Marijuana Abuse (Problem Cannabis Use)

What marijuana abuse means

Many people use cannabis without developing problems, but it can be addictive. THC, the main psychoactive compound, acts on the brain's cannabinoid receptors and reward system. With regular use, the brain adapts, leading to tolerance, cravings and withdrawal when stopping.

Today's cannabis is much stronger than in past decades. Flower commonly contains 15 to 30 percent THC, and concentrates (wax, shatter, oils, vapes) can exceed 60 to 90 percent, raising the risk of addiction and mental health effects.

Signs of cannabis use disorder

Doctors use 11 criteria. Having 2 or more within 12 months indicates cannabis use disorder (mild with 2 to 3, moderate with 4 to 5, severe with 6 or more):

• using more or for longer than intended
• wanting or trying to cut down without success
• spending a lot of time getting, using or recovering
• cravings
• failing to meet obligations at work, school or home
• continuing despite relationship problems
• giving up activities
• using in hazardous situations, such as driving
• continuing despite physical or mental health problems
• tolerance: needing more for the same effect
• withdrawal symptoms

Risk factors

• starting before age 18; the developing teenage brain is more vulnerable
• daily or near-daily use
• high-potency products and concentrates
• family history of addiction
• anxiety, depression, ADHD or trauma
• peer use and easy availability

Health effects

Mental health

• anxiety and panic attacks
• depression and low motivation
• psychosis: paranoia and hallucinations, especially with high-THC products; heavy use is linked to a higher risk of schizophrenia in vulnerable people
• suicidal thoughts in some young users

Thinking and learning

• problems with attention, memory and learning, which can persist for days to weeks after use
• poorer school and work performance

Physical health

• Cannabinoid hyperemesis syndrome: repeated cycles of severe nausea, vomiting and belly pain in long-term users, often relieved by hot showers; the only cure is stopping cannabis
• Lungs: smoking causes cough, phlegm and bronchitis symptoms
• Heart: raised heart rate and blood pressure; increased risk of heart problems in people with heart disease
• Driving: slower reaction time and impaired coordination increase crash risk
• Pregnancy: linked to lower birth weight; avoid during pregnancy and breastfeeding
• Children: accidental edible ingestion can cause severe drowsiness and breathing problems

Marijuana withdrawal

Withdrawal usually starts within 1 to 3 days of stopping, peaks within the first week and lasts 1 to 2 weeks, sometimes longer for sleep problems:

• irritability, anger and restlessness
• anxiety and low mood
• trouble sleeping and vivid dreams
• reduced appetite and weight loss
• cravings
• headaches, sweating, stomach pain or shakiness

Withdrawal is uncomfortable but not dangerous.

Treatment

• Cognitive behavioral therapy (CBT): identifies triggers and builds coping skills
• Motivational enhancement therapy: strengthens your own reasons for change
• Contingency management: rewards for verified abstinence
• Family-based therapy for adolescents
• Support groups such as Marijuana Anonymous or SMART Recovery
• Treatment of anxiety, depression, ADHD or sleep problems

No medicines are approved specifically for cannabis use disorder, but short-term help with sleep or withdrawal symptoms may be offered.

Tips for cutting down or stopping

• set a quit date and tell people who will support you
• remove cannabis and paraphernalia from your home
• plan for cravings with activities and exercise
• avoid people and places linked to use
• expect withdrawal symptoms and know they are temporary
• protect sleep with a regular routine

Frequently asked questions

Is marijuana addictive?

Yes. About 3 in 10 people who use cannabis develop some degree of cannabis use disorder. The risk is higher with daily use, high-potency products and starting in the teen years. Addiction shows as loss of control, cravings and continued use despite harm.

What are the signs of marijuana abuse?

Signs include using more than planned, being unable to cut down, cravings, needing more to get the same effect, neglecting responsibilities, giving up activities, using in risky situations and experiencing withdrawal when stopping.

What are marijuana withdrawal symptoms?

Common symptoms are irritability, anxiety, low mood, trouble sleeping, vivid dreams, poor appetite and cravings. They usually start within a few days of stopping, peak in the first week and ease within 1 to 2 weeks.

Can marijuana cause psychosis?

Yes. High doses and high-potency THC products can trigger temporary psychosis with paranoia and hallucinations. Heavy use, especially starting young, is linked to an increased risk of schizophrenia in people who are vulnerable.

Where can I get help for marijuana addiction?

Talk to your primary care doctor or a counselor. In the US, the SAMHSA National Helpline (1-800-662-4357) offers free, confidential referrals 24 hours a day. Therapy such as CBT and support groups are effective.