Substance Use Disorder with Physiological Dependence

Diagnostic Criteria

The American Psychiatric Association's DSM-5 criteria for Cannabis Use Disorder are met at the severe level (6 or more criteria within a 12-month period) 2, 1
The patient demonstrates tolerance by needing larger quantities for the same effect, as defined by the American Academy of Family Physicians 3, 4
The patient exhibits classic cannabis withdrawal symptoms, including insomnia, irritability, and physical discomfort, as described by the American Academy of Family Physicians 3, 4, 1

The patient's cannabis use has increased from 1 joint daily to 5 joints daily over the past year, indicating a larger amount/longer period of use, according to the American Academy of Family Physicians 4
The patient experiences social/interpersonal problems, including conflict with their partner about cannabis use, as reported by the American Academy of Family Physicians 3, 4
The patient has failed to fulfill major role obligations, including a drop in college coursework grades, as noted by the American Academy of Family Physicians 3, 4

The presence of both tolerance and withdrawal symptoms definitively establishes physiological dependence, as stated by the American Academy of Family Physicians 3, 4, 1
Cannabis withdrawal typically occurs within 24-72 hours of cessation and includes irritability, anxiety, insomnia, and physical symptoms, according to the American Academy of Family Physicians 5, 1

The American Academy of Family Physicians recommends intensive treatment with referral to specialized addiction services for patients with substance dependence/severe SUD 3, 4
Pharmacotherapy, including cannabinoid agonist replacement, may be considered for heavy users, as suggested by the American Academy of Family Physicians 5
Psychosocial interventions, such as motivational enhancement therapy and cognitive-behavioral therapy, show the best evidence for cannabis use disorder, according to the American Academy of Family Physicians 5, 1

Monitor for cannabis withdrawal syndrome during cessation attempts, which affects 50-95% of heavy users, as reported by the American Academy of Family Physicians 5, 1
Do not dismiss cannabis withdrawal as clinically insignificant, as it can contribute to relapse, according to the American Academy of Family Physicians 5