CANNABIS AND HALLUCINOGEN-

RELATED DISORDERS
Edna Chávez

Cannabis Use Disorder

Cannabis Intoxication
Cannabis withdrawal
Other Hallucinogen Use Disorder
Other Hallucinogen Intoxication

 CANNABIS USE DISORDER

Diagnostic criteria
01 02
A problematic pattern of an abuse leading to
1. Cannabis use is continued despite knowledge
clinically significant impairment or dis­tress, as
of having a persistent or recurrent physical or
manifested by at least two of the following,
psychological problem that is likely to have
occurring within a 12-month period:
been caused or exacerbated by cannabis.
Cannabis is often taken in larger amounts
2. Tolerance, as defined by either of the
or over a longer period than was intended.
following:
There is a persistent desire or unsuccessful
a. A need for markedly increased amounts of
efforts to cut down or control cannabis use.
cannabis to achieve intoxication or desired
A great deal of time is spent in activities
effect.
necessary to obtain cannabis, use canna­
b. Markedly diminished effect with continued
bis, or recover from its effects.
use of the same amount of cannabis.
Craving, or a strong desire or urge to use
3. Withdrawal, as manifested by either of the
cannabis.
following:
Recurrent cannabis use resulting in a failure
4. a. The characteristic withdrawal syndrome for
to fulfill major role obligations at work,
cannabis.
school, or home.
5. b. Cannabis (or a closely related substance)is
Continued cannabis use despite having
taken to relieve or avoid withdrawal
persistent or recurrent social or interper­
symptoms.
 Diagnostic Criteria
03 04
Specify if: Specify current severity:
In early remission: After full criteria for Mild: Presence of 2-3 symptoms.
cannabis use disorder were previously met, Moderate: Presence of 4-5 symptoms.
none of the criteria for cannabis use disorder Severe: Presence of 6 or more symptoms.
have been met for at least 3 months but for
less than 12 months.
In sustained remission; After full criteria for
cannabis use disorder were previously met,
none of the criteria for cannabis use disorder
have been met at any time during a period of
12 months or longer.
Specify if:
In a controlled environment: This additional
specifier is used if the individual is in an
environment where access to cannabis is
restricted.
 Diagnostic features

01 Cannabis is most commonly smoked

04
via a variety of methods: pipes, water
Synthetic oral formulations (pill/capsules)
pipes, cigarettes, or, most recently, in
of delta-9-tetrahydrocannabinol (delta-9-
the paper from hollowed-out cigars
THC) are available by prescription for a
or vaped .
number of approved medical indications
(e.g., for nausea and vomiting caused by
Periodic cannabis use and intoxication chemotherapy; for anorexia and weight
02 can negatively affect behavioral and
cognitive functioning and thus interfere
loss in individuals with AIDS).

with optimal performance at work or

school, or place the individual at
05
increased physical risk when
Individuals who regularly use cannabis
performing activities that could be
03 physically hazardous
often report that it is being used to cope
with mood, sleep, pain, or other
physiological or psychological problems,
Individuals with cannabis use disorder and those diagnosed with cannabis use
may use cannabis throughout the day disorder frequently do have concurrent
over a period of months or years, and thus other mental disorders.
may spend many hours a day under the
influence. Others may use less frequently,
but their use causes recurrent problems
related to family, school, work, or other
important activities (e.g., repeated
absences at work; neglect of family
obligations).
Development and course

Occur at any time during or following adolescence,

but onset is most commonly during adolescence or
young adulthood. Generally, cannabis use disorder
develops over an extended period of time, although
the progression appears to be more rapid in
adolescents, particularly those with pervasive
conduct problems.Moreover, cannabis intoxication
does not typically result in as severe behavioral and
cognitive dysfunction as does significant alcohol
intoxication, which may increase the probability of
more frequent use in more diverse situations than
with alcohol. Cannabis use disorder among preteens,
adolescents, and young adults is typically EXPRESSED
as excessive use with peers that is a component of a
pattern of other delinquent behaviors usually
associated with conduct problems.
PREVALENCE
For 12- to 17-year-olds, rates are highest
among Native American and Alaska Natives
(7.1%) compared with Hispanics (4.1%),
whites (3.4%), African Americans (2.7%), and
Asian Americans and Pacific Islanders
(0.9%). Among adults, the prevalence of
can­nabis use disorder is also highest
among Native Americans and Alaska
Natives (3.4%) rel­ative to rates among
African Americans (1.8%), whites (1.4%),
Hispanics (1.2%), and Asian and Pacific
Islanders (1.2%).
RISK AND
PROGNOSIS
FACTORS

A HISTORY OF CONDUCT DISORDER IN

CHILDHOOD OR ADOLESCENCE AND ANTISOCIAL
PERSONALITY DISORDER ARE RISK FACTORS FOR
THE DEVELOPMENT OF MANY SUBSTANCE-RELATED
DISORDERS.
ACADEMIC FAILURE, TOBACCO SMOKING,
UNSTABLE OR ABU SIVE FAMILY SITUATION, USE OF
CANNABIS AMONG IMMEDIATE FAMILY MEMBERS, A
FAMILY HISTORY OF A SUBSTANCE USE DISORDER,
AND LOW SOCIOECONOMIC STATUS.
HERITABLE FACTORS CONTRIBUTE BETWEEN 30%
AND 80% OF THE TOTAL VARIANCE IN THE RISK OF
CANNABIS USE DISORDERS.
 Functional Consequences of
Cannabis Use Disorder

These problems may be related to pervasive

intoxication or recovery from the effects of
intoxication.
Cognitive function, particularly higher executive
function, appears to be compromised in cannabis
users, and this relationship appears to be dose-
dependent
Chronic cannabis use may contribute to the onset
or exacerbation of many other mental disorders.
can contribute to the onset of an acute psychotic
episode, can exacerbate some symptoms, and can
adversely affect the treatment of a major psychotic
\llness.
COMORBIDITY
Major approximatel
depressive y 33% of
disorder adolescents
(11%), any with
anxiety cannabis
disorder use disorder
74% reported (24%), and have
problematic use of high rates of bipolar I internalized
alcohol use disorder disorders
a secondary or
disorder (greater (13%) are (e.g., anxiety,
tertiary substance: quite depression,
alcohol (40%), than 50%) and common. posttraumati
cocaine (12%), tobacco use among c stress
methamphetamine disorder (53%). individuals disorder),
(6%), and heroin or with a past- and 60%
other opiates (2%). year have
Among those diagnosis of externalizing
younger than 18 a cannabis disorders
years, 61% reported use disorder, (e.g.,
problematic use of as are conduct
a secondary antisocial disorder,
substance: alcohol (30%), attention-
obsessive- deficit/hyper
(48%), cocaine
compulsive, activity
(4%),
(19%), and disorder)
methamphetamine paranoid
(2%), and heroin or (18%)
other opiates (2%). personality
disorders. .
 Cannabis Intoxication
Diagnostic criteria

1. Recent Use Of Cannabis. Specify if:

2. Clinically significant problematic With perceptual disturbances:
behavioral or psychological changes, Hallucinations with intact reality
motor coordination, euphoria, anxiety, testing or auditory, visual, or tactile
etc. that developed during, or shortly illusions occur in the absence of
after, cannabis use. delirium.
3. Two(or more) of the following signs or
symptoms developing within 2 hours of
cannabis use:
4. Conjunctival injection
5. increased appetite
6. Dry mouth
7. Tachycardia
The signs or symptoms are not attributable
to another medical condition and are not
better explained by another mental
disorder, including intoxication with another
substance.
 CANNABIS INTOXICATION
01 Diagnostic features
Intoxication develops within minutes if the
cannabis is smoked but may take a few
hours to develop if the cannabis is ingested
orally. The effects usually last 3-4 hours, with
the duration being somewhat longer when
the substance is ingested orally.
Intoxication typically begins with a ''high"
feeling followed by symptoms that include
euphoria with inappropriate laughter and
grandiosity, sedation, lethargy, impairment
in short-term memory. Occasionally, anxiety
(which can be severe),
dysphoria, or social withdrawal occurs.
These psychoactive effects are accompanied
by two or more of the following signs,
developing within 2 hours of cannabis use:
conjunctival injection, increased appetite,
dry mouth, and tachycardia
02 Differential diagnosis
1. Other substance intoxication: alcohol
intoxica­tion and sedative, hypnotic, or
anxiolytic intoxication frequently decrease
appetite, in­crease aggressive behavior, and
produce nystagmus or ataxia.
2. Other cannabis-induced disorders: This is
distinguished because the symptoms in
these latter disorders predominate the
clinical pre­sentation and are severe
enough to warrant independent clinical
attention.
 CANNABIS WITHDRAWAL
01 Diagnostic Criteria
Cessation of cannabis use that has been heavy and

prolonged (i.e., usually daily or almost daily use over a

period of at least a few months).
B. Three (or more) of the following signs and symptoms
develop within approximately 1 week after Criterion A:
1. Irritability, anger, or aggression.
2. Nervousness or anxiety.
3. Sleep difficulty (e.g., insomnia, disturbing dreams).
4. Decreased appetite or weight loss.
5. Restlessness.
6. Depressed mood.
7. At least one of the following physical symptoms causing
significant discomfort: ab­
8. abdominal pain, shakiness/tremors, sweating, fever,
chills, or headache.
The signs or symptoms in Criterion B cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The signs or symptoms are not attributable to another
medical condition and are not better explained by another
mental disorder, including intoxication or withdrawal from
another substance.
 CANNABIS WITHDRAWAL

Development and Risk and prognosis

01 course 02 factors
The amount, duration, and frequency of
1. Most likely, the prevalence and severity of
cannabis smoking that is required to produce
cannabis withdrawal are greater among
an associated withdrawal disorder during a
heavier cannabis users, particularly among
quit attempt are unknown. Most symptoms
those seeking treatment for cannabis use
have their onset within the first 24-72 hours of
disorders. Withdrawal severity also appears
cessation, peak within the first week, and last
to be positively related to the se­variety of
approximately 1-2 weeks. Sleep difficulties
comorbid symptoms of mental disorders.
may last more than 30 days. Cannabis with­-
drawal has been documented among
adolescents and adults. Withdrawal tends to
be more common and severe among adults,
most likely related to the more persistent and
greater frequency and quantity of use among
adults.
FUNCTIONAL CONSEQUENCES,
RISK AND PROGNOSIS, AND
DIFFERENTIAL DIAGNOSIS.

Because many of the symptoms of Cannabis users

cannabis withdrawal are also report using
symptoms of other sub­stance cannabis to relieve
withdrawal syndromes or of withdrawal
depressive or bipolar disorders, symptoms.
careful evaluation should focus on Cannabis users
ensuring that the symptoms are not report relapsing to
better explained by cessation from cannabis use or
an­other substance (e.g., tobacco or initiating the use of
other drugs (e.g.,
alcohol withdrawal), another mental
tranquilizers) to
disorder (general­ized anxiety
alleviate cannabis
disorder, major depressive disorder),
withdrawal
or another medical condition.
symptoms.

01 Other Hallucigeon Use Disorder

A problematic pattern of
Diagnostic Criteria
02
hallucinogen (other than
phencyclidine) use leading to
clinically significant impairment or
distress, as manifested by at least
two of the following, occurring within Craving, or a strong desire or urge to
a 12-month period: use the hallucinogen.
The hallucinogen is often taken in Recurrent hallucinogen use resulting
larger amounts or over a longer in a failure to fulfill major role
period than was intended. obligations at work, school, or home.
There is a persistent desire or
unsuccessful efforts to cut down
or control hallucinogen use.
A great deal of time is spent in
activities necessary to obtain the 03
hallucinogen, use the
hallucinogen, or recover from its Continued hallucinogen use despite
effects. having persistent or recurrent social or
interpersonal problems caused or
exacerbated by the effects of the
hallucinogen
Important social, occupational, or
recreational activities are given up or
reduced because of hallucinogen use.
 Other Hallucigeon Use Disorder
04
Recurrent hallucinogen use in
situations in which it is
physically hazardous.
Hallucinogen use is continued
despite knowledge of having a
persistent or recurrent physical
or psychological problem that
is likely to have been caused
or exacerbated by the
hallucinogen.
Tolerance, as defined by either
of the following:
A need for markedly increased
amounts of the hallucinogen
to achieve intoxication or
desired effect.
A markedly diminished effect
with continued use of the
same amount of the
hallucinogen.
Specify the particular
hallucinogen.
05
In early remission: After full criteria for
other hallucinogen use disorder were
previously met, none of the criteria for
other hallucinogen use disorder have
been met for at least 3 months but for
less than 12 months.
In sustained remission: After full criteria
for other hallucinogen use disorders
were previously met, none of the criteria
for other hallucinogen use disorders
have been met at any time during a
period of 12 months or longer
Specify if:
In a controlled environment: This additional
specifier is used if the individual is in an
environment where access to hallucinogens
is restricted.
Specify current severity:
Wild: Presence of 2-3 symptoms.
Moderate: Presence of 4-5 symptoms.
Severe: Presence of 6 or more symptoms.
 Diagnostic features

Development and course

Some of these substances (e.g., LSD and MDMA)
have a long half-life and prolonged duration, so
that users can spend hours to days consuming
and/or recovering from the effects of these
drugs. However, other hallucinogenic drugs (e.g.,
DMT, salvia) are short-lived.
Cross-tolerance exists between LSD and other
hallucinogens (e.g., psilocybin, mescaline) but
does not extend to other drug categories such as
amphetamines and cannabis. MDMA/ecstasy as
a hallucinogen may have distinctive effects
attributable to both its hallucinogenic and
stimulant properties.
Unlike most substances where an early age of
onset is associated with an increased risk for the
corresponding use disorder, it is unclear whether
there is an association of early age of onset with
increased risk for other hallucinogen use disorders.
Little is known about the evolution of other
hallucinogen use disorders, but it is generally
believed to have a low incidence, low persistence,
and high recovery rates.
Another hallucinogen use disorder is a disorder
seen primarily in individuals under the age of 30,
and rates are low among older adults.

Among heavy ecstasy users, continued use

despite physical or psychological problems,

tolerance, dangerous use, and spending a lot of
time obtaining the substance are the most
commonly reported criteria over 50% in adults
and over 30% in a younger sample, whereas
legal problems related to substance use and
persistent craving/inability to quit are rarely
reported.

DIFFERENTIAL DIAGNOSIS, RISK

FACTORS AND COMORBIDITY

Schizophrenia: Other substance use disorders, particularly

Adolescents who use
may falsely alcohol, tobacco and cannabis, and major
MDMA/ecstasy and other
attribute their depressive disorder are associated with hallucinogens, as well as adults
symptoms to elevated rates of other hallucinogen use who have recently used
the use of disorders. Antisocial personality disorder ecstasy, have a higher
hallucinogens. may be elevated among individuals who use prevalence of other substance
panic disorder, more than two drugs in addition to use disorders compared to
depressive and
hallucinogens, compared to their nonusers of hallucinogens.
bipolar
counterparts with a less extensive history of Both adult and adolescent
disorders,
use. ecstasy users are more likely
alcohol or
The influence of adult antisocial behaviors than other drug users to be
sedative
on other hallucinogen use disorders may be polydrug users and to have
withdrawal
stronger in women than in men. other substance use disorders.
Cannabis use has also been implicated as a

precursor to the onset of hallucinogen use

(e.g., ecstasy), along with early alcohol and
tobacco use.

 Other Hallucinogen intoxication

Diagnostic

features
Recent Use Of A Hallucinogen (other than phencyclidine).
Clinically significant problematic behavioral or psychological changes (e.g.,
marked
anxiety or depression, ideas of reference, fear of “losing one’s mind,” paranoid ide­-
ation, impaired judgment) that developed during, or shortly after, hallucinogen
use.
Perceptual changes occurring in a state of full wakefulness and alertness (e.g.,
subjective intensification of perceptions, depersonalization, derealization, illusions,
hallu­cinations, synesthesias) that developed during, or shortly after, hallucinogen
use.
Two (or more) of the following signs developing during, or shortly after,
hallucinogen
use:
a. Pupillary dilation.
b. Tachycardia.
c. Sweating.
d. Palpitations.
e. Blurring of vision.
f. Tremors.
g. Incoordination.
The signs or symptoms are not attributable to another medical condition and are
not better explained by another mental disorder, including intoxication with
Diagnostic features
Other hallucinogen intoxication reflects
the clinically significant behavioral or
psychological changes that occur
shortly after ingestion of a hallucinogen.
Depending on the specific hallucinogen,
the intoxication may last only minutes
or several hours or longer.
Prevalence
The prevalence of other hallucinogen
intoxication may be estimated by use of
those substances:
1.8% of individuals age 12 years or
older
3.1% of 12- to 17-year-olds and 7.1% of
18- to 25-year-olds used
hallucinogens in the past year,
compared with only 0.7% of
individuals age 26 years or older.
Twelve-month prevalence for
hallucinogen use is more common in
males (2.4%) than in females (1.2%),
and even more so among 18- to 25-
year-olds (9.2% for males vs. 5.0% for
females).
individuals ages 12-17 years, there
are no gender differences (3.1% for
both gen ders).
 OTHER HALLUCINOGEN INTOXICATION
Functional
Consequences
Other hallucinogen intoxication can have
serious consequences. The perceptual
disturbances and impaired judgment
associated with other hallucinogen
intoxication can result in injuries or fatalities
from automobile crashes, physical fights, or
unintentional self injury ( attempts to "fly"
from high places). Continued use of
hallucinogens, particularly MDMA, has also
been linked with neurotoxic effects.
Differential Diagnosis
Other substance intoxication.(Phencydeline,
cocaine, inhalants, etc)
Other conditions.
Hallucinogen persisting perception disorder
because symptoms in the latter continue
episodically or continuously for weeks (or
longer) after the most recent in­toxication.
Other hallucinogen-induced disorders. (e.g.,
hallucinogen-induced anxiety disor­der,
with onset during intoxication)
 References

American Psychiatric Association. (2013).

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS. (DSM-V) American Psychiatric
Association. Recuperado en: https://cdn.website-
editor.net/30f11123991548a0af708722d458e476/files/
uploaded/DSM%2520V.pdf