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Cannabis Use Disorder
Cannabis Use Disorder (CUD) is a mental health condition associated with the use of cannabis in a way that causes significant adverse effects to health, relationships, and overall quality of life. Tetra hydra cannabinol (THC) is the active substance found in cannabis, and it is responsible for the psychoactive properties of cannabis. In Nigeria, cannabis, often called “igbo” or “weed,” is the most commonly used illegal drug, owing to its availability, widespread cultivation, and cultural acceptance in some communities. It was reported that 10.8% of the adult population in the country is involved in cannabis abuse. There is up to 15.9% life-time prevalence among adolescents and young adults in sub-Saharan Africa. Socio-economic factors such as poverty, unemployment, and peer pressure further contribute to this burden, particularly among young adults and adolescents. Despite its widespread use, not many people are enlightened about its health effects; among them are psychosis, anxiety, and cognitive impairments, all of which can be detrimental to overall health if not well managed.
Symptoms
Cannabis Use Disorder (CUD) affects people in different ways. These symptoms are primarily classified into three categories, based on how a person acts (behavioural), how their body feels (physical), and how they think or feel emotionally (psychological).
- Behavioural Symptoms: Increased intake of cannabis, difficulty reducing or controlling consumption, neglect of daily obligations, and continued use even when adverse effects are evident.
- Physical Symptoms: development of tolerance, withdrawal symptoms upon discontinuance (including irritability, insomnia, decreased appetite, and restlessness), and Cannabis related health issues such as chronic bronchitis and potential cardiovascular disorders.
- Psychological Symptoms: strong urges to use cannabis, persistent thoughts about cannabis, and frequent mood disturbances, reduced cognitive functioning and/or violence. A rare condition called “Run amok” can also be seen in chronic cannabis users or acute intoxication.
In Nigeria, CUD is linked with social issues such as poor academic performance, unemployment, and increased participation in criminal activities, especially among the youth.
Clinical Findings
Doctors might notice the following during CUD assessment:
- Psychiatric Examination: presence of signs of intoxication, which include euphoria, anxiety, uncontrollable laughter, altered perception and inattentiveness, or withdrawal, which causes a depressed mood resulting in apathy, lack of motivation, and isolation. Sometimes patients may also show signs of cognitive impairment.
- Physical Examination: presence of chronic cannabis use symptoms, such as conjunctival injection (red eyes), tachycardia, dry mouth, and poor hygiene. Chronic users also experience respiratory issues, such as chronic bronchitis and other cannabis-related pulmonary symptoms.
Differential Diagnosis
CUD differential may include intoxication syndromes from other conditions, including:
- Other Substance Use Disorders: Intoxication from alcohol or opioids is common and may obscure diagnosis.
- Mood Disorders: comorbid with CUD are depression and bipolar disorder, which may follow cannabis use
- Anxiety Disorders: restlessness, inattentiveness, and other panic disorders associated with cannabis withdrawal might be evident.
- Psychotic Disorders: Cannabis-induced psychosis and primary psychotic disorders, such as schizophrenia symptoms, may overlap, as both can cause hallucinations, delusions, and disorganized thought processes.
Investigations
CUD is primarily diagnosed clinically; however, some investigations help to confirm use, evaluate the extent of physiological or psychological impact, and guide management.
Some of these investigations include:
- Toxicology Screening: One major method for cannabis use diagnosis is urine toxicology tests also known as Urine Drug Analysis (UDA). While this might not give details of levels of damage, it's particularly helpful to confirm cannabis use, understand the patient's history, and monitor treatment.
- Laboratory Blood Tests: Routine blood tests, especially in patients with long-term cannabis use, liver function tests, and complete blood count, are tests useful to identify systemic complications in chronic users.
- Neuroimaging: Changes in the brain structure may mediate the adverse outcomes of CUDs, which makes brain imaging studies such as Magnetic Resonance Imaging or Computed Tomography necessary in individuals showing neurological symptoms of CUD. Neuroimaging is useful to inform treatment and rule out other causes of cognitive impairment.
- Psychological Assessments: This involves testing, interviewing, observation, and record review of patients to arrive at a solid diagnosis, treatment decisions, and monitoring. It involves the use of standardized measures or tools like the Cannabis Use Disorders Identification Test (CUDIT) to evaluate the behaviors and personal qualities of a suspect user.
Treatment
Treatment for CUD in Nigeria is not only medical but also non-medical, based on an individual's needs and the cultural atmosphere of the population. Drug rehabilitation is the most important in management of patients with CUD, this included admission into a rehabilitation program. However, it can be managed as an out-patient with insignificant success rate. The treatment follows the bio-psycho-social approach in a multidisciplinary team involving the Psychiatrist, psychologist, occupational therapist, psychiatric nurses and social workers.
- Pharmacotherapy: Currently, there are no FDA-approved medications that solely target CUD, but symptomatic treatments such as antidepressants and anxiolytics are considered to target withdrawal symptoms, craving, or relapse
- Psychotherapy: Cognitive-behavioral therapy and motivational interviewing are effective for the psychological management of CUD. Engaging in group therapy and support groups has also been found to be helpful.
- Cultural and Spiritual Interventions: The non-medical approaches, which include traditional medicine and spiritual counseling, can also help in the management of CUD, especially in places where the people are deeply involved in traditional practices.
Follow-Up
Regular follow-up is necessary to monitor treatment improvement, prevent relapses, and provide ongoing assistance:
- Frequency: Early follow-up treatment should be within 1-2 weeks of starting, with checkups every 4-6 weeks later.
- Monitoring: There should be assessment for restraint from cannabis, proper use of medicine, and any potential complications.
Prevention and Control
Prevention of CUD in Nigeria entails:
- Public Education: Creation of awareness about the risks of cannabis consumption and promotion of healthy conduct through public education campaigns.
- Screening: CUD screening at regular intervals in primary care, especially among high-risk individuals such as teenagers and drug addicts.
- Policy Measures: Legislation and regulation on cannabis production, sale, and consumption that target underage consumption and driving under the influence.
Cannabis Use Disorder is a serious health concern affecting the Nigerian populace, especially due to its availability, cultural acceptability, stigma, and resource constraints. Interventions of the government in providing public education, integrated care, and those of the community in ensuring early identification, collaboration with the government by accepting treatment developments are essential to avert outcomes.
A case of a 22-year-old Nigerian student who had used cannabis for three years was brought to the psychiatric clinic. He claimed he started using cannabis solely for recreational purposes, but he became dependent on it and started taking it every day. Attempting to stop was a big huddle because whenever he tried to stop, he began to experience sleeplessness, appetite loss, irritability, and other withdrawal symptoms. After he went through a series of investigations and was diagnosed with severe cannabis use disorders, he was enrolled in a local support group and referred for cognitive-behavioural therapy. He was monitored for six months with regular checkups; his proper adherence and participation in the support group helped him develop consistent self-control during the treatment window, and he was able to enhance his academic performance and mend his relationships. This case highlights the importance of well-tailored treatment recommendations in improving recovery outcomes even in severe cases of CUD.
- Gureje, O., Degenhardt, L., Olley, B., Uwakwe, R., Udofia, O., Wakil, A., & Adeyemi, O. (2007). A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century. Drug and Alcohol Dependence, 91(1), 1-9.
- Adewuya, A. O., & Ola, B. A. (2005). Prevalence of substance use disorders among Nigerian university students: A comparative study. Journal of Substance Use, 10(5), 309-315.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between cannabis use disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
Author's details
Reviewer's details
Cannabis Use Disorder
Cannabis Use Disorder (CUD) is a mental health condition associated with the use of cannabis in a way that causes significant adverse effects to health, relationships, and overall quality of life. Tetra hydra cannabinol (THC) is the active substance found in cannabis, and it is responsible for the psychoactive properties of cannabis. In Nigeria, cannabis, often called “igbo” or “weed,” is the most commonly used illegal drug, owing to its availability, widespread cultivation, and cultural acceptance in some communities. It was reported that 10.8% of the adult population in the country is involved in cannabis abuse. There is up to 15.9% life-time prevalence among adolescents and young adults in sub-Saharan Africa. Socio-economic factors such as poverty, unemployment, and peer pressure further contribute to this burden, particularly among young adults and adolescents. Despite its widespread use, not many people are enlightened about its health effects; among them are psychosis, anxiety, and cognitive impairments, all of which can be detrimental to overall health if not well managed.
- Gureje, O., Degenhardt, L., Olley, B., Uwakwe, R., Udofia, O., Wakil, A., & Adeyemi, O. (2007). A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century. Drug and Alcohol Dependence, 91(1), 1-9.
- Adewuya, A. O., & Ola, B. A. (2005). Prevalence of substance use disorders among Nigerian university students: A comparative study. Journal of Substance Use, 10(5), 309-315.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between cannabis use disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
Content
Author's details
Reviewer's details
Cannabis Use Disorder
Background
Cannabis Use Disorder (CUD) is a mental health condition associated with the use of cannabis in a way that causes significant adverse effects to health, relationships, and overall quality of life. Tetra hydra cannabinol (THC) is the active substance found in cannabis, and it is responsible for the psychoactive properties of cannabis. In Nigeria, cannabis, often called “igbo” or “weed,” is the most commonly used illegal drug, owing to its availability, widespread cultivation, and cultural acceptance in some communities. It was reported that 10.8% of the adult population in the country is involved in cannabis abuse. There is up to 15.9% life-time prevalence among adolescents and young adults in sub-Saharan Africa. Socio-economic factors such as poverty, unemployment, and peer pressure further contribute to this burden, particularly among young adults and adolescents. Despite its widespread use, not many people are enlightened about its health effects; among them are psychosis, anxiety, and cognitive impairments, all of which can be detrimental to overall health if not well managed.
Further readings
- Gureje, O., Degenhardt, L., Olley, B., Uwakwe, R., Udofia, O., Wakil, A., & Adeyemi, O. (2007). A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century. Drug and Alcohol Dependence, 91(1), 1-9.
- Adewuya, A. O., & Ola, B. A. (2005). Prevalence of substance use disorders among Nigerian university students: A comparative study. Journal of Substance Use, 10(5), 309-315.
- Oladeji, B. D., & Gureje, O. (2013). The comorbidity between cannabis use disorders and other mental health conditions in low- and middle-income countries. Current Opinion in Psychiatry, 26(1), 1-7.
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