Cannabis Addiction in Pakistan: Why “Just Weed” Is Not Harmless and When to Seek Help

Nobody starts smoking charas thinking they are going to become dependent on it. That is precisely what makes cannabis one of Pakistan’s most under-treated addiction problems. It arrives quietly, it escalates gradually, and by the time it is causing real damage, the person using it has usually convinced themselves that it cannot be a real addiction because it is just weed.

Pakistan has an estimated four million cannabis users, making it the most widely used substance in the country. Yet treatment rates for cannabis dependency are disproportionately low because neither patients nor families take it seriously enough to seek help. This article is an attempt to correct that.

What Is Cannabis and Why Is It Addictive?

Cannabis, known in Pakistan as charas, hash, or chars, is derived from the Cannabis sativa plant and contains THC (tetrahydrocannabinol) as its primary psychoactive compound. Research published in Neuropsychopharmacology Reviews confirms that approximately 9 percent of people who use cannabis develop dependency, rising to 17 percent for those who begin in adolescence and 50 percent for those who use daily. These are not negligible numbers.

THC acts on the brain’s endocannabinoid system, producing relaxation, altered perception, and in many users, a sense of calm that becomes difficult to replicate without the drug. With regular use, the brain adapts, reducing its natural endocannabinoid production and increasing the number of cannabinoid receptors. The result is tolerance: more is needed to achieve the same effect, and the absence of cannabis begins to feel worse than it did before.

This is the biological foundation of cannabis dependency. The person does not choose to become dependent. Their brain changes in response to consistent exposure, and those changes make stopping uncomfortable, which makes continuing easier than stopping.

Is Cannabis Dependency Real? Addressing the Denial

The most consistent obstacle to treatment for cannabis dependency in Pakistan is the belief that it is not a real addiction. This belief is held by patients, by families, and sometimes by well-meaning people who know someone who smoked for years and stopped without difficulty.

Cannabis dependency is a clinically recognised condition listed in both the DSM-5 and the ICD-11. The fact that some people use cannabis without becoming dependent does not mean dependency does not exist, just as the fact that some people drink without becoming alcoholic does not mean alcohol dependency does not exist.

If someone is using cannabis daily, finds it difficult or impossible to reduce use despite wanting to, experiences anxiety, irritability, or insomnia when they cannot access it, and continues using despite clear negative consequences in their relationships, work, or mental health, they meet the clinical criteria for cannabis use disorder.

The Signs of Cannabis Dependency

Physical and cognitive signs

• Bloodshot eyes and increased appetite: Consistent with regular use. Over time, the tolerance to these effects may reduce their visibility.
• Memory and concentration problems: Heavy cannabis use impairs short-term memory and cognitive function, particularly in adolescents whose brains are still developing. Academic and professional performance typically deteriorates with sustained heavy use.
• Respiratory problems: Regular cannabis smoking causes bronchitis-like symptoms including chronic cough, increased mucus production, and greater susceptibility to respiratory infections.
• Fatigue and reduced motivation: One of the most damaging long-term effects of heavy cannabis use is the gradual erosion of motivation and energy, sometimes described clinically as amotivational syndrome.
•  Withdrawal symptoms: Irritability, anxiety, insomnia, decreased appetite, and restlessness within 24 to 48 hours of cessation are the hallmarks of cannabis withdrawal and confirm physical dependency.

Behavioural signs

• Organising daily life around cannabis: Ensuring supply, planning use, and managing the day around when they can use next.
• Using cannabis to manage emotions: Inability to sleep, relax, or manage anxiety without cannabis is a significant indicator of dependency.
• Failed attempts to reduce or stop: Repeated attempts to cut down that consistently fail are a defining feature of dependency.
• Continued use despite knowing it is causing harm: This is the clinical definition of dependency.

Cannabis and Mental Health: The Pakistani Context

The relationship between cannabis and mental health is bidirectional. Research from the Lancet Psychiatry has established that regular cannabis use, particularly at high potency levels, significantly increases the risk of psychotic disorders. Daily users of high-potency cannabis are five times more likely to develop psychosis than non-users.

In Pakistan, where high-potency charas is the most common form of cannabis available, this risk is particularly relevant. FCRC treats a significant number of patients presenting with cannabis-induced psychosis, characterised by paranoia, auditory hallucinations, disorganised thinking, and severe anxiety. Families often attribute these symptoms to stress or a spiritual problem and delay seeking clinical help as a result.

The mental health complications of heavy cannabis use are not inevitable and they are treatable, but they require clinical intervention, not continued use of the substance that is producing them.

Who Is Most at Risk in Pakistan?

Young men in urban areas

Cannabis use in Pakistan is most prevalent among young men aged 15 to 30 in urban environments. University campuses, neighbourhood peer groups, and social settings where cannabis is normalised as a relaxation tool are common entry points.

People using cannabis for anxiety or stress

Pakistan’s significant unmet need in mental health treatment means that many people discover cannabis as a self-medication for anxiety, social discomfort, or stress before they ever see a mental health professional. The short-term relief it provides is real. The long-term cost, in worsened anxiety and dependency, is also real.

Adolescents

Cannabis use that begins in adolescence carries a significantly higher risk of dependency and cognitive impact than use that begins in adulthood. The developing adolescent brain is more vulnerable to the effects of THC on the endocannabinoid system, and early use is associated with worse long-term mental health outcomes.

Treatment for Cannabis Dependency at FCRC

Cannabis dependency responds well to structured, evidence-based treatment. While there is no pharmacological substitute for cannabis in the way that methadone is used for opioid dependency, the psychological and behavioural dimensions of cannabis dependency are very effectively addressed through a combination of individual therapy, group therapy, and where indicated, psychiatric support for underlying mental health conditions.

At FCRC, treatment for cannabis dependency begins with a comprehensive clinical assessment to establish the severity of use, the presence of co-occurring mental health conditions such as anxiety or depression, and the appropriate level of care. Our dual diagnosis programme is particularly important for cannabis users, given the high rate of co-occurring anxiety and mood disorders in this population.

CBT-based approaches have the strongest evidence base for cannabis dependency treatment, addressing the thought patterns and emotional triggers that drive use. Motivational Enhancement Therapy is also highly effective for patients who are ambivalent about stopping. Both are delivered by our doctoral-level clinical psychologists.

For patients with cannabis-induced psychosis or significant psychiatric complications, our consultant psychiatrists provide direct assessment and treatment, stabilising the mental health presentation as part of the integrated programme.