Treatment for Cannabis Use Disorder

You may already know the use is costing you sleep, work, or a relationship, and still hear that cannabis is too mild to need treatment. NIDA defines cannabis use disorder as a pattern that causes clinically significant harm. It is not a verdict on someone's character, and it is not settled by whether a state allows sales. The checklist is the same kind clinicians use for other substance use disorders: loss of control, time spent using or recovering, use that continues despite damage at work or at home, and withdrawal. Most people who use cannabis do not go on to other drugs. Some people still need treatment. Both of those sentences come from NIDA, and they can be true at the same time.

If someone has severe vomiting, chest pain, trouble breathing, or will not wake up, call 911. For a mental health crisis, call or text 988.

What the pattern looks like

NIDA, citing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, says cannabis use disorder is two or more listed symptoms in a 12-month period. The list includes using more or longer than intended, wanting to cut down and not being able to, spending a lot of time getting or using cannabis or recovering from it, craving, failing at work or school or home because of use, relationship problems, giving up activities, using in situations where injury is a risk, continuing despite physical or psychological problems the person knows are tied to cannabis, needing more to get the same effect, and withdrawal.

Two or three symptoms is mild. Four or five is moderate. Six or more is severe. Only a clinician can place someone on that scale. A pattern that already includes failed attempts to cut down, or use that is costing a job or a relationship, is a reason to ask for an assessment. It is not a reason to wait for a worse version of the same year.

Studies NIDA cites estimate that 22 percent to 30 percent of people who use cannabis have the disorder. The strongest predictor NIDA names is how often the person uses. Family history and how long use has gone on also matter. Between 1995 and 2022, delta-9 THC in cannabis seized by law enforcement rose from 3.96 percent to 16.14 percent. Flower and concentrates sold in dispensaries can be above 40 percent. NIDA says higher THC concentrations have been linked to a greater chance that use progresses to cannabis use disorder. Strength is a health fact. It is not a moral score.

When it helps to get care

Treatment is worth a call when use is already doing the things on that symptom list, or when stopping has become physically rough. NIDA says chronic, heavy use, every day or nearly every day, is associated with developing the disorder. People also run into care because of a specific medical problem. Cannabinoid hyperemesis syndrome is repeated nausea, vomiting, and abdominal pain after long-term heavy use. People sometimes stand in a hot shower for relief. NIDA says the syndrome resolves only when cannabis stops completely, and that it often needs medical attention. That is a clinical stopping point, not a lecture about willpower.

Withdrawal is its own reason. A person can have it after cutting down heavy or long-term use even without a use-disorder diagnosis. NIDA cites a study that estimated withdrawal in 12.1 percent of people who use cannabis frequently. The symptoms it lists include anger, irritability, aggression, nervousness, restlessness, lower appetite or weight, depression, insomnia, strange dreams, headaches, sweating, abdominal pain, and tremor. Knowing the list can keep someone from deciding, on day two, that they need cannabis to be a functional person. The list is not a protocol for sweating it out alone, and it is not a promise that every heavy user will feel all of it.

Other health problems belong in the same conversation. NIDA says cannabis smoke carries many of the same toxins as tobacco smoke. Some evidence links cannabis use with earlier psychosis in people who already have genetic risk, and with worse symptoms in people who already have a psychotic disorder. The same factors, including genes, trauma, and stress, also raise the chance of both mental health problems and drug use. The dual-diagnosis guide covers care when both are present. It does not say cannabis causes schizophrenia in every user.

Adolescents are a special case because the brain is still developing. NIDA says regular heavy use in the teen years is associated with problems in working memory, processing speed, and school functioning. The teen and young-adult guide covers family-based care and confidentiality. It is not a punishment plan.

Pregnancy is another. NIDA reports that the American College of Obstetricians and Gynecologists recommends clinicians counsel patients not to use cannabis while trying to become pregnant, during pregnancy, or while breastfeeding. Research it cites has linked prenatal exposure with lower birth weight and preterm birth. The pregnancy guide covers the longer page. Do not stop a prescribed medicine, or start cannabis for nausea, without the obstetric clinician.

What treatment is

NIDA says behavioral therapies are the treatments with evidence for cannabis use disorder. Cognitive behavioral therapy helps people notice and handle the situations where they are most likely to use. Motivational enhancement therapy uses the person's own reasons for change. Contingency management uses rewards or privileges for specific goals, such as attending sessions or providing negative drug tests. NIDA's treatment chapter says that for cannabis, as for stimulants, no medications are currently available to assist treatment, so care is behavioral and should be fitted to the person's pattern of use and to medical, mental, and social problems around it.

The cannabis research page is even more specific: there is no FDA-approved medication for the disorder or for medically assisted withdrawal. Research continues. That sentence is why a clinic should not hand someone a pill and call it an approved cannabis medicine. SAMHSA's quality checklist says a program should provide only FDA-approved medication for alcohol, tobacco, or opioid use, and notes that no FDA-approved medicine prevents a return to other substances such as methamphetamine and cocaine. Cannabis belongs with the group NIDA names directly as having no approved medicine.

SAMHSA describes where that care can sit. Outpatient means an appointment you leave the same day. Inpatient means an overnight stay for days or weeks. Residential means living at a program for at least a few weeks. Cannabis withdrawal is not in the same danger group as alcohol or benzodiazepine withdrawal. Many people will be assessed for outpatient care. A clinician still has to look at mental health, pregnancy, other substances, and whether the person can stop in the place they live. The detox-versus-rehab guide explains why detox is the wrong product name for a condition that has no approved withdrawal medicine. The inpatient-versus-outpatient guide covers level of care in general.

A few FDA-approved cannabinoid medicines exist for other illnesses. NIDA notes dronabinol and nabilone for chemotherapy nausea, dronabinol for appetite loss in HIV, and a plant-derived cannabidiol product for seizures in rare epilepsies. The FDA has not approved whole-plant cannabis as a medicine. Those approved drugs are not a home treatment for cannabis use disorder. Do not start or stop them on your own.

Legal products do not erase the disorder, and illegal products are not required for it. Delta-8 THC products are not FDA-approved for safe use. NIDA says eating large amounts has led to medical emergencies, including breathing problems. Synthetic cannabinoids sold as Spice or K2 are a different chemical class and are associated with severe, sometimes life-threatening effects. If the product is unknown, treat a collapse as an emergency.

Where to ask

FindTreatment.gov lists state-licensed facilities that answered SAMHSA's survey. Filter for substance use treatment and read whether the program treats cannabis. Clinics are not named or ranked here, and state sales rules are a different question from the disorder.

Call or text (800) 653-9376 if you want help asking what level of care fits.

Additional Resources

Sources cited on this page:

• NIDA: Cannabis (Marijuana)
• NIDA: Treatment and Recovery
• SAMHSA: Finding quality treatment
• SAMHSA: Learn about treatment
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

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