What Exactly Is Cannabis Use Disorder?

If you’ve read any cannabis studies recently, you may have seen the term “cannabis use disorder.” Its use has become more widespread in recent years. First mentioned in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, healthcare providers generally diagnose the condition when patients continue cannabis use despite negative effects. 

While we don’t know exactly how many people have the disorder, experts estimated that around 22.1 million people fit the criteria for CUD in 2016. But cannabis use, habits, and impacts are all subjective (not to mention, the cannabis scene has changed quite a bit in the last ten years).

So what does the diagnosis really mean? Let’s take a closer look:

How Is Cannabis Use Disorder Diagnosed?

According to the DSM-5, a CUD diagnosis requires “clinically significant impairment or distress in 12 months,” including at least two of the following 11 scenarios:

• Use of cannabis in larger amounts or in a longer period of time than originally intended
• Persistent failed attempts to cut down on use
• Excessive time spent getting, using, or recovering from the effects of cannabis 
• Cannabis cravings
• Neglecting social obligations due to recurrent use
• Continued use even when it causes social or interpersonal problems 
• Neglecting social, occupational, or recreational activities in favor of using cannabis 
• Continuing to use cannabis despite physical harm 
• Continuing to use cannabis despite negative physical or psychological effects
• Tolerance
• Withdrawal symptoms when not consuming 

Cannabis Use Disorder Diagnostic Accuracy 

As we mentioned above, the way people use cannabis and the impacts it has on their lives are subjective. This can make accurately diagnosing cannabis use disorder a challenge, according to some experts. 

Tammy Chung, director of the Center for Population Behavioral Health at Rutgers Institute for Health, Health Care Policy and Aging Research, says one of the biggest challenges in accurately diagnosing CUD is separating “problem use” from therapeutic use. 

In a Rutgers article, she says that “The manual’s diagnosis of cannabis use disorder requires an individual to meet only two or more of 11 criteria. These criteria might include only increased tolerance for cannabis and withdrawal symptoms, which are commonly reported by individuals who use cannabis for therapeutic reasons.”

People who use cannabis for medical reasons may find themselves meeting the criteria for CUD, without any other signs that their cannabis habits are problematic. Additionally, Dr. Olalekan Otulana MBChB, DRCOG, MRCGP, DFSRH, FRSPH, MBA, an advanced addiction medicine practitioner, tells us that the self-reported, subjective nature of CUD diagnoses can be challenging, too. 

Dr. Otulana says, “Patients may not always present openly about their use, especially if they don’t see it as an issue so a lot depends on how well the clinician builds rapport and asks the right questions,” he said. “While the criteria are useful, they’re still quite clinical, so they don’t always capture the nuances of how cannabis use fits into someone’s wider mental health, social context, and coping mechanisms. [Diagnostic criteria] is effective as a starting point but they should always be paired with clinical judgement.

The challenges of accurate diagnosis go beyond individual care. Researchers use CUD as criteria in various studies, which can bring into question the accuracy of the study itself. For example, a recent study found that people with CUD were about 60% more likely to have a heart attack, stroke, or other heart problem than compared to those without the diagnosis. 

But given what we know about the diagnostic challenges associated with CUD, it’s difficult to gauge the habits of those involved in the study. This highlights a need for more thorough research on the topic. 

See If You Qualify For Medical Marijuana - Select Your State!

Select Your State

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Never miss a post

Get updates on cannabis culture, new research, and expert insights

SIGN ME UP

Veriheal medical reviewer and lead cannabis educator, Dr. Abraham Benavides, MD, also points out how, “A fundamental problem is that there isn’t a simple diagnosis code for regular or routine medical cannabis use. This confounds study results because right now, providers have no way of simply documenting a patient’s responsible cannabis use as part of their life or treatment plan without saying it’s problematic. Many issues in research and practice can be solved by having a separate ICD code for non-problematic cannabis use.”

Who Is At Risk for Cannabis Use Disorder?

The Centers for Disease Control (CDC) says that people who start using cannabis during their youth or adolescence, and those who use cannabis more frequently, are more likely to develop a cannabis use disorder. 

The organization also suggests that there could be a potential correlation between the use of high-THC products and developing CUD, but notes that researchers do not yet know the full extent of the potential correlation. 

But even defining “heavy use” can present challenges. Generally, heavy use is defined as some form of daily or near-daily consumption. For example, the Colorado government’s cannabis education materials define heavy use as daily or near-daily cannabis use. A 2019 narrative review evaluating the way cannabis impacts the brain defines heavy use as (near) daily use, as well. 

Addiction or Disorder?

The Cleveland Clinic states that CUD can be mild, moderate or severe, and notes that addiction is the most severe form of the disorder. They state that “addiction to marijuana happens when the reward system in your brain takes over and amplifies compulsive marijuana-seeking.”

This may be a shock to some who have been told “you can’t get addicted to weed.” But we’ve talked about it before—cannabis can be addictive based on many factors, including early first-use age, frequent use, socioeconomic status, and existing mental health conditions. In general, adolescents and males are the most prone to cannabis dependence or addiction.

READ MORE: Cannabis Across Life: Teens

About 10% of cannabis users will eventually go on to develop an addiction. While some people diagnosed with CUD may have a mild or moderate form, other users’ habits may be considered more severe and qualify as an addiction. 

Treatment for Cannabis Use Disorder 

Those with a CUD diagnosis must decide for themselves if the condition requires intervention. It’s possible that other factors, such as using cannabis for medical purposes, may lead users to meet the criteria for the disorder without exhibiting any signs of negative impacts from their use. 

For those who do notice negative impacts from their cannabis habits, a CUD diagnosis can help them to move toward a treatment plan. CUD often co-occurs with other substance abuse or mental health conditions for complicated reasons, which can be serious and also require additional treatment.

While there is no specific treatment suggested for the disorder, clinical trials have found that a focus on psychotherapy treatments (motivational enhancement therapy, cognitive behavioral therapy, and contingency management) may be an effective option. 

Additionally, medications like N-acetylcysteine and gabapentin show promise as an additional option for treatment. These may work best when combined with psychotherapy options, like CBT.