Home > CICMH Toolkits > Reducing cannabis harms: A guide for Ontario campuses > Section 1: Cannabis and Substance Use > 4. Understanding Substance Use Disorders and Problematic Substance Use

4. Understanding Substance Use Disorders and Problematic Substance Use

For some people, the use of substances such as cannabis can lead to problematic use. In some people, it can lead to a substance use disorder, the term used in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s text of recognized mental illnesses.[1]American Psychiatric Association.(2018). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Available at: https://www.psychiatry.org/psychiatrists/practice/dsm

Substance use disorder is a complex condition in which problematic patterns of substance use may interfere with a person’s life and lead to physical and/or psychological dependence and withdrawal symptoms. It is commonly known as addiction or problematic use of substances (Figure 1), and can range from mild to severe.

The majority of students will not develop a substance use disorder when cannabis is legalized, but there are risks of harm associated with use. Signs and symptoms of problematic use among students include not showing up to classes or other activities, difficulty with memory or concentration, and putting substance use ahead of school work or other obligations.[2]Government of Canada. (2017). Help a friend who is using or abusing drugs. Retrieved from: https://www.canada.ca/en/health-canada/services/substance-abuse/get-help/help-friend.html#a1

The 4Cs approach[3]Centre for Addiction and Mental Health. (2007). Addiction: An information guide. Retrieved from: https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Documents/addiction_guide_en.pdf is a simple way to describe problematic substance use that may have a negative impact on a person:

  • Craving: Strong need to use the substance.
  • Control: Difficult controlling how much or how often the substance is used.
  • Compulsion: Feeling urges to use the substance.
  • Consequences: Continuing to use the substance despite negative outcomes

About 9% of people who use cannabis will develop cannabis use disorder, and that number may increase to 16% among those who start using it as teenagers.[4]Anthony, J.C. (2006). The epidemiology of cannabis dependence. In R.A. Roffman & R.S. Stephens (Eds.), Cannabis dependence: Its nature, consequences and treatment (pp. 58–105). Cambridge, UK: Cambridge University Press By comparison, the estimated risk of developing a substance use disorder with other substances is 68% for nicotine, 23% for alcohol, and 21% for cocaine.[5]Lopez‐Quintero C, Pérez de los Cobos J, Hasin DS, Okuda M, Wang S, et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 115: 120‐ 130 More than one in 20 Canadians between the ages of 15 and 24 met the criteria for cannabis use disorder in 2012 and the peak age for the disorder is between 16 and 18 years old.[6]Pearson, C., Janz, T., & Ali, J. (2013). Health at a glance: Mental and substance use disorders in Canada. (Statistics Canada Catalogue no. 82-624-X).

Screening and assessments tools* which are grounded in research and proven to be reliable and valid, can help service providers understand where a student might be on the substance use continuum.

Some of these can also identify if the substance use is affecting the person’s life, if they meet the criteria for cannabis use disorder, and appropriate interventions to help them reduce their use. Below are commonly used assessment tools in Ontario:

Tool Information
Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) ASSIST is designed primarily for use by primary healthcare providers but has also been found useful for those in other fields who work with people who use substances. It includes cannabis-related questions.
Global Appraisal of Individual Needs (GAIN)-SS GAIN instruments can be used to identify those who have a substance use disorder in a variety of clinical settings.
CRAFFT CRAFFT is used with adolescents and young adults (12- 21 years) and can be completed as a self-administered questionnaire in clinical settings. Brief advice/interventions are recommended based on the person’s risk level.

 
*Costs may be attached to using some of these tools.

References   [ + ]

1. American Psychiatric Association.(2018). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Available at: https://www.psychiatry.org/psychiatrists/practice/dsm
2. Government of Canada. (2017). Help a friend who is using or abusing drugs. Retrieved from: https://www.canada.ca/en/health-canada/services/substance-abuse/get-help/help-friend.html#a1
3. Centre for Addiction and Mental Health. (2007). Addiction: An information guide. Retrieved from: https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Documents/addiction_guide_en.pdf
4. Anthony, J.C. (2006). The epidemiology of cannabis dependence. In R.A. Roffman & R.S. Stephens (Eds.), Cannabis dependence: Its nature, consequences and treatment (pp. 58–105). Cambridge, UK: Cambridge University Press
5. Lopez‐Quintero C, Pérez de los Cobos J, Hasin DS, Okuda M, Wang S, et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 115: 120‐ 130
6. Pearson, C., Janz, T., & Ali, J. (2013). Health at a glance: Mental and substance use disorders in Canada. (Statistics Canada Catalogue no. 82-624-X).
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