Despite the scare tactics of “Reefer Madness” and Harry Anslinger, the “OG” warrior of the federal Bureau of Narcotics, cannabis in the 60s and 70s was not considered a “drug of dependence,” primarily because there was no documentation of tolerance or withdrawal symptoms. Over time, the American Psychiatric Association, the group responsible for the DSM, changed its definition of addiction, describing “substance use disorder,” emphasizing the behavioral rather than physiologic signs and symptoms.
“The essential feature of Substance Dependence is a cluster of cognitive, behavioral and physiologic symptoms indicating that the individual continues use of the substance despite significant substance-related problems.”
Estimates of the number of cannabis-dependent individuals widely vary, although it is generally accepted that longer use fosters dependence. One study of our national comorbidities in the mid-1990s suggested that 9% of cannabis users evidenced substance dependence at some time in their lives. For context, substance use disorder was present at some time for 32% of nicotine users, 23% of heroin users, and 15% of users of alcohol.
The diagnosis is based upon a patient meeting two or more criteria. [1] Studies have demonstrated tolerance to cannabis, most likely secondary to physiologic changes in the function of cannabinoid receptors. Additionally, there appears to be a pattern of withdrawal symptoms, including “anxiety, insomnia, appetite…
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