Cannabis use disorder (CUD)

Cannabis use disorder (CUD) is defined as the persistent and problematic use of cannabis, or marijuana, despite significant impairment to the body and senses. Cannabis-induced impairments can range from moderate to severe. CUD is also referred to as cannabis addiction and marijuana addiction. It is included among several other substance use disorders within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD). According to the DSM-5, individuals diagnosed with CUD must present at least two of eleven symptoms that evaluate the user's lack of control, craving, withdrawal, and negative effects on personal and professional responsibilities within a twelve-month period. With treatment, individuals experiencing CUD can curb problematic habits.

Background

CUD was deemed a substance use disorder with the publication of the DSM-5 in 2013. The DSM-5 originally separated cannabis abuse and cannabis dependence into two separate disorders. These disorders were combined to form CUD in the DSM-5. With substance use disorders, problems arise as a result of the activation of the brain's reward system. When a person takes in a substance that activates this system, he or she is flooded with rewarding feelings such as pleasure and euphoria. Oftentimes, the experience a person has with a substance overtakes his or her ability to function in a normal environment. Instead, the individual prefers the experience of the reward-inducing drugs over normal brain function. Severe substance use disorders are referred to as addictions.

CUD involves a person experiencing repeated cannabis intoxication, which manifests when a person inhales or ingests cannabis. Symptoms of cannabis intoxication include behavioral and psychological changes that can impair a person's judgment, motor coordination, thinking, and memory. Cannabis intoxication can also lead to varying states of emotion such as euphoria or anxiety. Physical symptoms of cannabis intoxication include dry mouth, accelerated heart rate, blood-shot eyes, and increased appetite.

Cannabis intoxication symptoms usually subside within a few hours, but prolonged use of marijuana can potentially have long-term effects on a user's physical and mental health. As with many intoxicating substances, marijuana's effects tend to lessen with continued use. As users build a tolerance, more of the drug is required to achieve the same effect. This can result in individuals using marijuana more frequently and developing a dependency on the drug. If this becomes the case, the user usually feels symptoms of withdrawal when not taking marijuana, further prompting increased usage.

Overview

The DSM-5 defines CUD as a problematic pattern of cannabis use that leads to considerable impairment or distress as demonstrated by at least two of the following symptoms occurring within a twelve month period:

• The patient uses larger amounts of cannabis than needed or uses cannabis over a longer period of time than originally intended.
• The patient has unsuccessfully sought to cut down or control usage despite a desire to do so.
• The patient's life revolves around obtaining, using, and recovering from the use of cannabis.
• The patient craves or has a strong need to use cannabis.
• The patient's cannabis use has interfered with his or her ability to fulfill responsibilities at work, school, or home.
• The patient continues to use cannabis despite a rise in social or interpersonal problems resulting from usage.
• The patient reduces or cuts out engagement in important social, occupational, or recreational activities due to cannabis usage.
• The patient repeatedly uses cannabis during situations in which it is dangerous to do so.
• The patient continues to use cannabis despite knowing it is responsible for physical or psychological problems.
• The patient has a very high tolerance for cannabis usage and does not feel the effects of intoxication until a large quantity is taken.
• The patient experiences withdrawal when not using cannabis and uses cannabis to relieve withdrawal symptoms.

According to data reported in 2021 by the National Institutes of Health (NIH), 18.7 percent of people in the US age twelve or older, or a total of 52.5 million people, used marijuana that year. That year, approximately 5.8 percent of people in the US in that same age bracket, or a total of 16.3 million people, experienced CUD. Based on this data, up to 31 percent of cannabis users may develop CUD during their lifetimes. Cannabis use disorder is not unique to the US; a comprehensive global study, based on data collected between 1990 and 2016 and published in Lancet Psychiatry, estimated that 22.1 million people worldwide lived with CUD.

According to a study published in the Journal of the American Medical Association in 2015, people who had begun using cannabis before the age of eighteen were much more likely to develop a marijuana use disorder as opposed to those who began usage as adults. The potential long-term effects of CUD range from the physical to the mental. Evidence has shown that excessive use of marijuana—particularly in adolescents and young adults—can have detrimental effects on the neural development of the brain.

Cannabis use can affect the body's endocannabinoid system, a biological system located in the central nervous system of mammals. This system helps the body regulate various cognitive functions related to a variety of processes. The endocannabinoid system impacts mood, memory, sensory processes, appetite, and pregnancy, among other biological activities. Research has shown that cannabis use alters the way the endocannabinoid system works, and some studies suggest this can lead to cannabis dependence and abuse.

Heavy cannabis use in teenagers has been linked to diminished cognitive function later in life. It has also been associated with an increased risk of developing mental illness, particularly in those predisposed to developing such conditions. Apart from its cognitive effects, research suggests high marijuana usage can contribute to issues such as respiratory infection, memory loss or impairment, and exposure to cancer-causing substances.

For a person to be considered in full CUD remission, he or she must not exhibit any of the above criteria for a period of twelve months or longer. Treatment options for CUD are limited, however, and usually involve a combination of psychological treatments. Cognitive behavioral therapy, motivational enhancement therapy, and related psychological intervention methods are often recommended by health professionals. Drug rehabilitation centers and peer support groups can also help individuals in overcoming CUD.

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