I know people who are industrious while high and don’t question their cannabis use. More than that, they see their daily weed consumption as part of a health-conscious lifestyle. I also know people who work in cannabis and are so conflicted by their weed habit they’re fleeing the industry as a way to protect themselves.
This got me wondering if cannabis use disorder (CUD) simply comes down to an attitude to weed consumption? For starters, how can we define daily use as a disorder if people consuming on a daily basis manage to live busy lives and meet commitments? Is that the qualifier, the quality of a person’s life, their sense of personal fulfilment? Or are these people lying to us, to themselves?
WHAT IS CANNABIS USE DISORDER?
The DSM-5 defines cannabis use disorder (CUD) as a “problematic pattern of cannabis use leading to clinically significant impairment or distress,” which manifests at least 2 of the following behaviours:
1. Using more
2. Desire to stop but can’t
3. Excessive time spent acquiring cannabis or recovering from cannabis use
4. Persistent cravings
5. Failure to meet commitments
6. Failure to stop after failure to meet commitments
7. Missing out on social commitments
8. Recurrent use despite health problems
9. Continued use despite the risk of threat to existing psychological issue
10. Increased tolerance
11. Using to avoid withdrawal symptoms
A 2022 study on cannabis use disorder defines the symptoms of cannabis intoxication as including euphoria, anxiety, uncontrollable laughter, increased appetite, inattentiveness, forgetfulness, restlessness, tachycardia, conjunctival injection and dry mouth.
In rare cases, can also cause hallucinations. Prolonged use can cause withdrawal symptoms that include depressed mood, irritability, difficulty concentration and isolation. Those with mental health issues may use cannabis to mask symptoms but “prolonged use” may put users at risk for “unmasking the illness.”
The study notes that heavy users are more likely to report a “decreased sense of life satisfaction and achievement,” leading to problems that include addiction, altered brain development, cognitive impairment [and] poor educational outcomes.”
The study writers are most concerned with use amongst teenage school-goers, as they suggest increased use can lead to students “dropping out of school.” They are concerned that the legalization of cannabis will increase use “over time for most, if not all demographics.”
Based on 2015 figures, the 2022 study estimates that 9% of users “experience addiction,” of which a fifth began use in adolescence. Interestingly, the study finds that within the medical community, first-year psychiatry students are most likely to have CUD.
REAL CONSUMPTION HABITS
However, we now have the benefit of a real-time study going on in Canada since legalisation in 2018 with Health Canada providing annual figures on actual cannabis use. The figures from 2023 show that the number of users reporting daily use has been stable since 2018 at around 25% for adults and 20% for youth. The number of users classed as “high risk” has also remained stable at around 3%.
The problem with studies such as the 2022 study is defining what constitutes “problematic” use. On a 2023 episode of the Joe Rogan podcast, neuroscientist, Andrew Huberman, explained that the “main effect of cannabis is to narrow attention and focus.” The problem, he says, is that cannabis not a great “filter” meaning people can put the focus on anything from work to video games to their anxiety.
Anyone who uses cannabis regularly has experienced this at some point or another, a phenomenon I call the Vicious Cycle. In practice, this means that if you’re in a good place, cannabis will make you feel awesome. But if you’re in a bad place, cannabis will shred your soul. Which suggests the effect of cannabis has nothing to do with the substance and everything to do with the emotional baseline of the user.
Not only would this explain differences in effect across individual users it’s not new information. In fact, we’ve known this for the best part of 200 years thanks to the work of Dr. JJ Moreau. In his research, published in Hashish and Mental Alienation (1845), he notes that the specific situation of the subject, including personal background as well as atmosphere at the time of using deeply affects the effects of cannabis.
Is that why people like Seth Rogen, who in an episode of The Diary of a CEO with Stephen Bartlett, compared weed to glasses, saying that in the same way glasses help him see better weed helps him live better? Rogen is unapologetic about his daily cannabis use, saying many of his best ideas happened when he was high including blockbuster films like Superbad and Pineapple Express.
REFRAMING CUD
One of the points in the DSM-5 definition of cannabis that most bugs me is in relation to increased use and/or tolerance, which suggests that the more you use the more you need to use. As a user of cannabis for more than 30 years, my experience is the opposite: the more I use cannabis the less I need in individual sittings to get stoned. Over time, I actually use less to achieve the same effect.
Furthermore, the language used in the DSM-5 and related studies on cannabis, comes off as archaic and derogatory, completely lacking in nuance and the lived experiences of millions of users. The biggest problem with definitions of CUD is that they take their lead from the abuse patterns of other Schedule I drugs such as heroin and anyone who uses cannabis knows its effects are nothing like Class A drugs.
It’s said that if you want to solve a problem that can’t be solved, perhaps you have to change the question. In this case the question that no one can agree on is: does cannabis cause addiction? But perhaps a better question is: under what circumstances are people likely to abuse cannabis? In this instance, a pertinent question might be why are first-year psychiatry students attracted to cannabis?
On this point, I defer to Moreau who writes in Chapter I of Hashish and Mental Alienation: “I challenge the right of anyone to discuss the effects of hashish if he is not speaking for himself and if he has not been in a position to evaluate them in light of sufficient and repeated use.” Is this what psychiatry students are doing?
Are they experiencing more psychological issues than other students or are they simply making sure to have firsthand experience of a range of mind-altering substances, including cannabis? Is that a relevant question? Who knows? But until we can answer questions like this one, everything else is speculation.
The Healthy Hashhead 