Is Marijuana addictive?

For years, pro-marijuana lobbyists, users, and potheads have vociferously defended marijuana as non-addictive. Arguing that marijuana's non-addictive POTENTIAL made it a safe and relatively harmless substance, marijuana proponents have pushed for legalization and strong liberal protections for the medical use of marijuana.

But is it really non-addictive? 

The new Diagnostic and Statistical Manual of Mental Disorders (DSM-V) disagrees.

The new DSM-V which was released in 2013 includes 5 cannabis-associated disorders. These include:

•  Cannabis Use Disorder (While the DSM-IV included separate categories for substance abuse and dependence, the DSM-V has included both abuse and dependence in its new cannabis use disorder.)
•  Cannabis Intoxication
•  Cannabis Withdrawal

Other cannabis related disorders include, Cannabis Intoxication Delirium, Cannabis Induced Psychotic Disorder, Cannabis Induced Anxiety Disorder and Cannabis Induced Sleep Disorder. From the DSM-V, it appears clear that the use of marijuana can be far from harmless.

How is Cannabis Use Disorder diagnosed?

Cannabis use disorder is defined as the following:
A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:

• Cannabis is often taken in larger amounts or over a longer period than was intended.

• There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.

• A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.

• Craving, or a strong desire or urge to use cannabis.

• Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.

• Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.

• Important social, occupational, or recreational activities are given up or reduced because of cannabis use.

• Recurrent cannabis use in situations in which it is physically hazardous.

• Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.

• Tolerance, as defined by either a (1) need for markedly increased cannabis to achieve intoxication or desired effect or (2) markedly diminished effect with continued use of the same amount of the substance.

• Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms

In my years of working in this field, I've always known that addiction is characterized by tolerance, withdrawal, the disruption of normal psycho-social and relational functioning. These are the kinds of issues that are discussed in typical intake interviews and bio-psycho-social assessments. In looking at the co-occurring issues that must be present in a diagnosis of Cannabis Abuse Disorder, one can clearly see a similarity between harmful use of marijuana and other drugs.  

Notice the presence of cravings, which may often occur despite serious impairment in health, schoolwork, relationships with family and friends, employment, and threats to one’s own health and safety.  These cravings and the urge to “use” which are the subject of some pretty funny stoner movies and stories, are really no laughing matter. The urge to use marijuana is perfectly capable of destroying family, friends, and motivation for school, work, and home.

It is interesting that the DSM-V recognizes the development of tolerance in the use of marijuana. Tolerance means that our body requires increasing amounts of the same substance to achieve the desired effect. In other words, it takes more marijuana to get the same high. For years I heard that it was impossible to develop tolerance for marijuana. It seemed that tolerance was an issue related to heroin or later stage alcoholism – but not use of cannabis. I was wrong!

I also heard that there was no withdrawal associated with the use of marijuana. Proponents of legalized marijuana and potheads argued that the awesome “buzz” had no push back. They could quit anytime they wanted to, but they just didn’t want to. Now it seems clear that one of the factors that drives ongoing use of marijuana is withdrawal. Users are not just chasing the buzz; they are trying to stave off the physical and psychological symptoms of withdrawal. With heavy use of marijuana withdrawal symptoms can include: irritability, anger, or aggression, anxiety, nervousness, decreased appetite, restlessness, and a depressed mood. Physical symptoms can include: significant discomfort, abdominal pain, shakiness/tremors, sweating, fever, chills, or headache. I don’t know about you, but these symptoms describe use of a drug that is far from harmless for serious users.

The debate over legalization and the medical use of marijuana will continue. The pro-marijuana lobby seems committed to a world in which marijuana is readily accessible for all who want it. This is not likely to change anytime soon. As we move forward, it’s important that we consider the full addictive potential of marijuana for already committed stoners as well as casual or curious users. Nobody sets out to become addicted. It is the addictive nature of marijuana that takes the unwary as well as heavy users captive. 

It’s time to stop inhaling the smoke exhaled in our direction by those who simply want to pursue their high, and come to grips with the addictive potential of this supposedly "harmless" drug.

*top photo courtesy of Paul at FreeDigitalPhotos.net