Can Using Marijuana Lead to Cannabis Dependence?

In its long history of usage, marijuana has been alternately considered everything from a dangerous “gateway drug” that destroys health, to a natural and nonaddictive medicine that offers a safer alternative to oft-abused pharmaceuticals such as opioids. Even after decades of usage in American society, this substance is surrounded by a surprising amount of mystery and mythology.

These views are further confused by ever-changing laws and perceptions around cannabis use in the United States. According to the National Conference of State Legislatures, under federal law, marijuana is still a Schedule I illegal substance, but so far, 19 states, 2 territories, and the District of Columbia have legalized small amounts of cannabis (marijuana) for adult recreational use. Even more states have decriminalized cannabis or have legalized its use for medical purposes. These more permissive laws have been shown to increase usage among certain demographics.

However, as use increases and legal regulations ease, it’s important to note that marijuana has never been proven to be safe—after all, cigarettes and alcohol are legal, too, but that doesn’t mean they’re not extremely harmful to health. Let’s look more closely at some of the facts around marijuana use and dependence.

MARIJUANA’S EFFECTS ON THE BRAIN

Overall, marijuana has depressive effects. Brain imaging research at Amen Clinics, studying marijuana use and the brain, showed that marijuana users have lower blood flow in the brain than non-users. On brain SPECT scans, the decreased blood flow was most commonly seen in the hippocampus during concentration tests (when participants engage in a concentration task during the brain imaging process). A 2016 study published in the Journal of Alzheimer’s Disease presented similar findings: After studying imaging of 1,000 cannabis users’ brains, there were signs of noticeable deficiencies in brain blood flow, including in the right hippocampus, the area of the brain that helps with memory formation.

These results suggest that marijuana use has a damaging effect on regions important in memory and learning, which are areas also associated with Alzheimer’s. Such effects can even persist over time. Several studies in chronic cannabis users showed that structural changes to the hippocampus show up even after six months of abstinence from the drug.

CANNABIS ADDICTION IS REAL

There is also evidence that marijuana is far from “harmless” or “non-addictive.” A study using PET imaging to demonstrate the release of dopamine in the striatum—a region of the brain involved with working memory, impulsive behavior, and attention—showed that THC, marijuana’s main psychoactive compound, created similar dopamine-releasing behaviors as found in other addictive drugs, such as cocaine and heroin. This effect is what keeps people using a drug, even in the face of negative consequences.

Therefore, many medical organizations and experts have recognized that prolonged or excessive cannabis use can lead to cannabis use disorder or marijuana use disorder. According to an article published by The Pew Charitable Trusts, these disorders are on the rise—not only because of increased legalization measures but due to the greater potency that accompanies today’s genetically engineered plants and more concentrated products.

The National Institute on Drug Abuse (NIDA) points to recent data suggesting that 30% of those who use marijuana may have some degree of marijuana use disorder. The incidence increases among people who started using marijuana before the age of 18—they are 4 to 7 times more likely to develop a marijuana use disorder than those who start consuming the drug as adults. Studies have even shown that people are at greater risk for psychosis and a range of other risks if they start smoking marijuana at a younger age. In other words, marijuana use can have serious health consequences for people of all ages.

SYMPTOMS AND PREVALENCE OF CANNABIS USE DISORDER

What are the hallmarks of marijuana or cannabis use disorder, versus “recreational” use? The NIDA explains that these disorder designations are associated with dependence, which refers to users who experience withdrawal symptoms if they stop taking the drug. They may report symptoms including irritability, mood, and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort. These usually peak within the first week after quitting but can last for up to 2 weeks.

Beneath these outer symptoms, marijuana dependence occurs when the brain adapts to large amounts of the drug by reducing the production of and sensitivity to its own endocannabinoid neurotransmitters. The NIDA notes that it is possible to be dependent without being addicted, but research suggests that 9% of people who use marijuana will become dependent on it, although the number rises to 17% in those who start using marijuana in their teens.

However, in more extreme cases, a disorder can morph into an addiction. Yale Medicine reports that about 13% of U.S. adults use cannabis products, but to be considered addicted, the person should meet at least 2 of the 11 criteria for substance use disorders, as outlined by the American Psychiatric Association. These can include an inability to reduce or halt consumption, frequent cravings, relationship and social problems stemming from the drug’s usage, and the development of tolerance, which means that more of the substance is needed to get the same effects.

Finally, like with many drug addictions, marijuana use disorder often goes untreated. The NIDA estimated in 2015 that about 4 million people in the United States met the criteria for marijuana use disorder, but only 138,000 voluntarily sought treatment for their use.

THE DEVELOPMENT AND TREATMENT OF CANNABIS USE DISORDER

What determines whether a “recreational” pot smoker will become someone with a use disorder or addiction? This is a complicated question, but a study published in 2020, led by scientists at Washington University School of Medicine in St. Louis, showed that two regions of human DNA “appear to contribute to one’s risk of becoming dependent on marijuana, showing a genetic link.” But, as is often the case, nature meets nurture. The study noted that “researchers also identified behavioral factors linked to problems with marijuana via their genetic overlap, such as risk-taking behavior, schizophrenia, and lower levels of educational attainment.”

Ultimately, cannabis use disorder is a serious concern, and continued use of the drug can lead to a range of negative impacts. That’s why it’s important to first identify the problem and then to seek help for usage that raises the red flags of dependence and addiction (or, ideally, to stop usage before it reaches this point). Whether this type of disorder is classified as mild, moderate, or severe, all users can benefit from treatment, though no one type of treatment works for everyone. Therapy, residential treatment, or joining sober communities are just some steps that can be taken to help get a marijuana user on the right track—and prevent further damage to the body and brain.

The one factor that most treatment programs miss, however, is that the #1 reason why people get addicted is brain dysfunction. Healing the brain and optimizing brain function must be part of an addiction treatment program to kick the habit for good.

Dependence, addiction, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.