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As a millennial, I’ve seen the reputation of potheads elevate from burnouts buying incense and Grateful Dead shirts at the mall to successful adults who don’t drink but enjoy unwinding and having a good time. The legalized cannabis era has even cultivated a surprising conversational common ground. That family member you’re hoping doesn’t bring up politics at dinner? They’d love to talk gummies instead.
At the same time, ever since I was a teenager (buying incense at the mall), I’ve heard the same refrain over and over again: weed is not addictive. To be honest, that never felt entirely true. I mean, just because my high school friends could make gravity bongs did not make them experts on this topic. Admittedly, we had no clue what we were talking about. As for the weed-smoking community outside my circle of friends, there are over 360,000 users in the subreddit r/leaves, an online group for people trying to quit or seeking support in their recovery, who would beg to differ with the assessment that cannabis is not addictive.
If you reference cannabis use disorder (CUD), as it’s outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, marijuana seems pretty addictive — two of the main symptoms include craving the drug and experiencing withdrawal symptoms. However, physician Benjamin Caplan, M.D., author of The Doctor-Approved Cannabis Handbook, argues this definition is “deeply flawed” and ”so broad that they often classify normal cannabis use as pathological.”
By these standards, consuming cannabis regularly, building a tolerance and wanting to use more are considered defining characteristics of a disorder. In reality, though, people do the same thing with coffee, antidepressants and over-the-counter pain relievers. While gradual increases in dosages may not be great for an individual’s health over time, it isn’t pathologized in the same way. As Caplan puts it, “Developing tolerance is normal biology, not a sign of addiction.”
What we do know is that more people are consuming weed regularly. The number of adults in the U.S. who smoke marijuana has more than doubled since 2013.
Other data indicates that the number of adults who use cannabis daily or near-daily now exceeds the number of adults who drink with the same frequency. There’s evidence that in states where weed is legal, fewer people are filling their prescriptions for anxiety medications like Xanax and other benzodiazepines. Both alcohol and benzos are highly addictive substances linked with potentially fatal withdrawal symptoms, whereas the relationship between cannabis and addiction remains cloudy at best.
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According to Caplan, who writes a weekly newsletter about new cannabis research, part of the problem is that many early studies “were designed to find harm rather than to take an honest, scientific look at how cannabis interacts with the brain.” This is further complicated by the fact that the drug operates through the endocannabinoid system, “which is far less understood than the opioid or dopamine systems, which drive classic addiction models,” he tells me.
That said, there are reasons to believe that cannabis works differently than other habit-forming substances. Emerging research suggests that unlike alcohol, nicotine and opioids, cannabis does not follow a linear relationship between dosage and addiction. “Cannabis addiction is far more dependent on patterns of use and psychological factors than sheer quantity alone,” Caplan says.
True cannabis addiction, he argues, is better defined as when someone continues to use “despite severe harm.” Whether it’s damage to your health, job, or familial or social responsibilities, the inability to pull back from using and attend to those aspects of your life is the issue. Based on this criteria, someone using low-to-moderate doses on a daily basis who feels incapable of functioning without weed is at greater risk for addiction than someone who takes a higher dose to simply have a good time.
This is partly why traditional recovery models for people struggling to curb their cannabis use don’t always work. “Twelve-step programs like AA and NA were designed for substances with severe withdrawal risks and life-threatening consequences, which cannabis simply doesn’t have,” Caplan says. That’s why many weed users find an all-or-nothing approach to be a bad fit. “They don’t account for the unique nature of cannabis use, which often includes medical and therapeutic benefits.”
Still, symptoms of cannabis withdrawal can and do happen. These can include irritability, sleep disturbances, appetite fluctuations, anxiety or restlessness, and physical discomfort such as headaches and stomachaches. “Unlike alcohol or opioid withdrawal, which can be life-threatening, cannabis withdrawal is more of an inconvenience than a medical emergency,” Caplan says, comparing it to quitting caffeine abruptly. “Some people feel off for a bit, but their bodies adjust.”
Simple self-care strategies can ease these symptoms, like proper hydration, exercise and sleep. “Some people find CBD and melatonin useful for sleep disturbances,” Caplan adds, “but more research is needed.”
Although some studies have linked cognitive deficits to problematic cannabis use, the good news is that these are generally regarded as reversible, unlike with alcohol or methamphetamines which can cause permanent brain damage.
“Studies show that memory, motivation and executive function improve significantly within weeks to months of stopping,” Caplan says. If you’re impatiently waiting for your brain to bounce back, he recommends exercise to boost neuroplasticity and balance your endocannabinoid system, as well as omega-3 fatty acids found in fish and flaxseed for further cognitive health. He also suggests “engaging in mentally stimulating activities,” which help “strengthen neural pathways and restore executive function,” like reading, writing and problem-solving.
In other words, before you pick up a bowl of weed, pick up a book. But if you’re struggling to cut back on cannabis when it’s negatively impacting your life, Caplan points to harm-reduction strategies, motivational enhancement therapy (MET) and mindfulness-based relapse prevention (MBRP) as helpful tools.
“The key factor is why they struggled with cannabis use in the first place,” he says. Caplan has found that if people are self-medicating untreated mental health conditions like anxiety or depression with cannabis, they need to find alternative strategies for managing their issues. Think exercise, therapy or meditation. The bottom line: “Without alternative coping mechanisms, they may be at risk of returning to problematic use.”
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