Cannabis Use Disorder in Adolescents

 

With new research recently becoming available, the discussion of cannabis/marijuana use has been a popular topic in the news lately.  While there are some known benefits of cannabis, there are also risks that parents of adolescents should be aware of.  Teens before the age of 18 who use marijuana are 4 to 7 times more at risk of developing substance use disorder than people who start using marijuana as adults (Winters & Lee, 2008). Additionally, 1 in 6 people who use marijuana before age 18 will become addicted.

What is Cannabis Use Disorder?

Contrary to the belief, it is possible to become addicted to cannabis.  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), cannabis addiction is known as Cannabis Use Disorder (CUD).  Cannabis Use Disorder is a pattern of cannabis use leading to significant impairment or distress.  Having 2-3 of the following symptoms indicates mild CUD, 4-5 symptoms indicate moderate CUD and having over six symptoms present means severe CUD.  Symptoms include:

  • Using more significant amounts of cannabis over a more extended time than planned
  • Having a desire or unsuccessful efforts to cut down or control cannabis use
  • A great deal of time spent obtaining, using, or recovering from cannabis use
  • Craving or a strong desire or urge to use cannabis
  • Failure to fulfill major role obligations (i.e., work, school, home)
  • Persistent or recurrent social or interpersonal problems
  • Important activities are given up or reduced (e.g., social, occupational, recreational)
  • Recurrent cannabis use in situations in which it is physically hazardous
  • Continuing to use despite knowledge of physical or psychological problems due to cannabis use
  • Tolerance (needing a more considerable amount of cannabis to get the same effect over time)
  • Withdrawal (irritability, anger, craving, trouble sleeping, lost appetite, depressive symptoms)

(American Psychological Association, 2013)

For more on recognizing if marijuana use might be problematic, please visit this blog post by Madeline Weinfeld, LCSW.

Adolescent Cannabis Use is not new.  So, why is this such a concern now?

 

The two main active ingredients in marijuana are tetrahydrocannabinol (otherwise known as THC) and cannabidiol (otherwise known as CBD).  THC is a psychoactive component in cannabis, the part that causes the “high.” CBD is not the cause of feeling high and is not addicting, but it produces anti-inflammatory, pain-relieving, and anti-anxiety effects.

With time, marijuana has become much more potent than it once was.  ElSohly et al. (2016) found that the average THC concentration in marijuana products in 1995 was about 4%, and in 2014, the average THC concentration was about 12%.  They also found that while the THC content has increased with time, the CBD concentration in marijuana products has decreased.  Today, on average, THC concentration in marijuana products is over 20%.

The growing concentration of THC in marijuana products means growing risks.  Studies show many negative consequences of adolescent marijuana use, and the increasing THC content may be part of this growing problem.  The impact of cannabis use depends on the age at which one starts using, recency, frequency, how long they have been using, and the dose of THC they are consuming.

 

Cannabis/ Marijuana Use and the Adolescent Brain

 

During the adolescence years, it is a critical time of brain development, and cannabis use can negatively impact the developing brain.  Drug use affects the brain’s frontal cortex, the essential area of brain development for teens.  The frontal cortex controls our self-regulation, decision-making abilities, ability to plan, and impulse control.  Teens already have trouble with all these abilities because their frontal cortex is still developing, so imagine what happens when adding cannabis use to that?

 

Teenagers’ environment and the activities they participate in impact the pruning of their developing brain.  Pruning occurs when the brain eliminates neural connections (synapses) that it no longer needs or uses to make the brain more efficient.  Neural connections are used more and become strengthened.

All psychoactive substances impact the brain’s reward system by causing increases in dopamine.  With time and continued drug use, this reward system begins to get activated by environmental cues rather than just drug use itself.  It means that the reward system gets activated by things in the environment associated with drug use, including people or places, making the individual more likely to seek and use that drug again.  Over time, the brain becomes less sensitive to non-drug-related rewards, leading to a lack of motivation for everyday activities and relationships that are not associated with the drug.

It is all-important to keep in mind when discussing teen cannabis use disorder because, for teens who are consistently using cannabis, the associations the brain makes to the drug could strengthen with time and increase their usage.  As a result, drug use will continue, and addiction likely will develop.  While teens are developing their brains, it makes them more sensitive to the effects of drugs.  Because of this, once teens begin using cannabis regularly, it becomes more challenging to resist urges to use and follow through on decisions to stop using the drugs.  It makes teens more likely to crave cannabis and leads them to develop substance abuse problems much more quickly and more often than adults.  In comparison, adults who use cannabis already have a fully developed frontal cortex, and the pruning has stopped making them less vulnerable.  Therefore, addiction is more than likely not to be permanent.

 

Psychological Risks of CUD for adolescents

Psychosis and Schizophrenia

Recent studies have shown the link between cannabis use and psychosis and schizophrenia.  Teen cannabis use causes a 2-fold increase in developing schizophrenia or psychosis as an adult (Levine et al. 2017).  The risk becomes even greater depending on how early the individual begins using marijuana, how often they use marijuana, and for those who have a genetic risk factor for psychotic disorders.

 

Depression, Suicide, and Non-Suicidal Self Injury

There are mental health concerns in connection with cannabis use, like depression.  When there is more frequent usage, it becomes associated with an increase in depressive symptoms.  Studies have shown that suicidality, suicide attempts, and self-harming behaviors increase among teen marijuana users.  Fontanella et al. (2021) found that cannabis use was a common factor in adolescent self-harm, all causes of death for teens, and homicide in teens with mood disorders.

 

Opioids

Cannabis use is linked to an increased likelihood of developing nonmedical prescription opioid use disorder.

 

Treatment

 

While it is clear that there are serious risks to teen cannabis use disorder, the good news is there are effective methods of treatment.  The four main treatment methods include:

Family therapy

Family therapy is one of the most effective forms of treatment for adolescent CUD.  A family therapy approach would target communication between family members, family roles, and building trust.  Positive social support from loved ones can be essential for a teen’s recovery.  Family involvement can increase the teen’s motivation to change their behavior, as teens need to feel they are not alone and have support.  On the other hand, negative family interactions and patterns can contribute to relapse or continued substance use, which is why a family therapy approach could be so helpful.

 

Behavioral therapy

Behavioral therapy aims to reinforce positive behaviors and eliminate negative ones.  A behavioral approach would focus on teaching skills and coping methods and might use contingency management or rewards.  Dialectical Behavioral Therapy (DBT) is one such treatment that has shown effectiveness in helping teens cope with substance use disorders.  For more information on DBT, please visit our website.

 

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) addresses how thoughts, feelings, and behaviors are connected and will seek to understand how a teen perceives their environment.  This approach may help the teen understand their triggers for cannabis use and how to better cope with those triggers.

 

Motivational enhancement therapy

Motivational enhancement therapy aims to increase an individual’s motivation to change their behavior.  In this approach, the therapist engages the client and nonjudgmentally helps them explore their substance use and its impacts.  This approach acknowledges that there is often ambivalence and resistance to making changes, and it meets the client where they are.  With time, these techniques help build motivation and confidence within the client so they can make effective and long-lasting changes.

 

Adolescent Cannabis Use Disorder can be very challenging and distressing for the teen and the family.  However, there is support out there.  If you are seeking treatment for your teenager, the therapists at Gateway to Solutions are here to help.

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