Marijuana use disorder
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Understanding Marijuana Use Disorder: Epidemiology, Comorbidities, and Treatment
Prevalence and Trends in Marijuana Use Disorder
Marijuana use disorder (MUD), also known as cannabis use disorder (CUD), is a significant public health concern affecting approximately 10% of the 193 million cannabis users worldwide1. In the United States, the prevalence of marijuana use has more than doubled from 4.1% in 2001-2002 to 9.5% in 2012-2013, with a corresponding increase in marijuana use disorders from 1.5% to 2.9% during the same period5. Despite the rising prevalence, the perception of marijuana as a harmless substance has increased, contributing to higher usage rates3.
Comorbid Psychiatric Disorders and Cannabis Use Disorder
Cannabis use and CUD are frequently associated with other psychiatric disorders. Strong evidence links cannabis use with psychotic disorders, particularly when use begins early or involves high-potency cannabis2 6. Additionally, there are associations with mood disorders, anxiety disorders, and personality disorders, although the evidence for causality is less consistent2 6. Cannabis use is also linked to increased risks of mania and suicide, but the relationship with depression and anxiety remains unclear6.
Risk Factors and Demographics
Certain demographic groups are at higher risk for developing CUD. Men, Native Americans, unmarried individuals, those with low incomes, and young adults (especially those aged 18-24) show higher odds of developing CUD4. Early initiation and regular use during adolescence are significant risk factors, leading to a higher likelihood of developing dependence and associated negative outcomes such as impaired mental health, lower educational attainment, and criminal behavior9.
Treatment Approaches for Cannabis Use Disorder
Psychosocial Interventions
Psychosocial interventions, including cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management, have shown effectiveness in reducing cannabis use and related problems1 7 8. These therapies, particularly when combined, produce the best outcomes, although maintaining long-term abstinence remains challenging1 7. High-intensity interventions, involving more than four sessions over a month, are more effective in reducing the frequency of use and severity of dependence8.
Pharmacotherapy
Currently, no pharmacotherapies are approved specifically for CUD, but some medications show promise. N-acetylcysteine and gabapentin are among the most promising, although further research is needed to establish their efficacy1 7. The development of effective pharmacological treatments remains a critical area for future research.
Public Health Implications and Policy Considerations
The legalization of cannabis in several high-income countries has raised concerns about the potential increase in CUD due to the availability of more potent cannabis products at lower prices1. Public health education is essential to inform users about the risks of CUD and provide resources for those seeking help1 5. Policymakers should consider these risks when shaping cannabis-related laws and regulations.
Conclusion
Marijuana use disorder is a growing concern with significant public health implications. The disorder is associated with various psychiatric comorbidities and demographic risk factors. Effective treatment primarily involves psychosocial interventions, with ongoing research into potential pharmacotherapies. As cannabis legalization continues to spread, public health education and informed policy decisions are crucial to mitigate the risks associated with increased cannabis use.
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Most relevant research papers on this topic
Cannabis use and cannabis use disorder
Cannabis use disorder affects 10% of global cannabis users, and while treatment options are limited, cognitive behavioral therapy and contingency management can significantly reduce cannabis use and related problems.
Highly CitedCannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review
Cannabis use and cannabis use disorder are associated with comorbid psychiatric illness, but the exact role of cannabis in the etiology, course, and prognosis of these disorders remains unclear.
Systematic Review
Rigorous JournalMarijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys.
Marijuana use in adults in the USA increased from 2002 to 2014, with risk perceptions decreasing, suggesting the need for education on the risk of smoking marijuana and prevention messages.
Observational StudyRigorous JournalHighly CitedPrevalence and Correlates of DSM-5 Cannabis Use Disorder, 2012-2013: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.
DSM-5 cannabis use disorder is prevalent, associated with comorbidity and disability, and largely untreated.
Observational StudyHighly CitedPrevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013.
The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, with nearly 3 out of 10 users experiencing a marijuana use disorder, indicating a need for balanced public health messaging.
Observational StudyHighly CitedCannabis Use and the Risk for Psychosis and Affective Disorders
Heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis, while evidence for mania and suicide is growing but less convincing for depression and anxiety.
Systematic ReviewHighly CitedTreatment of Cannabis Use Disorder: Current Science and Future Outlook
Psychotherapy and pharmacotherapy are effective treatments for cannabis use disorder, with a combination of motivational enhancement therapy, cognitive behavioral therapy, and contingency management producing the best abstinence outcomes.
Literature ReviewHighly CitedPsychosocial interventions for cannabis use disorder.
Psychosocial interventions for cannabis use disorder can effectively reduce cannabis use and improve treatment completion rates, but more research is needed.
Systematic Review
Very Rigorous JournalHighly CitedCannabis use disorder: Epidemiology and management
Cannabis use disorders are prevalent, with early initiation and regular adolescent use increasing the risk of later problematic use, mental health issues, and criminal offending.
Highly CitedCannabis Use and Risk of Psychiatric Disorders: Prospective Evidence From a US National Longitudinal Study.
Cannabis use is associated with an increased risk for several substance use disorders in the general population.
Observational StudyHighly Cited