01 Apr Cannabis Use Disorder Definition Holds Up to Scrutiny
Cannabis use disorder is a diagnosis used since May 2013 to identify serious problems associated with either an addiction to cannabis products or non-addicted abuse of cannabis products. In a study published in January 2014 in the journal Drug and Alcohol Dependence, researchers from 10 U.S. and British institutions compared the real-world accuracy of a cannabis use disorder diagnosis to the accuracy of previously used definitions for identifying cannabis-related harms. These researchers concluded that, except in a limited set of circumstances, the current diagnosis gives doctors a comprehensive tool for accurately singling out affected individuals.
Cannabis is the collective term used for products that come from two species of cultivated and wild plants also known as cannabis. Most Americans are familiar with the main cannabis product, marijuana, which ranks as the second most popular recreational substance in global human society. Fewer Americans are probably aware of two concentrated, less commonly available forms of cannabis known as hashish and hashish oil. The THC (tetrahydrocannabinol) content in all cannabis products triggers pleasure and a range of other effects by altering the chemical balance inside the brain. Many people don’t know that the brain changes created by regular exposure to THC can set the stage for a form of substance addiction that, at its core, is not fundamentally different from the forms of addiction associated with the use of substances such as alcohol or opioid narcotics. In addition, non-addicted users of cannabis can develop patterns of problematic, drug-related behavior that meets the widely accepted definitions for substance abuse.
Cannabis Use Disorder vs. Past Definitions
Cannabis use disorder is defined through terms set down by the American Psychiatric Association (APA), a group that—through longstanding precedent—also sets the basic terms U.S. physicians use when diagnosing all other forms of substance abuse and substance addiction. Before May 2013, the APA’s guidelines required doctors to identify cases of cannabis addiction separately from cases of cannabis abuse. This pattern of official diagnosis also held true for alcohol abuse and addiction, as well as all other forms of drug abuse and addiction. However, as a rule, scientists and doctors no longer view the symptoms of substance abuse as essentially distinct from the symptoms of substance addiction. Instead, they acknowledge that these symptoms commonly appear together, either in relatively small numbers or in relatively large numbers. The APA established the new, combined category of conditions known as substance use disorders to accommodate this new scientific and practical consensus. Cannabis use disorder is the specific substance use disorder designated for marijuana-, hashish- and hashish oil-related issues.
In the study published in Drug and Alcohol Dependence, researchers from institutions including Washington University, Virginia Commonwealth University, the University of Connecticut and Great Britain’s King’s College compared the accuracy of diagnoses made with the current guidelines for cannabis use disorder to the accuracy of diagnoses made with the older, split definitions for cannabis abuse and cannabis addiction. They conducted this comparison with the help of 3,053 adults previously identified as users of cannabis products. This pool of participants was designed to include both white Americans and Americans of African descent. The researchers initiated their project because some experts are concerned that the new combined diagnosis of cannabis use disorder will lead to a decline in the proper identification of cannabis-related problems in the general population.
Upon completing their comparisons, the researchers concluded that the combined terms for cannabis use disorder correctly identify cannabis-related abuse and addiction in the vast majority of cases. The only decrease in identified cases occurs among white Americans; the researchers characterize this decrease as “exceedingly modest.”
Significance and Considerations
The authors of the study published in Drug and Alcohol Dependence also looked at the role that genetics might play in changing the accuracy of a cannabis use disorder in white or African-American populations. They concluded that white Americans do show signs of genetic variations that could potentially diminish the comprehensive nature of the cannabis use disorder diagnosis. However, they also concluded that the genetic variations found in white populations do not have a significant impact in real-world circumstances. The authors do note that other types of genetic variations might reduce the accuracy of a cannabis use disorder in certain individuals. They point toward a need for further research efforts designed to explore this issue.
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