Nearly 6 percent of American teens and adults have cannabis use disorder.
By Dana G. Smith
Smoking weed had always been a social activity for Julian. He first tried cannabis in high school, and as an adult he would smoke a couple of times a month with friends. But things changed after he moved to a new city where he didn’t know anyone. Julian (who asked not to use his last name when talking about a sensitive medical condition) didn’t have much of a social life, so he started smoking by himself to pass the time. “Weed became my friend,” he said. “I would get off work and I would smoke because I was bored.”
Soon, Julian’s life began to revolve around cannabis. Smoking never interfered with his work, but it stopped him from doing just about everything else. “Typically, when you move to a new city, you establish new relationships, and I was doing none of that,” he said. “I was living almost like a recluse.”
It was only through talking to a friend that Julian realized he might have a problem. He had “thought that it was impossible to become addicted” to weed. But when he looked up the definition of cannabis use disorder online, he realized that he met almost all of the criteria.
Despite the common misconception, people can become addicted to cannabis just as they can with other drugs, like alcohol or cocaine. As more states either decriminalize or legalize cannabis, more people are using it than ever before. According to the National Survey on Drug Use and Health, in 2021, approximately 19 percent of Americans 12 and older used cannabis, and nearly 6 percent of teens and adults qualified as having cannabis use disorder — the clinical name for addiction. (For comparison, close to 11 percent of Americans over the age of 11 have alcohol use disorder.)
“Most people who use cannabis do not have problems related to their use and are not going to develop a cannabis use disorder,” said Dr. Ayana Jordan, an associate professor of psychiatry at N.Y.U. Langone Health. But, she added, “just because cannabis is being legalized — and I actually think it should be legalized — it doesn’t mean that there is not any harm associated.”
The potential consequences of cannabis use disorder are not as severe as with other drugs like opiates, where overdose deaths are a dire concern. But cannabis addiction can cause “a dramatic decrease in quality of life,” said Dr. Christina Brezing, an assistant professor of psychiatry at Columbia University. Here’s what to know.
Signs of addiction
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines cannabis use disorder using 11 criteria that loosely fall into four symptom buckets (the same diagnostic criteria apply for all substance use disorders). If you meet at least two of the below criteria, you qualify as having a use disorder:
Loss of control
Taking more of the drug or using it more frequently than you intend to
Spending a great deal of time obtaining or using cannabis
Having an uncontrollable urge, or craving, to use it
Trying to stop or cut back and not being able to
Interpersonal consequences
Foregoing other social or recreational activities in order to use cannabis
Experiencing interpersonal conflicts as a result of your cannabis use
Failing to fulfill obligations at work or at home as a result of use
Risky use
Putting yourself in potentially dangerous situations as a result of obtaining or using cannabis
Continued use despite negative physical and psychological effects
Physical dependence
Developing tolerance — having to use more of the drug to achieve the same effect
Experiencing withdrawal symptoms when you stop using cannabis, such as insomnia, irritability, anxiety, depressed mood and decreased appetite
Risk factors
There are a few risk factors that can increase someone’s likelihood of developing cannabis use disorder. One is starting to use the drug as a teen.
“Cannabis use disorder occurs in all age groups, but it’s primarily a disease of young adults,” said Dr. David Gorelick, a professor of psychiatry at the University of Maryland School of Medicine. “And there is evidence that the younger the age at which you start cannabis use, the faster you’ll develop cannabis use disorder and the more severe the disorder will be.”
Having another psychiatric diagnosis, such as anxiety, depression, post-traumatic stress disorder or attention deficit hyperactivity disorder, is also associated with an increased risk. One possible reason for the overlap is that some people self-medicate with cannabis, and the heavier a person’s use, the more likely they are to develop physical dependence.
“I would say if you’re smoking daily and in larger amounts, it’s going to be hard not to develop tolerance and withdrawal,” Dr. Brezing said. “But it’s possible not to have a cannabis use disorder and to use daily.”
Treatment options
There are no medications approved to treat cannabis use disorder, but addiction psychiatrists will sometimes prescribe medications that can help alleviate withdrawal symptoms, including a lack of appetite and insomnia.
Most interventions for cannabis use disorder involve different types of therapy, such as motivational enhancement therapy and cognitive behavioral therapy. These are aimed at helping people develop coping strategies to deal with cravings or a desire to use.
“You try and deal with triggers,” Dr. Jordan said. “You try to really figure out what is the motivation for you to stop using altogether and really strengthen those motivations.”
Therapy can also be helpful for people dealing with underlying psychiatric issues that might be prompting their use.
That was the case for Julian. After realizing he had a problem, he started seeing a therapist, who diagnosed him with anxiety and helped him manage his feelings in healthier ways.
Julian now smokes weed very rarely — only once every few months if an old friend is around. He doesn’t miss it, he said. “The clarity that I have now makes me realize that I wasn’t really paying attention to life around me before.”