Introduction

Cannabis sativa is a plant that is cultivated into a recreational drug, known for its psychotropic properties since early human history.¹ The discovery of its compounds, tetrahydrocannabinol (THC) and cannabidiol (CBD), and their role in creating mind-altering and relaxative effects, has created interest in medical circles as a treatment for disorders such as depression and anxiety. 

People may consume cannabis in order to feel ‘high’ – this is the euphoric feeling caused primarily by THC. The inability to stop using the drug, even when it causes mental and physical harm, is called cannabis use disorder (CUD).²

Though some claim cannabis does not cause addiction, it is evident that some people can still experience symptoms of withdrawal from its use. This article will go over key features of cannabis addiction and link towards supportive resources for individuals who might struggle with cannabis dependence. 

Understanding cannabis addiction

Definition of cannabis addiction

First, we will learn the difference between cannabis addiction, dependence and CUD.

• Addiction features persistent cravings for a drug, with relapses during recovery³
• Dependence is a chronic disease which is associated with prolonged consumption of a drug, to the user’s detriment⁴
• CUD is characterised by detrimental experiences following cannabis consumption within 12 months⁵

Prevalence and risk factors

In England and Wales, cannabis has been reported to be the most used drug since 1995. It has a reputation as being a ‘gateway drug’ – meaning it is a substance people try before going on to more harmful drugs. The problems that accompany cannabis misuse should be recognised by itself, with cannabis users making up 30% of all admissions into addiction treatment within the EU. 

Some risk factors for cannabis use disorder are listed below:^6,7

• Family history of mental health issues
• Psychiatric disorders before cannabis use
• Using cannabis at a young age
• Cannabis consumption in any form except dried flower – edibles, extracts, and pre-rolled 
• Being assigned male at birth
• Lower educational background 

Behavioural indicators

Individuals who consume an increased amount of cannabis are more likely to engage in risky behaviours, such as driving under the influence of the drug or physical assault.⁸ Though these are more extreme examples, it can be useful to observe any changes in the way someone who uses cannabis acts. 

Changes in habits

Addicted individuals may spend an unusual amount of time using cannabis, despite efforts to reduce use. They might also go to excessive lengths to obtain the drug, such as spending a lot of money.

Impact on responsibilities

Cannabis misuse can negatively impact work, school or family obligations. Affected individuals might isolate themselves more, leading to feelings of loneliness; alternatively, they might show a lack of interest in hobbies or social activities in favour of taking drugs.⁹

Cravings and loss of control

The most telling factor of cannabis use disorder, or cannabis addiction, is the strong urge to use cannabis. People may struggle to control the frequency of its use despite its adverse effects on their overall well-being. 

Physical and psychological symptoms

Withdrawal symptoms can manifest physically as well as mentally, 1 to 2 days after quitting cannabis. It is possible to see these signs in someone who isn’t dependent on cannabis, too. 

Physical signs

• Appetite changes, leading to weight loss or weight gain
• Bloodshot eyes
• Dry mouth
• Chills
• Headache
• Muscle tension
• Sweating 
• Stomach pains

Psychological signs

• Irritability
• Anxiety
• Depression
• Aggression
• Cognitive impairments (e.g. memory issues, difficulty concentrating)
• Sleep disturbances¹⁰

Dependence and tolerance

People who are diagnosed with CUD are more likely to experience more intense and longer-lasting symptoms of withdrawal, as they consume higher amounts of the drug. Tolerance can occur when a drug is taken repeatedly, which has less impact over time as the body adapts. 

Tools and methods for assessment

To be able to provide the right care, it is important to be able to categorise the severity of cannabis dependence in an individual.

Screening tools

No single test comprehensively evaluates cannabis misuse, but several tools are commonly used:

• Cannabis Use Disorder Identification Test (CUDIT)
• Cannabis Abuse Screening Test (CAST), 
• Problematic Use of Marijuana (PUM)
• Severity of Dependence Scale (SDS)¹¹

Alternatively, the DSM-5 is a handbook containing a list of criteria which can be used to look for features of substance use disorders.

Patient interviews

To get more information about how someone might use cannabis, interviews may be used to provide context about the frequency, quantity and situations in which it is consumed. In these interviews, a counsellor may ask about reasons for using cannabis and how it affects the lifestyle of the person taking it.

Input from family members and close friends with consent may also guide users towards abstinence.¹²

Differential diagnosis

Many mental health disorders can have overlapping symptoms, which is why efforts should be made to differentiate between them.

Distinguishing cannabis addiction from other conditions

Some of the symptoms of cannabis addiction, such as sleep disturbances, appetite changes and reduced attention, also appear in conditions such as anxiety, depression and attention-deficit/hyperactivity disorder (ADHD).¹³

Co-occurring disorders

In addition, cannabis abuse may be a knock-on effect or exacerbation of pre-existing mental health issues. For example, a depressed patient might take cannabis to relieve feelings such as sadness, however, prolonged use can create adverse effects.¹⁴

As a result, other possible conditions should be considered before a diagnosis is made, as this will help to find the appropriate treatment for the individual’s needs. 

Summary

Cannabis use disorder (CUD) is a growing concern, particularly as cannabis becomes more widely accepted and accessible. While not everyone who uses cannabis becomes dependent, a significant number of individuals develop problematic patterns of use that can lead to addiction, withdrawal symptoms, and disruptions in daily life.

Recognising the signs of cannabis misuse, such as behavioural changes, physical symptoms, psychological distress, and impaired responsibilities, is essential for early identification and intervention. Understanding the differences between addiction, dependence, and CUD helps in diagnosing the severity and selecting appropriate treatment.

Assessment tools like the CUDIT, CAST, and DSM-5 criteria, alongside patient interviews, provide healthcare professionals with valuable insight into an individual’s cannabis use. It is also crucial to consider co-occurring mental health conditions that may overlap or be worsened by cannabis use.