Cannabis use disorder

Other names: Cannabis addictions, marijuana addiction, cannabis abuse, cannabis dependence
Video explanation
Specialty| Psychiatry
Symptoms| Use of cannabis in manner that leads to impairment or distress[1]
Usual onset| Late childhood, early adulthood[1]
Types| Mild, moderate, severe[1]
Causes| Cannabis[2]
Risk factors| Smoking tobacco, family history, poverty[1]
Differential diagnosis| Nonproblematic cannabis use, health problems due to cannabis[1]
Treatment| Counselling (cognitive behavioral therapy, motivational interviewing)[3]
Frequency| 1.5% of adults (US)[1]

Cannabis use disorder (CUD), also known as cannabis addiction, is defined as the use of cannabis in manner that leads to impairment or distress.[1][2] This may involve taking more than was intended, problems decreasing use, use resulting in work or school issues, reducing other activities to use cannabis, and not stopping despite health problems from such use.[1] Other issues may include cannabis withdrawal and tolerance to its effects.[1]

Risk factors include smoking tobacco, family history, and poverty.[1] Reasons given for use include to socially conform, experimentation, enjoyment, and to manage stress.[2] The diagnosis may be supported by testing urine, blood, saliva, or hair for cannabis.[2]

Treatment may involve counselling such as cognitive behavioral therapy and motivational interviewing.[3] Medications, as of 2020, do not have sufficient evidence to support their use.[2] About 7% of people with CUD seek treatment a year; however, despite treatment many continue to use.[4]

In 2018 about 192 million people (3.9% of adults) used cannabis globally.[3] This was more common in North America at 15% and Australia and New Zealand at 11%.[3] Of those who use cannabis daily almost half develop cannabis use disorder.[3] In the United States about 3.4% of older children and 1.5% of adults have cannabis use disorder.[1] Males are more commonly affected than females.[1] Onset is most commonly in late childhood or early adulthood.[1]

## Contents

* 1 Signs and symptoms
* 1.1 Dependency
* 1.2 Withdrawal
* 2 Cause
* 2.1 Risk factors
* 2.2 High risk groups
* 2.2.1 Adolescents
* 3 Diagnosis
* 4 Treatment
* 4.1 Counselling
* 4.2 Medication
* 4.3 Barriers
* 5 Epidemiology
* 6 Research
* 7 See also
* 8 References
* 9 External links

## Signs and symptoms[edit | edit source]

Cannabis use is associated with comorbid mental health problems, such as mood and anxiety disorders, and discontinuing cannabis use is difficult for some users.[5] Psychiatric comorbidities are often present in dependent cannabis users including a range of personality disorders.[6]

Based on annual survey data, many high school seniors who report smoking daily (nearly 7%, according to one study) may function at a lower rate in school than students that do not.[7] The sedating and anxiolytic properties of tetrahydrocannabinol (THC) in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders.[8]

### Dependency[edit | edit source]

Prolonged cannabis use produces both pharmacokinetic changes (how the drug is absorbed, distributed, metabolized, and excreted) and pharmacodynamic changes (how the drug interacts with target cells) to the body. These changes require the user to consume higher doses of the drug to achieve a common desirable effect (known as a higher tolerance), reinforcing the body's metabolic systems for eliminating the drug more efficiently and further down-regulating cannabinoid receptors in the brain.[9]

Cannabis users have shown decreased reactivity to dopamine, suggesting a possible link to a dampening of the reward system of the brain and an increase in negative emotion and addiction severity.[10]

Cannabis users can develop tolerance to the effects of THC. Tolerance to the behavioral and psychological effects of THC has been demonstrated in adolescent humans and animals.[11][12] The mechanisms that create this tolerance to THC are thought to involve changes in cannabinoid receptor function.[11]

One study has shown that between 2001–2002 and 2012–2013, the use of marijuana in the US doubled.[13]

Cannabis dependence develops in about 9% of users, significantly less than that of heroin, cocaine, alcohol, and prescribed anxiolytics,[14] but slightly higher than that for psilocybin, mescaline, or LSD.[15] Of those who use cannabis daily, 10–20% develop dependence.[16]

### Withdrawal[edit | edit source]

Cannabis withdrawal symptoms occurs in one-half of people in treatment for cannabis use disorders.[17] Symptoms may include dysphoria (anxiety, irritability, depression, restlessness), disturbed sleep, gastrointestinal symptoms, and decreased appetite. It is often paired with Rhythmic movement disorder. Most symptoms begin during the first week of abstinence and resolve after a few weeks.[5] About 12% of heavy cannabis users showed cannabis withdrawal as defined by the DSM-5, and this was associated with significant disability as well as mood, anxiety and personality disorders.[18]

## Cause[edit | edit source]

Cannabis addiction is often due to prolonged and increasing use of the drug. Increasing the strength of the cannabis taken and an increasing use of more effective methods of delivery often increase the progression of cannabis dependency. It can also be caused by being prone to becoming addicted to substances, which can either be genetically or environmentally acquired.[19]

### Risk factors[edit | edit source]

Certain factors are considered to heighten the risk of developing cannabis dependence and longitudinal studies over a number of years have enabled researchers to track aspects of social and psychological development concurrently with cannabis use. Increasing evidence is being shown for the elevation of associated problems by the frequency and age at which cannabis is used, with young and frequent users being at most risk.[20]

The main factors in Australia, for example, related to a heightened risk for developing problems with cannabis use include frequent use at a young age; personal maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using peers; moving away from home at an early age; daily cigarette smoking; and ready access to cannabis. The researchers concluded there is emerging evidence that positive experiences to early cannabis use are a significant predictor of late dependence and that genetic predisposition plays a role in the development of problematic use.[21]

### High risk groups[edit | edit source]

A number of groups have been identified as being at greater risk of developing cannabis dependence and, in Australia, for example, have been found to include adolescent populations, Aboriginal and Torres Strait Islanders and people suffering from mental health conditions.[22]

#### Adolescents[edit | edit source]

The endocannabinoid system is directly involved in adolescent brain development.[23] Adolescent cannabis users are therefore particularly vulnerable to the potential adverse effects of cannabis use.[23] Adolescent cannabis use is associated with increased cannabis misuse as an adult, issues with memory and concentration, long-term cognitive complications, and poor psychiatric outcomes including social anxiety, suicidality and addiction.[24][25][26]

Pregnancy

There is an association between smoking cannabis during pregnancy and low birth weight.[27] Smoking cannabis during pregnancy can lower the amount of oxygen delivered to the developing fetus, which can restrict fetal growth.[27] The active ingredient in cannabis (D9-tetrahydrocannabinol, THC) is fat soluble and can enter into breastmilk during lactation.[27] THC in breastmilk can then subsequently be taken up by a breastfeeding infant, as shown by the presence of THC in the infant's feces. However, the evidence for long-term effects of exposure to THC through breastmilk is unclear.[28][29][30]

## Diagnosis[edit | edit source]

Cannabis use disorder is recognized in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),[31] which also added cannabis withdrawal as a new condition.[32]

In the 2013 revision for the DSM-5, DSM-IV abuse and dependence were combined into cannabis use disorder. The legal problems criterion (from cannabis abuse) has been removed, and the craving criterion was newly added, resulting in a total of 11 criteria. These are: hazardous use, social/interpersonal problems, neglected major roles, withdrawal, tolerance, used larger amounts/longer, repeated attempts to quit/control use, much time spent using, physical/psychological problems related to use, activities given up and craving. For a diagnosis of DSM-5 cannabis use disorder, at least 2 of these criteria need to be present in the last 12-month period. Additionally, three severity levels have been defined: mild (2-3 criteria), moderate (4-5 criteria) and severe (six or more criteria) cannabis use disorder.[33]

Cannabis use disorder is also recognized in the 11th revision of the International Classification of Diseases (ICD-11),[34] adding more subdivisions including time intervals of pattern of use (episodic, continuous, or unspecified) and dependence (current, early full remission, sustained partial remission, sustained full remission, or unspecified) compared to the 10th revision.[35]

A 2019 meta-analysis found that 34% of people with cannabis-induced psychosis transitioned to schizophrenia. This was found to be comparatively higher than hallucinogens (26%) and amphetamines (22%).[36]

To screen for cannabis-related problems, several methods are used. Scales specific to cannabis, which provides the benefit of being cost efficient compared to extensive diagnostic interviews, include the Cannabis Abuse Screening Test (CAST), Cannabis Use Identification Test (CUDIT), and Cannabis Use Problems Identification Test (CUPIT).[37] Scales for general drug use disorders are also used, including the Severity Dependence Scale (SDS), Drug Use Disorder Identification Test (DUDIT), and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).[38] However, there are no gold standard and both older and newer scales are still in use.[38] To quantify cannabis use, methods such as Timeline Follow-Back (TLFB) and Cannabis Use Daily (CUD) are used.[38] These methods measure general consumption and not grams of psychoactive substance as the concentration of THC may vary among drug users.[38]

## Treatment[edit | edit source]

Clinicians differentiate between casual users who have difficulty with drug screens, and daily heavy users, to a chronic user who uses multiple times a day.[8] In the US, as of 2013[update], cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities.[16] Demand for treatment for cannabis use disorder increased internationally between 1995 and 2002.[39] In the United States, the average adult who seeks treatment has consumed cannabis for over 10 years almost daily and has attempted to quit six or more times.[15]

Treatment options for cannabis dependence are far fewer than for opiate or alcohol dependence. Most treatment falls into the categories of psychological or psychotherapeutic, intervention, pharmacological intervention or treatment through peer support and environmental approaches.[21] No medications have been found effective for cannabis dependence,[40] but psychotherapeutic models hold promise.[5] Screening and brief intervention sessions can be given in a variety of settings, particularly at doctor's offices, which is of importance as most cannabis users seeking help will do so from their general practitioner rather than a drug treatment service agency.[41]

The most commonly accessed forms of treatment in Australia are 12-step programmes, physicians, rehabilitation programmes, and detox services, with inpatient and outpatient services equally accessed.[42] In the EU approximately 20% of all primary admissions and 29% of all new drug clients in 2005, had primary cannabis problems. And in all countries that reported data between 1999–2005 the number of people seeking treatment for cannabis use increased.[43]

### Counselling[edit | edit source]

Psychological intervention includes cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), contingency management (CM), supportive-expressive psychotherapy (SEP), family and systems interventions, and twelve-step programs.[5][44]

Evaluations of Marijuana Anonymous programs, modelled on the 12-step lines of Alcoholics Anonymous and Narcotics Anonymous, have shown small beneficial effects for general drug use reduction.[medical citation needed] In 2006, the Wisconsin Initiative to Promote Healthy Lifestyles implemented a program that helps primary care physicians identify and address marijuana use problems in patients.[45]

### Medication[edit | edit source]

As of 2020, there is no single medication that has been proven effective for treating cannabis use disorder; research is focused on three treatment approaches: agonist substitution, antagonist, and modulation of other neurotransmitter systems.[5][40] More broadly, the goal of medication therapy for cannabis use disorder centers around targeting the stages of the addiction: acute intoxication/binge, withdrawal/negative affect, and preoccupation/anticipation.[46]

For the treatment of the withdrawal/negative affect symptom domain of cannabis use disorder, medications may work by alleviating restlessness, irritable or depressed mood, anxiety, and insomnia.[47] Bupropion, which is a norepinephrine–dopamine reuptake inhibitor, has been studied for the treatment of withdrawal with largely poor results.[47] Atomoxetine has also shown poor results, and is as a norepinephrine reuptake inhibitor, though it does increase the release of dopamine through downstream effects in the prefrontal cortex (an area of the brain responsible for planning complex tasks and behavior).[47] Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, has also been studied for cannabis use disorder, with the thought that the serotonergic component may be useful for the depressed mood or anxious dimensions of the withdrawal symptom domain.[47] While venlafaxine has been shown to improve mood for people with cannabis use disorder, a clinical trial in this population actually found worse cannabis abstinence rates compared to placebo.[47] It is worth noting that venlafaxine is sometimes poorly tolerated, and infrequent use or abrupt discontinuation of its use can lead to withdrawal symptoms from the medication itself, including irritability, dysphoria, and insomnia.[48] It is possible that venlafaxine use actually exacerbated cannabis withdrawal symptoms, leading people to use more cannabis than placebo to alleviate their discomfort.[47] Mirtazapine, which increases serotonin and norepinephrine, has also failed to improve abstinence rates in people with cannabis use disorder.[47]

People sometimes use cannabis to cope with their anxiety, and cannabis withdrawal can lead to symptoms of anxiety.[47] Buspirone, a serotonin 1A receptor (5-HT1A) agonist, has shown limited efficacy for treating anxiety in people with cannabis use disorder, though there may be better efficacy in males than in females.[47] Fluoxetine, a selective serotonin reuptake inhibitor, has failed to show efficacy in adolescents with both cannabis use disorder and depression.[47] SSRIs are a class of antidepressant drugs that are also used for the treatment of anxiety disorders, such as generalized anxiety disorder.[49] Vilazodone, which has both SSRI and 5-HT1A agonism properties, also failed to increase abstinence rates in people with cannabis use disorder.[47]

Studies of divalproex have found no significant benefit, though some studies have found mixed results.[47] Baclofen, a GABA-B receptor agonist and antispasmodic medication, has been found to reduce cravings but without a significant benefit towards preventing relapse or improving sleep.[47] Zolpidem, a GABA-A receptor agonist and "Z-hypnotic" medication, has shown some efficacy in treating insomnia due to cannabis withdrawal, though there is a potential for misuse.[47] Entacapone was well tolerated and decreased cannabis cravings in a trial on a small number of patients.[5] Topiramate, an antiepileptic drug, has shown mixed results in adolescents, reducing the volume of cannabis consumption without significantly increasing abstinence, with somewhat poor tolerability.[47] Gabapentin, an indirect GABA modulator, has shown some preliminary benefit for reducing cravings and cannabis use.[47]

The agonist substitution approach is one that draws upon the analogy of the success of nicotine replacement therapy for nicotine addiction. Dronabinol, which is synthetic THC, has shown benefit in reducing cravings and other symptoms of withdrawal, though without preventing relapse or promoting abstinence.[47] Combination therapy with dronabinol and the alpha 2 adrenergic receptor agonist lofexidine have shown mixed results, with possible benefits towards reducing withdrawal symptoms.[47] However, overall, the combination of dronabinol and lofexidine is likely not effective for the treatment of cannabis use disorder.[47] Nabilone, a synthetic THC analogue, has shown benefits in reducing symptoms of withdrawal such as difficulty sleeping, and decreased overall cannabis use.[47] Despite its psychoactive effects, the slower onset of action and longer duration of action of nabilone make it less likely to be abused than cannabis itself, which makes nabilone a promising harm reduction strategy for the treatment of cannabis use disorder.[47] The combination of nabilone and zolpidem has been shown to decrease sleep-related and mood-related symptoms of cannabis withdrawal, in addition to decreasing cannabis use.[47] Nabiximols, a combined THC and cannabidiol (CBD) product that is formulated as an oral (buccal) spray, has been shown to improve withdrawal symptoms without improving abstinence rates.[47] Oral CBD has not shown efficacy in reducing the signs or symptoms of cannabis use, and likely has no benefit in cannabis use withdrawal symptoms.[47] The CB-1 receptor antagonist rimonabant has shown efficacy in reducing the effects of cannabis in users, but with a risk for serious psychiatric side effects.[47]

Naltrexone, a mu opioid receptor antagonist, has shown mixed results for cannabis use disorder—both increasing the subjective effects of cannabis when given acutely, but potentially decreasing the overall use of cannabis with chronic administration.[47] N-acetylcysteine (NAC) has shown some limited benefit in decreasing cannabis use in adolescents, though not with adults.[47] Lithium, a mood stabilizer, has shown mixed results for treating symptoms of cannabis withdrawal, but is likely ineffective.[47] Quetiapine, a second-generation antipsychotic, has been shown to treat cannabis withdrawal related insomnia and decreased appetite at the expense of exacerbating cravings.[47] Oxytocin, a neuropeptide that the body produces, has shown some benefit in reducing the use of cannabis when administered intranasally in combination with motivational enhancement therapy sessions, though the treatment effect did not persist between sessions.[47]

Over-the-counter sedating Antihistamines such as Doxylamine have sedating and anti-emetic effects and may provide short term relief but should only be used within advised dosages.

### Barriers[edit | edit source]

Research that looks at barriers to cannabis treatment frequently cites a lack of interest in treatment, lack of motivation and knowledge of treatment facilities, an overall lack of facilities, costs associated with treatment, difficulty meeting program eligibility criteria and transport difficulties.[dubious - discuss][50][51][52]

## Epidemiology[edit | edit source]

Cannabis is one of the most widely used drugs in the world. In the United States, between 42%[53] and 49%[54] of people have used cannabis, an estimated 9% of those who use cannabis develop dependence.[15][55][needs update] Of Australians aged 14 years and over 34.8% have used cannabis one or more times in their life.[56] In the U.S., cannabis is the most commonly identified illicit substance used by people admitted to treatment facilities.[5] Most of these people were referred there by the criminal justice system. Of admittees 16% either went on their own, or were referred by family or friends.[57]

In the European Union (data as available in 2018, information for individual countries was collected between 2012 and 2017), 26.3% of adults aged 15–64 used cannabis at least once in their lives, and 7.2% used cannabis in the last year. The highest prevalence of cannabis use among 15 to 64 years old in the EU was reported in France, with 41.4% having used cannabis at least once in their life, and 2.17% used cannabis daily or almost daily. Among young adults (15–34 years old), 14.1% used cannabis in the last year.[58]

Among adolescents (15–16 years old) in a European school based study (ESPAD), 16% of students have used cannabis at least once in their life, and 7% (boys: 8%, girls: 5%) of students had used cannabis in the last 30 days.[59]

Globally, 22.1 million people (0.3% of the worlds population) were estimated to have cannabis dependence in 2016.[60]

## Research[edit | edit source]

Medications such as SSRI antidepressants, mixed action antidepressants, bupropion, buspirone and atomoxetine may not be helpful to treat cannabis use disorder, but the evidence is very weak and further research is required.[40] THC preparations, gabapentin, oxytocin, and N-acetylcysteine also require more research to determine if they are effective as the evidence base is weak.[40]

Heavy cannabis use has been associated with impaired cognitive functioning, however, its specific details are difficult to elucidate due to the potential use of additional substances of users, and lack of longitudinal studies.[61]

## See also[edit | edit source]

* La Guardia Committee, the first in-depth study into the effects of cannabis.
* Medical cannabis

## References[edit | edit source]

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. 2013. pp. 509. doi:10.1176/appi.books.9780890425596.156852. ISBN 978-0-89042-555-8. `{{cite book}}`: Cite has empty unknown parameter: `|1=` (help)
2. ↑ 2.0 2.1 2.2 2.3 2.4 Patel, J; Marwaha, R (January 2020). "Cannabis Use Disorder". PMID 30844158. `{{cite journal}}`: Cite journal requires `|journal=` (help)
3. ↑ 3.0 3.1 3.2 3.3 3.4 WORLD DRUG REPORT 2020 (SET OF 6 BOOKLETS) (PDF). [S.l.]: UNITED NATIONS. 2020. p. 11, 13, 32. ISBN 978-92-1-148345-1. Archived (PDF) from the original on 29 January 2021. Retrieved 20 February 2021.
4. ↑ Brezing, CA; Levin, FR (January 2018). "The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal". Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 43 (1): 173–194. doi:10.1038/npp.2017.212. PMID 28875989.
5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Danovitch I, Gorelick DA (June 2012). "State of the art treatments for cannabis dependence". The Psychiatric Clinics of North America (Review). 35 (2): 309–26. doi:10.1016/j.psc.2012.03.003. PMC 3371269. PMID 22640758.
6. ↑ Dervaux A, Laqueille X (December 2012). "[Cannabis: Use and dependence]". Presse Médicale (in French). 41 (12 Pt 1): 1233–40. doi:10.1016/j.lpm.2012.07.016. PMID 23040955.`{{cite journal}}`: CS1 maint: unrecognized language (link)
7. ↑ E.B., Robertson. "Information on Cannabis Addiction". National Institute on Drug Abuse. Archived from the original on 7 May 2018. Retrieved 7 May 2018.
8. ↑ 8.0 8.1 Clinical Textbook of Addictive Disorders Archived 27 July 2020 at the Wayback Machine, Marijuana, David McDowell, page 169, Published by Guilford Press, 2005 ISBN 1-59385-174-X.
9. ↑ Hirvonen J, Goodwin RS, Li CT, Terry GE, Zoghbi SS, Morse C, et al. (June 2012). "Reversible and regionally selective downregulation of brain cannabinoid CB1 receptors in chronic daily cannabis smokers". Molecular Psychiatry. 17 (6): 642–9. doi:10.1038/mp.2011.82. PMC 3223558. PMID 21747398.
10. ↑ Madras BK (August 2014). "Dopamine challenge reveals neuroadaptive changes in marijuana abusers". Proceedings of the National Academy of Sciences of the United States of America. 111 (33): 11915–6. Bibcode:2014PNAS..11111915M. doi:10.1073/pnas.1412314111. PMC 4143049. PMID 25114244.
11. ↑ 11.0 11.1 González S, Cebeira M, Fernández-Ruiz J (June 2005). "Cannabinoid tolerance and dependence: a review of studies in laboratory animals". Pharmacology, Biochemistry, and Behavior. 81 (2): 300–18. doi:10.1016/j.pbb.2005.01.028. PMID 15919107.
12. ↑ Maldonado R, Berrendero F, Ozaita A, Robledo P (May 2011). "Neurochemical basis of cannabis addiction". Neuroscience. 181: 1–17. doi:10.1016/j.neuroscience.2011.02.035. PMID 21334423.
13. ↑ "Marijuana use disorder is common and often untreated". National Institutes of Health (NIH). 4 March 2016. Archived from the original on 3 April 2019. Retrieved 3 April 2019.
14. ↑ Wilkie G, Sakr B, Rizack T (May 2016). "Medical Marijuana Use in Oncology: A Review". JAMA Oncology. 2 (5): 670–675. doi:10.1001/jamaoncol.2016.0155. PMID 26986677.
15. ↑ 15.0 15.1 15.2 Budney AJ, Roffman R, Stephens RS, Walker D (December 2007). "Marijuana dependence and its treatment". Addiction Science & Clinical Practice. 4 (1): 4–16. doi:10.1151/ascp07414. PMC 2797098. PMID 18292704.
16. ↑ 16.0 16.1 Borgelt LM, Franson KL, Nussbaum AM, Wang GS (February 2013). "The pharmacologic and clinical effects of medical cannabis". Pharmacotherapy (Review). 33 (2): 195–209. doi:10.1002/phar.1187. PMID 23386598.
17. ↑ Bahji, Anees; Stephenson, Callum; Tyo, Richard; Hawken, Emily R.; Seitz, Dallas P. (9 April 2020). "Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids". JAMA Network Open. 3 (4): e202370. doi:10.1001/jamanetworkopen.2020.2370.
18. ↑ Livne O, Shmulewitz D, Lev-Ran S, Hasin DS (February 2019). "DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults". Drug and Alcohol Dependence. 195: 170–177. doi:10.1016/j.drugalcdep.2018.09.005. PMC 6359953. PMID 30361043.
19. ↑ Coffey C, Carlin JB, Lynskey M, Li N, Patton GC (April 2003). "Adolescent precursors of cannabis dependence: findings from the Victorian Adolescent Health Cohort Study". The British Journal of Psychiatry. 182 (4): 330–6. doi:10.1192/bjp.182.4.330. PMID 12668409.
20. ↑ "DrugFacts: Marijuana". National Institute on Drug Abuse. Archived from the original on 17 April 2014. Retrieved 20 July 2015.
21. ↑ 21.0 21.1 Copeland J, Gerber S, Swift W (December 2004). Evidence-based answers to cannabis questions a review of the literature. National Drug and Alcohol Research Centre University of New South Wales, A report prepared for the Australian National Council on Drugs.
22. ↑ McLaren, J, Mattick, R P., Cannabis in Australia Use, supply, harms, and responses Monograph series No. 57 Report prepared for: Drug Strategy Branch Australian Government Department of Health and Ageing. National Drug and Alcohol Research Centre University of New South Wales, Australia.
23. ↑ 23.0 23.1 Volkow, Nora D.; Swanson, James M.; Evins, A. Eden; DeLisi, Lynn E.; Meier, Madeline H.; Gonzalez, Raul; Bloomfield, Michael A. P.; Curran, H. Valerie; Baler, Ruben (1 March 2016). "Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review". JAMA Psychiatry. 73 (3): 292–7. doi:10.1001/jamapsychiatry.2015.3278. ISSN 2168-622X. PMID 26842658.
24. ↑ Levine, Amir; Clemenza, Kelly; Rynn, Moira; Lieberman, Jeffrey (1 March 2017). "Evidence for the Risks and Consequences of Adolescent Cannabis Exposure". Journal of the American Academy of Child & Adolescent Psychiatry. 56 (3): 214–225. doi:10.1016/j.jaac.2016.12.014. ISSN 0890-8567. PMID 28219487. Archived from the original on 28 August 2021. Retrieved 25 November 2019.
25. ↑ National Academies of Sciences, Engineering, and Medicine (U.S.). Committee on the Health Effects of Marijuana: an Evidence Review and Research Agenda. (2017). The health effects of cannabis and cannabinoids : the current state of evidence and recommendations for research. The National Academies Press. ISBN 978-0-309-45304-2. OCLC 1021254335.`{{cite book}}`: CS1 maint: multiple names: authors list (link)
26. ↑ Montoya, Ivan D., editor. Weiss, Susan R.B., editor. (10 December 2018). Cannabis use disorders. ISBN 978-3-319-90364-4. OCLC 1029794724.`{{cite book}}`: CS1 maint: multiple names: authors list (link)
27. ↑ 27.0 27.1 27.2 Gunn, J K L; Rosales, C B; Center, K E; Nuñez, A; Gibson, S J; Christ, C; Ehiri, J E (2016). "Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis". BMJ Open. 6 (4): e009986. doi:10.1136/bmjopen-2015-009986. ISSN 2044-6055. PMC 4823436. PMID 27048634.
28. ↑ Metz, Torri D.; Stickrath, Elaine H. (December 2015). "Marijuana use in pregnancy and lactation: a review of the evidence". American Journal of Obstetrics and Gynecology. 213 (6): 761–778. doi:10.1016/j.ajog.2015.05.025. ISSN 0002-9378. PMID 25986032.
29. ↑ Brown, R.A.; Dakkak, H.; Seabrook, J.A. (21 December 2018). "Is Breast Best? Examining the effects of alcohol and cannabis use during lactation". Journal of Neonatal-Perinatal Medicine. 11 (4): 345–356. doi:10.3233/npm-17125. ISSN 1934-5798. PMID 29843260.
30. ↑ Seabrook, J.A.; Biden, C.; Campbell, E. (2017). "Does the risk of exposure to marijuana outweigh the benefits of breastfeeding? A systematic review". Canadian Journal of Midwifery Research and Practice. 16 (2): 8–16.
31. ↑ "Proposed Revision | APA DSM-5". Dsm5.org. Archived from the original on 17 July 2011. Retrieved 20 April 2011.
32. ↑ "DSM-5 Now Categorizes Substance Use Disorder in a Single Continuum". American Psychiatric Association. 17 May 2013. Archived from the original (PDF) on 7 February 2015. Retrieved 12 December 2013.
33. ↑ Hasin DS, O'Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, et al. (August 2013). "DSM-5 criteria for substance use disorders: recommendations and rationale". The American Journal of Psychiatry. 170 (8): 834–51. doi:10.1176/appi.ajp.2013.12060782. PMC 3767415. PMID 23903334.
34. ↑ "ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 1 August 2018. Retrieved 17 November 2019.
35. ↑ "ICD-10 Version:2016". icd.who.int. Archived from the original on 5 November 2018. Retrieved 17 November 2019.
36. ↑ Murrie, Benjamin; Lappin, Julia; Large, Matthew; Sara, Grant (16 October 2019). "Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis". Schizophrenia Bulletin. doi:10.1093/schbul/sbz102. PMID 31618428.
37. ↑ Casajuana, Cristina; López-Pelayo, Hugo; Balcells, María Mercedes; Miquel, Laia; Colom, Joan; Gual, Antoni (2016). "Definitions of Risky and Problematic Cannabis Use: A Systematic Review". Substance Use & Misuse. 51 (13): 1760–1770. doi:10.1080/10826084.2016.1197266. ISSN 1532-2491. PMID 27556867.
38. ↑ 38.0 38.1 38.2 38.3 López-Pelayo, H.; Batalla, A.; Balcells, M. M.; Colom, J.; Gual, A. (2015). "Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments". Psychological Medicine. 45 (6): 1121–1133. doi:10.1017/S0033291714002463. ISSN 1469-8978. PMID 25366671.
39. ↑ Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2003). Emergency department trends from the drug abuse warning network, final estimates 1995–2002, DAWN Series: D-24, DHHS Publication No. (SMA) 03-3780.
40. ↑ 40.0 40.1 40.2 40.3 Nielsen S, Gowing L, Sabioni P, Le Foll B (January 2019). "Pharmacotherapies for cannabis dependence". The Cochrane Database of Systematic Reviews. 1: CD008940. doi:10.1002/14651858.CD008940.pub3. PMC 6360924. PMID 30687936.
41. ↑ Degenhardt L, Hall W, Lynskey M (2000). Cannabis use and mental health among Australian adults: Findings from the National Survey of Mental Health and Well-being, NDARC Technical Report No. 98. Sydney: National Drug and Alcohol Research Centre, University of New South Wales.
42. ↑ Copeland J, Swift W (April 2009). "Cannabis use disorder: epidemiology and management". International Review of Psychiatry (Review). 21 (2): 96–103. doi:10.1080/09540260902782745. PMID 19367503.
43. ↑ EMCDDA (2007). Annual report 2007: The state of the drugs problem in Europe. Luxembourg: Office for Official Publications of the European Communities.
44. ↑ Gates, Peter J.; Sabioni, Pamela; Copeland, Jan; Le Foll, Bernard; Gowing, Linda (5 May 2016). "Psychosocial interventions for cannabis use disorder". The Cochrane Database of Systematic Reviews (5): CD005336. doi:10.1002/14651858.CD005336.pub4. ISSN 1469-493X. PMC 4914383. PMID 27149547. Archived from the original on 1 December 2019. Retrieved 30 October 2020.
45. ↑ "With Support From Collaborative, Primary Care Practices Identify and Address Behavioral Health Issues, Reducing Binge Drinking, Marijuana Use, and Depression Symptoms". Agency for Healthcare Research and Quality. 8 May 2013. Archived from the original on 25 January 2016. Retrieved 10 May 2013.
46. ↑ Zehra A, Burns J, Liu CK, Manza P, Wiers CE, Volkow ND, Wang GJ (December 2018). "Cannabis Addiction and the Brain: a Review". Journal of Neuroimmune Pharmacology. 13 (4): 438–452. doi:10.1007/s11481-018-9782-9. PMC 6223748. PMID 29556883.
47. ↑ 47.00 47.01 47.02 47.03 47.04 47.05 47.06 47.07 47.08 47.09 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 Brezing CA, Levin FR (January 2018). "The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal". Neuropsychopharmacology. 43 (1): 173–194. doi:10.1038/npp.2017.212. PMC 5719115. PMID 28875989.
48. ↑ Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J (2018). "Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review" (PDF). Psychotherapy and Psychosomatics. 87 (4): 195–203. doi:10.1159/000491524. PMID 30016772.
49. ↑ "Generalised anxiety disorder - NICE Pathways". pathways.nice.org.uk. NICE. Archived from the original on 29 March 2019. Retrieved 13 April 2019.
50. ↑ Treloar C, Holt M (2006). "Deficit models and divergent philosophies: Service providers' perspectives on barriers and incentives to drug treatment". Drugs: Education Prevention and Policy. 13 (4): 367–382. doi:10.1080/09687630600761444.
51. ↑ Treloar C, Abelson J, Cao W, Brener L, Kippax S, Schultz L, Schultz M, Bath N (2004). Barriers and incentives to treatment for illicit drug users. Monograph Series 53. Canberra: Department of Health and Ageing, National Drug Strategy.
52. ↑ Gates P, Taplin S, Copeland J, Swift W, Martin G (2008). "Barriers and Facilitators to Cannabis Treatment". Drug and Alcohol Review. National Cannabis Prevention and Information Centre, University of New South Wales, Sydney. 31 (3): 311–9. doi:10.1111/j.1465-3362.2011.00313.x. PMID 21521384.
53. ↑ Gordon AJ, Conley JW, Gordon JM (December 2013). "Medical consequences of marijuana use: a review of current literature". Current Psychiatry Reports (Review). 15 (12): 419. doi:10.1007/s11920-013-0419-7. PMID 24234874. Archived from the original on 7 August 2019. Retrieved 30 June 2019.
54. ↑ "6 facts about marijuana". Archived from the original on 27 June 2015. Retrieved 22 April 2015.
55. ↑ Marshall K, Gowing L, Ali R, Le Foll B (17 December 2014). "Pharmacotherapies for cannabis dependence". The Cochrane Database of Systematic Reviews. 12 (12): CD008940. doi:10.1002/14651858.CD008940.pub2. PMC 4297244. PMID 25515775.
56. ↑ "Drug Info". Australian Drug Foundation. Archived from the original on 25 April 2011.
57. ↑ "Treatment Episode Data Set (TEDS)2001 – 2011. National Admissions to Substance Abuse Treatment Services" (PDF). samhsa.gov. Substance Abuse and Mental Health Services Administration. Archived from the original (PDF) on 1 August 2017. Retrieved 17 April 2015.
58. ↑ "Statistical Bulletin 2018 — prevalence of drug use | www.emcdda.europa.eu". www.emcdda.europa.eu. Archived from the original on 31 December 2018. Retrieved 5 February 2019.
59. ↑ "Summary | www.espad.org". www.espad.org. Archived from the original on 7 February 2019. Retrieved 5 February 2019.
60. ↑ Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, et al. (GBD 2016 Alcohol and Drug Use Collaborators) (December 2018). "The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. Psychiatry. 5 (12): 987–1012. doi:10.1016/S2215-0366(18)30337-7. PMC 6251968. PMID 30392731.
61. ↑ Scott, JC; Slomiak, ST; Jones, JD; Rosen, AFG; Moore, TM; Gur, RC (1 June 2018). "Association of Cannabis With Cognitive Functioning in Adolescents and Young Adults: A Systematic Review and Meta-analysis". JAMA Psychiatry. 75 (6): 585–595. doi:10.1001/jamapsychiatry.2018.0335. PMC 6137521. PMID 29710074.

## External links[edit | edit source]

Classification|

* ICD-10: F12
* ICD-9-CM: 304.3

|

* v
* t
* e

Reinforcement disorders: Addiction and Dependence

Addiction|

| Drug|

* Alcohol
* Amphetamine
* Cocaine
* Methamphetamine
* Methylphenidate
* Nicotine
* Opioid

|

Behavioral|

* Financial
* Gambling
* Shopping
* Palatable food
* Sex-related
* Intercourse
* Pornography
* Internet-related
* Internet addiction disorder
* Internet sex addiction
* Video game addiction
* Digital media addictions

Cellular
mechanisms|

* Transcriptional
* ΔFosB
* c-Fos
* Cdk5
* CREB
* GluR2
* NF-κB

* Epigenetic
* G9a
* G9a-like protein
* HDAC1
* HDAC2
* HDAC3
* HDAC4
* HDAC5
* HDAC9
* HDAC10
* SIRT1
* SIRT2
* ...

Dependence|

| Concepts|

* Physical dependence
* Psychological dependence
* Withdrawal

|

Disorders|

* Drugs
* Alcoholism
* Amphetamine
* Barbiturate
* Benzodiazepine
* Caffeine
* Cannabis
* Cocaine
* Nicotine
* Opioid
* Non-drug stimuli
* Tanning dependence

Treatment and management|

| Detoxification|

* Alcohol detoxification
* Drug detoxification

|

Behavioral therapies|

* Cognitive behavioral therapy
* Relapse prevention
* Contingency management
* Community reinforcement approach and family training
* Motivational enhancement therapy
* Motivational interviewing
* Motivational therapy
* Physical exercise

Treatment programs|

* Drug rehab
* Residential treatment center
* Heroin-assisted treatment
* Intensive outpatient program
* Methadone maintenance
* Smoking cessation
* Nicotine replacement therapy
* Tobacco cessation clinics in India
* Twelve-step program

Support groups|

* Addiction recovery groups
* List of twelve-step groups

Harm reduction|

* Category:Harm reduction
* Drug checking
* Reagent testing
* Low-threshold treatment programs
* Managed alcohol program
* Moderation Management
* Needle exchange program
* Responsible drug use
* Stimulant maintenance
* Supervised injection site
* Tobacco harm reduction

See also|

* Addiction medicine
* Allen Carr
* Category:Addiction
* Discrimination against drug addicts
* Dopamine dysregulation syndrome
* Cognitive control
* Inhibitory control
* Motivational salience
* Incentive salience
* Sober companion

* Category

* v
* t
* e

Cannabis

* Outline of cannabis
* Recreational and medical applications
* Industrial applications

General|

* Autoflowering cannabis
* Cannabis
* indica
* ruderalis
* sativa
* Difference between C. indica and C. sativa
* Consumption
* Cultivation
* Etymology (cannabis, dagga, ganja, ma, marijuana)
* Glossary
* Cannabis strains
* Synthetic cannabis

Usage|

| General|

* Medical cannabis
* Cannabis product testing
* History
* In the US
* Medical cannabis card

* Religious and spiritual use
* Chalice
* Drug testing
* Marijuana Anonymous

|

Hemp|

* Hanfparade
* List of hemp diseases
* List of hemp products
* hempcrete
* jewelry
* milk
* oil
* paper
* rolling paper
* List of hemp varieties
* Hemp for Victory
* Hemp Industries Association
* The Emperor Wears No Clothes

Variants|

* Cannabis edible
* Bhang
* Cannabis tea
* Cannabis smoking
* Vaporizing

* Cannabis concentrate
* Essential oil
* Charas
* Hash oil
* Hashish
* Kief
* Tincture

* Phytocannabinoids
* Cannabidiol (CBD)
* Tetrahydrocannabinol (THC)

Effects|

* Amotivational syndrome
* Cannabis in pregnancy
* Cannabis use disorder (CUD)
* Cannabinoid hyperemesis syndrome (CHS)
* Entourage effect
* Endocannabinoid system
* Impaired driving
* Time perception
* Long-term effects
* Occupational health concerns
* Medical cannabis research

Culture|

* 420
* Books
* Budtender
* Cannabis Culture
* Cannabis Social Club
* Columns
* Competitions
* Cookbooks
* Etiquette
* Films (Stoner film)
* High Times
* Music
* Religion
* Sports
* Head shop
* KBUD-AM (defunct)
* Operation Overgrow
* Stoner TV

Pro-cannabis
organizations|

* ACT
* ALCP
* AMMA
* ASA
* CBN
* CLEAR
* CRC
* DFCR
* DPA
* FAAAT
* FCA
* GMM
* IACM
* LEAP
* MAPS
* MPP
* NCIA
* NORML
* SAFER
* SCC
* SSDP
* VMCA

Demographics|

* Adult lifetime use by country
* Annual use by country

Politics|

| General|

* Bootleggers and Baptists
* Cannabis rights
* Cannabis activists
* Capital punishment for cannabis trafficking
* Effects of legalized cannabis
* Global Marijuana March
* Legality of cannabis
* Legal history in the United States
* Marihuana Tax Act of 1937
* Timeline of cannabis law

|

Major legal
reforms|

* Canada: 2018 Cannabis Act
* UK: Return to class B
* Uruguay: Law No. 19172
* US:
* Decriminalization of non-medical use
* Rescheduling per the Controlled Substances Act
* Hemp Farming Act of 2018

Politicians
and parties|

* Cannabis political parties
* List of British politicians who have acknowledged cannabis use
* List of American politicians who have acknowledged cannabis use

Legal cases|

* Ker v. California (1963)
* Leary v. United States (1969)
* Kyllo v. United States (2001)
* Gonzales v. Raich (2005)
* ADPF 187 (2011)

Related|

* Impact of the COVID-19 pandemic on the cannabis industry

*   * Category

* v
* t
* e

Psychoactive substance-related disorder

General|

* SID
* Substance intoxication / Drug overdose
* Substance-induced psychosis
* Withdrawal:
* Craving
* Neonatal withdrawal
* Post-acute-withdrawal syndrome (PAWS)
* SUD
* Substance abuse / Substance-related disorders
* Physical dependence / Psychological dependence / Substance dependence

Combined
substance use|

* SUD
* Polysubstance dependence
* SID
* Combined drug intoxication (CDI)

Alcohol|

| SID|

| Cardiovascular diseases|

* Alcoholic cardiomyopathy
* Alcohol flush reaction (AFR)

|

Gastrointestinal diseases|

* Alcoholic liver disease (ALD):
* Alcoholic hepatitis
* Auto-brewery syndrome (ABS)

Endocrine diseases|

* Alcoholic ketoacidosis (AKA)

Nervous
system diseases|

* Alcohol-related dementia (ARD)
* Alcohol intoxication
* Hangover

Neurological
disorders|

* Alcoholic hallucinosis
* Alcoholic polyneuropathy
* Alcohol-related brain damage
* Alcohol withdrawal syndrome (AWS):
* Alcoholic hallucinosis
* Delirium tremens (DTs)
* Fetal alcohol spectrum disorder (FASD)
* Fetal alcohol syndrome (FAS)
* Korsakoff syndrome
* Positional alcohol nystagmus (PAN)
* Wernicke–Korsakoff syndrome (WKS, Korsakoff psychosis)
* Wernicke encephalopathy (WE)

Respiratory tract diseases|

* Alcohol-induced respiratory reactions
* Alcoholic lung disease

SUD|

* Alcoholism (alcohol use disorder (AUD))
* Binge drinking

Caffeine|

* SID
* Caffeine-induced anxiety disorder
* Caffeine-induced sleep disorder
* Caffeinism
* SUD
* Caffeine dependence

Cannabis|

* SID
* Cannabis arteritis
* Cannabinoid hyperemesis syndrome (CHS)
* Intravenous marijuana syndrome
* SUD
* Amotivational syndrome
* Cannabis use disorder (CUD)
* Synthetic cannabinoid use disorder

Cocaine|

* SID
* Cocaine intoxication
* Prenatal cocaine exposure (PCE)
* SUD
* Cocaine dependence

Hallucinogen|

* SID
* Acute intoxication from hallucinogens (bad trip)
* Hallucinogen persisting perception disorder (HPPD)

Nicotine|

* SID
* Green Tobacco Sickness (GTS)
* Nicotine poisoning
* Nicotine withdrawal
* SUD
* Nicotine dependence

Opioids|

* SID
* Opioid overdose
* SUD
* Opioid use disorder (OUD)

Sedative /
hypnotic|

* SID
* Kindling (sedative–hypnotic withdrawal)
* benzodiazepine: SID
* Benzodiazepine overdose
* Benzodiazepine withdrawal
* SUD
* Benzodiazepine use disorder (BUD)
* Benzodiazepine dependence
* barbiturate: SID
* Barbiturate overdose
* SUD
* Barbiturate dependence

Stimulants|

* SID
* Stimulant psychosis
* amphetamine: SUD
* Amphetamine dependence

Volatile
solvent|

* SID
* Sudden sniffing death syndrome (SSDS)
* Toluene toxicity
* SUD
* Inhalant abuse

Related
non-psychoactive
substances|

* Anabolic-androgenic steroids: SUD
* Anabolic-androgenic steroids abuse

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*[e]: Edit this template