Is Cannabis Addictive?

If there’s a question that can’t be answered with a straightforward yes or no, it’s this: is cannabis addictive?

Before joining Leafly, I wrote for a website that connected people with addiction treatment, and shortly before that I began using medical marijuana. It was a constant challenge finding harmony between my close relationship with cannabis and the struggles of our readers, many of whom were diagnosed with a thing called “cannabis use disorder.” How could I bring myself to write about the risks of cannabis when I used it on a daily basis for my own health, and what negative consequences would my words bring to the legalization movement I was passionate about?

At that ethical crossroad, it eventually occurred to me that my stance didn’t come down to taking one path or the other, but instead understanding the massive gray area between the two. That ambiguity begins with a single word that many spend their entire lives trying to define and refine.

What is Addiction?

If someone asked you to define “addiction,” what would you say? If you’re of the belief that addiction is a chemical dependence characterized by withdrawal symptoms that you’ve never experienced personally, you might be of the mind that cannabis is in fact non-addictive. Some subscribe to the belief that addiction manifests psychologically and that cannabis can be addictive in the same way that gambling, sex, or food might be considered addictive, as they all produce pleasurable responses in the brain. I’m no doctor, so I recruited the help of Roger Roffman, Professor Emeritus of Social Work at University of Washington, to help tease out a more standardized definition.

“The language of addiction, dependence, and disorders is one thing when you talk to scientists and it’s another when you talk to the public,” Roffman said. “Addiction results from a combination of biological and psychological factors that contribute to conditioned behavioral patterns that are very difficult to stop or resist.”

And of course, there’s an environmental component to addiction as well. Johann Hari, author of Chasing the Screams: The First and Last Days of the Drug War, presented his definition of addiction – one that emphasizes environment over biology:

“Human beings have an innate need to bond and connect. When we are happy and healthy, we will bond with the people around us. But when we can’t because we’re traumatized, isolated, or beaten down by life, we will bond with something that gives us some sense of relief. The path out of unhealthy bonds is to form healthy bonds, to be connected to people you want to be present with. Addiction is just one symptom of the crisis of disconnection.”

From this perspective, the question isn’t whether or not cannabis is addictive, but rather under which circumstances might one become addicted to cannabis?

What is Cannabis Use Disorder?

You don’t often hear people say “cannabis addiction” in the scientific and medical communities. Instead, you’re more likely hear the term “cannabis use disorder,” and that’s the condition you will find listed in the official manual of psychiatric diagnostics – the DSM-V. This manual’s definitions and criteria are universally recognized in the U.S. for treatment recommendations, and it characterizes cannabis use disorder using 11 indicators. These markers describe various behaviors relating to cannabis use, including cravings, time spent using, dose, and life impacts. The number of factors experienced by an individual determines the severity of the disorder.

The accuracy of these criteria markers is critically important in determining necessity of treatment, especially in states where rehabilitation programs are mandated for drug-related crimes. A person who meets as few as two criteria – let’s say #4 (has a strong desire to use cannabis) and #10 (needs markedly more cannabis to achieve desired effect) – would be diagnosed with minorly severe cannabis use disorder. Wait a minute – I just described myself, as well as many of my friends and colleagues who function perfectly well, so do we all have a “disorder”?

“If there’s a difficulty with [the DSM-V’s diagnostic criteria], it’s overreacting when just one or two of these indicators are present,” Roffman explained. This overreaction dilutes instances of legitimate need for help with situations in which cannabis is neutrally or positively impacting someone with no desire to quit.

“While we need to acknowledge that cannabis can be used moderately and responsibly, can enrich lives, and, of course, can be healing for a lot of people, the fact of the matter is we have a substantial minority of cannabis users who experience far more than one or two of these diagnostic criteria,” Roffman said. “We need to be compassionate to people for whom a moderate or severe disorder exists, and we need good science to understand it and find ways of helping.”

But getting good science on cannabis and other illicit drugs is nearly impossible in a country whose prohibition restricts research on their benefits. If cannabis were legal, or at least rescheduled under the Controlled Substances Act, how much more might we learn about addiction and its causes?

What’s the Relationship Between Cannabis Legalization and Addiction?