512 Substance-Related and Addictive Disorders
tolerance and withdrawal will naturally occur and should not be used as the primary cri-
teria for determining a diagnosis of a substance use disorder. Although medical uses of
cannabis remain controversial and equivocal,  use for medical circumstances should be
considered when a diagnosis is being made. 
Associated Features Supporting Diagnosis
Individuals who regularly use cannabis often report that it is being used to cope with
mood, sleep, pain, or other physiological or psychological problems, and those diagnosed
with cannabis use disorder frequently do have  concurrent other mental disorders. Careful
assessment typically reveals reports of cannabis use contributing to exacerbation of these
same symptoms, as well as other reasons for freq uent use (e.g., to experience euphoria, to
forget about problems, in respon se to anger, as an enjoyable social activity). Related to this
issue, some individuals who use cannabis mult iple times per day for the aforementioned
reasons do not perceive themselves as (and thus do not report) spending an excessive
amount of time under the influence or recovering from the effects of cannabis, despite be-
ing intoxicated on cannabis or coming down from  it effects for the majority of most days.
An important marker of a substance use disorder  diagnosis, particularly in milder cases, is
continued use despite a clear risk of negative co nsequences to other valued activities or re-
lationships (e.g., school, work, sport activity, partner or parent relationship). 
Because some cannabis users are motivated to  minimize their amount or frequency of
use, it is important to be aware of common signs and symptoms of cannabis use and intox-
ication so as to better assess the extent of us e. As with other substances, experienced users
of cannabis develop behavioral and pharmacolo gical tolerance such that it can be difficult