Marijuana Withdrawal Added to DSM 5
Cannabis-related disorders are a group of mental health conditions that stem from the use of THC-containing marijuana or hashish. The American Psychiatric Association (APA) classifies these conditions as specific examples of a more comprehensive category of problems called substance-related disorders. Cannabis withdrawal, one of the cannabis-related disorders listed in the 2013 edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders, is a newly defined condition. Another one of the listed disorders, called cannabis use disorder, combines the diagnoses of two conditions—cannabis abuse and cannabis dependence—formerly included as separate mental health issues in previous edition of the Diagnostic and Statistical Manual.
Cannabis-Related Disorder Basics
The new Diagnostic and Statistical Manual (designated by the American Psychiatric Association as DSM 5) contains definitions for four cannabis-related disorders: cannabis intoxication, cannabis use disorder, cannabis withdrawal and “other” cannabis-induced disorders. Cannabis intoxication is the only one of these disorders that appears in DSM 5 in essentially the same form as it appeared in DSM IV, the previous edition of the Diagnostic and Statistical Manual. Cannabis use disorder replaces both cannabis abuse and cannabis dependence. Cannabis withdrawal was created for DSM 5 in recognition of the possible effects of suddenly stopping or heavily reducing habitual marijuana or hashish intake. The “other” cannabis-induced disorders listing replaces several different DSM IV disorders, including cannabis-induced anxiety disorder, cannabis-induced psychotic disorder with hallucinations, and cannabis-induced psychotic disorder with delusions.
People affected by cannabis intoxication have typically smoked or ingested marijuana or hashish within roughly two hours of the onset of their symptoms. Specific symptoms that indicate the presence of intoxication include a significant spike in the normal heart rate, mouth dryness, appetite elevation and unusual fluid accumulation in the eyelids (a condition known as conjunctival injection). In addition to at least two of these cannabis-related alterations, all diagnosed individuals must experience substantial psychological or behavioral impairments as a result of marijuana or hashish use. They must also lack other conditions that provide a more reasonable basis for their mental/physical state.
Cannabis Use Disorder
Under the criteria listed in DSM IV, people with significant problems related to their cannabis use who show no signs of physical/mental dependence could receive a diagnosis of cannabis abuse. Examples of problems that qualified as significant include a frequent inability to meet any essential duties or responsibilities, frequent participation in dangerous activities while under the influence of cannabis, and an insistence on continuing cannabis use despite its known harmful life impact. The DSM IV criteria also allowed for a separate diagnosis of cannabis dependence in people who do show signs of physical/mental dependence on marijuana or hashish.
However, modern scientific thinking indicates that the difference between substance abuse and substance dependence is rarely cut-and-dried. In reality, doctors and researchers can find no consistently sensible way to address abuse and dependence as separate issues. For this reason, DSM 5 includes combined listings for specific substance use disorders instead of listings for various forms of abuse and dependence. This means that cannabis abuse and cannabis dependence are now addressed together under the cannabis use disorder heading.
According to the guidelines established by the American Psychiatric Association, substance withdrawal qualifies as a mental health concern when it produces symptoms that significantly degrade participation in a functional routine or trigger troublesome states of mind. Prior to the publication of DSM 5, there was not enough scientific evidence to ascribe these types of effects to withdrawal from the use of marijuana or hashish. However, times have changed, and the APA now officially recognizes the fact that at least some of the people who withdraw from these substances meet the mental health criteria for substance withdrawal. Doctors can now use the cannabis withdrawal diagnosis to indentify these people.
“Other” Cannabis-Induced Disorders
Cannabis is known for its ability to produce symptoms in some users that strongly resemble the symptoms of certain diagnosable mental conditions. DSM IV identified two such conditions: anxiety—which produces unreasonable worry, fear or dread—and psychosis, which classically involves the onset of either sensory hallucinations or fixed, irrational beliefs known as delusions. DSM 5 still allows doctors to diagnose these conditions in cannabis users; however, it also acknowledges the fact the cannabis users can potentially develop other mental health problems directly related to their marijuana or hashish use. The “other” cannabis-induced disorders category was created in order to provide doctors with the freedom to specify exactly which issues they uncover in their cannabis-using patients.