Cannabis (Hashish/Charas) Addiction: Evidence-Based Information, Statistics and Treatment

Cannabis (also known as marijuana, hashish, charas, weed, or bhang) is the most widely used illicit drug globally. Although many people perceive cannabis as harmless, regular or heavy use can lead to Cannabis Use Disorder (CUD), cognitive impairment, psychiatric complications, reduced educational and occupational functioning, and dependence.

Modern cannabis products often contain much higher concentrations of tetrahydrocannabinol (THC) than in previous decades, increasing the risk of addiction and adverse mental health effects.

According to the United Nations Office on Drugs and Crime (UNODC):

(Source: United Nations Office on Drugs and Crime; World Health Organization)

In Pakistan, cannabis is used in several traditional forms, most commonly charas (a resin-based hashish, often smoked) and bhang (a preparation typically consumed as a drink or edible, sometimes associated with cultural or religious occasions). While these forms may feel culturally familiar or less concerning than other illicit substances, they carry the same risk of dependence, cognitive impairment, and psychiatric complications as cannabis in any other form, and regular use should be assessed with the same clinical seriousness.

Because charas and bhang are sometimes viewed as socially acceptable or low-risk, individuals and families may delay seeking help even when use has become frequent or is affecting daily functioning. Recognizing that these traditional forms of cannabis carry genuine addiction potential is an important first step toward earlier assessment.

Because cannabis is widely available, sometimes legally regulated in certain jurisdictions, and often perceived as a 'natural' or low-risk substance, many people underestimate the possibility of developing a genuine addiction. This perception can delay recognition of a problem and discourage people from seeking assessment, even when use has become difficult to control or is causing clear harm.

The clinical reality is that Cannabis Use Disorder is a recognized diagnosis with the same core features as other substance use disorders — craving, loss of control, continued use despite harm, and withdrawal on stopping — and it deserves the same level of clinical attention as any other addiction.

Cannabis Use Disorder is characterized by:

Not everyone who uses cannabis develops addiction, but the risk increases with:

Long-term heavy cannabis use has been associated with:

Adolescents are particularly vulnerable because the brain continues developing into the mid-20s, making early and heavy cannabis exposure a significant concern for long-term cognitive and psychiatric health.

One of the most clinically important risks associated with heavy cannabis use, particularly high-potency products, is the potential to trigger or worsen psychotic symptoms in vulnerable individuals. This includes hallucinations, delusions, and disorganized thinking, which in some cases can persist beyond the period of acute intoxication.

Individuals with a personal or family history of psychosis or schizophrenia-spectrum disorders are at particularly elevated risk and should be assessed carefully before continuing any cannabis use. Early psychiatric evaluation is important whenever cannabis use is accompanied by unusual thoughts, perceptual disturbances, or significant changes in behaviour.

Withdrawal symptoms may begin within 24–72 hours after stopping and usually peak during the first week.

Although cannabis withdrawal is generally not life-threatening, it can significantly increase the risk of relapse, which is why structured support during this period is valuable even though medical supervision is not typically required for safety. Most withdrawal symptoms resolve within one to two weeks, though sleep disturbance and cravings can occasionally persist longer, particularly after heavy, long-term use.

The most effective treatments include:

Currently, no medication has been approved specifically for Cannabis Use Disorder. Medications may be prescribed to treat co-occurring depression, anxiety, insomnia, or other psychiatric conditions when clinically indicated.

Recovery outcomes improve with regular follow-up, family support, and long-term relapse prevention strategies, particularly when treatment also addresses any underlying or co-occurring mental health conditions.

Most individuals with Cannabis Use Disorder can be effectively treated on an outpatient basis, attending regular psychotherapy sessions while continuing with work, school, and family life. However, individuals with severe dependence, significant co-occurring psychiatric conditions such as psychosis, or an unstable home environment may benefit from a more structured treatment program with closer monitoring. A qualified psychiatrist or addiction specialist can help determine the most appropriate level of care based on an individual assessment.

Family involvement is one of the strongest supports in cannabis addiction recovery, particularly for adolescents and young adults still living at home. Families can help by approaching the issue with curiosity rather than judgment, avoiding ultimatums that can increase secrecy, and encouraging — rather than forcing — professional assessment.

Family therapy, where appropriate, can also address communication patterns, household stress, or conflict that may be contributing to continued use, while helping family members understand cannabis addiction as a treatable medical condition rather than simply a discipline problem.

Most individuals with Cannabis Use Disorder improve with structured psychological treatment, especially when treatment begins early. Addressing co-occurring mental health conditions further enhances recovery outcomes, and with consistent support, long-term abstinence or significant reduction in use is a realistic goal for most patients.

Dr. Muhammad Shoaib Zafar is a Consultant Psychiatrist and Addiction Specialist experienced in the assessment and treatment of Cannabis Use Disorder, including presentations involving cannabis-induced anxiety, psychosis, and co-occurring psychiatric conditions. Care is individualized and may include comprehensive psychiatric assessment, structured psychotherapy, family involvement — particularly for adolescents — and long-term relapse prevention planning. Individuals requiring structured, multidisciplinary support may also benefit from programs available through Revive Sobriety Center.

If you are unsure whether your own or a loved one's cannabis use has crossed into Cannabis Use Disorder, a confidential clinical conversation is the most reliable way to get clarity, rather than relying on informal impressions of what counts as 'normal' use.

This article is provided for general educational purposes and does not constitute a diagnosis or individualized treatment recommendation. If you or someone you know is struggling with cannabis use, a confidential evaluation with a qualified psychiatrist or addiction specialist is the safest way to understand what is happening and what treatment options are appropriate.