Is Cannabis Addictive?

How addictive?

There is absolutely no question that cannabis can be addictive, but it is fiercely debated how addictive it truly is. According to the field of addiction psychiatry, a group of specialists who have generally been anti-cannabis for half a century and who have promoted many of the U.S. Government’s mistruths about cannabis in the past, “cannabis use disorder”, (CUD), a term used synonymously with cannabis addiction, is diagnosed objectively when patients fulfill a certain number of criteria over time that have been carefully validated (see below) -- just as is done for addiction to opioids or alcohol.

Some of these symptoms that contribute to a diagnosis of cannabis addiction include tolerance, withdrawal, cravings, inability to control use, use in hazardous circumstances, and continued use despite negative consequences. This is not very different from how we diagnose other use disorders except that there are no provisions for medical cannabis patients who are getting needlessly saddled with a diagnosis of “cannabis addiction” merely because they have ‘tolerance’ and ‘withdrawal’. We all have tolerance and withdrawal to many of our prescribed medications – no one says you are addicted to your SSRI, or your coffee for that matter. When diagnosing opioid use disorder, these two qualifiers – tolerance and withdrawal – don’t count if the opioids are medically prescribed, because all patients would have tolerance and withdrawal but not all of them are addicted. So why wouldn’t the same be true for diagnosing cannabis addiction, for the millions of medical cannabis patient? In short, this is how the addiction specialists, operating under the hangover of the War on Drugs, have been (in my opinion) vastly overestimating the number of people with cannabis addiction, to the detriment of all involved.

According to the addiction psychiatrists, the consequences of having CUD can be quite severe (this is true), especially in teens and young adults who are particularly susceptible (this is true). CUD is associated with lower happiness, an unsatisfying social life, lack of career success, lower socioeconomic status, car crashes, emergency room visits, cognitive decline, problems with other drugs, other psychiatric diagnoses, suicide, and low motivation (though, these are misleading; the concept of “associated” is a big problem – it is not causation; other issues, such as poverty, can be an alternative explanation). According to many addiction specialists, use of cannabis should generally be discouraged, except, perhaps if the use is “medical” which they have been skeptical about (less and less so). They believe all drug use is bad (except, perhaps, the social use of alcohol, which caused 172,000 deaths last year).

Many addiction psychiatrists believe that CUD is extremely common and cite studies that show that CUD afflicts up to a quarter to a third of adult cannabis users (which is untrue). According to the American Society of Addiction Medicine (ASAM), “between 9.3% and 30.6% of American adults who use cannabis have CUD.” The fact that this range is gigantic—more than a factor of three begs the question of whether the criteria are somewhat, or possibly vastly, overinclusive and whether they are sensibly applicable to medical cannabis patients (they aren’t). Many are concerned that the legalization of cannabis will result in more cannabis users (this is true) and, consequently, more people that succumb to cannabis addiction (likely true – a proportion of people using any intoxicant get addicted). Regular cannabis users can get withdrawal symptoms which can make it harder to quit.

Many people in the cannabis community don’t believe that cannabis is addictive at all—they think it is just another bogus U.S. government propaganda point. Of note, it was a propaganda point, but that doesn’t mean it isn’t true. A common story is, “I used it for twenty years and then I was able to stop on a dime without any problems. How can it be addictive?” Others think it can be mildly or infrequently addicting, with an occasional person who goes off the rails. Cannabis proponents point out that the majority of studies of its addictiveness have been funded and conducted under the auspices of the War on Drugs, where there was, and still is, massive institutional pressure to demonstrate harm over benefits. (This is true).

How do we disentangle all of this?