Cannabis use disorder

Many people wonder whether weed is addictive, especially as cannabis becomes legal in more places. The short answer is that cannabis can be addictive for some people. Not everyone who uses it develops a problem, but regular, heavy use increases the risk, as does starting at a young age and using high-potency products.

Cannabis use disorder describes a pattern in which a person struggles to control their use despite negative consequences. Clinicians assess it on a spectrum from mild to severe depending on how many signs are present.

Legal status doesn't determine risk. Like alcohol, cannabis can be legal and still cause problems for some people. Higher-THC products, including concentrates and vapes, are associated with a greater likelihood of dependence and side effects than lower-potency cannabis.

Cannabis addiction is not a moral failing. It reflects how the drug affects the brain's reward and stress systems, combined with personal and environmental factors.

Signs of cannabis use disorder can include:

• Using more, or for longer, than you intended
• Wanting to cut down but finding you can't
• Spending a lot of time getting, using or recovering from cannabis
• Strong cravings
• Falling behind at work, school or home because of use
• Continuing despite relationship problems it causes
• Giving up activities you used to enjoy
• Using in risky situations, such as before driving
• Continuing despite worsening anxiety, low mood or other health problems
• Needing more to get the same effect (tolerance)
• Withdrawal symptoms when you stop

Other people may notice changes in motivation, memory or mood, or a person who seems to need cannabis to relax, eat or sleep. Some people use cannabis to cope with anxiety, depression or trauma, which can make it harder to stop.

If several of these signs sound familiar, it may be worth talking to a professional about your use.

Marijuana withdrawal is common among people who use heavily and then stop or cut back sharply. Symptoms typically begin within a few days and gradually ease over the following weeks. They can include:

• Irritability, anger or restlessness
• Anxiety or nervousness
• Trouble sleeping and vivid or unusual dreams
• Decreased appetite or weight loss
• Low mood
• Headaches, sweating, chills or stomach discomfort
• Strong cravings

Withdrawal from cannabis is not usually medically dangerous, but it can be uncomfortable and is one of the main reasons people return to using. Sleep problems in particular can linger.

Knowing what to expect helps. Many people find it useful to plan for the first couple of weeks, for example by reducing other stressors, scheduling physical activity and telling supportive people what they're doing.

If you also use other substances, have a medical condition or have a history of severe mental health problems, talk to a doctor before stopping.

Cannabis has a complicated relationship with mental health. Some people use it to relieve anxiety or stress, but regular use can worsen anxiety over time, and high doses can trigger panic.

Heavy cannabis use is also associated with low mood and reduced motivation, and people with depression are more likely to use cannabis heavily. It can be hard to tell which came first, and the two often reinforce each other.

Frequent use of high-potency cannabis is associated with a higher risk of psychotic symptoms, such as paranoia or hearing voices, particularly in people with a family history of psychosis and in young people whose brains are still developing. Anyone experiencing these symptoms should seek medical help promptly.

Some heavy users develop cannabinoid hyperemesis syndrome, a condition involving repeated severe vomiting, which requires medical evaluation.

A mental health professional can help untangle these issues and treat both the cannabis use and any underlying condition.

There are effective ways to cut back or stop using cannabis.

Psychological treatments with evidence include:

• Cognitive behavioral therapy (CBT), which helps identify triggers, manage cravings and develop other ways of coping
• Motivational interviewing or motivational enhancement therapy, which helps people explore their reasons for change without judgment
• Contingency management, which rewards milestones such as negative drug tests in some programs

There are currently no medications specifically approved to treat cannabis use disorder, but a psychiatrist may address withdrawal-related sleep problems or co-occurring conditions such as anxiety or depression.

Practical steps to quit weed:

• Decide whether to stop completely or taper gradually
• Remove cannabis and paraphernalia from your home
• Identify high-risk situations and plan alternatives
• Build routines around sleep, exercise and social activities
• Join a peer support group

Lapses are common and don't mean failure; they're opportunities to learn what to adjust.

A psychologist, clinical psychologist or psychiatrist with experience in addiction can assess your cannabis use and recommend treatment. Your primary care doctor is also a good place to start, particularly if you have physical symptoms.

In a first appointment, expect questions about how much and how often you use, what you use it for, how it affects your life, previous attempts to stop and your mental health. Honesty helps the clinician give you useful advice; their role is to help, not judge.

Consider seeking help if you've tried to cut back without success, your use is affecting work, studies or relationships, or you're experiencing anxiety, depression or paranoia.

Seek urgent help if you have thoughts of suicide or symptoms like severe paranoia or hallucinations: call 911 or your local emergency number, or call or text 988 in the US (Samaritans 116 123 in the UK and Ireland).

Parents worried about a teenager can also seek guidance from a professional.