In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), cannabis abuse constitutes one part of cannabis use disorder (CUD). The subsequent component of CUD is cannabis dependence. There are certain criteria used to diagnose the disorder, and these incorporate both the acute and chronic effects of cannabis use.

A mental status examination (MSE) should be carried out, as cannabis use alters mentation. There are specific aspects of mental function that are typically affected. These include mood, affect, thoughts, and cognition. Mood and affect manifestations differ acutely and chronically. In acute intoxication, patients may display a relaxed or euphoric mood, excessive laughter, and congruent affect. In chronic cases, the mood may be negative, for example, depressed, irritable, anhedonic, suicidal or homicidal. The affect is often restricted. Thought and perceptual disturbances include loosening of associations, and in some cases, hallucinations and delusions. Cannabis abuse can also lead to reversible cognitive impairment, compromising both memory and concentration [1] [2]. Furthermore, individuals often demonstrate a decreased interest in daily activities and a low level of motivation.

The hallmark signs of acute cannabis use, appearing hours after smoking, are redness of the eyes, dry mouth, and increased appetite [3]. In addition, tachycardia is also common. Other physical signs and symptoms include visual disturbances, sweating, headaches, and impaired motor abilities. Psychiatric effects include anxiety, paranoia, labile mood, forgetfulness, poor concentration, and psychotic features. Symptoms disappear after 2 to 3 hours.

Cannabis abuse may interfere with various aspects of life, such as social interactions and financial stability. It is often used by drug abusers as a second drug, in combination with other drugs [4].

The complications of cannabis abuse include the worsening of pre-existing psychiatric disorders, as well as the occurrence of new psychotic disorders, such as schizophrenia. The risk of schizophrenia is magnified with earlier onset of use, especially before the age of 15 years [5]. Further, depression and dependence are recognized complications of cannabis use [6]. The latter particularly poses a challenge to treatment [7]. Moreover, there is an increased lifetime risk of both depression and anxiety disorders in users. Cannabis dependence can lead to withdrawal symptoms, but these are usually less severe in comparison to various drugs of abuse [8]. This is more commonly seen in long-term users [8].

Systemically, it has been shown that there is temporary damage to the respiratory system, that resolves upon cessation of smoking cannabis [9]. There is, however, no confirmed link between cannabis use and acquiring chronic obstructive pulmonary disease (COPD) or lung cancer.

Cannabis abuse, as part of cannabis use disorder, is categorized into mild, moderate, and severe. The diagnostic procedures include a physical examination as well as an MSE. The DSM-5 definition and criteria for cannabis use disorder stipulate that an individual must have clinically significant impairment of functioning in two or more areas, for at least one year. The list of criteria includes: taking increasingly large amounts of the drug, cravings, strained interpersonal relationships, a significant amount of time dedicated to use of the drug, tolerance, development of dependence, and the occurrence of withdrawal symptoms upon withdrawal of the drug.

Treatment for cannabis abuse typically involves a combination of approaches:

• Behavioral Therapy: Cognitive-behavioral therapy (CBT) helps patients recognize and change problematic behaviors.
• Motivational Enhancement Therapy: This approach encourages individuals to develop a personal motivation to change.
• Support Groups: Programs like Marijuana Anonymous provide peer support and shared experiences.
• Medication: While no specific medications are approved for cannabis abuse, some may be used to manage withdrawal symptoms or co-occurring disorders.

The prognosis for individuals with cannabis abuse varies. With appropriate treatment, many can achieve significant improvement and maintain long-term abstinence. However, the risk of relapse is present, and ongoing support is often necessary to sustain recovery.

Cannabis abuse can result from a combination of genetic, environmental, and psychological factors. Genetic predisposition may increase susceptibility, while environmental influences such as peer pressure and availability of cannabis can contribute. Psychological factors, including stress and mental health disorders, also play a role.

Cannabis is one of the most commonly used illicit substances worldwide. The prevalence of cannabis abuse is higher among adolescents and young adults, with males generally more affected than females. The increasing legalization and decriminalization of cannabis in various regions have influenced usage patterns.

Cannabis contains compounds called cannabinoids, with delta-9-tetrahydrocannabinol (THC) being the primary psychoactive component. THC interacts with the brain's endocannabinoid system, affecting areas involved in pleasure, memory, thinking, concentration, and coordination. Chronic use can alter brain function, leading to dependence and withdrawal symptoms.

Preventing cannabis abuse involves education and awareness. Strategies include:

• Educating young people about the risks associated with cannabis use.
• Promoting healthy coping mechanisms for stress and mental health issues.
• Implementing policies to limit access to cannabis, especially for minors.
• Encouraging open communication within families about substance use.

Cannabis abuse is a significant public health concern characterized by the problematic use of cannabis, leading to various negative outcomes. Understanding its presentation, workup, and treatment options is crucial for effective management. Prevention efforts focus on education and reducing access, particularly among vulnerable populations.

If you or someone you know is struggling with cannabis use, it's important to recognize the signs of abuse. These may include using more cannabis than intended, experiencing withdrawal symptoms, and neglecting responsibilities. Treatment options are available and can help individuals regain control over their lives. Support from healthcare professionals, therapy, and peer groups can be instrumental in recovery.

1. Sharma P, Murthy P, Bharath MM. Chemistry, metabolism, and toxicology of cannabis: clinical implications. Iran J Psychiatry. 2012;7(4):149-156.
2. Rabin RA, Zakzanis KK, Daskalakis ZJ, George TP. Effects of cannabis use status on cognitive function, in males with schizophrenia. Psychiatry Res. 2013;206(2-3):158-165.
3. Saugy M, Avois L, Saudan C, et al. Cannabis and sport. Br J Sports Med. 2006;40(Suppl 1):i13-i15.
4. Epstein DH, Preston KL. Review Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment? Past findings and more evidence against. Addiction. 2003;98(3):269-279.
5. Evins AE, Green AI, Kane JM, Murray RM. Does using marijuana increase the risk for developing schizophrenia? J Clin Psychiatry. 2013;74(4):e08.
6. Cannabis and mental health. Royal College of Psychiatrists. http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/cannabis.aspx. Published February, 2009. Accessed 21 October, 2017.
7. Danovitch I, Gorelick DA. State of the art treatments for cannabis dependence. Psychiatr Clin North Am. 2012;35(2):309-326.
8. Budney AJ. Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue? Addiction. 2006;101(Suppl 1):125-133.
9. Joshi M, Joshi A, Bartter T. Marijuana and lung diseases. Curr Opin Pulm Med. 2014;20(2):173-179.