Monday February 4, 2019
By Erin Hiatt
As cannabis legalization marches forward, many opposed to adult-use markets are upping the volume on their protestations. One recent example is the book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, written by former The New York Times reporter and spy novelist, Alex Berenson. And Berenson is not alone. Last August, an article in The Atlantic pointed out that academics and public health officials are raising strong concerns about the risks of cannabis being overlooked and underplayed, in part because the large majority of people who consume cannabis do so without becoming dependent or addicted.
Mark A.R. Kleiman, professor of public policy at NYU says that 25 years ago, around nine percent of self-reported cannabis users reported daily or near-daily use. Today, that number is closer to 40 percent. It has long been believed that becoming addicted to cannabis is impossible. But cannabis use disorder is a real condition. Is cannabis addiction as well?
Just What is Cannabis Use Disorder?
Cannabis use disorder is a relatively new term. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists all categories and symptoms for mental health disorders. Published by the American Psychiatric Association, it is the bible for clinicians and psychiatrists to diagnose psychiatric illness. The most recent iteration of the manual, the DSM-5, took two separate cannabis-related conditions categorized in the DSM-IV-TR, cannabis abuse, and cannabis dependence, and merged them into one diagnosis: cannabis use disorder.
Broadly interpreted, cannabis use disorder is characterized by problematic marijuana use. Exhibiting two or more of the following symptoms within a year is indicative of cannabis use disorder:
Symptoms of Cannabis Use Disorder:
- Taking more cannabis than intended
- Difficulty controlling or cutting down use
- Spending a lot of time consuming cannabis
- Continuing to consume despite social or relationship problems
- Problems related to cannabis consumption at work, school, or home
- Giving up or reducing activities to consume
- Consuming in high risk situations
- Cannabis tolerance, and withdrawal when discontinuing
- Continuing to consume despite physical or psychological problems
The National Institute on Drug Abuse (NIDA) reports that up to 30 percent of consumers may have some degree of cannabis use disorder. If consumption began before the age of 18, the chances of experiencing cannabis use disorder are four to seven times higher than those who started consuming as adults.
Dependence often goes hand-in-hand with cannabis use disorder. Defined by symptoms of withdrawal when not consuming, marijuana consumers have reported craving, irritability, mood and sleep difficulties, and physical discomfort when consumption ceases. Most people who have tried to stop consuming caffeine or tobacco, for example, have experienced similar symptoms of dependence.
But addiction, to any substance, is another beast entirely. Addiction, as defined by NIDA, constitutes 1) the inability to limit or cease substance use, and 2) the irresistible urge to continue seeking and taking the drug despite serious negative consequences. This could show up as committing crimes to obtain the substance, being jailed, or losing employment and relationships.
Defining addiction, especially when it comes to cannabis, gets complicated, because studies on substance abuse, NIDA writes, “often use dependence as a proxy for addiction even though it is possible to dependent without being addicted.” And there are many other factors that could play a role in addiction, including socioeconomic status, genetics, accessibility to substances, and the surrounding environment.
Does A Changing Landscape Play a Part?
A change in the cannabis landscape that has not been well-studied is the rising use of cannabis concentrates, like shatter and wax. BDS Analytics, a cannabis market and consumer research firm, reported that sales of concentrates reached nearly $3 billion in 2018, up 49 percent. By 2022, they estimate that concentrate sales will $8.4 billion, just behind the sale of flower at $8.5 billion. Concentrates are hot among consumers for a few reasons, but primary among them is ease of use, more consumption methods, quicker onset, and higher potency.
It’s no secret that cannabis potency has risen over the past few decades. In the 1990s, average potency was just shy of four percent THC. By 2014, that potency had risen to around 12 percent. The average potency of concentrates is between 50-80 percent.
But researchers are unclear as to whether or not higher potency is behind more consumers receiving diagnoses of cannabis use disorder. Many balk at NIDA’s hard take on defining cannabis addiction – which they estimate affects around nine percent of users – because the organization has frequently been characterized as searching for the harms of cannabis instead of its benefits. “It’s just a plant,” a consumer could argue, or may concede to a psychological addiction without being “physically” or “really addicted” to cannabis.
Annie Lowrey, a writer for The Atlantic describes how, in her piece, “America’s Invisible Pot Addicts,” those who had lost jobs, marriages, houses, and money due to their self-described cannabis addiction had difficulty convincing people that the symptoms they were experiencing were real, that they weren’t just a “lazy stoner.” Continuing, she writes, “The condition remains misunderstood, discounted, and strangely invisible, even as legalization and white-marketization pitches ahead.”
The large majority of cannabis consumers will never use problematically, and most people who present for cannabis treatment are juveniles or come through the legal system. Dr. Carl Hart, professor of neuroscience and psychology at Columbia University, specializes in drug abuse and drug addiction. He is also the author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society. For Hart, the questions to ask are, “do you have a problem with drugs? Are they disrupting psychosocial, educational, and occupational functioning? Are they disrupting relationships?”
So, is cannabis addictive? Michael Kuhar, PhD, professor of neuropharmacology at Emory University’s School of Medicine wrote the book, “The Addicted Brain: Why We Abuse Drugs, Alcohol, and Nicotine,” and his answer is, “If you’re doing something that’s wreaking havoc in your life, you need help. Forget what we call it.”
Do you believe cannabis addiction is real? Why or why not? Share your thoughts in the comments below!