Cannabis Use Disorder DSM-5 Criteria

What is cannabis use disorder?

Cannabis use disorder is a psychiatric condition classified in the DSM-5 under substance use disorders. It involves recurrent cannabis use despite significant impairment in personal, social, or occupational functioning. Symptoms range from drug abuse and cannabis dependence to withdrawal symptoms, including a characteristic withdrawal syndrome when cannabis use is reduced or stopped. This disorder can vary in severity, from mild cannabis use disorder to severe cannabis use disorder, depending on the level of control over cannabis consumption and the presence of cannabis intoxication. Risk factors include frequent use and co-occurring psychiatric disorders. Early intervention can prevent long-term substance abuse complications.

How is cannabis use disorder diagnosed?

Cannabis use disorder is diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for substance use disorders, which assess patterns of recurrent cannabis use causing clinically significant impairment or distress. A diagnosis typically involves identifying at least two symptoms within a 12-month period.

Symptoms may include difficulty controlling cannabis use, continued use despite social or occupational problems, and spending significant time obtaining, using, or recovering from cannabis. Other signs include giving up important activities, using cannabis in hazardous situations, developing cannabis dependence, and experiencing withdrawal symptoms when not using.

Cannabis intoxication and a characteristic withdrawal syndrome, such as irritability, sleep disturbances, or appetite changes, may also be considered. The severity of the disorder—mild, moderate, or severe—depends on the number of symptoms present.

Mental health professionals evaluate these criteria through interviews, medical history, and assessments. They also rule out other psychiatric disorders or substance intoxication that could explain the symptoms. Clinicians consider risk factors, such as frequent or early cannabis use, which can contribute to the disorder.

A thorough diagnosis helps guide treatment, which may include behavioral therapies, support for withdrawal management, and addressing underlying psychiatric or substance abuse concerns.

DSM-5 cannabis use disorder diagnostic criteria

The DSM-5 defines Cannabis Use Disorder as a problematic pattern of cannabis use leading to significant impairment or distress. Diagnosis requires at least two symptoms to occur within a 12-month period, which includes the following:

1. Cannabis is consumed in larger amounts or over a longer period than intended.
2. Persistent desire or unsuccessful efforts to cut down or control cannabis use.
3. Significant time spent obtaining, using, or recovering from cannabis.
4. Strong cravings or urges to use cannabis.
5. Recurrent use leading to failure in fulfilling obligations at work, school, or home.
6. Continued use despite interpersonal or social problems caused by cannabis.
7. Important activities are reduced or abandoned due to cannabis use.
8. Use in physically hazardous situations.
9. Continued use despite physical or psychological issues likely caused or worsened by cannabis.
10. Tolerance, shown by:

• Needing more cannabis to achieve the same effects.
• Reduced effect with regular use of the same amount.

11. Withdrawal, shown by:

• Experiencing cannabis withdrawal symptoms.
• Using cannabis to relieve or avoid withdrawal.

Severity levels are as follows:

• Mild: 2-3 symptoms.
• Moderate: 4-5 symptoms.
• Severe: 6+ symptoms.

How is cannabis use disorder treated and managed?

Effective treatment focuses on managing withdrawal symptoms, reducing cannabis dependence, and addressing co-occurring psychiatric disorders or substance-induced mental disorders.

Behavioral therapies

Cognitive behavioral therapy (CBT) is widely used to help individuals identify the thought patterns driving their cannabis addiction and develop healthier coping mechanisms. Motivational enhancement therapy (MET) builds motivation to change recurrent cannabis use, while contingency management provides rewards for abstinence. These therapies are effective in both mild cannabis use disorder and severe cannabis use disorder cases.

Pharmacological interventions

Although no specific medication is approved for cannabis use disorder, certain drugs may help manage cannabis withdrawal symptoms like difficulty concentrating, irritability, and sleep disturbances. These are especially useful during acute withdrawal and early remission.

Lifestyle modifications

Encouraging cannabis users to adopt stress management strategies, exercise, and mindfulness can reduce dependency on cannabis and prevent severe intoxication.

Support networks

Support groups such as Narcotics Anonymous and mental health services administration programs help patients maintain abstinence and sustain remission.

Long-term care

Ongoing follow-up ensures progress and identifies potential triggers, such as recurrent physical or psychological problems linked to cannabis use. Managing risk factors like illicit substance use or polysubstance abuse (e.g., drug and alcohol use) is crucial.

By addressing the multifaceted nature of substance use disorders, including cannabis use disorder, practitioners can provide comprehensive care tailored to the individual’s needs.