Cannabis: tolerance and dependence

Diagnosis and treatment of marijuana dependence | British Columbia Medical Journal

Cannabis: tolerance and dependence

Marijuana and its extracts are derived from Cannabis sativa, a type of hemp plant that contains active compounds called cannabinoids, which are categorized as psychoactive (e.g., cannabinol), non-psychoactive (e.g.

, cannabidiol), and inactive. Marijuana is the most common illicit drug in Canada and is used to manage symptoms of some health conditions. However, as with many drugs, regular use of marijuana can result in dependence.

In 2012, the prevalence of marijuana use among the general population in Canada was 10.2%, and the rate of past-year marijuana use among youth age 15 to 24 was 20.3%, with an average age of 16 years for first use.[1] Although marijuana use is widespread among adolescents and young adults, dependence is often underdiagnosed.

The effects of cannabinoids come from the action of two major receptor subtypes: CB1 receptors (located mainly in the central nervous system but also found in the lungs, liver, and kidneys) and CB2 receptors (located in the immune system and hematopoietic cells).

Tetrahydrocannabinol (THC) is one of the main C. sativa substances to have psychoactive effects.

The dried plant material is smoked while other preparations, such as natural extract and hash oil, are smoked, inhaled, or ingested.

Inhalation is the most common route of administration because of the rapid transit of active compounds to the brain. When smoked, the effects of cannabinoids usually last less than 2 hours.

Diagnosing dependence

The DSM-5[2] defines cannabis dependence as a disorder characterized by a problematic pattern of use leading to clinically significant impairment or distress, as manifested by at least two of the following symptoms occurring within a 12-month period:

  • Using cannabis in larger amounts or over a longer period than was prescribed or intended.
  • Making unsuccessful efforts to cut down or control cannabis use.
  • Spending a lot of time in activities necessary to obtain, use, or recover from cannabis effects.
  • Craving cannabis or feeling an urge to use cannabis.
  • Failing to fulfill major life obligations at work, school, or home.
  • Continuing to use cannabis despite persistent or recurrent social or interpersonal problems.
  • Giving up or reducing involvement in important social, occupational, or recreational activities.
  • Using cannabis in physically hazardous circumstances.
  • Continuing to use cannabis despite having a persistent or recurrent physical or psychological problem.
  • Tolerance, as defined by a need for markedly increased amounts of cannabis or a markedly diminished effect with continued use of the same amount of cannabis.
  • Withdrawal, as manifested by the characteristic withdrawal syndrome.

Individuals use cannabinoids for many reasons. Although the effects vary from person to person, users often report improved sleep, improved appetite, reduced anxiety, and better pain control. However, cannabinoids can have many other less desirable effects on organ systems, including cognitive effects (e.g.

, psychosis, memory and learning problems, cognitive impairment, amotivational syndrome), cardiovascular effects (e.g., unstable blood pressure, tachycardia), respiratory effects (e.g., heavy cough, frequent acute chest infections), and endocrine effects (e.g., reduced testosterone levels).

Symptoms of intoxication with or withdrawal from cannabinoids can complicate management of other health conditions. In addition, cannabinoids can interact with commonly prescribed medications such as certain antidepressants, theophylline, fentanyl, zolpidem, lorazepam, and disulfiram.

While cannabinoid overdose is unly, cannabinoids often produce unwanted effects such as sedation, intoxication, clumsiness, dizziness, dry mouth, lowered blood pressure, and increased heart rate.[3]

Results from both human and animal studies of cannabis consumption indicate that regular use can lead to increased tolerance and dependence. Approximately 10% of individuals who regularly use cannabis will develop dependence.

The potency of the cannabinoid as well as the amount used, the duration of use, and the route of administration will determine the severity of withdrawal symptoms.

[4] Withdrawal symptoms usually start within 24 to 48 hours of abstinence, reach a peak within 4 to 6 days, and can last up to 4 weeks.

Cannabis withdrawal is defined in the DSM-5 as clinically significant distress or impairment of social or occupational functioning seen approximately 1 week after cessation of heavy and prolonged use.

[2] Withdrawal will involve the development of three or more of the following signs and symptoms: irritability, anger or aggression, anxiety, difficulty sleeping (i.e., insomnia, disturbing dreams), decreased appetite, restlessness, depressed mood.

In addition, withdrawal will involve at least one physical symptom: abdominal pain, shakiness/tremors, sweating, fever, chills, severe headache. Significant individual variation has been reported regarding the severity and duration of withdrawal symptoms.

Before an accurate diagnosis of marijuana dependence can be made, a comprehensive assessment is required. Such assessment must take into account the duration of use, amount used daily, route of administration, and other substances of abuse.

Also, general health and mental health conditions must be assessed to differentiate between symptoms that could be attributable to other substances or other physical and mental health conditions. A urine drug screen (UDS) is needed to identify the type of substances being abused.

It is common to hear from substance users that some drug dealers add addictive substances such as heroin or fentanyl to their marijuana for secondary gain. A baseline UDS can help health care providers identify other undiagnosed opioid dependencies among marijuana users.

Managing dependence

Once an accurate diagnosis of marijuana dependence has been made, treatment options can be considered. Both pharmacological and psychosocial options have been studied.

Although a comprehensive review of the published literature indicates insufficient evidence for a single broadly and consistently effective pharmacological treatment for cannabinoid dependence,[5] adjunctive treatment for nausea, anxiety, and insomnia can be helpful.

Some studies have evaluated the effect of bupropion, divalproex, naltrexone, nefazodone, and oral THC in the management of cannabinoid withdrawal syndrome.

Two randomized controlled trials found that replacement therapy and short-term dose tapering with synthetic cannabinoids was effective in reducing cravings, anxiety, feelings of misery, difficulty sleeping, and chills.[4,6] Nefazodone has been found to reduce anxiety and muscle pain.[6]

Psychosocial treatments of cannabinoid dependence have been tested in several studies. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and contingency management (CM) have been carefully evaluated and have all shown promising results.

Motivational enhancement therapy uses principles of motivational psychology to produce a rapid change. MET consists of an initial assessment using various instruments followed by four individualized treatment sessions.

The first two sessions focus on structured feedback from the initial assessment, future plans, and motivation for change.

The final two sessions are for reinforcing progress, encouraging reassessment, and providing objective perspective on the process of change.[7]

Cognitive-behavioral therapy was originally developed to treat depression and has since been used to prevent relapse when treating substance dependence.

CBT helps individuals identify and change problematic behaviors by enhancing their self-control and teaching them to use effective coping strategies.

Individuals using CBT explore the positive and negative consequences of substance use, self-monitor for triggers, and employ strategies for coping with triggers, cravings, and high-risk situations.

Contingency management interventions are principles of behavioral modification and operant conditioning. First, CM therapists arrange the environment so that target behaviors (e.g., abstinence from cannabis) are readily detected through frequent monitoring and urinalysis.

Second, therapists provide tangible reinforcement such as a gift certificate whenever the target behavior is demonstrated. Third, when the target behavior does not occur, therapists systematically withhold rewards or administer small punishments (e.g.

, withdrawal of methadone carry privileges).[8]

Findings indicate that although each of these interventions represents a reasonable and efficacious treatment approach, the combination of MET and CBT is more potent.[9]

Summary

Despite widespread use among adolescents and young adults in Canada, cannabinoid dependence is often underdiagnosed and undertreated.

While no single pharmacological treatment for dependence has been identified, adjunctive treatment for nausea, anxiety, and insomnia and replacement therapy and short-term dose tapering with synthetic cannabinoids may be used to manage withdrawal symptoms.

Long-term behavioral therapies, including motivational enhancement therapy, cognitive-behavioral therapy, and contingency management, may also be used to treat marijuana dependence.

Competing interests

None declared.

This article has been peer reviewed.

1.    Health Canada. Canadian alcohol and drug use monitoring survey. Summary of results for 2012. Accessed 25 September 2015. www.hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2012/summary-sommaire-eng.php.

2.    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Arlington, VA: American Psychiatric Association, 2013.

3.    Robson P. Therapeutic aspects of cannabis and cannabinoids. Br J Psychiatry 2001;178:107-115.

4.    Budney AJ, Vandrey RG, Hughes JR, et al. Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms. Drug Alcohol Depend 2007;86:22-29.

5.    Weinstein AM, Gorelick DA. Pharmacological treatment of cannabis dependence. Current Pharm Des 2011;17:1351-1358.

6.    Haney M, Hart CL, Vosburg SK, et al. Marijuana withdrawal in humans: Effects of oral THC or divalproex. Neuropsycho-pharmacol 2004;29:158-170.

7.    National Institute on Alcohol Abuse and Alcoholism. Motivational enhancement therapy: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Accessed 19 December 2015. http://pubs.niaaa.nih.gov/publications/ProjectMatch/match02.pdf.

8.    Petry NM. A comprehensive guide to the application of contingency management procedures in standard clinic settings. Drug Alcohol Depend 2000;58:9-25.

9.    Stephens RS, Roffman RA, Copeland J, Swift W. Cognitive-behavioral and motivational enhancement treatments for cannabis dependence. In: Cannabis dependence: Its nature, consequences and treatment. Roffman RA, Stephens RS, Marlatt GA, editors. Cambridge, UK: Cambridge University Press, 2006.

Dr Jafari is an addiction and mental health physician with Vancouver Coastal Health. Dr Tang is a resident in the Department of Family Practice at the University of British Columbia.

Source: https://www.bcmj.org/articles/diagnosis-and-treatment-marijuana-dependence

Learn About Marijuana: Factsheets: Dependence on Marijuana

Cannabis: tolerance and dependence

Dependence on Marijuana

This information was prepared by the National Cannabis Prevention and Information Centre in Australia, and used with permission.  Some information may not be accurate for U.S. readers.

Typically, people who use marijuana do not progress to using the drug regularly, or for long periods of time. Most will experiment every now and then with marijuana during adolescence and early adulthood and stop using once they are in their mid-to-late 20s.

However, some people will use marijuana for longer and more often, and become dependent on the drug.

Historically, marijuana was not seen as a drug of dependence in the same way as heroin or alcohol, but marijuana dependence is now well recognised in the scientific community.

What is Marijuana Dependence?

Dependence on marijuana means that the person needs to use marijuana just to feel 'normal'. In order to be diagnosed as marijuana dependent, a person needs to experience at least three of the following in the one year:

  • Tolerance to the effects of marijuana, meaning that more marijuana is needed to get the same effect;
  • Withdrawal from the effects of marijuana, such as irritability, trouble sleeping and depressive symptoms;
  • Using more marijuana than was intended;
  • Persistent desire to stop taking marijuana or to cut down and being unsuccessful at this;
  • Spending lots of time obtaining, using or recovering from the use of marijuana;
  • Giving up important activities in favour of using marijuana; and/or
  • Using marijuana even when it is known that it causes problems.

What are the Consequences of Being Dependent on Marijuana?

People who are dependent on marijuana are at a higher risk of suffering from the negative consequences of using the drug, such as short term memory impairment, mental health problems and respiratory diseases (if marijuana is smoked). Regular use and dependence also leads to problems with finances, conflict in relationships with family and friends, and employment problems.

How Many People Become Dependent on Marijuana?

It has been estimated that there are at least 200,000 people dependent on marijuana in Australia. About one in ten people who have tried marijuana at least once in their lifetimes will become dependent on the drug.

The more often you use marijuana the more ly you are to become dependent. If someone uses marijuana everyday, then they have a 50/50 chance of becoming dependent.

Young people develop marijuana dependence more quickly than adults.

Who are Most at Risk of Being Dependent on Marijuana?

The earlier a person starts using marijuana, and the more they use, the more ly they are to become dependent. Studies have shown that males are more ly than females to be dependent on marijuana.

What are the Symptoms of Marijuana Withdrawal?

One of the most common symptoms of marijuana dependence is the experience of discomfort when ceasing use known as withdrawal. Studies with marijuana users who have recently quit report that withdrawal symptoms start on the first day, usually peak in the first two to three days, and with the exception of sleep disturbance, are usually very mild by the sixth day.

The most common symptoms include:

  • Anxiety/nervousness;
  • Reduced appetite;
  • Irritability/restlessness;
  • Sleep difficulties including strange dream.

Even though these symptoms are not life threatening, they can be distressing enough for the person trying to stop smoking marijuana, to start using again.

Is There Any Treatment for Marijuana Dependence?

There are a number of treatment options available for marijuana-dependent people to cut down or quit. Studies have shown that even a single session with a counselor can assist the marijuana-dependent person to bring about significant improvements in their level of use and wellbeing.

The intensity of treatment depends on the individual circumstances, some people respond to general education and information about managing craving and high risk situations for relapse, others may even need inpatient management for marijuana withdrawal and rehabilitation.

As yet, there are no effective pharmacological treatments to help reduce marijuana withdrawal symptoms or to block the effects of marijuana, although studies are underway.

Source: https://adai.uw.edu/marijuana/factsheets/dependence.htm

Yes, You Can Become Addicted to Marijuana. And the Problem is Growing

Cannabis: tolerance and dependence

SAN RAFAEL, Calif. — For as long as most residents can remember, smoking marijuana has been a part of life here. The fact that California legalized the practice in January went practically unnoticed in this quiet town a half-hour’s drive north of San Francisco, where some claim the normalization of America’s marijuana culture got its start.

For Quintin Pohl and countless teenagers before him, smoking pot was a rite of passage. It was a diversion from the loneliness he felt at home when his parents were splitting up and a salve for middle-school angst. It was his entire social life in seventh and eighth grades, when social life is everything.

Even though nearly all his friends were using marijuana and seeming to enjoy it, Pohl said, at some point his marijuana use took a turn he never saw coming: He became addicted.

Many people are unaware of marijuana addiction. But in the public health and medical communities, it is a well-defined disorder that includes physical withdrawal symptoms, cravings and psychological dependence.

Many say it is on the rise, perhaps because of the increasing potency of genetically engineered plants and the use of concentrated products, or because more marijuana users are partaking multiple times a day.

“There should be no controversy about the existence of marijuana addiction,” said Dr. David Smith, who has been treating addiction since the 1960s when he opened a free clinic in San Francisco’s drug-drenched Haight-Ashbury neighborhood. “We see it every day. The controversy should be why it appears to be affecting more people.”

Although estimates of the number of people who have ever tried marijuana or who use it regularly vary widely from survey to survey, the federal government and the marijuana industry tend to agree that total marijuana use has remained relatively constant over the past decade. Increased use in the past three years has been slight, despite increased commercial availability in states that have legalized it.

The percentage of people who become addicted to marijuana — about 9 percent of all users, and about 17 percent of those who start in adolescence — also has been stable.

Yet here in Northern California, some addiction treatment practitioners say they’re seeing something new — a surge in demand for marijuana addiction treatment, particularly among adolescents, even though national surveys show little to no increase in the number of adults using the substance, and some studies show a decline in marijuana use among adolescents.

At fewer than 1 in 10 users, marijuana’s estimated rate of addiction is lower than cocaine and alcohol (15 percent) and heroin (25 percent). Un opioids and stimulants, marijuana dependence tends to develop slowly: Months or years may pass before debilitating symptoms begin to negatively affect the average dependent user’s life.

To be sure, there are no known reports of anyone dying of a marijuana overdose or its commonly experienced withdrawal symptoms — chills, sweats, cravings, insomnia, loss of appetite, nausea, anxiety and irritability.

Still, since so many Americans use marijuana recreationally — more than any other mood-altering substance other than alcohol — the number of people who develop a dependence on it is substantial.

According to Nora Volkow, director of the National Institute on Drug Abuse, an estimated 2.7 million Americans meet the diagnostic criteria for marijuana dependence, second only to alcohol dependence.

Potency and Frequency

About 20 miles north of here, at Muir Wood Adolescent and Family Services, where Pohl eventually got treatment as he entered his senior year in high school, Smith, a visiting physician there, said the number of patients seeking help for marijuana dependence has more than doubled in the last two years.

And he doesn’t think the increased demand can be explained by greater public awareness of addiction or improved access to treatment. Smith speculates that it’s the potency of concentrated products that’s causing a higher prevalence of problematic marijuana use.

“Back in the day when kids were sitting around smoking a joint, the THC levels found in marijuana averaged from 2 to 4 percent,” Smith said. “That’s what most parents think is going on today. And that’s why society thinks marijuana is harmless.”

But selective breeding has resulted in an average marijuana potency of 20 percent THC, the primary psychoactive compound in marijuana. Some strains exceed 30 percent.

Marijuana concentrates and extracts, much more commonly used in the last five years, have THC levels that range from 40 to more than 80 percent, according to marijuana industry promotional information and Drug Enforcement Administration reports.

Other addiction specialists say that although the number of marijuana users may not be rising significantly, the percentage of users who use it multiple times a day is increasing, which may also be contributing to higher rates of dependence. According to the National Institute on Drug Abuse, daily use among young adults is at the highest rate in more than 30 years.

In general, only about 5 percent of people with marijuana addiction get specialized treatment, compared with nearly a quarter of those with an opioid addiction, according to the Substance Abuse and Mental Health Services Administration.

Federal officials are trying to increase awareness.

Dr. Elinore McCance-Katz, an addiction physician and director of the substance abuse administration told Stateline in an interview that she plans to be the first director of the agency in any administration to speak out about the dangers of marijuana and correct what she says is “rampant misinformation” being spread by the marijuana industry.

Susan Weiss, who directs research on the health effects of marijuana at the National Institute on Drug Abuse, told a group of addiction doctors at the annual meeting of the American Society of Addiction Medicine in April that the federal government is trying to get the message out that marijuana can be addictive.

“But believe it or not,” she told the group, “we’re having a hard time convincing people that addiction exists.”

The National Cannabis Industry Association’s chief spokesman, Morgan Fox, said he’s not surprised the federal government is having a hard time convincing the public that marijuana can be addictive.

“It’s their own fault,” he said of the government. “When people find out they’ve been lied to by the federal government about the relative harms of marijuana for decades, they are much less ly to believe anything they have to say going forward even if that information is accurate.”

Fox said his organization has no disagreement with the scientific finding that about 9 percent of people who use marijuana become addicted, and his organization urges its members to make that clear in their marketing information. But he disagrees that more potent forms of marijuana may be causing an increase in addiction. “It just means people need to consume less to achieve the desired effect,” he said.

So far, no scientific studies have shown that stronger pot increases the lihood of addiction, and large swaths of the general public continue to question the existence of marijuana addiction. But for Quintin Pohl, addiction was real.

Quintin's Story

Pohl said his marijuana addiction took years to develop. His mother, Kimberly Thomas, said that once she realized her son was using marijuana frequently, “it was a roller coaster chugging up hill, chugging, chugging, chugging. You know something is happening,” she said, “and then just within a couple of days, you reach the peak and zoom downhill. It was awful, awful.”

Scott Sowle, director of the Muir Wood center, where Pohl got treatment, said he gets the same call from parents nearly every day.

“It’s Groundhog Day,” he said. “They call and say, ‘My 16-year-old son was doing really well in school. He was interested in sports and involved in extracurricular activities. But suddenly, he’s just not the same kid anymore.’”

Pohl recalled that he drank a little, off and on, but that marijuana was his constant obsession. After middle school, he got involved in rowing for a couple of years and took a break from his marijuana friend group. But after he decided competitive rowing wasn’t for him, Pohl said he started smoking pot again, this time with a new group of friends who smoked all the time.

And then the roller coaster plunged.

His grades plummeted; he stopped going home most of the time and was couch surfing for a while. Finally, he said, his mom called the cops on him for stealing her car. “At that point, I was heartless, emotionless,” he said. “I was just kind of a blob taking up space. I was baked 24/7.”

Pohl’s mother said she saw that he was in trouble and demanded that he stay at home every moment he wasn’t in school. (Pohl’s father was living in San Francisco and his sister was away at college.)

“She told me to come back home. So, I did,” Pohl said. “At the time, I wasn’t sure why she did that. I was still in that whole miserable phase, smoking at least an ounce of weed a week — two ounces on a good week.” (One ounce is enough to smoke four to eight joints every day for a week, depending on their size.)

Then early one morning before school, Pohl recalled, “I got the shower with a towel around my waist. I walked from the bathroom into my bedroom. There was steam everywhere. But through the haze, I could see two big guys in my room in leather jackets, two really big guys.

“They said, ‘Get dressed, young man, and come with us.’”

They were private investigators his mother hired to take him to Muir Wood.

Pohl said he went through a week of pure misery at Muir Wood: angry, in denial and suffering. “I couldn’t sleep for a week. I was cold and then I was sweating. I hated everything,” he said. “And then the sun hit my face one morning and it felt great. Things tasted good, smelled better, everything was just enhanced.”

During his six weeks at Muir Wood, Pohl took intensive classes with about 10 other boys and talked to his therapist frequently. His mother spent eight hours a week there, attending parent classes, sharing meals with her son, and working with him and his therapist to address the underlying issues that led him to self-medicate with marijuana.

Pohl says he hasn’t smoked marijuana since he left Muir Wood last July and hasn’t had any desire to. For the rest of the summer and after school in the fall, he attended classes at a Muir Wood outpatient clinic in San Rafael.

“In general, kids who come residential and go through an outpatient program and then go to meetings for sober teens are pretty successful,” Sowle said. “It’s the kids who don’t have a continuing care program and whose parents think a short stint in a residential program is a cure-all who aren’t so successful.”

Wearing black pants, a black sweatshirt and a pink skull cap on a cool but sunny day in late May, Pohl smiles broadly when he talks about his future. He graduates June 14 and plans to start working full time at the grocery store where he’s had a part-time job for the last year. He also plans to move to Petaluma and share a house with friends, he said. “I it up there in cow country.”

As for smoking marijuana again, Pohl is confident he’ll be able to smoke socially when he’s an adult. He plans to stay in Northern California and can’t picture not smoking pot when he grows up.

Squatting under a statue of Louis Pasteur at San Rafael High School, he proudly explains his town’s place in marijuana history. In 1971, he says, a group of high school kids who called themselves the Waldos met at the statue every day at 4:20 p.m. to smoke pot.

Source: https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/06/06/yes-you-can-become-addicted-to-marijuana-and-the-problem-is-growing

Marijuana Tolerance: Is a Break Necessary? What to Do

Cannabis: tolerance and dependence

Marijuana is an herb that contains a chemical called THC. This chemical is what produces the high that people experience when they use marijuana. The high causes mind-altering effects that vary depending on the strain and the individual experience of the user.

In the U.S., marijuana is the illicit drug that is most commonly used, according to the Substance Abuse and Mental Health Services Administration. While some states have legalized its use for medical or recreational purposes, it is still illegal at the federal level.

Those who use this drug should know more about tolerance, the effects of the drug, and when to take a break from using it. 

Signs of Marijuana Tolerance

Marijuana can be eaten or smoked. When someone smokes it, the THC in the marijuana goes from the lungs to the bloodstream quickly. THC is then carried to the brain via the blood. When someone eats marijuana, it is absorbed by the body more slowly. It can take up to 60 minutes to start feeling its effects. 

  • Altered senses
  • Mood changes
  • Trouble with problem-solving and thinking
  • Altered sense of time
  • Impaired body movement
  • Impaired memory

When marijuana is taken in high doses, the following effects are possible:

  • Hallucinations
  • Delusions
  • Psychosis

In the Western world, the THC content of marijuana tends to be lower, so dependence on marijuana that leads to drug-seeking behavior tends to occur less frequently, according to research in the Annals of the New York Academy of Sciences. This could also reduce how quickly people develop a tolerance to this drug.

Whether people develop a tolerance to marijuana is a topic that is frequently argued. Some data does show that people who use marijuana regularly may develop a tolerance to the drug’s effects, according to research published in Neuroscience and Biobehavioral Reviews.

This research further determined that the element with the highest degree of tolerance was a person’s cognitive function. In some cases, full tolerance was observed. Partial tolerance was seen in acute intoxication, cardiac effects, and psychotomimetic effects. 

Once someone becomes tolerant of marijuana, they will usually need to consume more to continue achieving the high they desire. In some cases, once tolerance is achieved by someone who usually ingests marijuana, they need to start smoking this drug to experience the high that the THC chemical provides. 

Do You Need a Break?

Taking a break from marijuana use will ultimately lower tolerance. If someone has a marijuana use disorder, they ultimately need to step away from marijuana use altogether. In the U.S., it is estimated that 9 percent to 30 percent of people who use marijuana develop a marijuana use disorder, according to research published in JAMA Psychiatry. 

  • Grouchiness
  • Decreased appetite
  • Cravings
  • Sleeplessness
  • Anxiety

How severe these effects are ultimately depends on the individual, but even when they are mild, they make it more difficult to stop using marijuana. The timeline for how long they last varies, but on average, most people report that withdrawal symptoms subside within about a month of discontinuing marijuana use. 

In cases of substantial abuse, addiction to marijuana is possible, according to the National Institute on Drug Abuse. 

Taking a break from marijuana is something that casual users can typically do on their own. However, those who regularly use the drug might need some assistance to stop using marijuana. Many rehabilitation facilities across the U.S. can help people who want to stop using marijuana. 

How to Deal With a Tolerance to Marijuana

Once someone develops a tolerance to marijuana, there is a chance that they will need help to stop using the substance. It is important to remember that marijuana is a drug. There are clinical signs that indicate that a person is struggling with marijuana addiction. 

The treatment needed for marijuana dependence or addiction is similar to the treatment required for any drug addiction. The first step is determining if the person will most benefit from inpatient or outpatient treatment. 

Outpatient programs can provide the appropriate setting for people who can continue with everyday life while receiving treatment. These programs allow people to go to work, live at home, and attend school while they receive treatment. 

An inpatient program requires that people in recovery from substance abuse to live at a treatment facility. The average stay is 30 to 90 days. How long someone needs to attend an inpatient program will depend on their needs and their level of dependence or addiction. 

Whether someone chooses inpatient or outpatient treatment, the overall programs are similar in what they offer. The first step provides detox if the person requires it. This may include medications and behavior therapy. 

Group therapy and individual counseling are common elements of the recovery process, according to the Substance Abuse and Mental Health Services Administration.

  • Cognitive behavioral therapy (CBT) helps people to recognize negative behavior and thinking patterns so that they can change them. This therapy also emphasizes helping people to learn coping skills that can help them avoid future substance abuse.
  • Motivational enhancement therapy (MET) allows people to create plans for the future and develop methods to keep them motivated to meet their goals.
  • Contingency management (CM) is another option for therapy. This works to reinforce positive behaviors by providing incentives to those who remain abstinent from using marijuana.
  • Twelve-step facilitation therapy uses the 12-step model for support and to help clients remain abstinent from marijuana use.

Therapy can be individual or in a group. Group counseling might also include peer-to-peer support. 

When Is Help Needed?

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Call Now (954) 893-2710

Because many states throughout the U.S. are legalizing marijuana, many people believe it is a safe drug. However, there are issues that people should know about regarding its use, abuse, and potential for tolerance, dependence, and addiction.

If you are struggling with the abuse of marijuana or a rising tolerance to it, it is ly time to reach out for help.

With comprehensive addiction treatment, you can step away from the fog of marijuana abuse and embrace a more balanced life in recovery.

Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved December 2018 from from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf

(June 2018) Marijuana. National Institute on Drug Abuse. Retrieved December 2018 from from https://www.drugabuse.gov/publications/drugfacts/marijuana

(1976) Aspects of Tolerance to and Dependence on Cannabis. Annals of the New York Academy of Sciences. Retrieved December 2018 from from https://www.ncbi.nlm.nih.gov/pubmed/828472

(October 2018) Cannabis Use and the Development of Tolerance: A Systematic Review of Human Evidence. Neuroscience and Biobehavioral Reviews. Retrieved December 2018 from from https://www.sciencedirect.com/science/article/pii/S0149763418302665

(December 2015) Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry. Retrieved December 2018 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037576/

Treatments for Substance Use Disorders. Substance Abuse and Mental Health Services Administration. Retrieved December 2018 from from https://www.samhsa.gov/treatment/substance-use-disorders

Source: https://areterecovery.com/drug-tolerance/marijuana/

Tolerance to marijuana

Cannabis: tolerance and dependence

Tolerance to marijuana is said to develop when the response to the same dose of marijuana decreases with repeated use. But how marijuana works in the body to provoke increased tolerance is not really understood.

 You can develop tolerance simply by using marijuana over a length of time or by having a natural tendency to tolerate marijuana in the system.

However, building up tolerance to marijuana does not mean that you are addicted to THC (Is THC addictive substance? Yes).

In this article, we discuss the difference between tolerance, dependence and addiction. And then we invite your questions about marijuana at the end.

Developing tolerance to marijuana

Tolerance is characterized by a need for a larger dose of a medication to maintain the original effect. While doctors still don’t understand WHY tolerance occurs, developing tolerance to marijuana can involve both psychological and physiological factors. So, what DO we know?

Tolerance to the behavioral and psychological effects of THC has been demonstrated in adolescent humans and animals in a number of studies conducted in the last 15 years.

Gross tolerance to the major effects of marijuana does not ordinarily occur in people with moderate or intermittent use and if tolerance does occur, it is to certain aspects of the physiological responses to marijuana.

The mechanisms that create this tolerance to THC are thought to involve changes in cannabinoid receptor function.

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You may be concerned that as you start to develop a tolerance to marijuana, this means they are becoming addicted. This isn’t the case. To be clear, tolerance to marijuana does not necessarily mean that addiction or dependence will develop.

Physical dependence is defined as development of withdrawalsymptoms when marijuana use is discontinued abruptly. tolerance, this is a normal physiologic response (expected after 2-4 weeks of continuous and frequent use daily). And drug addiction is the compulsive use of a substance, despite its negative or dangerous effects.

Tolerance simply means that your body has adapted to the presence of marijuana in your system and does not react to its chemical cues.

Marijuana tolerance symptoms

Characteristics of marijuana tolerance include reversibility, differential development by person and differential rate of occurrence, depending on the particular drug, dosage and frequency of use. The Diagnostic and Statistical Manual of the American Psychiatric Association defines drug tolerance as having either or both of the following characteristics:

1. A need for markedly increased amounts of marijuana or THC to achieve intoxication or the desired effect

2. A markedly diminished effect on the user with continued use of the same amount of marijuana or THC

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If you find that these marijuana tolerance symptoms apply to you, don’t worry. This doesn’t mean you are addicted to marijuana. Instead, these are only indicators that the effects of marijuana no longer work for you. While tolerance, dependence, and addiction can be present simultaneously, each condition is a separate and different entity.

Marijuana tolerance: How long?

Marijuana tolerance is different for everyone. Studies of marijuana tolerance suggest that with continuous, frequent daily use, a person can expect to build up a tolerance to marijuana over a 2-4 week period. However, time periods will vary from person to person.

Additionally, individuals diagnosed with depression or anxiety may find that they build marijuana tolerance faster than those who use recreationally or those who use marijuana medicinally.

Similarly, those who use marijuana in peer situations may find they build up a tolerance quicker because their use can be more frequent.

High tolerance to marijuana

There is plenty of speculation as to what constitutes ‘high’ tolerance to marijuana. It is suggested that each strain of marijuana has a different ceiling. That is to say, each strain of marijuana will only get you so high.

Therefore, high tolerance is strain specific.

High tolerance is also dependent on what the individual is hoping to achieve with use and if there are any underlying psychological or physiological conditions, as different people with experience tolerance to different aspects of the high.

While one person can adapt to the physical effects of marijuana use, others will adapt to the psychological effects.

More research is needed in this area to better understand how marijuana tolerance is processed by the body and brain.

  But if you’re looking to stay motivated to stop smoking weed, know that tolerance generally returns after a period of abstinence and that the best way to stop smoking marijuana is to stay stopped.

How to lower tolerance to marijuana

You can lower your tolerance to marijuana but little evidence is available to indicate if you could lower tolerance to your original base level.

In other words, there could always be a level of maintained tolerance as long as you are smoking marijuana.

If you want to lower tolerance to marijuan, the best way to do so is to cut back on the amount and frequency with which you use marijuana. Other suggestions include:

  1. Reduce the amount of marijuana used initially upon waking.
  2. Starting the day with a large dose of marijuana will reduce the effects of any marijuana used throughout the day.
  3. Alternate one week on, one week off to preserve effect. Some call this a “drug holiday”. That is, you stop taking marijuana for a while to give the body time to lower its tolerance.
  4. Incorporate regular exercise and a healthy diet into regular marijuana use. Keeping the body at a peak level allows the body to ‘flush’ the residual marijuana the system by lowering the number of fat cells to maintain potency.

Building up tolerance to marijuana questions

Do you still have questions about building up tolerance to marijuana? Please send use your questions, comments, and feedback in the comment form below. We try to respond to all questions with a personal and prompt reply. And if we don’t know the answer, we will refer you to someone who does.

Office of National Drug Control Policy

Source: https://drug.addictionblog.org/tolerance-to-marijuana/

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