Taken together, the results suggest that cannabis use disorders should be diagnosed with a single criterion set consisting of both cannabis abuse and dependence diagnostic criteria. That dependence criteria are related to a single underlying dimension of cannabis use disorder severity is not surprising since the dependence criteria are expected to operationalize two closely related concepts: physical dependence (i.e., tolerance) and impaired control/compulsive use. However, three of the four cannabis abuse criteria also operationalize impaired control/compulsive use, that is, cannabis use despite social/interpersonal problems or recurrent use resulting in neglect of role responsibilities or legal problems. In contrast, the fourth abuse criterion, recurrent cannabis use in situations likely to cause physical harm to the user, is not conceptually related to impaired control/compulsive use and appears best represented as a risk factor of potential harm and not a diagnostic criterion for cannabis use disorder. This study showed a strong relationship of this hazardous use criterion to the observed cannabis use disorder continuum, but the conceptual distinction indicates that further investigation is warranted.
