Cannabis use disorder
[8] The sedating and anxiolytic properties of tetrahydrocannabinol (THC) in some users might make the use of cannabis an attempt to self-medicate personality or psychiatric disorders.[10] Cannabis users have shown decreased reactivity to dopamine, suggesting a possible link to a dampening of the reward system of the brain and an increase in negative emotion and addiction severity.[14] Cannabis dependence develops in about 9% of users, significantly less than that of heroin, cocaine, alcohol, and prescribed anxiolytics,[15] but slightly higher than that for psilocybin, mescaline, or LSD.Longitudinal studies over a number of years have enabled researchers to track aspects of social and psychological development concurrently with cannabis use.[25] The main factors in Australia, for example, related to a heightened risk for developing problems with cannabis use include frequent use at a young age; personal maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using peers; moving away from home at an early age; daily cigarette smoking; and ready access to cannabis.The researchers concluded there is emerging evidence that positive experiences to early cannabis use are a significant predictor of late dependence and that genetic predisposition plays a role in the development of problematic use.[26] A number of groups have been identified as being at greater risk of developing cannabis dependence and, in Australia have been found to include adolescent populations, Aboriginal and Torres Strait Islanders and people with mental health conditions.According to a study completed by Bill Sanders, influence from friends, difficult household problems, and experimentation are some of the reasons why this population starts to smoke cannabis.[6] Screening and brief intervention sessions can be given in a variety of settings, particularly at doctor's offices, which is of importance as most cannabis users seeking help will do so from their general practitioner rather than a drug treatment service agency.[55] In 2006, the Wisconsin Initiative to Promote Healthy Lifestyles implemented a program that helps primary care physicians identify and address marijuana use problems in patients.[56] As of 2023, there is no medication that has been proven effective for treating cannabis use disorder, research is focused on three treatment approaches: agonist substitution, antagonist, and modulation of other neurotransmitter systems.[57] For the treatment of the withdrawal/negative affect symptom domain of cannabis use disorder, medications may work by alleviating restlessness, irritable or depressed mood, anxiety, and insomnia.[58] Atomoxetine has also shown poor results, and is as a norepinephrine reuptake inhibitor, though it does increase the release of dopamine through downstream effects in the prefrontal cortex (an area of the brain responsible for planning complex tasks and behavior).[58] Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, has also been studied for cannabis use disorder, with the thought that the serotonergic component may be useful for the depressed mood or anxious dimensions of the withdrawal symptom domain.[58] It is worth noting that venlafaxine is sometimes poorly tolerated, and infrequent use or abrupt discontinuation of its use can lead to withdrawal symptoms from the medication itself, including irritability, dysphoria, and insomnia.[58] Baclofen, a GABAB receptor agonist and antispasmodic medication, has been found to reduce cravings but without a significant benefit towards preventing relapse or improving sleep.[58] Zolpidem, a GABAA receptor positive allosteric modulator and "z-drug" medication, has shown some efficacy in treating insomnia due to cannabis withdrawal, though there is a potential for misuse.[6] Topiramate, an antiepileptic drug, has shown mixed results in adolescents, reducing the volume of cannabis consumption without significantly increasing abstinence, with somewhat poor tolerability.[58] Quetiapine, an atypical antipsychotic, has been shown to treat cannabis withdrawal related insomnia and decreased appetite at the expense of exacerbating cravings.[50] Heavy cannabis use has been associated with impaired cognitive functioning; however, its specific details are difficult to elucidate due to the potential use of additional substances of users, and lack of longitudinal studies.