Marijuana Use Disorder

The following are signs of marijuana use disorder:
• Using more marijuana than intended
• Trying but failing to quit using marijuana
• Spending a lot of time using marijuana
• Craving marijuana
• Using marijuana even though it causes problems at home, school, or work
• Continuing to use marijuana despite social or relationship problems.
• Giving up important activities with friends and family in favor of using marijuana.
• Using marijuana in high-risk situations, such as while driving a car.
• Continuing to use marijuana despite physical or psychological problems.
• Needing to use more marijuana to get the same high.
• Experiencing withdrawal symptoms when stopping marijuana use.
In a study of cannabis research samples over time, the average delta-9 THC (the main form of THC
in the cannabis plant) concentration almost doubled, from 9% in 2008 to 17% in 2017.7 Products from
dispensaries often offer much higher concentrations than seen in this study. In a study of products
available in online dispensaries in 3 states with legal non-medical adult marijuana use, the average
THC concentration was 22%, with a range of 0% to 45%.8 In addition, some methods of using marijuana (for example, dabbing and vaping concentrates) may deliver very high levels of THC to the
user.
About 10% of people who begin smoking cannabis will become addicted, and 30% of current users
meet the criteria for addiction.

The risk of developing marijuana use disorder is greater in people who start using marijuana during
youth or adolescence and who use marijuana more frequently.

Due to the high prevalence of cannabis use, the impact of cannabis on public health may be significant. A range of acute and chronic health problems associated with cannabis use has been identified.
Cannabis can frequently have negative effects in its users, which may be amplified by certain demographic and/or psychosocial factors. Acute adverse effects include hyperemesis syndrome, impaired coordination and performance, anxiety, suicidal ideations/tendencies, and psychotic symptoms. Acute cannabis consumption is also associated with an increased risk of motor vehicle crashes, especially fatal collisions. Evidence indicates that frequent and prolonged use of cannabis can be detrimental to
both mental and physical health. Chronic effects of cannabis use include mood disorders, exacerbation of psychotic disorders in vulnerable people, cannabis use disorders, withdrawal syndrome, neurocognitive impairments, cardiovascular and respiratory and other diseases.
Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders, but whether and to what extent it actually causes these conditions is not always easy to determine. Recent research suggests that smoking high-potency marijuana every day could increase the chances of developing psychosis by nearly five times compared to people who have never used marijuana. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability.

Several studies have been conducted to truly evaluate the long term effects of cannabis use. These are limited by concentration of cannabis used. Some studies have found that regular marijuana use in adolescence is associated with altered connectivity and reduced volume of specific brain regions involved in memory, learning, and impulse control. Several studies, suggest that marijuana use can cause functional impairment in cognitive abilities but that the degree and/or duration of the impairment depends on the age when a person began using and how much and how long he or she used.
Some studies have also linked marijuana use to declines in IQ, especially when use starts in adolescence and leads to persistent cannabis use disorder into adulthood. Other studies have found individuals have less satisfaction in life and decreased achievement by increase feelings of depression or anxiety.
Other long term effects are closely related to smoking, respiratory illnesses, cancers and chronic lung problems.

Behavioral therapies and medication management can help some individuals with cannabis use disorder. The most effective treatments are behavioral interventions. There are urgent developments of effective pharmacological treatments for cannabis use disorder, but currently the best approaches are behavioral interventions with pharmacological interventions to treat symptoms of dependence.
Motivational interviewing (MI), cognitive behavioral therapy (CBT), contingency management (CM), family therapy (MDFT), and combinations are all effective in the treatment of cannabis use disorder.
In studies of treatment-seeking patients, all interventions lead to reductions in use of between 20–60 % after receiving treatment.
Cognitive-behavioral therapy (CBT)
This form of therapy is based on the principle that one’s thoughts, feelings, and behaviors can all
influence one another. The goal is to help patients stop disordered stimulant use by adjusting patterns
of thinking and feeling that cannabis use.

Motivational Interviewing
This therapy helps people identify and accept ambivalent feelings about their use with the goal of
strengthening a commitment to their recovery goals.

Contingency Management
This is an intervention with the aim to change specific behaviors that are closely related to substance
use by providing positive reinforcement procedures, or rewards. Evidence shows that behaviors that
are rewarded are likely to increase. Examples of Contingency Management at Sage Prairie include,
rewarding patients for progress by having decreased restrictions and they are given rewards when
peers recognize positive behavior.

Family Counseling
For people with cannabis use disorder and their families, this form of therapy helps all involved to identify and face consequences of cannabis use in order to support abstinence and program compliance.

Several studies have tested the effects of medications on cannabis dependence and withdrawal. These medications are either aimed at directly suppressing the withdrawal syndrome or are designed to indirectly alleviate symptoms of cannabis withdrawal (e.g. dysphoric mood, irritability). They work by influencing the brain circuits that work together to cause these symptoms. No medication has regulatory approval for the treatment of cannabis dependence or withdrawal.
Because symptoms of cannabis withdrawal may be severe, the symptoms often serve as negative reinforcement, and result in relapse in individuals trying to abstain. The most commonly used pharmalogical treatments are aimed at alleviating cannabis withdrawal, which may result in prevention of relapse and reduce dependence. There are some hopeful medications that reduce symptoms of
cravings in some individuals, but the evidence has not been substantiated in all individuals.

Several studies have tested the effects of medications on cannabis dependence and withdrawal. These medications are either aimed at directly suppressing the withdrawal syndrome or are designed to indirectly alleviate symptoms of cannabis withdrawal (e.g. dysphoric mood, irritability). They work by influencing the brain circuits that work together to cause these symptoms. No medication has regulatory  approval for the treatment of cannabis dependence or withdrawal. Because symptoms of cannabis withdrawal may be server, the symptoms often serve as negative reinforcement, and result in relapse in individuals trying to abstain. The most commonly used pharmacological treatments are aimed at alleviating cannabis withdrawal, which may result in prevention of relapse and reduce dependence. There are some hopeful medications that reduce symptoms of cravings in some individuals, but the evidence has not been substantiated in all individuals

These include 12-step groups, SMART recovery, Al-Anon Family groups, All Recovery groups, and
others. Sage Prairie also has developed a partnership with local Recovery Community Organizations
to offer other peer services. These programs are designed to offer participants active help and support for one another in their recovery

Housing
Sage Prairie has partnered with Recovery Properties to offer patient housing. In the housing, there
are only current and former Sage Prairie patients. This helps patients to develop a community, which
is supportive of recovery.
Financial Assistance
A major barrier to recovery can be access to care. Sage Prairie has partnered with navigators to assist individuals to fund treatment and access other financial services available through Federal, State
and local programs and scholarships.
Physical Health
Patients are given a healthy meal each treatment day. Patients living in housing are offered a free
local gym membership to improve their physical health.

The history of cannabis and the United States in a tenuous one. The most horrific parts of that history
are the injustices that the war on drugs and cannabis prohibition has caused, as well as the millions
of lives both have destroyed. However, the history, of cannabis, marijuana, and hemp have been an
integral part of American life for centuries.
It begins in Colonial Virginia with hemp. In 1606, King James I granted the Virginia Company a charter for Jamestown, however, by 1619, England needed financial help from the colony. As a result, the
Virginia Company required Jamestown’s land owners to grow and export 100 hemp plants to help
England financially. Over a century later, George Washington noted in his diary about the sowing of
hemp seeds each day until mid-April and later recounted that he grew 27 bushels of the crop that
year. Throughout colonial America, hemp was used to make fabric, rope, and sails, among other
items, and this continued throughout most of the 18th and 19th centuries.
The use of industrial hemp continued until1906, when Congress passed the Pure Food and Drug Act.
This legislation aimed to revamp poison laws– ironically, the first state to label cannabis as a poison
was California.
In 1937, the Marijuana Tax Act was passed in the United States, which levied a tax on anyone who
dealt commercially in cannabis, hemp, or marijuana, effectively making all three illegal. However,
after the Philippines fell to Japanese forces in 1942, the U.S. Department of Agriculture and the U.S.
Army urged farmers to grow hemp and even issued tax stamps for its cultivation to farmers. Without
any change in the Marijuana Tax Act, over 400,000 acres of hemp were cultivated between 1942 and
1945. The last commercial hemp fields were planted in Wisconsin in 1957.
In the decades following World War II, cannabis, hemp, and marijuana remained illegal, though
attempts were made to reconsider those policies. After a 1969 Supreme Court case rendered the
Marijuana Tax Act unconstitutional, the Nixon Administration decided, based on unscientific terms, to
create the Controlled Substances Act and place cannabis in Schedule I — where it remains to this
day.
In the decades since cannabis was designated a controlled substance, millions of individuals have
gone to jail related to marijuana possession and use.
To date, more than 30 states have enacted medical cannabis laws, and 11 now permit the adult-use
of cannabis for those over 21.