When Cannabis Use Becomes Cannabis Use Disorder
An article by Calen Trentini
In Canada, an estimated one in eleven people who use cannabis will develop cannabis use disorder, a number that climbs to one in six among those who started using as teenagers (Canadian Centre on Substance Use and Addiction, 2020). In the United States, that risk is estimated even higher: roughly three in ten people who use cannabis will go on to develop cannabis use disorder, and an estimated 20.6 million people aged 12 or older met the clinical criteria for it in 2024 (SAMHSA, 2024).
That figure sits awkwardly next to how cannabis is generally talked about. Legalization has made the drug more visible and more socially acceptable, and for most people who use it, that use never becomes a problem. But normalization hasn't changed how dependence forms, and it has just made it harder to recognize when it does. Cannabis use disorder is real, it is common, and it responds well to the right kind of treatment.
What cannabis use disorder actually looks like
Cannabis use disorder is not defined by how often someone uses or how much. It is defined by loss of control: using more than intended, being unable to cut down despite wanting to, spending a lot of time using or recovering from use, and continuing despite it causing problems at work, in relationships, or with health.
Tolerance and withdrawal are part of the clinical picture too, which surprises people who assume cannabis withdrawal isn't a real phenomenon. It is. Stopping after regular heavy use commonly brings irritability, disrupted sleep, decreased appetite, and anxiety in the days that follow, symptoms specific enough that they show up in the DSM-5, the same diagnostic manual used for other substance use disorders.
What's easy to miss from the inside is the loop this creates: someone smokes believing it treats their sleep or anxiety, when what's actually happening is that use is suppressing the withdrawal-driven sleep disruption and anxiety that regular use itself produces. In psychology, this pattern has a name: negative reinforcement, where a behaviour gets repeated because it removes an uncomfortable feeling, not because it produces a positive one.
Research tracing cannabis and sleep has documented this cycle directly: tolerance develops to cannabis's sleep-promoting effects, use increases to chase the same result, and abstinence then brings on the very sleep disturbance the person was using cannabis to manage in the first place (Babson & Bonn-Miller, 2014). In one clinical sample, 65% of people who'd tried to quit named poor sleep as the reason they relapsed (Budney et al., 2008). What looks like cannabis solving a problem is, for a meaningful number of users, cannabis maintaining the problem it appears to solve.
Why it goes unnoticed
Cannabis dependence tends to hide in plain sight. Unlike substances associated with acute crisis, cannabis use disorder usually develops slowly, and a lot of people who meet criteria for it are still functioning: going to work, maintaining relationships, meeting most obligations most of the time. Legal status reinforces the idea that if something is legal, it can't be a problem. None of that changes what's happening underneath: a pattern of use someone has tried and failed to control, costing them more than they intended to pay.
What actually works: motivational interviewing and CBT
The evidence on treatment is more encouraging than most people expect. A systematic review and meta-analysis of motivational interviewing for cannabis use disorder found it significantly increased the odds of abstinence in adults at roughly three months, with an odds ratio of 3.84 compared to control conditions (Calomarde-Gómez et al., 2021).
Cognitive behavioural therapy shows a similar pattern, and the strongest results tend to come from combining the two. In the Marijuana Treatment Project, the largest controlled trial of cannabis dependence treatment conducted to date, a combined motivational enhancement and cognitive behavioural approach produced the highest abstinence rates of any condition studied (Marijuana Treatment Project Research Group, 2004).
CBT works by identifying the specific thoughts, triggers, and habits that maintain use, and building alternative responses to them. Motivational interviewing works differently: rather than telling someone why they should change, it helps them examine their own reasons, at their own pace.
Why ambivalence is the starting point, not a barrier
Most people who seek help for cannabis use are not fully decided. Part of them wants to change, and part of them isn't sure they want to, or isn't sure they can. Motivational interviewing treats that ambivalence as the actual starting material of the work, not an obstacle to get past before the real therapy begins. Nobody needs to arrive certain. They need a space where their own reasons for change, and their own doubts about it, can be worked through honestly, without being argued out of either.
Acceptance and commitment therapy adds another piece: learning to tolerate the discomfort, cravings, and boredom that come with cutting down or stopping, rather than using cannabis to avoid them. Used alongside CBT and motivational interviewing, it gives people something to do with the urge in the moment it shows up, not just an explanation for where it came from.
Frequently asked questions (FAQs) about cannabis use disorder
Is cannabis actually addictive?
Yes. Cannabis use disorder is a recognized clinical diagnosis with its own criteria for tolerance, withdrawal, and loss of control, and roughly three in ten people who use cannabis will meet criteria for it at some point.
What are the signs someone has developed cannabis use disorder?
The clearest signs are using more than intended, repeated unsuccessful attempts to cut down, and continuing to use despite it causing problems at work, in relationships, or with health, rather than the amount used.
Does legal cannabis mean it isn't risky?
Legal status affects access and stigma, not how dependence forms. The pattern of use that defines cannabis use disorder develops the same way whether the substance is legal or not.
What does cannabis withdrawal actually feel like?
Most commonly irritability, disrupted sleep, reduced appetite, and anxiety in the days after stopping regular heavy use. It's uncomfortable rather than medically dangerous, but it's real, and it's a major reason people relapse when trying to quit alone.
What kind of therapy actually helps?
Motivational interviewing and cognitive behavioural therapy have the strongest evidence base, and the two combined tend to outperform either alone. Acceptance and commitment therapy is often used alongside them to help with cravings and discomfort in the moment.
Do I need to be ready to quit completely before I ask for help?
No. Motivational interviewing in particular is built for people who are still ambivalent. Working through that ambivalence honestly is part of the process, not a precondition for starting it.
About the author: Calen Trentini
I spent ten years as a coach and manager in the tech industry before training as a counsellor, and I bring a practical, grounded approach to that work now. My capstone research focused on therapeutic interventions for cannabis use disorder, and I draw on acceptance and commitment therapy, motivational interviewing, and dialectical behaviour therapy in my work with clients navigating anxiety, stress, burnout, addiction, and grief.
I offer a free 15-minute consultation so you can get a sense of what working together would be like and decide if we're the right fit.
