or employment suspension). The general change in substance use disorder diagnostic cri-
teria from DSM-IV to DSM-5 (i.e., removal of  the recurrent substance-related legal prob-
lems criterion) mitigates this concern to some degree.
Diagnostic Markers
Biological tests for cannabinoid metabolites are useful for determining if an individual has
recently used cannabis. Such testing is help ful in making a diagnosis, particularly in
milder cases if an individual denies using while others (family, work, school) purport con-
cern about a substance use problem. Because cannabinoids are fat soluble, they persist in
bodily fluids for extended periods of time an d are excreted slowly. Expertise in urine test-
ing methods is needed to reliably interpret results. 
Functional Consequences of Cannabis Use Disorder
Functional consequences of cannabis use disord er are part of the di agnostic criteria. Many
areas of psychosocial, cognitive, and health  functioning may be co mpromised in relation
to cannabis use disorder. Cognitive function, particularly higher executive function, ap-
pears to be compromised in cannabis users, an d this relationship appears to be dose de-
pendent (both acutely and chronically). This  may contribute to increased difficulty at
school or work. Cannabis use has been related to a reduction in prosocial goal-directed ac-
tivity, which some have labeled an amotivational syndrome,  that manifests itself in poor
school performance and employ ment problems. These problems may be related to perva-
sive intoxication or recovery from the effects of intoxication . Similarly, cannabis-associated
problems with social relationships are common ly reported in those with cannabis use dis-
order. Accidents due to engagement in pote ntially dangerous behaviors while under the