Cannabis Use Disorder
Cannabis, which is commonly called Marijuana, is the most abused illegal substance, and Tetrahydrocannabinol (THC), which is the active ingredient in Cannabis, makes Cannabis an addictive substance (Patel & Marwaha, 2019). Cannabis is considered by the Food and Drug Administration (FDA) as Schedule One drug, and it has no accepted medical purpose and is with high abuse tendencies (Patel & Marwaha, 2019).
Diagnostic Criteria for Cannabis Use Disorder
According to the American Psychiatric Association (2013), in order to diagnose a person with Cannabis Use Disorder, at least two of the following criteria will be met within a 12-momth period:
- Cannabis is taken in larger amount or over a longer period
- There is a persistent desire or unsuccessful efforts to cut down or control the use
- A great deal of time is spent on activities to obtain Cannabis or use the substance
- Cravings or urge to use Cannabis
- Recurrent Cannabis use which causes failure to fulfill major role obligations at work, home, or school
- Important social, occupational, or recreational activities are given up or reduced because of Cannabis use
- There is Withdrawal as manifested by a need for markedly increased amounts of Cannabis to achieve intoxication or desired effects
Evidenced-Based for Psychotherapeutic and Psychopharmacologic Treatment for Cannabis Use Disorder
It is important that psychiatric clinicians should be able to identify patients who have issues with Cannabis Disorder and provide education and effective evidence-based treatments (Brezing & Levin, 2017). Psychotherapy has been proven effective in the treatment of Cannabis Use Disorder, and according to Walther, Gantner, Heinz, and Majic (2016), Cognitive Behavioral Therapy (CBT) ranks high and effective among other psychotherapy in the treatment of Cannabis Use Disorder. Walther, et. al. (2016) also posited that a study which CBT and Motivational Enhancement Therapy (MET) combined for the treatment of Cannabis Use Disorder showed a reduction in the use of Cannabis compared with the control group after 4 months; hence, CBT in combination with MET achieved significantly higher abstinence rates and a more marked reduction in use compared with online CBT alone.
Williams and Hill (2019) pointed out that no medications have been approved by the FDA for the treatment of Cannabis Use Disorder, unlike Opioid Use Disorder that has FDA-approved medications. On the other hand, as emphasized by Williams and Hill (2019), there are several off-label medications available for the treatment of Cannabis cravings, treatment of Cannabis withdrawal symptoms, and treatment of Comorbid psychiatric disorders that may be the contributing factor in the frequent use of Cannabis. Medications that research has proven to be effective for preventing craving include Naltrexone in a single dose of 50mg daily and Bupropion between 150 and 450mg daily, and this is said to work via Dopamine and Norepinephrine that are FDA approved for smoking cessation (Williams & Hill, 2019).
Withdrawal symptoms can occur when patients are trying to stop or being treated to stop the cravings of cannabis which can result in the patient not being willing to continue treatment. Withdrawal symptoms include anxiety, insomnia, and irritability which can persist for weeks or even months beyond the last use of Cannabis (Williams & Hill, 2019). SSRI medications and SNRI, Hydroxyzine Alpha-2 agonist, and Gabapentin can be effective in the treatment of withdrawal symptoms and medications for sleep (Williams & Hill, 2019). It is also pivotal to treat comorbid psychiatric problems in order to stop addictive behaviors that may be the cause of Cannabis use.
Clinical Features that I Would Expect to Observe in a Client that May Have Cannabis Use Disorder
There are some clinical features that may indicate that a patient may have Cannabis Use Disorder, and these may include red eyes, lack of appearance and personal hygiene, secrecy or deception about one’s actions or whereabouts, dry mouth, lack of ability to focus or concentrate, impaired sensory perception, lack of fatigue, weight gain, memory problem, and poor decision-making skills, (Wellness Resource Center, 2021). The DSM-5 criteria that support my rationale are that the patient spends a great deal of time in activities to obtain and use Cannabis, and recurrent Cannabis use causes failure to fulfill major, daily obligations at work, home, or school. The patient gives up activities such as social, occupational, or recreational because of Cannabis use (American Psychiatric Association, 2013).
American Psychiatric Association (2013).
diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author
Brezing, C. & Levin, F. R. (2017). Treatment for cannabis use disorder: A case report. Psychiatric Times, 34(8). Retrieved from https://www.psychiatrictimes.com
Patel, J. & Marwaha, R. (2019). Cannabis use disorder. Retrieved from https://www.ncbi.nlm.nih.gov
Walther, L. Gantner, A., Heinz, A. & Majic, T. (2016). Evidence-based treatment options in cannabis dependency. Retrieved from https://www.ncbi.nlm.nih.gov
Wellness Resource Center (2021). Retrieved from https://www.wellnessresurcecenter.com
Williams, A. R. & Hill, K. P. (2019). Cannabis and the current state of treatment for cannabis use disorder. Retrieved from https://www.focuspsychiatryonline.org