What Are the Signs of Cannabis Use Disorder After 65?
About 1 in 9 older adults who used cannabis in the past year meet clinical criteria for a use disorder. The pattern is recognizable at home: near-daily smoking, hours a day preoccupied with it, cravings, and needing more for the same effect. Most cases are still mild, which is when cutting back and evidence-based behavioral therapy work best.
The number comes from a UC San Diego analysis of 21,189 adults 65 and older, drawn from the 2021 to 2024 National Survey on Drug Use and Health and published in Addiction on September 28, 2026. About 8.9% of them used cannabis in the past year. Of those users, 11.4% met DSM-5 criteria for cannabis use disorder (CUD). Three quarters of those cases were mild, one in five moderate, and fewer than one in twenty severe. That severity split is the piece that matters most.
What "mild" looks like at 65+
CUD isn't defined by how much someone smokes. It's defined by whether the use is starting to run the day. Two criteria in a year meet the threshold, two or three qualifies as mild, four or five as moderate, six or more as severe. In this study, the three criteria older users endorsed most often were concrete.
| Warning sign | How often older users endorse it | What it looks like day to day |
|---|---|---|
| Time spent obtaining, using, or recovering from cannabis | 74.4% | Hours a day tied up in getting it, using it, or coming down |
| Craving | 67.5% | Strong urges to use between uses |
| Tolerance | 48.3% | Needing more to get the same effect |
Two of those, cravings and needing more for the same effect, are what most people picture when they hear "dependence." The first one is sneakier. Losing hours to obtaining, using, and coming down is easy to explain away as a routine.
Why daily smoking is where a disorder most often appears
Frequency and route are where the risk concentrates. Older adults using cannabis 300 or more days a year were nearly four times as likely to meet criteria for a use disorder as less frequent users. About two thirds of users smoked it.
This is the pattern many older adults were told was reasonable: daily use for pain, sleep, or anxiety, taken by the fastest-acting route. The data don't say that use was wrong. They say that daily inhaled use is the pattern where a disorder most often shows up. An earlier study of older veterans, drawn from VA care and a more concentrated group of users, found 36% of past-30-day users met CUD criteria, and more than half were using 20 or more days a month.
What to do while most cases are still mild
The severity split is what makes this treatable. Behavioral therapies (cognitive behavioral therapy, motivational enhancement therapy, and contingency management) have consistent randomized-trial evidence for reducing cannabis use and dependence severity in adults. Effects are strongest during treatment and taper afterward, which is a real limit, but they're the best-tested option and they work best when use is still in the mild range. In May 2026, SAMHSA issued a primary care advisory asking clinicians to screen older adults for CUD and refer them to evidence-based treatment.
No medication is FDA-approved for CUD. A large randomized trial of N-acetylcysteine was no better than placebo. Cannabinoid replacement drugs like nabiximols and dronabinol help with withdrawal and retention but aren't cures. Aelis Farma's AEF0117, a CB1 signaling inhibitor in development, missed its main goal in a Phase 2b trial.
For someone unwilling to stop, two moves lower risk in the meantime. Cut frequency below daily. Swap smoking for a lower-dose oral route. Neither is a treatment on its own, but both move away from the pattern most tied to the disorder.
Where the evidence stops
No randomized trial of CUD treatment has been done specifically in adults 65 and older. The behavioral therapy data come from younger adults and get applied up. The new study is cross-sectional, so it can name the pattern that goes with a disorder but not prove daily smoking caused it. Clinicians don't yet have age-tailored deprescribing guidance for cannabis the way they do for benzodiazepines.
None of that changes the practical picture. If you or a parent is using cannabis on most days, mostly by smoking, and one or more of the top signs are there (the hours, the cravings, the creeping dose), raise it with a primary care clinician now, while most cases are still mild and behavioral therapy has the best chance of working.