Is Cannabis Addictive?

This hot-button question is representative of a huge grey area of misunderstanding. The ambiguity stems from a lack of understanding of fundamental concepts around addiction, as well as an exaggerated history of “reefer madness.”

If someone asked you to define “addiction,” what would you say? If you’re of the belief that addiction is a chemical dependence characterized by withdrawal symptoms that you’ve never experienced personally, you might be of the mind that cannabis is in fact non-addictive. Some subscribe to the belief that addiction manifests psychologically and that cannabis can be addictive in the same way that gambling, sex, or food might be considered addictive, as they all produce pleasurable responses in the brain. I’m no doctor, so I recruited the help of Roger Roffman, Professor Emeritus of Social Work at University of Washington, to help tease out a more standardized definition.

“The language of addiction, dependence, and disorders is one thing when you talk to scientists and it’s another when you talk to the public,” Roffman said. “Addiction results from a combination of biological and psychological factors that contribute to conditioned behavioral patterns that are very difficult to stop or resist.”
And of course, there’s an environmental component to addiction as well. Johann Hari, author of Chasing the Screams: The First and Last Days of the Drug War, presented his definition of addiction – one that emphasizes environment over biology:
“Human beings have an innate need to bond and connect. When we are happy and healthy, we will bond with the people around us. But when we can’t because we’re traumatized, isolated, or beaten down by life, we will bond with something that gives us some sense of relief. The path out of unhealthy bonds is to form healthy bonds, to be connected to people you want to be present with. Addiction is just one symptom of the crisis of disconnection.”
From this perspective, the question isn’t whether or not cannabis is addictive, but rather under which circumstances might one become addicted to cannabis?

Cannabis Use Disorder

People who have an unhealthy relationship with cannabis do not have an addiction—they have cannabis use disorder. While it may seem like this is splitting hairs, substance use disorders and addictions are actually quite different. When it comes to cannabis, there aren’t major physical withdrawal symptoms, like those of someone getting off heroin or meth would experience. But cannabis can cause some problems for people who overuse the substance. Cannabis, like many other substances, can keep some from thriving in life. A resource by Medscape helps define a cannabis-related disorder as “a problematic pattern of cannabis use leading to clinically significant impairment or distress.”

So, rather than simply asking “is cannabis addictive?” the perspective of the question should shift slightly. We should be asking “what does cannabis use disorder look like?” Stigmas are responsible for the widespread belief that cannabis is automatically damaging and addicting. It’s also still viewed as a gateway drug, despite there being government provided evidence that proves otherwise.

Cannabis use disorder, a cannabis-related disorder coded as 305.20 for mild or 304.30 for moderate or severe, is defined by DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) as the following:

  • A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period:
  • Cannabis is often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
  • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
  • Craving, or a strong desire or urge to use cannabis.
  • Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.
  • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  • Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
  • Recurrent cannabis use in situations in which it is physically hazardous.
  • Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
  • Tolerance, as defined by either a (1) need for markedly increased cannabis to achieve intoxication or desired effect or (2) markedly diminished effect with continued use of the same amount of the substance.
  • Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms

Medical cannabis fights a surprising number of diseases and disorders, including epilepsy, eating disorders, mesothelioma and even many types of cancers. Smoking, on the other hand, is undeniably not good for us. When something is burned and smoked, whether that’s a cigarette or joint, carcinogens are produced. The produced carcinogens and heat can cause a lot of problems for our bodies. Smoking is also one of the most common cause of sore throats. Gum disease is also a commonly overlooked side effect of smoking, as well as other oral health issues and mouth and esophagus cancer.

However, smoking isn’t the only way to ingest cannabis; cannabis oil and other medical concentrates (including CBD which doesn’t induce a head high) are common forms of treatment for women’s health issues, anxiety, pain and insomnia.
The United States’ solution to drug abuse and addiction is criminalization.  Most Americans know by now that this approach to drugs and addiction doesn’t work. In fact, it’s made things remarkably worse. Prohibition imposes a social environment in which recovery becomes even harder. You’re removed from any friends and family. Job prospects dwindle. Life becomes more challenging than before, and even then drugs were a necessary escape, something to bond with.
Despite the obvious failure of this policy, it continues to feed public opinion. Legal restrictions over research provide an easy out for policymakers to claim that we don’t know enough about the risks to legalize it, and that attitude readily bleeds into the public sector.
“All of the messages about health risks under prohibition are skewed in terms of overstating and sometimes blatantly misrepresenting science,” Roffman said. “Under legalization, we have an awful lot more room to speak about the continuum of health benefits, possible health risks, and how to make good decisions.”
Roffman’s history with cannabis is an unconventional medley of government-funded risk studies and advocacy efforts. Heading NORML’s Washington chapter in the mid 70s and co-sponsoring the state’s recreational marijuana law in 2012, his work demonstrates that acknowledging risks associated with cannabis does not necessarily undermine a strong rationale in support of legalization.
Just as public opinion can swing problematically far to the oppositional side, ardently proclaiming its harmlessness can cause issues as well. This is a conflict I’ve grappled with personally, and being immersed in a community of avid activists and patients can certainly cause passion to burn so brightly, it blinds. We need that strong community to speak about the ways cannabis has changed our lives, but we need to do so without losing sight of the fact that people with different circumstances can be impacted differently. With our collective efforts and voices, cannabis legalization is now visible on the horizon, and now it’s our duty to not only help those who need cannabis medicinally and those who want the freedom to use it recreationally, but those who need help quitting or moderating their use so they too can become counter-examples of negative stereotypes.

As our conversation came to a close, Roffman ended with the following:“We’re a long way – a long way – from effectively educating the public about the health risks. We have a long history of Reefer Madness, we have a whole slew of people who are really angry about marijuana myths and lies, and we have a bunch of people who say that if you’re going to argue for legalization, you cannot acknowledge there are risks. For this movement to eventually mature so it’s serving the undoing of injustice but also promoting public health, we’re going to have to find ways of bringing accurate, non-judgmental information about health risks to the public.”
That process begins with acknowledging that your relationship to cannabis is unique to you and can never be used to define others’ experiences. It requires lending support to those who need it, providing them with an environment in which there’s more to bond with than just cannabis. And, of course, it requires that we never lower our supportive voice for cannabis, so that policymakers and the public never forget how much this War on Drugs has failed patients and citizens who only ever wanted to feel a point of connection with the world.

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