cannabis use disorder
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Hi Sam, I recently got into a debate with someone online about whether or not you can be addicted to cannabis. It’s such a polarizing topic that it’s hard to know if the fears around addiction are legit, or if there’s truth to the idea that you can become dependent on it.

I ask because I’ve had problems with alcohol before, and cannabis is now legal where I live, so I’m wondering if it’s risky for me to try it? Any thoughts?

I totally hear you on the murkiness around whether or not cannabis addiction is a thing. I’ve actually wondered the same thing myself! I’m also glad you’re being cautious before diving into this. I think slowing your roll is a smart choice (pun intended).

But I’m wondering if the addiction question is the right one — because I’m not convinced that the semantics here really matter.

More importantly: Can your use become problematic? Can it begin interfering with your life in ways that have some pretty uncanny parallels to alcohol addiction? Can cannabis use be disordered without being an addiction?

Abso-freakin-lutely.

There are very few open and honest conversations around what happens when cannabis isn’t so fun anymore. I could write ad nauseum about the complexities of addiction and whether or not cannabis falls under that heading. But I don’t necessarily think that’s helpful.

I believe it’s more important to be able to recognize when that line is crossed

While I’m not a clinician, I do think my lived experience offers a snapshot into what this kind of disorder can look like.

For starters, clocks were no longer a way of telling time — they existed only to time my edible consumption so that it hit the exact second I was done with work.

My schedule slowly warped, until it was essentially built around the next time I could get high. At first it was a small, occasional part of my week, until it was suddenly the main event... every single day.

I set rules for my use, but the goal posts constantly moved. First, it was just “a social thing.” Then it was a “weekend thing.” It was just at home, until it was at home and at yoga class, until eventually all bets were off and you’d be hard-pressed to interact with me when I was sober, assuming I ever really was.

My use became so excessive that I had the highest tolerance of anyone I was around, and while I set limits, I never stuck to them.

My ratio of THC steadily climbed until eventually, I was vaping pure THC concentrate, and spent most mornings trying to piece together what happened the night before, my memory as hazy as the smoke filling my tiny apartment every evening until I fell asleep.

At my worst? I’d had so much THC in my system, it had induced psychosis (to be clear — I consumed the amount you’d normally give to four people).

I had to call in sick to work the next day because I was (1) still high the entire next day and (2) experiencing traumatic flashbacks from the paranoia and hallucinations. Those flashbacks haunted me for weeks after the fact (it didn’t stop me from smoking again, though).

And despite my dogged determination to cut back on my use? I never seemed to be able to.

You mention having had a “problem” with alcohol. Ditto, friend. And in many recovery spaces, I know that folks are divided as to whether or not cannabis can ever be used safely by someone who has a dicey relationship to other substances.

And I totally get it. For a while, I really thought cannabis was my get-out-of-alcoholism-free card. So much for that.

I know folks who have used cannabis to wean themselves off of alcohol, or as a form of harm reduction, opting for the “safer” substance when the compulsion to use comes up. This has been an important step in recovery for many people, myself included, and I’d never discourage someone from making the safer choice between the two.

Some folks in recovery stick to CBD products and opt out of THC. (I tried this but I always slid backwards after a while, eventually reintroducing THC after a period of feeling a little too comfortable.)

There are others who are in recovery from addiction who seem to be able to handle cannabis just fine, or manage to for a few years and then suddenly cross a line, in which they inevitably return to sobriety. And there’s every kind of person in-between!

The point is, each and every person is unique. I can’t say for sure what your relationship to cannabis is going to be.

But what I can do is give you some information to make the best possible decision for yourself:

  • If you know you’ve had issues with other substances in the past, don’t introduce anything else — weed included — without a mental health provider on your support team. While many mental health professionals will not endorse using cannabis to anyone with a history of substance misuse, this extra supervision, or transparency with a professional, can help ensure that if your use starts to become problematic you can formulate a support plan for getting sober, sooner rather than later.
  • Consider attending a harm reduction support group. If you’re specifically exploring cannabis because you’re struggling with alcohol or want an alternative, it’s best to have a support system of others who are navigating similar situations.
  • Do you have any co-occurring mental health issues that might increase your risk of misusing cannabis? This can include conditions like PTSD, ADHD, OCD, anxiety, and depression. If so, discuss with your care providers if cannabis might exacerbate your symptoms (for example, weed definitely made my OCD much worse), interact with your current medications, and whether the benefits of use are strictly short-term or sustainable over a longer period of time.
  • Know the signs. Does it feel more like a thoughtful choice or an urge or compulsion when you use? Are you able to take a break from using? Is your tolerance growing? Has it interfered with obligations or relationships in your life? Has it created problems (financially, emotionally, socially, even legally) or taken you away from things that are important to you?
  • It’s helpful to keep a journal and log your use, particularly if you’ve had issues with other substances in the past. In addition to looking for the signs above, consider the context in which you’re using. Is it in a recreational setting? Or in response to a trigger, stressor, or uncomfortable emotion?

While the DSM-5 does acknowledge cannabis use disorder, I think that’s largely irrelevant here. Because every one of us, whether we risk addiction or not, should be monitoring our substance use and checking in to ensure that it’s not impacting our lives negatively.

That should be part and parcel of any kind of substance use — alcohol and weed included.

The bottom line? No one should be on autopilot when they’re using mind-altering substances, however normalized it is in our culture

My days of “Sharknado”marathons and “green outs” are a distant, bizarre memory, which I’m pretty glad for. My circus does not need any additional monkeys, even if those monkeys also happen to make ice cream taste 10 times better (*cue sad trombones*).

I’m completely sober (and happy!), which wound up being the best possible choice for me.

At the end of the day, this is a personal decision that only you can make (and, depending on the legality within your state, please be advised it might also be a criminal decision).

It may be “just a plant,” but plants can be harmful, too. Did you know that tomato leaves, for example, are mildly poisonous? If you tried to eat an acorn, you could still chip your tooth or choke on it (why would you do this? I don’t know, I’m not here to judge you — maybe you were roleplaying as a squirrel).

Take it from someone who learned the hard way — it’s all fun and games until you’re so paranoid that you’re convinced the illuminati is after you (yes, this seriously happened to me). Which makes for a hilarious story, but trust me, there are a million better ways to spend a Friday night than having a completely unnecessary panic attack.

Cannabis might be “just a plant,” but that doesn’t make it inherently safe for each and every person! My best recommendation is to tread carefully, seek out additional support, and be thoughtful about your use.

Your brain is a very precious organ, so treat it that way, okay?

Sam


This is Crazy Talk: An advice column for honest, unapologetic conversations about mental health with advocate Sam Dylan Finch. While he’s not a certified therapist, he has a lifetime of experience living with obsessive-compulsive disorder (OCD). He’s learned things the hard way so you (hopefully) don’t have to. Got a question Sam should answer? Reach out and you might be featured in the next Crazy Talk column: sfinch@healthline.com