Cannabis Dependence: Where You Stand

Since 2013, clinicians have used one diagnosis, cannabis use disorder, in place of two older ones. It is defined by a list of eleven signs. Two or three of them within a year is mild, four or five is moderate, and six or more is severe.

• Control: using more, or for longer, than you meant to; wanting to cut down and not managing it
• Time: a lot of the day goes to getting cannabis, using it, or recovering from it
• Craving: a strong desire or urge to use
• Priorities: work, study, home or relationships are suffering, or things you used to do have dropped away
• Risk: using where it is physically dangerous, or carrying on despite a health or mental health problem it is making worse
• Body: needing more for the same effect, or feeling unwell when you stop

Most people who use cannabis do not meet the criteria. A substantial minority do. A 2020 analysis of 21 studies found that 22% of people who use cannabis had a use disorder. An older figure of 9% is still widely quoted, but it counts only the more severe form, over a lifetime, in US data from 2001 to 2005. The two numbers measure different things.

• In a US survey of 36,309 adults in 2012–2013, 2.5% had a cannabis use disorder in the past year and 6.3% at some point in their lives
• Among people who became dependent, half did so within about five years of first use
• Only about 13% of people who had ever had the disorder had used a 12-step program or professional help

How often you use matters most. In an analysis of cohort studies, the estimated added risk of developing a use disorder rose from about 3.5% with yearly use to 8% with monthly use, 17% with weekly use and 36% with daily use. Starting young and using stronger products are also linked with higher risk.

• Among young people who used weekly or daily, about one in three developed dependence
• THC concentrations in herbal cannabis rose steadily between 1970 and 2017, while CBD did not change
• Stronger products are associated with a higher risk of a use disorder; these are observational studies, so they show a link, not a cause
• In a survey of 512 young adults in California, people who used stronger flower used on more days and used more each day, which suggests people do not automatically use less of a stronger product

Questionnaires exist for this. The best known is the CUDIT-R, which has eight questions. Studies disagree about what score should worry you: the best cut-off was 6 in one group of college students and between 10 and 14 in a group of US veterans. For that reason this guide does not give you a score. It gives you the questions that matter. If several of them fit, that is worth a conversation with a clinician. It is not a verdict.

• How many days in the past month did you use, and is that more than a year ago?
• Do you often use more, or for longer, than you planned?
• Have you tried to cut down or stop, and found you could not?
• Has cannabis taken the place of things you used to do or people you used to see?
• Do you keep using even though you can see it making something worse?
• When you go without, do you sleep badly, feel irritable, or lose your appetite?

There is more than one way forward, and stopping completely is not the only one that counts. In studies of people getting help, using on fewer days went with better sleep, mood and anxiety.

• A break shows you how you feel without cannabis; the guide on taking a break covers what to expect
• Cutting back is a real outcome in the research, not a consolation prize
• Professional help reduces use for most people who complete it, and most people never try it
• Some situations call for a clinician before you change anything; the guide on getting help lists them