Marijuana is the most commonly used illicit drug in the U.S., with an astonishing 22.2 million people in America actively using the drug in July, 2016 alone.1 While long-term problems and withdrawal symptoms are major concerns to those working to help people with marijuana use disorders, one of the biggest issues is the fact that people with other substance use disorders often start out using marijuana.1 As a starter drug, marijuana is just the beginning before people move on to more powerful alternatives.
And though it’s true that many people who smoke marijuana do not move on to use other drugs, individuals with a marijuana use disorder are three times more likely to become addicted to heroin.2 Marijuana use also has been linked to increased consumption of other substances including nicotine, alcohol, cocaine, and methamphetamine.3
While marijuana is commonly viewed as a recreational substance with little risk of harm, this line of thinking can be a serious misconception. Research shows that people who use marijuana regularly are more likely to struggle academically, and may also be at risk for work-related accidents, injuries, and absenteeism.1
It is for these reasons that medical and addiction professionals are quick to dispel the myth that marijuana is a fun drug, with no consequences and no potential for addiction. Marijuana is now known to be an addictive drug, and heavy users report that marijuana has affected their performance at school or work, socialization, physical health, mental health, and intellectual abilities.1 While these risks do not apply to everyone who uses marijuana, knowledge of them could motivate those who sense that their marijuana use has become problematic to seek treatment for a potential marijuana use disorder.
Marijuana is derived from the hemp plant, cannabis sativa. It is a mixture of leaves and flowers, which can be smoked, vaporized, infused to make tea, baked into edibles, or concentrated in a resin form.1 Marijuana has many slang names, including weed, grass, pot, bud, and Mary Jane. Despite the common misconception that marijuana is not addictive, approximately 30% of users meet the criteria for some degree of marijuana use disorder, which can range from mild to severe.1 Even with this information, it can be difficult for individuals to understand that they may be addicted to marijuana.
Growing support for the medical marijuana movement and widespread recreational use among young people reduces the public’s belief of marijuana as a potentially addictive and dangerous drug. Further complicating the issue is that fact that marijuana use is now approved in various US states for medical purposes, including the management of many painful conditions and illnesses, including cancer, AIDS, autoimmune disorders, and seizures. Even so, marijuana is still not approved for medicinal use by the Food and Drug Administration (FDA).4 Many individuals may view smoking marijuana as a normal part of adolescence, or simply a phase that kids will eventually grow out of.
Smoking marijuana can have both short-term and long-term physical and mental effects. Short-term physical effects may include increased heart rate for as long as three hours after smoking; bloodshot eyes; impaired movement; and dry mouth, commonly referred to as “cotton mouth.”5
Over time, continued marijuana use can lead to lung problems, such as coughing, increased production of phlegm, and an increased risk of lung infections and pulmonary ailments. However, marijuana has not been conclusively shown to increase one’s risk of lung cancer—even though marijuana is often unfiltered, smoke is held in the lungs for a long time, and marijuana users are more likely to also smoke cigarettes.5
Marijuana use leads to a feeling of euphoria, or what’s more commonly known as a high.5 Use can alter sensory perception and distort time, as well as change one’s mood, inhibit judgment, and impair memory, thinking, and problem-solving skills.5 Over time, chronic use of marijuana has been linked to mental illness, such as depression, anxiety, and in some users, hallucinations or paranoia.4 Marijuana use in adolescence can affect the developing brain and reduce the functions of thinking, memory and learning.5
Signs of Abuse and Dependence
Marijuana is considered by many to be a recreational drug—something they do with friends or to chill out after a stressful day. Initial signs that a person may be abusing marijuana can include bloodshot eyes, lack of motivation, increased appetite, giddy laughter, and the odor of marijuana. Paraphernalia may be found too, such as rolling papers, roach clips, marijuana pipes (bowls), water pipes (bongs), or cigars.
Signs of a marijuana use disorder can vary between individuals, and the severity of the addiction is dependent on the number of criteria (listed below) that they meet. The addiction is considered mild if 2 to 3 criteria are met; moderate if the user meets 4 to 5 of the criteria; and severe if 6 or more criteria are met.6 Approximately 9% of marijuana users will develop dependence to the drug.1
The warning signs of marijuana use disorder may include:6
- Strong cravings or urges to use marijuana.
- Continued use of marijuana, even after experiencing negative consequences.
- Difficulty fulfilling duties at work, school, or home due to marijuana use.
- Continued use of marijuana even in physically dangerous situations, such as while driving.
- Continued use of marijuana after facing repeated or persistent issues with social relationships that are caused or exacerbated by marijuana use.
- Developing a tolerance, meaning that the user requires more marijuana to achieve the desired effect.
- Going through withdrawal symptoms upon ceasing or drastically reducing the amount of marijuana used.
- Using more marijuana than originally intended, or for a longer period of time than planned.
- Having difficulty controlling one’s use of marijuana despite having a strong desire to cut back on use.
- Spending a lot of time obtaining, smoking, or recovering from marijuana use.
- Reducing or cutting out important actions due to marijuana use, such as occupational, social, or recreational activities.
Physical vs. Psychological Addiction
What most people think of when they hear the word “addiction” is physical addiction, which involves the brain becoming so used to having the drug through regular use that it becomes dependent on the substance, as discussed above. The body actually begins to crave it and experiences physical withdrawal symptoms when it does not have its regular hit.
Psychological addiction, however, is when you become mentally or emotionally dependent on marijuana, as in, you don’t feel happy or “normal” unless you have it. Many people still suffer from their psychological addiction to a drug even after they have gotten clean from it physically. They think about using and how it makes them feel and the people and environments associated with it and long to return to that time. This is why good addiction counseling is essential to help you acknowledge these thoughts and feelings, process them, and learn how to replace them with healthier thoughts that don’t involve abusing marijuana.
Since many people believe marijuana is not addictive, they remain unaware of the potential withdrawal symptoms that may occur when a person stops taking the drug (particularly heavy users of marijuana). Marijuana users may continue to use the drug to alleviate their withdrawal symptoms—even if they are not aware that is what they are doing—leading to the vicious cycle of addiction. Symptoms of marijuana withdrawal are more pronounced in heavy users, and can include:
- Changes in mood.
- Cravings to use marijuana.
- Difficulty sleeping.
- Increased irritability.
- Physical discomfort.
- Reduced appetite.
- Restlessness.1, 5
Studies have shown that marijuana withdrawal symptoms can appear less than 1 day after last use, reaching peak intensity between days 2 and 4, and can generally last for 7 to 10 days.7 Even after withdrawal symptoms have disappeared, it is important to seek treatment to address the underlying causes of the addiction.
Marijuana may be difficult to quit without professional help. Marijuana users may be reluctant to seek treatment, especially if they do not view the drug as addictive or do not want to be labeled a drug addict. However, treatment is non-judgmental, can ease the transition into recovery, and provide support, education, and therapy that can help a marijuana addict maintain sobriety.
There are various treatment options available for an individual with a marijuana use disorder.
Adults who seek treatment for addiction to marijuana have often used the drug daily for an extended period of time, and have attempted to quit on their own multiple times.1 Many individuals also suffer from other addictions or mental health disorders that will need to be treated concurrently.1 This can be accomplished in an inpatient or outpatient setting, or in private therapy.
Inpatient or Outpatient Treatment
Inpatient treatment involves a stay in a hospital or residential-type setting for 28 to 90 days (or longer, if necessary), where patients will receive group and individual counseling, education, and in many cases, exposure to self-help meetings to enhance the treatment experience.
Outpatient treatment is less restrictive, and patients attend group and individual counseling several times a week and are free to attend school, work, and tend to household duties while still receiving treatment. Group therapy can provide a strong basis for peer support and is an extremely effective treatment technique. Private therapy with a therapist or psychologist is also helpful, especially for mild addictions.
Cognitive Behavioral Therapy
Therapeutic techniques that have been shown to be highly effective include a range of behavioral therapies.1,5 These can include Cognitive Behavioral Therapy (CBT), which aids in changing the thoughts, emotions, and behaviors associated with addiction. CBT helps individuals to identify triggers to relapse and high-risk situations, and teaches effective coping strategies to apply to maintain sobriety.1
Contingency management is another technique that monitors sobriety through regular drug testing, and provides positive rewards when an individual remains sober.1 Resistant individuals may benefit from Motivational Interviewing techniques, which helps to increase one’s own desire to stay in treatment and stay sober by identifying the pros and cons of both continued use and sobriety, addressing resistance in a non-threatening way.1
There are currently no medications approved for use in treating marijuana addiction, although non-addictive sleep aids may be prescribed to ease the insomnia that can accompany withdrawal.1,4 If there are underlying mental health issues, appropriate medications and treatment can facilitate the recovery process and help individuals sustain long-term sobriety.
Generally, the first year of sobriety is the most difficult and the time when relapse is most likely to occur. Professional treatment can ease the transition from marijuana use to sobriety, provide education about addiction and recovery, and most importantly, leave patients with an understanding of relapse triggers and coping skills to use to maintain sobriety. Since marijuana use may be a way for individuals to socialize, relax, or feel good, treatment can help individuals develop healthier alternatives to have social interactions, unwind, and experience feelings of happiness.
- National Institute on Drug Abuse. (2016). Marijuana.
- Centers for Disease Control and Prevention. (2015). Today’s Heroin Epidemic Infographics.
- The New York Times. (2016). Marijuana has proven to be a gateway drug.
- National Institute on Drug Abuse. (2015). DrugFacts: Is marijuana medicine?
- National Institute on Drug Abuse. (2016). DrugFacts: Marijuana.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
- Psychiatric Times. (2002). Does marijuana withdrawal syndrome exist?