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What Is Cannabis Use Disorder (CUD) and Why Is It Misunderstood?
Cannabis use disorder (CUD) is a recognized medical condition in the Diagnostic and Statistical Manual of Mental Health Disorder, 5th edition (DSM-5). It describes cannabis use that causes harm or distress related to the inability to control or stop use.
CUD is often misunderstood because it is seen as less severe or addictive than other substances. Some people also think that is “safe” and “natural” because it comes from a plant. However, cannabis is addictive and can lead to psychological and physical dependence.
The Yale School of Medicine in 2023 reported the increased potency of THC (Tetrahydrocannabinol) – the psychoactive element in cannabis – contributes to rising addiction rates. In 2005 the THC levels in cannabis were around 4% whereas by 2017 they had risen to 17%, with some products today – like dabs and edibles – being as high as 90%.
This article will review information on cannabis addiction, how it affects our brain, signs of cannabis dependence, and will provide treatment options.
How Does Cannabis Affect the Brain’s Reward System?
Cannabis affects the brain’s reward system through the system responsible for feeling pain, appetite, immune system, and gut health – the endocannabinoid system (ECS). THC binds to and activates cannabinoid receptors (CB1). It overstimulates CB1 receptors causing the release of excessive levels of dopamine, which is a chemical messenger (neurotransmitter) responsible for:
- Experiencing happiness and
- pleasure
- Managing mood
- Focus and attention
- Movement
- Motivation
THC acts on areas of the reward system as follows:
- The prefrontal cortex helps us make decisions and control impulses and is sensitive to THC. When we use cannabis regularly, this area loses control, making it harder to control behaviors and make good decisions.
- The hippocampus helps us create and store new memories. THC activates the CB1 receptors in this area and can stop the brain from storing new information, making it harder to remember things.
- The amygdala processes emotions like fear and anxiety. THC affects the brain’s cannabinoid receptors in this area, changing reactivity to fear, anxiety, and pain.
Short-term use of THC can reduce anxiety, but chronic use can cause an increase in anxiety and lead to paranoia.
A study in the journal Nature in 2017 showed that dopamine levels fluctuate with chronic cannabis use causing dopamine imbalances. Short-term cannabis use increases dopamine release, while prolonged use is associated with blunting of the dopamine system – meaning you’ll need more THC to get the same effect, leading to tolerance and dependence.
Frequent cannabis use can disrupt the brain’s endocannabinoid system by reducing natural endocannabinoid production and receptor sensitivity, potentially impairing mood, memory, stress regulation, and overall mental health.
Is Cannabis Really Addictive? What the Research Says
Cannabis is addictive like any other psychoactive drug. Research done by the JAMA Network in 2023 reported that cannabis use disorder was as high as 21.3% among adults in the US where recreational use was legal.
Cannabis use rises to the level of addiction in the DSM-5 because of its ability to cause dependence and withdrawal symptoms in addition to other disruptive symptoms. The criteria for diagnosis include:
- Using more cannabis for a longer time than you intended.
- Strong needs and desires to use.
- Difficulty reducing or stopping cannabis use.
- Spending a lot of time using or recovering from cannabis use.
- Difficulty maintaining responsibilities at work, school, or home due to cannabis use.
- Continuing to use it even though it’s caused relationship problems.
- Having physical or mental health problems caused by the use.
- Needing more, or a higher dose of, cannabis to get the desired effect.
- Experiencing withdrawal symptoms when you stop or lower the amount.
THC creates physiological dependence with the rates being around 30%, according to the CDC in 2024. Long-term heavy users experience withdrawal symptoms such as:
- Irritability
- Depressed mood
- Anxiety
- Restlessness
- Decreased appetite
- Headaches
- Nausea
- Insomnia
Can Cannabis Use Change Brain Chemistry Over Time?
Yes, cannabis use changes brain chemistry over time. Here’s how long-term cannabis use changes areas responsible for memory, decision-making, and motivation:
- THC alters the ability of the hippocampus to adapt and change. This is the area responsible for learning and forming memories. THC makes it harder to create new memories or hold onto new information.
- THC impacts the prefrontal cortex, which is responsible for making decisions, solving problems, and controlling impulses – making it more difficult to think clearly and plan for the future.
- Chronic cannabis use can make your brain less sensitive to dopamine and can decrease motivation, resulting in anhedonia – difficulty experiencing pleasure in activities that used to be pleasurable.
Chronic cannabis use can also result in developing psychotic symptoms. Very high THC levels are frequently correlated with increased psychosis risk.
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How Do You Know If You Need Help for Cannabis Addiction?
To know if you need help with cannabis addiction you can start by taking a self-assessment. This will help you identify signs of dependence. Here is how to assess for dependence criteria:
1. Users should assess their consumption patterns.
- Are you using cannabis more frequently or more of it than you intend?
- Do you find it difficult to cut back or stop using even though you want to?
- Have you tried to quit or reduce using but find yourself continuing to keep using it?
2. Look for changes in behavior, as dependency reveals itself through behavioral shifts.
- Has cannabis use started to interfere with your daily responsibilities?
- Do you prioritize using cannabis over other activities?
- Do family or friends express concern over your cannabis use?
3. Evaluate psychological effects.
- When you don’t use cannabis, do you feel anxious, irritable, or restless?
- Do you use cannabis to handle stress, negative emotions, or social situations?
- Have you noticed your motivation, focus, or overall mood declining?
Answering “yes” to many of these questions can be a sign that you’ve crossed over from casual use to cannabis addiction or cannabis use disorder. The line between casual use and addiction becomes crossed when you meet dependence criteria. The red flags to look out for are:
- Compulsive use even when you’re aware of negative consequences.
- Experiencing physical or psychological withdrawal symptoms when you cut back or stop using.
- You need more to achieve the same effects (tolerance).
- You use cannabis instead of engaging with friends, family, and other social activities.
- You rely on cannabis to feel “normal” or to cope with emotions.
If you recognize these signs in yourself, that can indicate you need help for cannabis addiction.
What Are the Most Effective Treatments for Cannabis Addiction?
The most effective treatments for cannabis addiction include psychological therapies and support groups. Psychological therapy helps manage cravings and relapse prevention strategies that improve long-term success rates. Therapy helps reframe thought patterns while support groups provide accountability.
Here’s how treatment restores your brain’s natural balance and changes your thoughts about cannabis cravings:
Here’s how treatment restores your brain’s natural balance and changes your thoughts about cannabis cravings:
- Cognitive Behavioral Therapy (CBT) helps to identify and reframe unhealthy thoughts and behaviors associated with cannabis use. By addressing triggers, cravings, and unhelpful thoughts, you can develop healthy coping skills and reduce reliance on cannabis.
- Motivational Enhancement Therapy (MET) helps you find internal motivation to change behaviors by exploring the pros and cons of cannabis use, strengthening your commitment to change, and building confidence in the ability to quit.
- Support Groups, like Marijuana Anonymous (MA), offer a community that is supportive and provides accountability so you feel less isolated and more empowered to stay sober.
Effective cannabis treatment also includes managing withdrawal to avoid relapsing. Withdrawal management strategies include slowly cutting back rather than quitting cold turkey and practicing relaxation techniques, like meditation, to help manage anxiety and stress without returning to cannabis use.
Potential Medications to Treat Cannabis Addiction
There are several potential medications to treat cannabis addiction that are currently under research, though none are currently FDA-approved. A study mentioned by the Columbia University Department of Psychiatry in 2023 reported that the drug candidate, AEFO117, reduced the effects of cannabis in daily users. It also stated that this potential medication appears to counteract the high associated with THC at the CB1 receptor without disrupting the receptor’s physiological and behavioral functions of learning, emotional processing, sleep, and appetite.
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