Marijuana: Addiction and Other Issues Sep29

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Marijuana: Addiction and Other Issues

Tetrahydrocannabinol; THC; Marinol

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Marijuana is at once an interesting area of inquiry and a subject of practical concern for young adults in the United States. Though used within minority groups (e.g., urban Blacks, including musicians, artists, and the general population) in the first half of the twentieth century, it wasn’t until majority youth (white college students, and then high-schoolers, from suburban and even rural areas) began smoking pot in the 1960s that marijuana gained widespread attention. Marijuana is America’s most commonly used illegal drug; more than 1/3 of the U.S. population ages 12 and older have tried marijuana at least once.

Marijuana has always been a politicized subject—as are all controlled substances. It is common knowledge that the marijuana plant grows wild in many parts of the country, but to possess it or distribute it is a crime. During the course of the current public debate about decriminalization of drugs, many have argued that marijuana is relatively harmless, so prohibition of its use is illogical.

This view has found considerable support among many groups and organizations. Still, there are some issues related to marijuana use that today’s college students should at least be aware of. It is reasonable to wonder, for example, how marijuana use might affect performance in school or interpersonal relationships. What kinds of effects does it produce in its users? Is the marijuana of today as tame and harmless as the marijuana of earlier decades? And to what extent can it be truly addictive?

Marijuana and Addiction

The question of addiction is especially intriguing. The majority of marijuana users do not develop addiction: they do not experience loss of control; they use when they choose to, in the amounts they choose to, getting the results—in general—that they intend to get. Parents of today certainly recall many acquaintances from college in the 1960s or ’70s, or high school in the ’80s and ’90s, who smoked marijuana without developing dependence or any other long-term negative consequences. But just because addiction doesn’t occur in all users, or even most users, doesn’t mean that addiction doesn’t happen to any user.

Addiction to marijuana has the same features as addiction to other substances: after a period of regular controlled use, users gradually develop an inability to consistently use within the limits that they have set for themselves. Use won’t just result in “fun” or “getting high”; it will lead to problems with job performance, school performance, interpersonal relationships, or even health.

The cycle of addiction follows a regular pattern. After an initial period of stable substance use, the user will begin to lose control. Others will comment that there is a change in the user—and the user will at first deny or rebut such concerns. Use will continue despite the problems it has caused. Larger and larger amounts of the substance are used, consuming money that could go to other purposes, and the person may spend more and more of the day or the week either using, thinking about using, or arranging to get more supplies of the drug. The substance use takes on a central place in the person’s life, with other activities—including major life responsibilities—falling by the wayside. Despite the pleas of friends or family to examine or change the behavior, substance use continues, causing distress to others before the addict experiences the distress himself. Eventually, the person may seek help, or at least agree to a professional assessment at the behest of family, friends, school, or employer. Most pot users, however, do not fall into this cycle of addiction.

A useful distinction is often made between substance abuse (recurrent use despite harmful consequences) and substance dependence (the cycle of addiction just described). Substance dependence, as mentioned above, is not common among pot users. Abuse, which involves continued use despite legal, occupational, or academic problems (e.g., recurrent use after an arrest for impaired driving, or after a drug-related work suspension) is more common. Despite being considered less severe than addiction, cannabis abuse nevertheless creates distress for loved ones and other interested parties, and by definition involves an observable downturn in the user’s performance of some important life task.

Physical Dependence

Two decades ago, addiction medicine doctors and counselors believed that the difference between substance abuse and substance dependence was whether tolerance and withdrawal were present. Now it is known that, although tolerance or withdrawal may occur in individuals with addiction, the condition of addiction can exist without any sign of tolerance or withdrawal. Still, a common question of interest is, does marijuana produce physical dependence (that is, tolerance or withdrawal)?

By the twenty-first century, the answers to these questions are clear. Tolerance does develop to THC (the active chemical in marijuana). Moreover, withdrawal definitely occurs in some users. The effects of this withdrawal are generally the opposite of the effects of intoxication: anxiety and insomnia instead of relaxation; loss of appetite rather than hunger; excessive salivation instead of dry mouth; and also decreased pulse, irritability, and sometimes tremor. People who have used marijuana as a way to control underlying anger may also experience irritability, increased mood swings, and even an increase in aggressive behavior, as symptoms of withdrawal.

Final comment

Although marijuana use has been common in many segments of the American population for two generations, and many adults and teenagers know marijuana users who have not developed addiction even to prolonged use, the potential for the development of addiction is almost certainly greater today than in the 1960s or ’70s. The marijuana of today is different. It’s not just much more expensive; it also contains significantly more THC. In fact, the THC content of today’s pot is several times higher than that of even strong “weed” from the ’60s. This makes it more potent, but also more likely to induce tolerance and true addiction.

Written by Michael Miller, M.D., of Meriter Hospital, and Brian Glueck, editor, UHS. Michael M. Miller, M.D., is Medical Director of the NewStart Alcohol/Drug Treatment Program at Meriter Hospital in Madison, WI. For other NewStart articles about drug addiction, as well as many related links, visit the Meriter chemical dependency page.

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