SUBSTANCE ABUSE
DISORDERS
Cannabis-Related Disorders
TABLE OF CONTENTS
01
02
Syed Tayeb
Syed Mujtaba
05
Mussab anees
03
Sadia shoukat
04
Zainab mahdi
01
Cannabis
Use Disorder
Substance use Disorder
Cannabis
Cannabis refers to a group of three plants
with psychoactive properties, known
as Cannabis sativa, Cannabis indica,
and Cannabis ruderalis. Some call it weed,
some call it pot, and others call it
marijuana.
Chemical Nature
THC
This is the main psychoactive
compound in cannabis. THC is
responsible for the “high” that most
people associate with cannabis.
CBD
This is a psychoactive cannabinoid, yet
it’s non-intoxicating and non-euphoric,
meaning it won’t get you “high.” It’s
often used to help reduce inflammation
and pain. It may also ease nausea,
migraine, seizures, and anxiety.
Diagnostic Criteria according to DSM-5 TM
A. A problematic pattern of cannabis use leading to clinically significant impairment or
distress, as manifested by at least two of the following, occurring within a 12-month period:
1.
Cannabis is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or
recover from its effects.
4. Craving, or a strong desire or urge to use cannabis.
5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or
home.
6. Continued cannabis use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of cannabis.
Diagnostic Criteria
8. Recurrent cannabis use in situations in which it is physically hazardous.
9. Cannabis use is continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by cannabis.
10. Tolerance, as defined by either of the following:
a.
A need for markedly increased amounts of cannabis to achieve intoxication or desired
effect.
b.
Markedly diminished effect with continued use of the same amount of cannabis.
Specifiers
Mild
Moderate
Severe
305.20 (F12.10)
304.30 (F12.20)
304.30 (F12.20)
Presence of 2–3 symptoms.
Presence of 4–5 symptoms.
Presence of 6 or more symptoms.
Differential Diagnosis
Nonproblematic use of cannabis
●
The distinction between
nonproblematic use of cannabis and
cannabis use disorder can be difficult
to make because social, behavioral, or
psychological problems may be
difficult to attribute to the substance,
especially in the context of use of
other substances.
Other mental disorders
●
Cannabis-induced disorder may be
characterized by symptoms (e.g., anxiety)
that resemble primary mental disorders
(e.g., generalized anxiety disorder vs.
cannabis-induced anxiety disorder, with
generalized anxiety, with onset during
intoxication). Chronic intake of cannabis can
produce a lack of motivation that resembles
persistent depressive disorder (dysthymia).
Cannabis intoxication
Cannabis intoxication refers to the set of physiological and
psychological changes after consumption of cannabis.
Consumption of cannabis intoxication include several
symptoms,
1. Euphoria
●
2. Increased or decrease in appetite
3. Red eyes
4. Dry mouth
5. Paranoid or anxiety, sometimes
6. Hallucinations or delusions
7. Slowed memory
8. Altering perception
The main psychoactive
component of cannabis is
THC. (tetrahydrocannabinol)
which is responsible for the
feelings of cannabis use.
Cannabis intoxication
●
THC is a natural compound that is often
found in cannabis plants.
●
When TCH binds with our brain
receptors alters various neural pathways
and ultimately results in physical and
psychological impairments.
Cannabis can be used by smoking,
vaporization, or within the food.
●
●
(E.G): If THC binds to cannabinoid
receptors in the brain it will increase the
amount of dopamine neurotransmitter
Diagnostic Criteria
 Diagnostic criteria according to dsm-5 TM
●
Recent use of cannabis.
●
Clinically significant problematic behavioral or psychological changes.
(Difficulty in concentration, difficulty with managing emotions, & impaired memory etc.)
●
The signs or symptoms are not attributable to another medical condition and are not better
explained by another mental disorder, including intoxication with another substance.
●
Two or more of the following signs of symptoms developing within 2 to 4 hours of cannabis use.
1.
2.
3.
4.
The conjunctival injections (redness
Dry mouth
Increased appetite
Tachycardia
of the white part of the eye)
Etiology
●
Genetics: some research suggests that there may be a genetic component to cannabis use, as an
individual with a family history of substance abuse may be at higher risk of developing a problem
with cannabis.
●
Environmental factors: individuals who have easy access to cannabis are likely to use cannabis.
●
Mental health conditions: individuals with certain mental health conditions such as anxiety,
depression, they are more likely to use cannabis as a way to cope.
●
Peer pressure: individuals who associate with others who use cannabis are more likely to begin using
the drug themselves.
●
Medical condition: individual use cannabis as way to pain management, such as chemotherapy and
controlling seizures.
Treatment
 Psychoeducation: providing the patient excessive information related to the use of cannabis use
such as its negative effects and risks.
 Group therapy: group session or therapy can be beneficial to share their experiences and way of
their coping strategies with their peers.
 Medications: medication also helpful to reduce and stop cravings of cannabis addictions.
such as, N-acetylcysteine (NAC) or gabapentin
 Relapse interventions: therapist develops some of coping strategies to stop or reduce cravings,
teaching, how to manage the triggering moments.
 Cognitive Behavioural therapy is also used to challenge the persons negative thought into positive.
03
Cannabis
Withdrawal
292.0 (F12.288)
Substance use Disorder
Diagnostic Criteria According to DSM-5 TM
A. Cessation of cannabis use that has been heavy and prolonged (i.e., usually daily or almost
daily use over a period of at least a few months).
B. Three (or more) of the following signs and symptoms develop within approximately 1 week
after Criterion A:
1. Irritability, anger, or aggression. 2. Nervousness or anxiety.
3. Sleep difficulty (e.g., insomnia, disturbing dreams).
4. Decreased appetite or weight loss.
5. Restlessness.
6. Depressed mood.
7. At least one of the following physical symptoms causing significant discomfort: abdominal
pain, shakiness/tremors, sweating, fever, chills, or headache.
C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D. The signs or symptoms are not attributable to another medical condition and are not better
explained by another mental disorder, including intoxication or withdrawal from another
substance.
Diagnostic Features
In addition to the symptoms in Criterion B, the following
may also be observed post abstinence:
● Fatigue
● Yawning
● Difficulty concentrating
● Rebound periods of increased appetite
● Hypersomnia that follow initial periods of loss of
appetite and insomnia.
For the diagnosis, withdrawal symptoms must cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
(Criterion C).
Treatment for CUD
Psychotherapeutic Treatments
Cognitive-Behavioral Therapy (CBT)
Motivational Enhancement Therapy (MET)
Multidimensional family therapy (MDFT)
Pharmacologic Treatments
Antidepressant :
bupropion,
Nefazodone,
delta-9-tetrahydrocannabinol (THC)
Case study.
●
Nelson willie is a legendary country musician who has been open about his struggle with
cannabis addiction. He has been quoted as saying that he uses cannabis to help manage pain
from injuries sustained during his long career. Despite its benefits for his physical health,
nelson has also struggled with addiction to the drug.
●
Nelson has been arrested multiple times for cannabis possession. He has also been quoted as
saying that he believes that cannabis should be legalized and regulated like alcohol and
tobacco.
●
Despite his struggle with addiction nelson has remained one of the most successful and
beloved musicians of all time. He has been inducted into the music hall of fame and has won
numerous awards for his music.
Video Clip
●
https://www.youtube.com/watch?v=AWhWA5dWGHg&ab_channel=VoiceofAmerica
Prevalence
Among adult and adolescent cannabis users, prevalence estimates of cannabis withdrawal symptoms
vary widely, from 35% to 95%, based on research in the United States and other countries.
Some of the variation in rates is likely attributable to assessment methods, and some to differences
between samples.
Among adult regular cannabis users in the general population, 12% reported signs and symptoms that
met criteria for the full syndrome of DSM-5 cannabis withdrawal, with substantial differences in
prevalence among non-Latinx Whites (10%), African Americans (15.3%), and Asian Americans, Native
Hawaiians, and Pacific Islanders (31%). Among adults and adolescents who are enrolled in treatment or
are heavy cannabis users, 50%– 95% report cannabis withdrawal.
These findings indicate that cannabis withdrawal occurs among a substantial subset of regular cannabis
users who try to quit.
Prevalence
●
Comorbidity
●
Among adult frequent cannabis users, cannabis withdrawal is associated with comorbid
depression, anxiety, and antisocial personality disorder. Given the typical overlap of
cannabis withdrawal with cannabis use disorder.
Comparative analysis of cannabis use worldwide
●
Pakistan has emerged as the secondhighest consumer of cannabis in the
world, according to ABCD2018
Cannabis Price Index, despite the fact
that it is illegal in the country.
●
According to the index, Karachi comes
just second after New York (77.44
metric tones) in terms of consuming
cannabis — including hashish — at
41.95 metric tones, or 41,950 kgs.
●
https://flowhub.com/cannabisindustry-statistics
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