The United States Drug Enforcement Administration (DEA) classifies marijuana (cannabis) as a Schedule I controlled substance, placing it in a category of chemical substances that are designated as having no useful medicinal purposes and being extremely prone to abuse and the development of physical dependence. Despite this classification, a number of states have legalized marijuana for medicinal purposes, and some states have legalized recreational use of marijuana, creating a clash between federal and state statutes regarding use of the drug. This has led to a number of debates regarding marijuana’s potential as a substance of abuse, and its treatment efficacy for a number of different physical and mental conditions.
Nonetheless, despite all of these debates, it is clear that a number of research studies have identified medicinal uses for cannabis. However, just because a particular substance can be used medicinally does not mean that it does not also have abuse potential and the potential for the development of a substance use disorder in individuals who misuse it. This situation occurs quite frequently. Some of the most common examples include medications designed to deal with pain (e.g., opiate medications) and anxiety (e.g., benzodiazepines). Thus, while it is clear that cannabis does have potential medicinal uses and the federal classification is inaccurate, this has no bearing on whether or not cannabis products can lead to substance use disorders when misused.
At this point, it should be mentioned that the notions of having a substance use disorder and the development of physical dependence represent two separate but related concepts. Physical dependence is a syndrome that occurs with chronic use of a drug (typically longer than 4-6 weeks) that results in the development of tolerance to the drug (needing more of the drug to get the effects that were experienced previously at lower doses) and withdrawal (a series of negative symptoms that occur if the individual stops using the drug or reduces the dosage they are taking). Physical dependence on a drug occurs whether an individual is using it for medicinal purposes or misusing it for other purposes.
As it turns out, the development of the symptoms of physical dependence that occur in individuals who chronically misuse drugs may be important indicators that they have developed a formal substance use disorder; however, having either tolerance or tolerance and withdrawal to a substance is not deemed necessary, nor is it deemed sufficient, in order to be diagnosed with any type of substance use disorder. A substance use disorder would only be diagnosed in cases where the individual chronically uses the substance for nonmedicinal reasons, displays difficulty controlling their use, and their use results in a number of negative ramifications and dysfunctional situations for them. A person who uses marijuana under the supervision of a prescription and according to its prescribed purposes/instructions would not be considered to have a substance use disorder even if they developed physical dependence on the drug.
Marijuana’s Addictive Potential
APA has developed formal diagnostic criteria for a cannabis use disorder based on research, controlled studies, and case studies. Despite a number of lay organizations’ claims that “marijuana is not addictive,” this assertion is not consistent with the facts.
It has long been recognized that cannabis products are the most commonly used illicit drugs in developed countries and that 10-30 percent of chronic cannabis users develop symptoms severe enough to qualify for a diagnosis of cannabis use disorder. In addition, research has identified a fairly stable and diagnosable withdrawal syndrome associated with discontinuing cannabis products as well as diagnostic criteria to determine if an individual is under the influence of cannabis products to a significant extent (cannabis intoxication).
- Cannabis does have some recognized medicinal uses. Having the potential to treat certain conditions does not disqualify a drug from being a potential drug of abuse that can lead to addiction.
- Chronic cannabis use can lead to the development of physical dependence (having both tolerance and withdrawal symptoms associated with using the drug).
- Chronic misuse of marijuana may lead to the development of a substance use disorder (a cannabis use disorder), which is a diagnosable condition that is listed as a mental health disorder that often requires formal treatment.
- The majority of individuals who use cannabis do not develop cannabis use disorders even if they develop some mild level of physical dependence on the drug.
How Do I Tell If I Have a Cannabis Use Disorder?
If a person has to ask this question, there may be a serious issue with their use of cannabis. Questioning whether one’s use of any drug is dysfunctional should be evidence enough for the individual to seek a consultation with a licensed mental health clinician to fully understand the potential problem.
- Nonmedicinal use of the drug
- Continued use of the drug that results in significant distress to the person or in dysfunction in their life
- Issues with controlling use of the drug, such as:
- Frequently taking more of the drug than originally intended
- Frequently using it over longer periods of time than originally intended
- Frequently spending inordinate amounts of time using the drug
- Frequently using the drug in situations that are dangerous
- Continuing to use the drug in spite of its use leading to significant issues at work, at school, in personal relationships, with physical health, or with emotional health
- Experiencing strong desires to use the drug
- The development of tolerance to the drug
- The development of withdrawal symptoms associated with cutting down or stopping use of the drug
The only conditions that are mandatory in the diagnostic classification of a substance use disorder are that use of the substance occurs for nonmedicinal reasons and such use results in significant distress and/or impairment in aspects of daily life. Other symptoms, such as cravings, specific types of loss of control, tolerance, withdrawal, etc., are not necessary to receive a diagnosis of a substance use disorder.
Ultimately, marijuana can indeed be addictive. The diagnosis of a substance use disorder associated with marijuana use is dependent on the above symptoms, and the official diagnosis can only be made by licensed mental health professional. If a person is suffering from marijuana addiction, comprehensive treatment can effectively address the disorder, allowing the person to leave marijuana abuse in their past and to embrace a healthy, balanced life in recovery.