Cannabis use disorder (CUD) is the clinical name for cannabis addiction. The DSM-5 lists 11 criteria. A diagnosis needs at least 2 of the 11 within 12 months. Severity: 2 to 3 criteria is mild, 4 to 5 is moderate, 6 or more is severe.
The 11 DSM-5 criteria for cannabis use disorder
- Using more cannabis, or using for a longer time, than intended.
- Failed attempts to cut down or stop.
- Large amounts of time spent getting, using, or recovering from cannabis.
- Craving.
- Use that blocks work, school, or home duties.
- Continued use after social or relationship problems caused by cannabis.
- Giving up hobbies, work, or social events because of cannabis.
- Use in hazardous situations, such as driving or operating machines.
- Continued use despite health or mental health problems made worse by cannabis.
- Tolerance: needing more for the same effect, or getting less effect from the same amount.
- Withdrawal: symptoms that appear when use stops.
Cannabis withdrawal symptoms
The DSM-5 defines cannabis withdrawal as 3 or more of these symptoms within about 1 week after stopping heavy use:
Understanding Cannabis Use Disorder: Signs and Symptoms
- Irritability, anger, or aggression
- Nervousness or anxiety
- Sleep problems, such as trouble falling asleep or waking at night
- Decreased appetite or weight loss
- Restlessness
- Depressed mood
- At least one physical symptom: stomach pain, shakiness, sweating, fever, chills, or headache
Onset: 1 to 3 days after the last use. Peak: the first week. Duration: up to 2 to 3 weeks for most people. Sleep problems can run longer.
Symptoms of Cannabis Dependence: DSM-5 Signs and Timeline
Signs that point to addiction rather than heavy use
- Use continues after a doctor, family member, or employer raises a concern.
- Money problems tied to buying cannabis.
- Use before work, school, or driving.
- Use alone and in the morning.
- More than one failed quit attempt.
Daily use and a first use before age 18 raise the risk. Concentration in the product also matters: high-THC products carry a higher risk of dependence than low-THC products.
Numbers
NIDA reports that about 3 in 10 people who use cannabis develop cannabis use disorder. Among people who start before age 18, about 1 in 6 develop it.
Cannabinoid hyperemesis syndrome
This is a separate condition, not part of the CUD criteria. It shows up in long-term heavy users. Symptoms: repeated vomiting, stomach pain, and a strong urge to take hot showers or baths. Hot water eases symptoms for many people. The vomiting stops after cannabis use ends.
Treatment
No medication has FDA approval for cannabis use disorder. Options with research support:
- Cognitive behavioral therapy (CBT)
- Motivational enhancement therapy (MET)
- Contingency management, which uses rewards for negative urine tests
- CBT plus MET, often 6 to 12 sessions
Peer support groups and 12-step programs are common additions. SAMHSA runs a free national helpline and a treatment locator.
CBD is not a treatment here
CBD is not approved by the FDA for cannabis use disorder, and no CBD product is sold for that purpose. Talk to a doctor about CUD treatment. Talk to a doctor before using CBD for any other reason, since CBD can interact with some prescription drugs.
When to get an assessment
Get an assessment if you meet 2 or more criteria, if withdrawal disrupts sleep or mood, or if you have tried to stop more than once without success. A primary care doctor, an addiction medicine specialist, or a licensed therapist can run the assessment.