Pot Matters: Marijuana Use Disorder

The National Institute of Health (NIH) issued a press release last Friday, stating that “Marijuana use disorder is common and often untreated.” The NIH reports that the condition is “associated with other substance use disorders, behavioral problems, and disability, and goes largely untreated.” These are findings from a recent study led by Bridget Grant published in the American Journal of Psychiatry.

This is an important study, but one easily misunderstood and certainly one that will be misrepresented by opponents of marijuana’s legalization.

Marijuana use disorder is a new term introduced by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by psychiatrists and mental health professionals for diagnostic criteria. Marijuana use disorder is a combination of two prior terms—marijuana abuse and marijuana dependence. The condition is diagnosed by way of a list of 11 symptoms. The presence of any two symptoms justifies the diagnosis, and the severity of the condition can be rated at mild, moderate or severe based on the number of symptoms present.

Before getting to these 11 symptoms, two important facts require recognition. First, marijuana can be and is abused by some users, and second, the prevalence of marijuana use disorder is comparable to the prevalence of alcohol use disorder. 

According to the study by Grant and her colleagues about 30 percent of marijuana users “manifested a marijuana use disorder in 2012-2013.” A 2013 study evaluating the new DSM-5 criteria found 32.1 percent of the subjects met the criteria for alcohol use disorder.

Here are the criteria used for diagnosing substance use disorders:

1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts you in danger
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Two or three of these symptoms indicate a mild disorder, four to five a moderate disorder, and six or more indicate a severe disorder.

Grant’s team notes that surveys report that marijuana use in the United States has doubled between 2001/2 and 2012/13. 

They interviewed more than 36,000 adults about alcohol and drug use, as well as related mental health conditions. Their study indicates that those with marijuana use disorder, especially those with a severe form, experience mental disability. Of greater concern, only seven to 14 percent of these receive any marijuana-specific treatment. 

The emphasis of the recommendations from the authors of this study stress the need for “identifying and implementing prevention and treatment” and that “with ongoing changes in the drug’s legal status… and a shift in beliefs associated with its use… public education will be increasingly important to address public beliefs that marijuana use is harmless.”

While not its purpose nor noted by its authors, this type of research makes a strong case for marijuana’s legalization. 

Opponents of legalization will use this sort of research to argue against legalization; however, they refuse to acknowledge that millions of Americans use marijuana whether it is legal or not, that illicit marijuana commerce makes it more available to teenagers than would a regulated market, and that anti-marijuana propaganda used to support prohibition impairs the credibility of legitimate and science-based public education campaigns that are integral and vital to the prevention and treatment of marijuana abuse and dependence.

Many argue that marijuana is a safer substance than alcohol. The data cited above indicates that, with respect to abuse and dependence, marijuana is certainly not more dangerous than alcohol. The United States has made tremendous progress in reducing public health problems related to alcohol abuse with a legal, regulated and taxed market that provides a social context for credible public education campaigns about responsible use of the drug and treatment regarding problems related to its abuse. 

Reports like this one underscore the urgency of using a similar legal and social framework for marijuana.

(Photo Courtesy of The Daily Chronic)