Cannabis Use Disorder

The DSM-5 criteria

A diagnosis requires at least 2 of these 11 within a 12-month period:

1. using larger amounts or for longer than intended
2. wanting or trying to cut down without success
3. spending a lot of time getting, using or recovering from cannabis
4. cravings
5. failing to meet obligations at work, school or home
6. continuing despite relationship or social problems caused by use
7. giving up important activities
8. using in physically risky situations, such as driving
9. continuing despite physical or psychological problems caused or worsened by use
10. tolerance: needing more for the same effect
11. withdrawal when stopping

For more on the signs and health risks of heavy use, see marijuana abuse.

Who is at risk?

• starting use in the early teens, while the brain is still developing
• daily or near-daily use
• high-THC products: concentrates, dabs, vapes and potent strains
• mental health conditions such as anxiety, depression, PTSD and ADHD
• family history of substance use disorders
• using cannabis to cope with stress, sleep or emotions

Cannabis withdrawal

About half of people who use regularly experience withdrawal when they stop.

Most symptoms peak within the first week and fade over 2 to 3 weeks; sleep problems may persist longer. Withdrawal is uncomfortable but not dangerous. It often drives relapse, so planning for it helps.

Health effects linked to heavy cannabis use

• Mental health: anxiety, depression, and a higher risk of psychosis and schizophrenia, especially with high-potency daily use from adolescence.
• Thinking: problems with memory, attention and learning, which may improve after stopping.
• Cannabinoid hyperemesis syndrome: cycles of severe nausea and vomiting in long-term users.
• Lungs: smoking causes cough, phlegm and bronchitis symptoms.
• Heart: raised heart rate; possible links with heart rhythm problems and heart attacks in vulnerable people.
• Pregnancy: associated with lower birth weight.
• Driving: impaired reaction time and higher crash risk.
• Combined use with tobacco often adds nicotine dependence.

How it is diagnosed

A doctor or addiction specialist asks about how much and how often you use, what products, attempts to stop, withdrawal and the effects on your life, using the DSM-5 criteria. Screening questionnaires such as the CUDIT-R are sometimes used. They will also check for mental health conditions and other substance use. Urine tests can detect cannabis use but do not diagnose the disorder.

Treatment

Talking therapies

• Cognitive behavioral therapy (CBT): identifies triggers and builds skills to cope with cravings and stress.
• Motivational enhancement therapy: short, structured sessions to strengthen your own reasons for change.
• Contingency management: rewards for verified abstinence; highly effective in studies.
• Family-based therapies for teenagers.

These approaches are often combined, delivered individually, in groups or through digital programs.

Medicines

No medicine is approved specifically for cannabis use disorder. Doctors may treat co-occurring depression, anxiety, ADHD or insomnia. Some medicines have shown promise in trials for withdrawal or cravings but are not standard.

Practical steps for cutting down or quitting

• Set a quit date or a clear reduction plan.
• Remove cannabis and equipment from your home.
• Tell supportive friends or family.
• Plan for evenings and stressful times, when urges are strongest.
• Expect poor sleep for a few weeks; keep a regular schedule, exercise and avoid caffeine late in the day.
• Use support groups such as Marijuana Anonymous or SMART Recovery.

In the US, SAMHSA's National Helpline (1-800-662-4357) offers free, confidential treatment referral 24/7.

Outlook

Cannabis use disorder is treatable. Relapse is common, as with other substance use disorders, and is a reason to adjust the plan rather than give up. Many people who stop notice clearer thinking, better sleep after the first weeks, improved mood and more energy within 1 to 3 months.

Frequently asked questions

What are the signs of cannabis use disorder?

Signs include using more than intended, failing to cut down, cravings, spending a lot of time using or recovering, neglecting responsibilities, giving up activities, using in risky situations, needing more for the same effect, and withdrawal when stopping. Two or more in a year meets the definition.

Can you get addicted to marijuana?

Yes. Roughly 3 in 10 people who use cannabis have some degree of cannabis use disorder, and the risk is higher with daily use, high-THC products and starting in adolescence. Addiction means continuing despite harm and finding it hard to stop.

How long does cannabis withdrawal last?

Withdrawal usually starts within 1 to 3 days, peaks in the first week, and mostly settles within 2 to 3 weeks. Sleep problems and vivid dreams can last a month or more. Symptoms are uncomfortable but not dangerous.

What is the best treatment for cannabis use disorder?

Talking therapies work best: cognitive behavioral therapy, motivational enhancement therapy and contingency management, often combined. Treating co-occurring anxiety, depression or sleep problems also helps. No medicine is approved specifically for cannabis use disorder.

Does cannabis cause psychosis?

Heavy use, especially of high-potency cannabis and starting in adolescence, increases the risk of psychotic episodes and schizophrenia, particularly in people with a family history. Cannabis can also trigger short-lived psychosis after large doses or edibles. Stopping reduces the risk.