Cannabis addiction: recognise, understand, treat

TL;DR

• DSM-5: Cannabis Use Disorder affects ~9 % of users, ~17 % with adolescent onset.
• Withdrawal: irritability, sleep problems, appetite loss, sweating – peak day 2-6, duration 1-3 weeks.
• Effective interventions: CBT, motivational interviewing; no medication approved in Switzerland.
• Contacts: Addiction Switzerland (0800 104 104), safezone.ch, regional addiction services.

Am I addicted? The 6-point self-check

Two or more of the following over 12 months meet DSM-5 criteria for a clinically relevant cannabis use disorder:

• Using more or longer than planned.
• Repeated failed attempts to cut down.
• A lot of time spent on obtaining/using.
• Craving/strong urge.
• Neglecting work, studies or family.
• Continued use despite physical or mental problems.

What helps in Switzerland

Outpatient CBT at specialised addiction services (in every canton), online programmes like safezone.ch, self-help groups (Marijuana Anonymous CH). Usually covered by basic insurance with a physician referral.

Neurobiological mechanisms of cannabis dependence

With regular and intensive consumption of THC-containing cannabis, the brain adapts to the constant supply of external cannabinoids. This occurs primarily through a downregulation of the body's own CB1 receptors in the central nervous system. Since the endocannabinoid system plays a central role in regulating emotions, sleep, appetite, and pain processing, this adaptation means that the body falls out of balance without the external supply of THC. Those affected develop a tolerance and require increasingly larger amounts to achieve the desired effect.

In addition, THC influences the neural reward system through an increased release of dopamine. Chronic consumption can blunt this natural signal transmission, leading to everyday activities being experienced as less pleasurable or motivating without the consumption of the substance. When ceasing cannabis use, a temporary neurobiological deficit occurs, which manifests in typical withdrawal symptoms such as inner restlessness, irritability, and depressive moods. These biological changes make it clear that dependence is not a pure matter of willpower, but a profound alteration of brain chemistry.

• Downregulation of CB1 receptors in the central nervous system
• Interference with the body's own endocannabinoid system
• Altered dopamine release in the neural reward center
• Development of tolerance through chronic overstimulation

Psychological comorbidities and dual diagnoses

A cannabis use disorder rarely occurs in isolation, but is frequently linked to other psychological distress or illnesses. In professional circles, this is referred to as a dual diagnosis. Many of those affected unconsciously use cannabis as a form of self-medication to alleviate symptoms of anxiety disorders, depressive episodes, or attention deficit hyperactivity disorder (ADHD). While consumption brings apparent short-term relief, in the long term it usually significantly worsens the underlying psychological problems and complicates the diagnosis of the actual primary condition.

For successful withdrawal and long-term stabilisation, it is therefore essential to treat these co-occurring disorders as part of the therapeutic process. If only the addiction is treated without addressing the underlying depression or anxiety disorder, the risk of relapse is extremely high. Modern, integrated therapy concepts therefore target both aspects simultaneously. They help those affected to develop healthy coping strategies for their psychological distress that do not rely on the consumption of psychoactive substances.

• Frequent occurrence of dual diagnoses in substance use disorders
• Risk of self-medication in depression and anxiety
• Interactions between cannabis use and ADHD
• Necessity of integrated therapeutic approaches for both disorders

Swiss care structure and harm reduction

Switzerland pursues a pragmatic approach in its addiction policy, which is based on the pillars of prevention, therapy, harm reduction, and repression. While cannabis with a total THC content of over 1 percent is legally classified as an illegal narcotic, the focus in addressing addiction is on health support. Scientifically monitored pilot trials in various Swiss cities are currently investigating how the regulated sale of cannabis can increase consumption safety while simultaneously improving youth protection and addiction prevention through targeted education directly at the point of sale.

Anyone seeking support for withdrawal will find a dense and professional network of contact points in Switzerland. Cantonal addiction counselling centres offer confidential, often free consultations and support those affected as well as their relatives. In the event of acute crises or suspected consumption of contaminated products, Tox Info Suisse provides medical assistance around the clock on the telephone number 145. Since August 2022, the prescription of medical cannabis has also been simplified, enabling patients to undergo controlled, medically supervised therapy.

• Pragmatic approach according to the Swiss Narcotics Act
• Early intervention and education in scientific pilot trials
• Cantonal addiction counselling centres as the first, often free point of contact
• Emergency assistance for consumption risks via Tox Info Suisse on number 145

FAQ