Medical Cannabis Myth Busters: What Is Cannabis Addiction?

What is the exact definition of cannabis addiction? Is cannabis use disorder real? How many people become addicted?

Oct 26, 2016

Many prospective patients and recreational consumers have concerns about becoming overly reliant on the herb. Many argue the plant is not physically addictive, so what’s the deal with “cannabis use disorder”? To separate myth from fact, here’s the scoop on cannabis addiction.

What is cannabis addiction?

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When it comes to cannabis addiction, generally speaking, there are two trains of thought.

First, many claim that the herb is not physically addictive. This means that cannabis consumers don’t go through the shaking, vomiting, and extreme withdrawal symptoms associated with harder substances like heroin.

The second definition stems from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM is the ultimate ruling guide for psychiatrists. It defines all psychiatric disorders recognized by the U.S. healthcare system.

In order to be diagnosed with “cannabis use disorder”, two of the following 11 conditions must be met in the past year:

  • Cannabis is taken in larger and larger amounts, for longer than intended
  • There is persistent desire or uncontrollable efforts to decrease cannabis use
  • A great deal of time spent in activities necessary to obtain cannabis, use cannabis or recover from its effects
  • Craving or a strong desire or urge to use cannabis
  • Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home
  • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis
  • Important social, occupational, or recreational activities are given up or reduced because of cannabis use
  • Recurrent cannabis use in situations in which it is physically hazardous
  • Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis
  • Tolerance, as defined by either a need for markedly increased cannabis to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of the substance
  • Withdrawal, as manifested by either the characteristic withdrawal syndrome for cannabis or cannabis is taken to relieve or avoid withdrawal symptoms

“Cannabis use disorder” and cannabis withdrawal were added to the 5th edition of the DSM and was not previously characterized as a condition. Though, cannabis abuse and cannabis dependence existed in earlier editions.

Is caffeine abuse also psychiatric condition?

Funny enough, the DSM-5 also hints that caffeine use may one day be listed as a psychiatric condition. They write in their factsheet,

DSM-5 will not include caffeine use disorder, although research shows that as little as two to three cups of coffee can trigger a withdrawal effect marked by tiredness or sleepiness. There is sufficient evidence to support this as a condition, however it is not yet clear to what extent it is a clinically significant disorder. To encourage further research on the impact of this condition, caffeine use disorder is included in Section III of DSM-5.

Conflicts of interest in the DSM

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Though the DSM has provided uniform diagnostic guidelines for American psychiatrists since the 1950s, panel members that oversee submissions and revisions to the DSM have been cited on multiple occasions for receiving money from pharmaceutical companies.

In 2006, a study published found that of the 170 DSM-IV panel members 95 (56%) of them had financial ties to pharmaceutical manufacturers. 100% of the panel members in the categories of “Mood Disorders” and “Schizophrenia and Other Psychotic Disorders” had financial ties to pharmaceutical companies.

A follow-up study in 2012 on conflicts of interest in the most recent version of the DSM found that 69% of all panel remembers reported financial ties to the pharmaceutical industry. This was after the American Psychiatric Association changed its policy to mandate that panel members disclose financial relationships.

What is withdrawal?

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Research has shown that 9 to 10% of cannabis consumers can become dependent on the herb. This is compared to 20 to 30% of tobacco consumers, 15% of alcohol consumers, and 15 to 20% of cocaine users.

Similar to caffeine, consumers can also go through withdrawal symptoms if they have been using cannabis for a while and then suddenly stop. Though, many people experience no withdrawal symptoms when stopping cannabis.

Withdrawal occurs because compounds in cannabis take the place of chemicals the body produces naturally. When the body receives an abundance of these compounds, it grows used to the constant input.

The body then adjusts and temporarily loses sensitivity to our natural endocannabinoids (the body’s own THC) and becomes less responsive to THC overall.

When a person stops using cannabis, the body needs to adapt to its new internal environment. This can cause temporary discomfort, including sleeplessness, irritability, low mood, anxiousness, and changes in appetite.

The body goes through similar adjustment periods when someone stops drinking coffee or transitions from a high-carbohydrate to a low-carbohydrate diet. Many who suddenly start on a low-carb diet, for example, will experience flu-like symptoms for up to two weeks.

As mentioned before, cannabis does not cause the extreme symptoms of physical dependency like drugs heroin and opioid pain medications.

Yet, with cannabis, it’s possible to experience the lag between the cessation of the external source of cannabinoids and the internal production and sensitivity to the endocannabinoids humans create naturally.

Is cannabis addiction real or myth?

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There’s no doubt that some people may struggle with cannabis. If at any point a habit or behavior begins to interfere with the ability to lead a happy, thriving, and productive life, or if the habit becomes harmful to others, then there’s a good chance that something needs to change.

If cannabis is causing harm or if a person feels like they are unable to stop consuming the herb, then seeking help and assistance to change that behavior is wise. Up to 10% of cannabis consumers may have this experience.

However, there are some serious points of contention when it comes to how “cannabis use disorder” is defined and characterized in clinical settings.

At what point is something a natural and temporary response to environmental changes, versus a psychiatric problem that is defined as a condition in diagnostic manuals?

Only two of the 11 criteria listed above need to be true in order to be diagnosed with a “cannabis use disorder”.

This means that a veteran with PTSD, for example, can be defined as having a problem with cannabis addiction if, at some point in the past year, they needed to up their dose and were irritable, depressed, and had trouble sleeping when they could not medicate with the herb.

All in all, in general, addiction is a complicated interplay between physical, mental, behavioral, and social factors. Strict definitions of cannabis addiction may apply in some cases, but circumstances vary and depend heavily on who is doing the defining.

Oct 26, 2016