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See Also:

Addiction;

Drug addiction;

Marijuana usage;

Smoking;

Substance abuse.

Psychology & Behavioral Health

Marijuana dependence

by Elizabeth M. Nielson

Type of psychology: Addiction; Biological bases of human behavior; Clinical; Psychopathology; Social

Marijuana is the most widely used illicit drug in the US, and probably in the world. At present, although it is still prohibited at the federal level 25 states have approved its use for medical purposes and four for recreational purposes. Marijuana is hence becoming more widely available and socially sanctioned of late. Marijuana use can lead to cannabis use disorder, an addictive disorder in which the individual experiences clinically significant impairment or distress in relation to the use of marijuana. How the recently increased legal and social approval of marijuana use will affect rates of cannabis use disorder and its treatment are as yet unclear. Prevalence, risk factors, and behavioral and pharmacological treatments for cannabis use disorder are discussed.

Key Concepts

  • Addiction treatment

  • Cannabis use disorder

  • Co-occurring disorders

  • ∆9-Tetrahydracannabinol

  • Psychological and physical symptoms

Introduction

Marijuana is the leaves, stems, and seeds of the plant cannabis sativa. It is the most widely used illicit drug. It is estimated that about 25 million Americans have used marijuana in the last year, and that over four million meet criterion for a cannabis use disorder at any given time. In most cases marijuana causes relatively brief and mild intoxication. Addiction to marijuana is diagnosed as a cannabis use disorder, and can range from moderate to severe depending on the number of criteria met. Chronic use can effect motivational and reward systems, leading to addiction. For chronic users, ceasing marijuana use can result in a withdrawal syndrome not unlike nicotine withdrawal in intensity and duration. Several treatments exist including behavioral and pharmacological therapies.

Diagnosis

Cannabis Abuse and Cannabis Dependence were initially listed as a diagnosis in the Diagnostic and Statistical Manual – III (DSM-III) published by the American Psychiatric Association in 1980. Prior to 1980, a diagnosis of drug addiction would have been made with a specification of marijuana as the drug. The DSM-III notes that – at the time of publication – tolerance and withdrawal related to marijuana use had not been established, so unlike other drugs, cannabis dependence was to be diagnosed based on level of impairment and not the presence of tolerance and withdrawal. The Abuse and Dependence diagnostic categories were carried through the DSM-IV with only minor changes. Although these terms are no longer in use, they and their related criterion were used as standards in research until the publication and adoption of the DSM-5 started in 2013.

In the years since the DSM-III scientists have established that tolerance and withdrawal do exist in cases of chronic marijuana use, and that these play a complex role in the addictive cycle. With the publication of the DSM-5 the diagnostic system changed to conceptualize cannabis use disorders on a continuum. In addition to using marijuana in a way that results in clinically significant impairment or distress, the patient must meet at least two of eleven criteria. Tolerance to the drug, and a withdrawal syndrome upon stopping use of the drug are two of the listed criterion.

Acute Intoxication

Marijuana intoxication is usually relatively mild and short. It can include feelings of euphoria, levity, and relaxation. Marijuana intoxication is accompanied by distorted perceptual experiences, for instance, the user may experience a distorted sense of time or distance. Users may experience a decreased sensation of pain as marijuana alters the perception of pain. Negative effects may include paranoia, drowsiness, difficulty concentrating, and increased appetite. Panic is not uncommon during acute marijuana intoxication: 40% of marijuana users report that they have experienced panic related to their marijuana use at some time. When used for medical purposes marijuana is often used for its acute effects of decreased perception of pain, decrease nausea, and to induce appetite.

Prevalence and Epidemiology

Cannabis use disorders have high prevalence rates, reflective of the widespread use of marijuana. Approximately 8.6% of the population of the United States has used marijuana in the past year, and about 10% of those who try marijuana will go on to develop a Cannabis Use Disorder. Based on DSM-IV criteria, about 3.4% of youth ages 12 - 17 and 1.5% of adults meet criterion for a cannabis use disorder. Rates of cannabis use disorders are higher in males and younger adults than in females and older adults. There are also differences in rates of cannabis use disorders between racial and ethnic groups in the US.

Course of Addiction

Marijuana contains over 60 chemicals called cannabinoids which are unique to the cannabis plant family. The cannabinoids found in marijuana are similar to the endogenous cannabinoid (or endocannabinoid) anandamide, which occurs naturally in the human brain that they can bind to existing cannabinoid receptors. The chemical responsible for marijuana's psychoactive effects is one of these cannabinoid compounds: ∆9-Tetrahydracannabinol, or ∆9-THC. Cannabinoid 1 receptors are found throughout the human brain, spinal cord, and peripheral nervous system, but it is in the brain that ∆9-THC's action at these receptor sites causes its psychoactive properties.

Marijuana is usually consumed by smoking in a small pipe or marijuana cigarette. When smoked, ∆9-THC quickly enters the bloodstream through the capillaries of the lungs and reaches the brain within seconds. Marijuana can also be eaten and the ∆9-THC absorbed into the blood stream through the gastrointestinal system. When eaten the effects of marijuana are slower to commence and longer-lasting. As users develop tolerance and require more of the drug to obtain effects they may change their smoking methods by using paraphernalia that will cool the smoke so it can be held longer in the lungs, use pressurized devices to force smoke deeper into the lungs, or vaporize marijuana so that the smoke will not cause irritation that requires quick exhalation.

Most cannabis users start as adolescents or young adults. Most illicit drug users start with a licit drug, such as alcohol or tobacco before trying marijuana or other illicit drugs however some follow an alternative sequence, trying marijuana first. Marijuana is often the first illicit drug tried because of its perceived safety and wide availability. Other risk factors include having family members who use drugs, having low academic performance, and engaging in other deviant behaviors. It is unclear how these patterns will be affected by the legalization of marijuana for recreational and medical use.

Potential for addiction is dose-dependent, with higher doses and more frequent use leading to higher likelihood of addiction. Likewise, due to refined plant breeding and growing practices, marijuana is increasing in potency and is now estimated to be 15–20 times stronger than it was in the 1960's. As ∆9-THC levels in marijuana has increased, the potential for addiction has risen, and the tolerance and withdrawal have become more prominent in maintaining cannabis use disorders.

Psychological Symptoms

Adolescent and young adult users of marijuana often display an array of anti-social behaviors of which marijuana use is just one. Indeed, marijuana has long been associated with counterculture movements and used to repudiate mainstream societal values of hard work and achievement. Many young users will continue use despite disapproval and some consequences from their families or schools. If cannabis use progresses young people will often experience loss of interest in pro-social activities (such as after-school clubs or sports), a drop in grades, and truancy.

Cannabis use can cause cognitive problems and loss of motivation for goal-directed activity. In the short-term, marijuana use impairs cognitive and psychomotor performance, especially in relation to complex or demanding tasks. In some cases, reduced cognitive function can be found months after marijuana use is stopped, however it is unclear if marijuana use has caused these impairments or exacerbated existing cognitive problems. In cases of chronic use antimotivational syndrome may occur, in which the individual seems depressed and lethargic and is unable to find motivation for daily activities that once seemed rewarding.

Physiological symptoms

Because marijuana is usually smoked, the most significant consequence to physical health is respiratory problems, especially bronchitis. Compared to regular tobacco smokers, lung function of marijuana-only smokers is significantly worse. Marijuana smokers are also at increased risk of lung cancer. Some animal research suggests that marijuana impairs the immune and reproductive systems; however these effects have not been consistently established in humans.

Treatments

Reflecting the high prevalence of cannabis use disorders in the general population people seeking to quit smoking marijuana are often seen in treatment settings. Among those who meet criteria for cannabis use disorder there are also high rates of alcohol use disorder and tobacco use disorder. Cannabis use can be seen as a secondary problem; however it is likely an integral part of the picture for those who meet criteria for multiple diagnoses and requires treatment in its own right.

Cannabis use disorders are not easily treated. Research shows that most promising treatments are those already applied to other types of substance use disorders such as Motivational Interviewing and Cognitive Behavioral Therapies. Longer duration treatments seem more promising for cannabis use disorders than brief interventions, such as two-session Motivational Enhancement Therapy. Voucher incentives may also help produce positive outcomes in treatment of cannabis use disorders.

One classic theory of drug addiction is that it is driven by negative reinforcement when the drug user suffers withdrawal symptoms which are relieved by taking more of the drug. Several pharmacological interventions under investigation for cannabis use disorders, some of which may alleviate this withdrawal so that further marijuana use is no longer negatively reinforced. Researchers have noted that administering synthetic ∆9-THC (dronabinol, Marinol®) will reduce symptoms of marijuana withdrawal. Other medications may be able to block the psychoactive effects of marijuana, such that further use is not rewarded. Although several medications are under investigation, none are as-yet approved for the treatment of cannabis use disorders.

Co-occurring Disorders

Marijuana users have higher rates of other mental disorders than are found in the general population. An estimated 33% of adolescents with cannabis use disorder also meet criterion for an internalizing disorder (such as a mood disorder) and an estimated 60% meet criterion for an externalizing disorder (such as conduct disorder). In adults who have met the criterion for cannabis use disorder at some point in the past year, 11% meet criterion for depressive disorder, 24% for an anxiety disorder, and 13% for bipolar I disorder. Personality disorders are also common among this group, with 30% meeting criterion for antisocial, 19% for obsessive-compulsive, and 18% for paranoid personality disorders. These co-occurring diagnoses will need to be taken into account when planning treatment for individuals with cannabis use disorders.

Bibliography

1 

American Psychiatric Association (2013) “Cannabis Use Disorders”, in Diagnostic and Statistical Manual of Mental Disorders, 5th Ed, Washington, DC. The most recent edition of the DSM gives full diagnostic criterion and an explanation of how these apply to cannabis use disorders. These criteria represent a change from the categorical diagnoses of cannabis abuse and cannabis dependence found in the previous edition.

2 

National Institute on Drug Abuse: Marijuana http://www.drugabuse.gov/publications/research-reports/marijuana/letter-director NIDA's main informational page on marijuana includes information about its addictive potential and use in medical settings.

3 

Panagis, G., Mackey, B., & Vlachou, S. (2014). “Cannabinoid Regulation of Brain Reward Processing With an Emphasis on the Role of CB1 Receptors: A Step Back Into the Future”, Frontiers in Psychiatry, 5(92), 1–19. An overview of how the ∆9-THC in marijuana interacts with the brain's existing endocannabinoids and their respective receptors to create addiction to marijuana, and implications for treatment.

Citation Types

Type
Format
MLA 9th
Nielson, Elizabeth M. "Marijuana Dependence." Psychology & Behavioral Health, edited by Paul Moglia, Salem Press, 2015. Salem Online, online.salempress.com/articleDetails.do?articleName=PBH_0379.
APA 7th
Nielson, E. M. (2015). Marijuana dependence. In P. Moglia (Ed.), Psychology & Behavioral Health. Salem Press. online.salempress.com.
CMOS 17th
Nielson, Elizabeth M. "Marijuana Dependence." Edited by Paul Moglia. Psychology & Behavioral Health. Hackensack: Salem Press, 2015. Accessed September 17, 2025. online.salempress.com.