Advocating for Evidence Based Marijuana Policy
From the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition, DSM-V (2013)
“The substance-related disorders encompass 10 separate classes of drugs: alcohol; caffeine; cannabis;hallucinogens (with separate categories for phencyclidine … and other hallucinogens); inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants (amphetamine-type substances), cocaine, and other stimulants); tobacco; and other (or unknown) substances. These 10 classes are not fully distinct. All drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the production of memories. They produce such an intense activation of the reward system that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the system and produce feelings of pleasure, often referred to as a “high”. Furthermore, individuals with lower levels of self-control, which may reflect impairments of brain inhibitory mechanisms, may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.” (Page 483. Underscoring ours.)
WTR-RI Research and Analysis Team Note:
To clarify with respect to activation of the brain reward system, adaptive behaviors refers to the pleasure experienced as a result of a good meal, sexual activity, achievement, aerobic exercise, etc, or “natural highs”. The impacts of excessive use of abusive substances can be understood to result in a “highjacking” of these brain pathways in such a way as to reinforce the need of this system for more of the “effects” of the specific substance involved. What constitutes “excessive” either in terms of quantity or frequency of use varies from substance to substance.
See pages 483 through 490 of the DSM-V (Hardcover Edition) for an extensive discussion of and the diagnostic criteria for Substance Use and Substance Induced disorders.
There are 6 specific mental health conditions identified in the DSM-V as Substance Related and Addictive Disorders involving Cannabis (Marijuana) including the following.
Cannabis Use Disorder (Mild, Moderate, Severe)*
At least two of the Following in past 12 Months
— Taken in larger amounts or longer period of time than first intended.
— Persistent desire or unsuccessful attempts to cut down or control use.
— Great deal of time spent obtaining, using, or recovering from effects.
— Craving or strong desire to use.
— Recurrent use resulting in failure to fulfill major role obligations at work, school or home.
— Continued use despite persistent or recurring social or relationship problems caused or worsened by the effects of use.
— Important social, occupational or recreational activities are given up or reduced because of use.
— Recurrent use in situations that are physically dangerous.
— Use is continued despite knowledge that having a persistent or recurrent physical or psychological problem that is likely to have been caused or made worse by use.
— Tolerance occurs, as defined by either of the following:
– Need for markedly increased to achieve intoxication or desired effect.
– Markedly diminished effect with continued use of the same amount.
— Withdrawal, as manifested by either of the following:
– Characteristic withdrawals syndrome. DSM-V Diagnosis (292.0)
– Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
* Mild = 1 or 2; Moderate = 4 or 5; Severe 6 or more
Cannabis Intoxication (292.89)
Causes the following clinically significant problematic behavioral or
psychological changes during or shortly after cannabis use.
- Impaired motor coordination
- Sensation of slowed time
- Impaired judgment
- Social withdrawal
- Perceptual disturbances (i.e. hallucinations with intact reality or auditory, visual or tactile illusions in the absence of delusions)
Cannabis Withdrawal (292.0)
Three or more of the following signs & symptoms causing clinically significant distress or impairment in social, occupational or other important areas of functioning following cessation of daily or almost daily use over a period of at least a few months.
- Irritability, anger or aggression
- Nervousness or anxiety
- Sleep difficulty (e.g., insomnia, disturbing dreams)
- Decreased appetite or weight loss
- Depressed mood
Plus at least one physical symptom causing significant discomfort:
- Abdominal pain, shakiness/tremors, sweating, fever, chills or headaches.