Signs of Cannabis Dependence Chronic Cannabis Use: Dependency and Addiction
Antonia Teresa Amore-Broccoli, MSW, LCSW
(This is a rough draft. Antonia is still rewriting with a professional editor. Sign up for updates on our landing page.)
Cannabis abuse is also referred to as cannabis use disorder. This disorder can metamorphose into a dependence on cannabis and/or an addiction when an individual can’t stop using the drug despite adverse consequences which interferes with their daily activities, friendships, job performance, parenting, educational goals, and/or marriage or intimate relationships.
When asking ourselves about cannabis addiction we can look at addiction medicine, which defines addiction as a chronic medical condition. A condition or the disease we call addiction is caused by complex interactions among brain circuits, an individual’s genetics, the environment, and an individual's life experiences. People with an addiction use substances chronically, which leads to uncontrollable behaviors that become compulsive. Often the user will continue to use that substance despite obvious harmful or adverse consequences.
Prevention efforts, psycho-education and treatment approaches are generally successful for those with other chronic conditions or diseases, such as autoimmune disorders, hypertension, and diabetes, to name a few. Prevention efforts and various treatment approaches or modalities for cannabis abuse can also be successful. We will explore treatment modality options that can be utilized specific to cannabis addiction in a later chapter.
Cannabis addiction is just like that of any other substance of abuse. Cannabis addicts in the later stage of addiction will typically begin using upon waking up in the morning and continuing use throughout the day. However, others may only use after work or school but still have adverse consequences from their chronic cannabis use.
Tolerance is often a factor with cannabis dependence and addiction. Cannabis users tend to need more cannabis to feel the same effect or sometimes any effect. This is similar with every other substance of abuse, cannabis addiction ultimately leads to the inability to moderate or control use when they become chronic users.
Signs of Cannabis Dependence and/or Addiction: Frequent/daily use, Lack of motivation and/or ambition, migraines, depression, repression of traumatic memories, enhanced disassociation.
Anxiety, panic attacks, fast heart rate, dependence, codependency, difficulty concentrating (ADD or ADHD), short-term and long-term memory issues, impaired decision making and risk-taking. Later stages of addictions can lead to moderate to severe depression when going through withdrawals attempts: as well as an increase risk of cyclical mental health issues and pneumonia. Classic signs of cannabis addiction: financial problems, career and educational problems, relationship problems, and spiritual problems. There is recent research of an increased risk of mental health issues such as: cannabis induced psychosis, cannabinoid hyperemesis, suicidal ideation, self harm, eating disorders, major depressive symptoms: as well a potential of Borderline personality and/or Bi-Polar l or ll characteristics.
Cannabis Detox and Withdrawal is a significant factor in determining the problem of chronic cannabis use, dependency and addiction.
Physical Symptoms: Tremors, shaking, sweating, headaches, muscle cramps, anxiety, Tachycardia (fast heart rate) and sometimes low blood pressure, vomiting, diarrhea, watery eyes, restlessness, sweats, fever and chills. Some people have reported extreme sweating, stomach pain, irritable bowel, diarrhea, migraines, difficulty sleeping and even extreme insomnia for several nights in a row and fatigue during the day. Lastly one common symptom is a low to no appetite causes weight loss in the first 7-30 days of acute detox.
Mental Psychological and Emotional Symptoms durring Cannabis withdrawel; Moderate to extreme mood swings can include symptoms such as agitation, anger outbursts, depression, paranoia, delusions, vivid return of dreams, anxiety, heightened senility, exaggerated startle response are also not uncommon. Some people have reported psychosis and mild to moderate hallucinations or delusions which tend to go away after 48-72 hrs.
It is recommend that people receive help for detox symptoms from a professional addiction specialist medical provider. Detoxing alone, it’s not advisable. It is best to be enrolled in a substance-abuse treatment program and if it’s a self-help program, we advise to seek outside professional health providers assistance; a nurse practitioner or physician or psychiatrist and/or a LCSW or MFT. Seek out a professional healthcare provider with training in addiction medicine.
PAWS: Post Acute Withdrawal Syndrome specific to Cannabis Addiction.
Depending on how long and how much a person had been using cannabis before the stoped it can take 6-24 months for a recovering cannabis addict to have stable and manageable emotional and psychological regulation.
(A whole chapter will be dedicated to PAWS later in the book)
Amore-Broccoli’s research is also supported and backed up by the 2013 updated Cannabis Use Disorders According to DSM V: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition: Definition/Symptoms; American Psychiatric Association: A problematic pattern of cannabis use leading to clinically significant impairment or distress as manifested by at least two of the following occurring in a 12 month period:
Citation: DSM V: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition: Definition/Symptoms; American Psychiatric Association©2013
Cannabis Use (Marijuana Use) Disorders According to DSM V
Definition/Symptoms
A problematic pattern of cannabis use leading to clinically significant impairment or distress as manifested by at least two of the following occurring in a 12 month period:
Consequences of Cannabis Use Disorder:
1) Cannabis is often taken in larger amounts over a longer period than was intended.
2) There is a persistent desire or insignificant effort to cut down or control cannabis use.
3) A great deal of time is spent in activities necessary to obtain cannabis, use cannabis or recover from its effects.
4) Craving or a strong desire or urge to use cannabis.
5) Recurrent cannabis use resulting in failure to fulfill major role obligations at work, school or home.
6) Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
7) Important social, occupational or recreational activities are given up or reduced because of cannabis use.
8) Recurrent cannabis use in situations which is physically hazardous.
9) Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are unlikely to have been caused or exacerbated by cannabis.
10) Tolerance, as defined by either:
1) A need for markedly increased amounts of cannabis to achieve intoxication and desired effect, or
2) A markedly diminished effect with continued use of the same amount of cannabis.
11) Withdrawal, as manifested by either:
Withdrawal, as manifested by either:
A closer related substance is taken to relieve or avoid withdrawal symptoms.
Cannabis Intoxication
1. Recent use of cannabis.
2. Clinically significant problematic behavior or psychological changes (e.g. impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) that develop during, or shortly after, cannabis use.
3. Two or more of the following signs or symptoms developing within two hours of cannabis use:
1) Conjunctival injection
2) Increased appetite
3) Dry mouth
4) Tachycardia
4. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.
Cannabis Detox and Withdrawal
1. Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost daily over a period of at least a few months)
2. Three or more of the following signs and symptoms develop within approximately one week after cessation of heavy, prolonged use:
1) Irritability, anger or aggression
2) Nervousness or anxiety
3) Sleep difficulty (e.g. insomnia, disturbing dreams)
4) Decreased appetite or weight loss
5) Restlessness
6) Depressed mood
7) At least one of the following physical symptoms causing significant discomfort:
i. Abdominal pain,
ii. Shakiness/tremors,
iii. Sweating,
iv. Fever,
v. Chills, or
vi. Headache
3. The signs or symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
Cannabis Induced Mental Disorders:
1. Affective Disorders
a. Anxiety Disorders
b. Depression
c. Bipolar Disorder
2. Schizophrenia
3. Amotivational Syndrome
4. Disruptive Cognitive Function
5. Neuropsychological decline
6. Psychotic Disorders
Cannabis Induced Physical Disorders:
1. Lung Damage
2. Heart Disease
3. Cancer
4. Pregnancy Complications
5. [CHS; Cannabinoid Hyperemesis Syndrome] insert by author
DSM-5 Cannabis Use and Addictive Disorders.
The DSM-5 Cannabis Use Disorder (Addictive Disorder) provides 11 criteria to identify a problematic pattern of cannabis use leading to clinically significant impairment or distress as manifested by at least two of the 11 criteria occurring in a 12 month period. Criteria 1-9 represent the behavioral patterns for addictive use of marijuana. These behavioral criteria represent the loss of control over the use of marijuana with adverse consequences over a period, and recurrent pattern of problematic cannabis use. Criteria 10 and 11 represent the pharmacological phenomena of tolerance and dependence.
While specific diagnoses for DSM Cannabis Use Disorders do not contain the terminology, “addiction”, they are classified within the DSM diagnostic category “Addictive Disorders”. In addition, the 11 criteria for Cannabis Use Disorder are subsumed under an accepted definition for addiction for purposes of conceptualizing marijuana addiction: 1) a preoccupation with acquiring the drug or substance, 2) compulsive use which is continued use despite adverse consequences, and 3) a pattern of loss of control or an inability to refrain from relapse or recurrence of adverse consequences from the drug use. Pervasive to all three criteria is an impaired or loss of control despite harmful or adverse effects. These criteria form the basis of the criteria in DSM-5 criteria for Cannabis Use Disorders, (Substance-Related and Addictive Impaired or loss of control is represented by Criteria, 1, 2, 3, 4 and social impairment (due to loss of control) is represented by criteria 5, 6, 7 and high risk use (loss of control) by criteria 8, 9 and pharmacological tolerance and dependence by criteria 10, 11.
Criterion 1: Cannabis is often taken in larger amounts over a longer period than was intended (loss of control). Individuals with cannabis use disorders may use throughout the day over a period of months to years, and may spend many hours a day under the influence. Others may use less frequently but with adverse consequences from their cannabis use. Periodic cannabis use and intoxication can negatively affect behavioural and cognitive functioning and interfere with performance at work or school, place the individual at increased physical risk when performing activities such as driving or working with devices or machinery.
Criterion 2. There is a persistent desire or insignificant effort to cut down or control cannabis use (loss of control). While it is hard to get an addict to admit they want to quit or made a serious effort to quit, many regular users addicted to marijuana do find abstinence difficult, and represents preoccupation with using and acquiring marijuana.
Criterion 3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects, and represents preoccupation with acquiring and using marijuana and compulsive use from adverse use in prolonged withdrawal.
Criterion 4. Craving or a strong desire or urge to use cannabis, which is often not conscious and reflects a preoccupation with acquiring and using marijuana.
Criterion 5. Recurrent cannabis use resulting in failure to fulfil major role obligations at work, school or home and illustrates compulsive use or use despite adverse consequences.
Criterion 6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis and illustrates compulsive use or use despite adverse consequences.
Criterion 7. Important social, occupational, or recreational activities are given up or reduced because of cannabis use and illustrates compulsive use or use despite adverse consequences.
Criterion 8. Recurrent cannabis use in situations which is physically hazardous and illustrates compulsive use or use despite adverse consequences.
Criterion 9. Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are unlikely to have been caused or exacerbated by cannabis illustrates compulsive use or use despite adverse consequences.
Criterion 10. Tolerance, as defined by either: a need for markedly increased amounts of cannabis to achieve intoxication and desired effect or a markedly diminished effect with continued use of the same amount of cannabis.
Pharmacological tolerance is an expected consequence of regular, repetitive use of marijuana.
Criterion 11. Withdrawal, as manifested by either: The characteristic withdrawal symptoms for cannabis, or cannabis or a closely related substance is taken to relieve or avoid withdrawal symptoms. Pharmacological withdrawal is common with regular repetitive use.
Tolerance and dependence frequently accompany addictive use of drugs, in this instance, marijuana. However, they are not specific to addictive use and can occur independently of marijuana addiction. Tolerance (pharmacological) is the need to use more marijuana due to the adaptation of the brain to the presence of marijuana. Dependence (dependence) is the expression of withdrawal effects from the adaptation due to discontinuation of marijuana.
Severity of the Cannabis Use Disorder is dependent on the number of criteria in each assessment: Mild: Presence of 2-3 symptoms, Moderate: Presence of 4-5 symptoms, Severe: Presence of 6 or more symptoms.
The National Institute on Drug Abuse; Advancing Addiction Science:
Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders, but whether and to what extent it actually causes these conditions is not always easy to determine.32 Recent research suggests that smoking high-potency marijuana every day could increase the chances of developing psychosis by nearly five times compared to people who have never used marijuana.114 The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability.62
https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
site here please
Cannabis addiction is characterized by an inability to control the use of the the substance of cannabis, an intense mental obsessive focus on using it, and find ways of using cannabis it more frequently, when not using it there is also an obsessive thinking about the substance, cravings which is manifested by an uncontrollable impulse and compulsion to use and continuing to use cannabis in spite of problems and adverse consequences that it causes.
Researchers estimate that 4 million people in the United States met the criteria for cannabis use disorder in 2015. Of that group, 138,000 voluntarily sought treatment for their cannabis use disorder.
The potential for cannabis abuse and subsequent addiction is as real as it is for any drug, despite the growing acceptance and perception of cannabis as being completely safe, Addiction medicine is slowly beginning to recognize that cannabis addiction is an increasing problem in the United States. Many more treatment facilities are now seeing an increase in the number of chronic cannabis users seeking assistance with their inability to control or moderate their cannabis use. The treatment center True Recovery in Newport Beach, CA validates cannabis as an addiction. The True Recovery website states:
True Recovery’s addiction treatment program was founded in 2014 because we saw something missing in traditional treatment programs.
Cannabis has long held a reputation as being a harmless substance, to the extent that some do not even consider it a drug. As with any drug of abuse, however, there is “no free lunch” with marijuana abuse. The difficulty of those entering treatment for marijuana abuse in achieving long-term sobriety led some researchers to investigate whether marijuana caused a withdrawal syndrome that was being ignored.T he results of the moderate to extreme detox and withdrawal symptoms from cannabis shatter the notion that marijuana is a harmless substance.
In the following chapters, we will discuss the relationship of the higher and higher potency of THC in the female cannabis plants. We will explore how this higher THC potency in cannabis is directly contributing to an increase of people seeking treatment for cannabis addiction. Chronic cannabis use is on the rise and as a result so are the mental and physical health issues directly related to the use of cannabis. Specifically high does of the THC levels in cannabis and/or chronic and long term cannabis use. A chapter dedicated to the medical research regarding Cannabis Induced Psychosis and how cannabis use can increase the risk of schizoaffective disorder and schizophrenia. As well as a later chapter on the most innovative information about Cannabis Hyperemesis Syndrome (CHS). The consequences of these medical issues have resulted in more and more cannabis users seeking mental health and/or medical treatment; as well as treatment for their addiction to cannabis.
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Is addiction treated equally between sex and gender?
Addiction Medicine have demonstrated significant differences in the biological sexes when it comes to substance abuse and addiction. One Example according to a 2010 report from Harvard Medical Journal (3):
Men are more likely than women to become addicts. In 2008, the U.S. National Survey on Drug Use and Health found that 11.5% of males ages 12 and older had a substance abuse or dependence problem, compared with 6.4% of females.
But in other respects, women face tougher challenges. They tend to progress more quickly from using an addictive substance to dependence (a phenomenon known as telescoping). They also develop medical or social consequences of addiction faster than men, often find it harder to quit using addictive substances, and are more susceptible to relapse. These gender differences can [profoundly] affect treatment.
Within the general population, it is reported by addiction specialists that men are nearly three times as likely as women to report smoking cannabis on a daily basis. Professionally and personally, I believe that there are many more women who are using cannabis on a regular basis too but women tend to self-report less than men do because of the social stigma and secrecy around cannabis use. The number of chronic cannabis users among people are increasing. I have professionally and personally witnessed an increase of self report’s of cannabis dependence and addiction among women in the last three decades, and even more so in the last five years of my private practice as an LCSW and as a Medical Social Worker in the Health care settings. This has been especially true during the COVID pandemic or 2020-2021 with access to zoom self help recovery groups; I have witnesses an extraordinary amount of women seeking help for their cannabis addiction. However, what has been so heartbreaking is I have witnessed and counseled far more women unable to stay clean off cannabis for any length of time then women who are able to maintain continuous sobriety. Many women chronically relapse perhaps partly do to the fact that cannabis is experienced as a subtle less obviously dangerous relapse than other relapses such as alcohol or narcotics. However, many women have the habit of using cannabis as coping mechanism for the ups and downs of metal health and emotions as well as the good times, celebrations or successful accomplishments.
Preliminary research suggests that women might suffer more or perhaps experience more severe adverse consequences, medically, cognitively, and socially. Women self-report issues of family and partner intimacy which are being affected by their cannabis use, and they report its impact on their educational and career endeavors. It is also suggested by some research that it’s possible women progress more quickly into dependence and addiction. We have seen this to be true for women alcoholics compared to men alcoholics who may take 25-30 years to progress, while a women's average is 10-15 years. The latter may have to do with the fact that these women addicted to or chemically dependent on cannabis may have also had other risk factors predetermining their addiction.
Women especially women who are non white and/or LGBTQIA+ have complex issues which often affect their ability. One risk factor could include the fact that the onset of their use began early in life as teens or as young adults, before the frontal lobe of the brain was fully developed. We know that teenagers in general, regardless of their sex, have a two-fold risk of addiction when they begin any substance before the age of 18-23. Coupled with environmental, behavioral, and genetic depositions, this risk can increase to a 100% chance of addiction among teens/young adults. Addiction does not discriminate on the basis of sex, class, culture, or ethnicity. However, many of these same risks for addiction contribute to chronic cannabis use and relapse among women.
More research is needed about gender differences in cannabis use. More research is also needed regarding cannabis use in non white and LGBTQI+ populations. The Lesbian, Gay, Bisexual and Transgender Health journal looks at the disparities of substance abuse at the intersections of race, sexual orientation, and gender identity. However, no research has been explored specific to cannabis addiction. We have know for years of that disparities of health care is most pronounced among race and ethnicity, LGBTQI+ women, which may reflect their unique experiences of discrimination at the intersection of multiple minority identities. This is a closer look at substance abuse which is a factor of health:
Purpose: Lesbian, gay, and bisexual (LGB) racial/ethnic minority individuals experience minority stress due to both their sexual identity and race/ethnicity and may be at elevated substance use risk (relative to heterosexuals) compared with their White LGB peers. We examined differences in the presence and magnitude of substance use disparities among LGB adults across race/ethnicity.
Methods: Using data on 168,560 adults (including 11,389 LGB adults) from the 2015–2018 National Survey on Drug Use and Health, we examined disparities in cigarette smoking, heavy episodic drinking (HED), and marijuana use by race/ethnicity (White, Black, Hispanic, and other race/multiracial). Analyses compared lesbian/gay and bisexual adults, respectively, with heterosexual adults of the same gender and race/ethnicity. We also tested the magnitude of racial/ethnic minority disparities relative to the corresponding White disparity.
Results: Significant disparities in smoking, HED, and marijuana use were observed for lesbian/gay and bisexual women across nearly all racial/ethnic groups. Disparities were consistently greater in magnitude for Black and Hispanic LGB women compared with White LGB women. Few disparities were observed among men; the magnitude of observed disparities did not differ by race/ethnicity.
Conclusion: Disparities were most pronounced among racial/ethnic minority LGB women, which may reflect their unique experiences of discrimination at the intersection of multiple minority identities. However, racial/ethnic minority gay and bisexual men were not at elevated risk relative to their White counterparts. Future research on substance use disparities among LGB individuals using an intersectional framework is warranted to elucidate differential minority stress processes that contribute to the observed heterogeneity across race/ethnicity, sexual identity, and gender.
LGBT Health Vol. 7, No. 6 Original Articles: Substance Use Disparities at the Intersection of Sexual Identity and Race/Ethnicity: Results from the 2015–2018 National Survey on Drug Use and Health (4) Megan S. Schuler, Dana M. Prince, Joshua Breslau, and Rebecca L. Collins Published Online: 31 Aug, 2020, https://doi.org/10.1089/lgbt.2019.0352
Freedom from Cannabis Addiction we understand the gender disparities may affect susceptibility, recovery, and risk of relapse. Until the early 1990s, most research on substance abuse and dependence focused on men. That changed once U.S. agencies began requiring federally funded studies to enroll more women. Since then, investigators have learned that important sex and gender differences exist in some types of addiction.
https://www.omicsonline.org/open-access/marijuana-addictive-disorders-and-dsm5-substancerelated-disorders-2155-6105-S11-013.php?aid=84734