Mr. X, a 22-year-old male pursuing his postgraduation, presented to us in March 2017. He was premorbidly a well-adjusted individual, with no significant medical history and family history suggestive of cannabis use and conduct disorder in younger brother. Mr. X started using marijuana at the age of 19 due to peer pressure and curiosity. Gradually, he developed tolerance, leading to increase in the number of joints per day, significant craving, loss of control, and withdrawal symptoms in the form of irritability and restlessness. He was found to be euphoric, disinhibited, and unable to concentrate in the class after smoking cannabis, unlike his premorbid self. His teachers and friends often noted him to have conjunctival injection. He had tried alcohol on a few occasions, but cannabis remained his substance of preference. He had missed classes in order to procure, use, or recover from the effects of cannabis and failed to pay his college fees. Parents were informed by the institute, following which he was brought to us for treatment. His last use of cannabis was on the previous day. There was no significant period of abstinence. His physical examination was normal except for conjunctival injection. Mental status examination revealed anxious affect, craving for cannabis, and precontemplation phase of motivation. His cognitive functions were intact and there was no evidence of organic or other psychiatric illness. He was diagnosed to have cannabis dependence according to International Classification of Diseases-10^th Edition.[8] He was admitted, evaluated in detail with blood investigations, and other comorbidities were ruled out. During psychotherapy sessions, the patient used the restroom frequently—at least twice during every 45-min session.

On enquiry, he revealed that he has been passing urine at least 15–20 times during daytime and 3–4 times at night since 12 years of age. During school days, he would wait for every period to finish and rush to the restroom. There was an occasional history of urge incontinence. The patient reported that this had caused significant distress, but he had not sought any medical help. Surprisingly, for the past 2 years, he did not have this problem, and he was able to sit in the class for 2–3 h at a continuum. However, following his admission to the hospital and abstinence from cannabis, there was a reappearance of urinary symptoms.

The patient was evaluated with urine routine examination, culture and sensitivity, and ultrasound abdomen and pelvis, which were normal. The patient was asked to maintain a diary, and an input-output chart was maintained for 3 days. The mean frequency of micturition was 25 times during the day and four at night. The output quantity was normal. Urologist opinion was obtained, and an urodynamic study showed detrusor hyperactivity characterized by involuntary detrusor contractions during the filling phase of micturition cycle. A diagnosis of OAB was made. Lifestyle modifications and behavioral interventions, including avoiding caffeinated beverages, restricting fluid intake before bedtime, pelvic floor exercises, and gradually increasing the holding time of the bladder, were initiated. The patient was also started on T. Tolterodine 4 mg after that the frequency and urgency reduced significantly. The patient was discharged after 3 weeks once his motivation to abstain from cannabis improved. The patient was lost to follow-up in June 2017, and he discontinued T. Tolterodine, leading to relapse of OAB. In September 2017, he presented again after 2 months of relapse to cannabis use, during which his OAB symptoms were completely absent. The patient believed that cannabis helped with his OAB symptoms, which were one of the maintaining factors of his cannabis use along with craving and peer pressure.