Definition and Diagnosis
Cannabis use disorder is a problematic pattern of cannabis use leading to clinically significant impairment or distress, including craving, tolerance to the drug's effects, and a recognized withdrawal syndrome on cessation in regular heavy users.
Epidemiology
Cannabis is among the most widely used psychoactive substances globally. An estimated 9-10% of those who use cannabis develop a use disorder, with the risk higher among those who begin use in adolescence or use daily.
Risk Factors
Risk factors include early age of first use, frequent or high-potency use, family history of substance use disorders, co-occurring psychiatric conditions, and genetic vulnerability.
Symptoms and Subtypes
Features include craving, using larger amounts or over longer periods than intended, tolerance, and a withdrawal syndrome comprising irritability, anxiety, sleep disturbance, decreased appetite, and restlessness.
Diagnosis
Diagnosis follows DSM-5-TR criteria for substance use disorder applied to cannabis, requiring at least two of eleven criteria within a twelve-month period, with severity graded by the number of criteria present.
Treatment
Treatment is primarily psychosocial, including CBT, motivational enhancement therapy, and contingency management; no medication is currently approved specifically for cannabis use disorder, though symptomatic treatment of withdrawal or co-occurring conditions may be used.
Prognosis
Many individuals reduce or stop use with brief intervention, though those with heavier, earlier-onset use and co-occurring psychiatric conditions face a more persistent course.
Reference
New Oxford Textbook of Psychiatry (2nd ed.); Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).