DSM-IV

In DSM-IV, this is a category called Cannabis Use Disorders

Disorders

  1. Cannabis Dependence
  2. Cannabis Abuse

 DSM-5

Diagnostic Criteria

A. A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

  1. Cannabis is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
  3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
  4. Craving, or a strong desire or urge to use cannabis.
  5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  7. Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
  8. Recurrent cannabis use in situations in which it is physically hazardous.
  9. 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.
  10. Tolerance, as defined by either of the following:
    • a. A need for markedly increased amounts of cannabis to achieve intoxication or desired effect.
    • b. A markedly diminished effect with continued use of the same amount of cannabis.
  11. Withdrawal, as manifested by either of the following:

Specify if:

  • In early remission: After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use cannabis," may be met).
  • In sustained remission: After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use cannabis," may be met).

Specify if:

  • In a controlled environment: This additional specifier is used if the individual is in an environment where access to cannabis is restricted.

Note: If a cannabis intoxication, cannabis withdrawal, or another cannabis-induced mental disorder is also present, the comorbid cannabis use disorder is indicated in the cannabis-induced disorder. For example, if there is comorbid cannabis-induced anxiety disorder and cannabis use disorder, only the cannabis-induced anxiety disorder diagnosis is given, with the recording indicating whether the comorbid cannabis use disorder is mild, moderate, or severe (e.g., mild cannabis use disorder with cannabis-induced anxiety disorder; moderate or severe cannabis use disorder with cannabis-induced anxiety disorder).

Specify current severity:

  • Mild: Presence of 2-3 symptoms.
  • Moderate: Presence of 4-5 symptoms.
  • Severe: Presence of 6 or more symptoms.

Specifiers

"In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

Changing severity across time in an individual may also be reflected by changes in the frequency (e.g., days of use per month or times used per day) and/or dose (e.g., amount used per episode) of cannabis, as assessed by individual self-repot, report of knowledgeable others, clinician's observations, and biological testing.

Differential Diagnosis

Nonproblematic use of cannabis

The distinction between nonproblematic use of cannabis and cannabis use disorder can be difficult to make because social, behavioral, or psychological problems may be difficult to attribute to the substance, especially in the context of use of other substances. Also, denial of heavy cannabis use and the attribution that cannabis is related to or causing substantial problems are common among individuals who are referred to treatment by others (i.e., school family, employer, criminal justice system).

Other mental disorders

Cannabis-induced disorder may be characterized by symptoms (e.g., anxiety) that resemble primary mental disorders (e.g., generalized anxiety disorder vs. cannabis-induced anxiety disorder, with generalized anxiety, with onset during intoxication). Chronic intake of cannabis can produce produce a lack of motivation that resembles persistent depressive disorder (dysthymia). Acute adverse reactions to cannabis should be differentiated from the symptoms of panic disorder, major depressive disorder, delusional disorder, bipolar disorder, or schizophrenia, paranoid type. Physical examination will usually show an increased pulse and conjunctival injection. Urine toxicological testing can be helpful in making a diagnosis.

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