The DSM-5 Mental Disorders Associated with Cannabis Use Disorder

By Laura Stack

In my writing, I often focus on the mental effects of marijuana use, since it caused psychosis in my son, Johnny, and ultimately destroyed his life. A recent 2020 study in the journal Addictive Behaviors indicates that people who use cannabis have a 1 in 5 risk of developing a CUD. Risks increase if cannabis is initiated early and used frequently. The risk of developing CUD increased to 1 in 3 or 33% among young people who engaged in regular (weekly or daily) use of cannabis.

CUD was officially defined by the American Psychiatric Association (APA) in their key publication, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013. A closer look at the science and the Cannabis-Based Mental Disorders listed in DSM-5 provides further insight into the mental issues potentially caused by marijuana use. In this article, we’ll take a detailed look at them.

The DSM-5 Cannabis-Induced Mental Disorders

Upon its publication in 2013, DSM-5 specified six basic types of mental illness marijuana could either contribute to or trigger:

  1. Affective disorders of thought and feeling, including bipolar disorder, anxiety disorders, and depression
  2. Schizophrenia
  3. Amotivational syndrome
  4. Disruptive cognitive function
  5. Neuropsychological decline
  6. Psychotic disorders

In the years since the publication of the DSM-5 in 2013, the evidence for most of the DSM-5 categories has increased. Anxiety, panic attacks, depression, and bipolar disorder clearly fit within the DSM-5’s Category 1, Affective disorders. Suicidal thought and behavior also appear to represent an affective disorder.

Schizophrenia has its own category (#2) as do psychotic disorders (#6), in which paranoia is now included as a “delusional disorder.” We’re going to cover schizophrenia in depth in an upcoming article.

Category 3, Amotivational syndrome, is the classic “stoner effect” people joke about. When I first ran across it, I thought it was a reference to “motivational deficiency disorder,” a joke promulgated in 2006 as an effort by scientists to redefine laziness as an illness; this was meant to parody disease mongering by pharmaceutical companies. However, Amotivational Syndrome is quite real. Thus far it has been associated with cannabis abuse, and the use of SSRI medications.

Amotivational syndrome manifests as a general lack of motivation and ambition. Sufferers show an increase in apathy and a decrease in interest in activities associated with success and achievement. Detachment, blunted emotions, dulled physical drives, passivity, disinterest, and damaged attention and memory—many of these executive functions all controlled by the prefrontal cortex—also characterize amotivational syndrome. The sufferer basically gives up and accepts whatever life hands them. Their abilities to make decisions, prioritize activities, express emotions, and concentrate are all damaged, which may lead to some level of incoherence. In all this, combined with the loss of IQ, we see the classic ambition-free stoner: not a stereotype, but a concrete reality.

Categories 4 and 5, disruptive cognitive function and neuropsychological decline, are basically associated with the way marijuana “messes with your head.” Permanent IQ drop represents one symptom of disruptive cognitive function, while long-term mental effects like loss of memory, susceptibility to false memories, and increasing academic problems among students are typical of neuropsychological decline.

The Cannabinoid Connection

Ultimately, all the mental effects and deficits suffered by cannabis abusers are physical in nature because they result from a form of brain damage caused by cannabinoids, natural chemicals present in marijuana. Cannabinoids just happen to fit into the receptors in brain cells intended for neurotransmitters called endocannabinoids, so called because of their internal nature and resemblance to cannabinoids, which were identified by science first (sadly).

Endocannabinoids, which have become a rich field of study in recent years, only coincidentally resemble cannabinoids. Among other things, endocannabinoids are crucial to memory, thought transmission, sleep, physical growth, and brain development, making them especially important for young people. Unfortunately, the cannabinoids blocking their absorption into neurons can’t do the jobs of the real thing, so havoc ensues. This may affect everything from thought patterns to anxiety and sleep. The resulting damage can also trigger schizophrenia and psychotic episodes like Johnny’s, and brain development may end up arrested and stunted.

And while we know that marijuana can cause these disorders as listed in the DSM-5, we also know it can go the other way as well, with people who are already vulnerable to mood disorders and depression made worse by marijuana. According to a brand-new January 19, 2021 study, “Association of Cannabis Use with Self-harm and Mortality Risk Among Youths With Mood Disorders,” CUD is common among adolescents and young adults with mood disorders and is associated with an elevated risk of self-harm, overall mortality, and death by unintentional overdose and homicide in this already vulnerable population.

So, whether you are one of the ones who would not get a psychotic disorder from using marijuana anyway, or you’d cause yourself a psychotic disorder from using marijuana, or your mental disorder would be made worse by marijuana, causing you to harm yourself, are ANY of these worth the risk? Johnny would say no.

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