START TO TREAT CANNABIS ADDICTION
Marijuana use has become one of society’s hot topics. Almost everyone has an opinion – and critics waiting to pounce on whatever opinion it is. One argument which gets little air time is the addictive side of cannabis use. Lorne Hildebrand reports from the therapeutic and media front line.
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Everyone seems to have an opinion about marijuana use, be it based on fact and research or not. In particular, anyone raising concerns has many critics waiting to pounce and voice their rebuttals. The arguments from both sides range from loss of tax revenue from legal sales, to policing/legal costs and medical advantages/vs potential harms to anti big-pharma and government infringements on personal rights.
The one argument that seems to not get much air time is looking at the addictive side of cannabis use. In the middle of all the conversations, we seem to miss out on this critical point. As I have made that point in the media, and in lectures and talks, I usually get as angry and vociferous reactions as I have had to any other single item.
Let me explain that that my opinion comes from treating many people suffering from addiction, and from treating their families. This is most recently at Edgewood, which has been around for almost 20 years and has worked with over 11,000 people in that t ime. It is interesting to note that the biggest single drug-group in treatment has moved from alcohol to marijuana.
Make no mistake: the long-term cannabis addict can be as sick and unhealthy as the long-term untreated alcoholic.
Chemical dependency is defined as “a committed pathological love relationship of a person to a mood-altering chemical substance, a psychoactive drug, in expectation of a rewarding experience” and those who come to Edgewood with marijuana as their main drug of choice battle the same demons as the alcoholic or opiate addict. Regardless of the consequences, addicts keep using until the pain of staying the same is greater than the fear of changing.
THREE COMMON DENIALS OF CANNABIS-ADDICTED PATIENTS
Denial/delusional thinking is a clear indicator of addiction disorder, and cannabis-addicted patients have some unique kinds of denials. Below are three very common ones we see in treatment.
1) “I don’t see anything negative about my use, I think it is just other people have it ‘in’ for me.”
This doesn’t make sense for someone addicted. The clinician needs to review the drug use history and negative consequences to show that it is getting progressively worse with greater negative consequences. If family members or employers/co workers see it as a problem, the denial and paranoia itself is an indicator of an addiction problem. Like any chemically dependent person, the longer the disease is active the greater the denial delusion. Do not be fooled: they or their support system are asking for help for a reason.
2) “It’s less harmful than alcohol, would you rather I was drinking?”
Whether any one drug is more harmful than another is a moot point for someone who is addicted. A chronic long-term marijuana user has many negative consequences, medically and emotionally. An addicted person must learn to deal with his/her disorder by being abstinent and working a recovery programme. The question is not about which is more harmful, but about improving the addicted person’s life, giving freedom from the addiction and giving their loved ones relief and hope.
3) “I’m using it medicinally; I’ve read evidence that says its that it is a good medicine, why should I stop?”
Often used to make an excuse for chronic use, our job as clinicians is to help the person see the negative consequences. In an intervention situation, I recall a young man heavily addicted to marijuana who planned to be a distributor for others (like himself) needing it ‘medicinally’. He was so clear about the his views that treatment seemed a remote possibility – until I looked at his wife who was in tears. She was so hurt by his addiction she was ready to leave him. She still loved him but could not carry on.He came to treatment.
A clear review of the medical evidence cites the latest evidence and conclusions about medicinal marijuana including potential harms and cases of lack of evidence. Read it carefully, and keep in mind this information does not apply to those people who already have an addiction disorder.
EDGEWOOD CASE STUDY – ‘STEVE’.
Admitted: Spring 2013.
“I wouldn’t be able to sleep if I knew I still had it with me. I’d finish what I had before sleep and I’d worry about how to get it the moment it was gone,” is how Steve described his obsession. How many times have addicts, or the counsellors who treat them, heard a comment like that about a drug? Was it heroin? Crack cocaine? Oxycontin? Alcohol? It was cannabis.
‘Steve’ is a quiet, likable 23 year-old drug addict. His story began with a two-year, late teenage love affair with marijuana. Within months he was smoking five grams of pot a day.
After two years of daily pot intake, the threat of drug tests put his career in jeopardy. Rather than stop, he switched to synthetic cannabis.
Promoted as natural herbs, “Spice” or K2 is a psychoactive designer drug sprayed with synthetic chemicals which produce the high. When smoked, Spice offers a similar high to that produced with pot ingestion and it does not trigger a positive result in most drug screens. But, like most drugs, it is not cheap. Steve was quickly spending about £1,200 a month. The cost was high in all areas of his life.
How did it all get this crazy?
In school, Steve had been a high-level athlete, a good student, close to his family. By the time he arrived at Edgewood, he was no longer involved with sports, was not talking to his family and was lying regularly to his girlfriend and employer to hide his abuse of chemicals. In his first therapeutic assignment, describing his symptoms of addiction, Steve was brutally honest.
“I spend most of my free time at home where I can smoke up without any interruption. Every day, I smoke Spice. I convince myself I would not be able to function the same without it, I have resentment towards myself for not being able to control my addiction.”
THE TRUTH IS NOT PRETTY
As governments scramble to draft laws in response to the legalisation of marijuana and as marijuana lobby groups attempt to knock down arguments both scientific and holistic about the potential for trouble with marijuana, treatment centres continue to battle with the nasty facts of addiction. Whether it is heroin, cocaine or marijuana, away from the campaigns of lobbyists, the truth is not pretty. And the truth is that Steve’s story is just one of many.
Though case study after case study shows the necessary criteria are being met to prove cannabis addiction is debilitating, a quick search of the web serves up tens of thousands of sites arguing each point presented by the other side.
Heavy users experience significantly lower educational achievement, lower income and a subjective, self-assessment of impaired cognitive function, social life and health. Scans of long-term marijuana addicts show abnormal decreased brain mass along with a range of psychiatric symptoms. Problems also include underperformance in occupation or trouble in relationships, lack of energy and inattentiveness.
Inhalation of the toxins in marijuana smoke can be more damaging than tobacco smoke. Withdrawal symptoms experienced by long-term users include: irritability, restlessness, anxiety, sleep disturbances, appetite disturbances and stomach pains.
If you look at the classic symptoms of addiction, any pot addict will relate to what the cost of that reward is. An addict will:
>> see substance use begin to take a central role in life
>> deny claims from friends/family that changes are happening
>> continue to use despite negative consequences
>> lose control, needing increasingly larger amounts
>> spend more time thinking about using
>> spend more time and money acquiring more of their drug
>> get irritable or agitated if they run out of their drug.
The confusion round the danger of using cannabis is probably due to the fact that marijuana can be used in a relatively safe manner, just like alcohol. How does someone trying to sort out the facts when one’s personal experiences with a drug have not caused personal negative consequences?
Like an occasional drinker that has no negative consequences from drinking, the occasional toker might not see the problem, or at least not understand it. Their reaction has been to, if not make light of it, then to dismiss the negative ramifications as problems of the addicts’ lack of willpower or an overstated position of a rigid and uptight anti-marijuana lobby.
If we examine the harm that alcohol causes we find: addiction disease, brain damage, damage to other tissues, families in crisis, children suffering, and countless, police/legal and medical emergencies, all costing society tremendous amounts of money and untold individual pain and suffering.
Our experience shows the kinds of harm which happens with marijuana. Like alcohol, there is a small but clear percentage of users who are, or will be, addicted to the that drug and the synthetic substitutes. Our marijuana patients and their families suffer some different but just as difficult medical/emotional/psychiatric issues as alcoholics and their families.
The culprit, as is the main contributing factor in all addictions, is a person’s genetic susceptibility to addictions (seems to average about 5% of the population). That genetic susceptibility is a mesolimbic reward system in certain people’s brains that are more vulnerable to ‘rewiring’ the ‘need’ circuit by constant use of an addictive drug.
The actual percentage of cannabis addicts might be a little lower since many people, even those with a genetic vulnerability, choose not to use an illegal or controlled substance.
Undoubtedly, legalising marijuana will change harm patterns. Moreover, with alcohol many people can enjoy a glass of wine at dinner without getting drunk, while a marijuana user’s goal is generally to get high.
Edgewood’s marijuana-addicted patients who used “medicinally” generally do not want a controlled dosage via a pill, but wanted the ability to smoke as much as they thought was okay. Imagine a cancer doctor allowing a patient to completely control the drug usage without any real input.
Let’s be honest about this. While some symptomology might be helped, our experience tells us that this is not as much about medicine as it is about getting high.
Meanwhile we wait to see clear evidence that marijuana has any better medicinal value than what is already available. But, considering the inhalation of any cancer-causing toxic substance, such as tobacco or marijuana smoke, any doctor should steer completely away from it. Who now would think a doctor should prescribe cigarettes for anxiety?
So as we endeavor to have the much-needed societal debate around marijuana use and the legalities and ramifications, let us at least be armed with knowledge. Remember that for some people, perhaps even for someone in your family or for yourself, it is a direct road to self-destruction. Just like those suffering from alcoholism, marijuana addicts need to be identified and treated: the earlier the better.
LORNE HILDEBRAND is Edgewood’s executive director. Edgewood is a private CARF-accredited residential abstinence treatment facility in British Columbia, Canada. Its main campus is on Vancouver Island and has 140 beds for first-stage care, extended care and family programmes. It pioneered online aftercare and serves people across the world.