Psychotherapeutic treatments, including motivational enhancement treatment (MET), cognitive behavioral therapy (CBT), and contingency management (CM), have demonstrated effectiveness in reducing frequency and quantity of cannabis use, but abstinence rates remain modest and decline after treatment. He expresses an interest in treatment and asks what options are available. He becomes upset and states that he was not aware one could develop an “addiction” to cannabis. M’s 9 symptoms and counsel him about severe cannabis use disorder. As such, he meets 9 criteria, which qualify him for a diagnosis of severe cannabis use disorder.

M demonstrates 3 symptoms of impaired control: using longer than intended, unsuccessful efforts to cut back, and craving 3 symptoms of social impairment: failure to fulfill home obligations, persistent problems with his wife, and reduced pursuit of occupational opportunities 1 symptom of risky use: continued use despite paranoia and 2 symptoms of pharmacological properties: tolerance and withdrawal. Severity of the disorder is characterized as “mild” if 2 or 3 criteria are met, “moderate” if 4 or 5 criteria are met, and “severe” if 6 or more criteria are met. To qualify as having a cannabis use disorder, a threshold of 2 criteria must be met. A new criterion for craving or a strong desire or urge to use cannabis has been added, and the terms abuse and dependence were eliminated.

The criterion for recurrent legal problems has been removed.Ģ. The criteria to qualify for a cannabis use disorder remain the same except for the following:ġ. In the transition from DSM IV-TR to DSM-5, cannabis use disorders, along with all substance use disorders, have been redefined in line with characterizing a spectrum of pathology and impairment. He denies tobacco or other drug use, including use of synthetic marijuana products such as K2 or spice, and reports having a glass of wine or champagne once or twice a year for special occasions. Resumption of his cannabis use relieved these symptoms. M reports multiple previous unsuccessful attempts to reduce his use and 2 days when he stopped completely, which resulted in “terrible dreams,” poor sleep, sweating, no appetite, anxiety, irritability, and strong cravings for cannabis. He admits missing an important awards ceremony for her work and sporting events for his children, for which he had to “come up with excuses,” but the truth is that he ended up smoking more than he had intended and lost track of the time. More recently, he identifies conflict and regular arguments with his wife over his cannabis use-she feels it prevents him from being present with his family and is a financial burden. He reports liking how cannabis decreases his anxiety and helps him fall asleep, although he thinks the cannabis sometimes makes him “paranoid,” which results in his avoidance of family and friends. Over time, he has needed more cannabis to “take the edge off” and has strong cravings to use daily. He first used cannabis in college and initially only smoked “a couple hits” in social settings. M says he has been smoking 2 or 3 “joints” or taking a few hits off of his “vaping pen” of cannabis daily for many years, for which he spends approximately $70 to $100 a week. When asked what factors have prevented him from seeking different career opportunities, he states that he would “fail a drug test.” Upon further inquiry, Mr. He presents as a referral from his primary care physician to your outpatient psychiatry office for an initial evaluation regarding “managing some mid-life issues.” He states that while he likes his job, it is the only job he has had since graduating college and he finds the work boring, noting that most of his co-workers have gone on to law school or more senior positions in the firm. M is a 43-year-old legal clerk who has been working in the same office for 20 years. Although these products are chemically distinct from the psychoactive compounds in the traditional cannabis plant, some cannabis users have tried synthetic “marijuana” products because of their gross physical similarity to cannabis plant matter. This article provides a brief overview of each of these topics by walking through clinical decision-making with a case vignette that touches on common experiences in treating a patient with cannabis use disorder.Ī separate and important issue is screening for emerging drugs of abuse, including synthetic “marijuana” products such as K2 and spice. It is vital that physicians-particularly psychiatrists who are on the frontlines with patients who struggle with cannabis use-are able to identify and characterize cannabis use disorders provide education and offer effective, evidence-based treatments.

Cannabis use disorder dsm 5