Torres Strait Islanders and people with mental health conditions.Adolescents
The endocannabinoid system is directly involved in adolescent brain development. Adolescent cannabis users are therefore particularly vulnerable to the potential adverse effects of cannabis use. 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 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. This fear of rejection plays a big role in their decision to use cannabis. However it does not seem to be the most important factor. According to a study from Canada, the lack of knowledge about cannabis seems to be the main reason why adolescents start to smoke. The authors observed a high correlation between adolescents that knew about the mental and physical harms of cannabis and their consumption. Of the 1045 young participants in the study, those who could name the least number of negative effects about this drug were usually the ones who were consuming it. They were not isolated cases either. Actually, the study showed that the proportion of teenagers who saw cannabis as a high-risk drug and the ones who thought the contrary was about the same.
In a 2023 national inpatient study, researchers found that adolescents with Cannabis Use Disorder 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.