Stigma, Mental Health, Addiction, Cannabis

THIS INFORMATION  UPDATED May 16; see bottom of the post.. IF YOU SEE THIS NOTICE THE MATERIAL POSTED MAY CHANGE IN THE NEAR FUTURE, PLEASE CHECK BACK.

Mental illnesses and addictive disease are sometimes lumped together under the category “behavioral health.” One thing they have in common, unfortunately, is that both mental illnesses and addictions are highly stigmatized. Among other findings,  researchers have seen that reactions to mental illness include the following:

  1. fear and exclusion: persons with severe mental illness should be feared and, therefore, be kept out of most communities;

  2. authoritarianism: persons with severe mental illness are irresponsible, so life decisions should be made by others;

  3. benevolence: persons with severe mental illness are childlike and need to be cared for.

There are many myths about mental illness including the idea that people with mental illness are dangerous. In fact, they are ten times more likely to be victims of violence the the general population. Another widespread, incorrect belief is that people with mental illness are responsible for their illnesses. This belief is typically not held toward people with other health problems.

Stigma toward people with addictions is even worse. This is despite the widespread acknowledgement by various sources such as the DSM 5  that substance use disorders (SUD’s) are a category of mental disorder. Many myths about addiction continue to be widespread.

Into this already confused field comes the changing role of cannabis in society. Is it a miracle substance that cures otherwise difficult to treat ailments? Is it a deadly drug that is, as past anti-marijuana crusaders claimed, an “assassin of youth?” Fortunately, and National Academies of Science, Engineering, and Medicine have compiled an excellent review of the literature on the effects of cannabis and cannabinoids. What the review shows, not surprisingly, is that a great many claims, pro and con, have no basis in any research. However, from a mental health perspective, there were some key conclusions that anyone might want to note.

There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.

There is moderate evidence of a statistical association between cannabis use and increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users, increased incidence of suicide completion and increased incidence of social anxiety disorder (regular cannabis use).

Most importantly for anyone concerned about youth, the report finds that there is substantial evidence that  initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use and that there is moderate evidence that during adolescence the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the
development of problem cannabis use.

CAN YOU BE ADDICTED TO MARIJUANA?

The short answer is yes. The DSM 5 includes cannabis use disorder. The criteria for a substance use disorder are as follows:

1. Substance is often taken in larger amounts and/or over a longer period than the patient intended.

2. Persistent attempts or one or more unsuccessful efforts made to cut down or control substance use.

3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from effects.

4. Craving or strong desire or urge to use the substance

5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued substance use despite having persistent or recurrent social or interpersonal problem caused or exacerbated by the effects of the substance.

7. Important social, occupational or recreational activities given up or reduced because of substance use.

8. Recurrent substance use in situations in which it is physically hazardous.

9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following:
a. Markedly increased amounts of the substance in order to achieve intoxication or desired effect;
b. Markedly diminished effect with continued use of the same amount.

11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance;
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

Depending on how many of the eleven symptoms a person has, the disorder is qualified as mild, moderate, or severe.

 

How many people are currently using marijuana?

The main reference for this is the National Study of Drug Use and Health (NSDUH)

It found, in part, that:

Aged 12 to 17

In 2017, 6.5 percent of adolescents aged 12 to 17 were current users of marijuana (Figure 13). This means that approximately 1.6 million adolescents used marijuana in the past month. The percentage of adolescents in 2017 who were current marijuana users was lower than the percentages in most years from 2009 to 2014, but it was similar to the percentages in 2015 and 2016.

Aged 18 to 25

In 2017, about 1 in 5 young adults aged 18 to 25 (22.1 percent) were current users of marijuana (Figure 13). This means that 7.6 million young adults used marijuana in the past month. The percentage of young adults who were current marijuana users in 2017 was higher than the percentages between 2002 and 2016.

Aged 26 or Older

In 2017, 7.9 percent of adults aged 26 or older were current users of marijuana (Figure 13), which represents about 16.8 million adults in this age group. The percentage of adults aged 26 or older who were current marijuana users in 2017 was higher than the percentages in 2002 to 2016.

HOW MANY PEOPLE START USING MARIJUANA EACH YEAR?

According to the NSDUH:

In 2017, an estimated 1.2 million adolescents aged 12 to 17 used marijuana for the first time in the past year (Figure 28), which translates to approximately 3,300 adolescents each day who initiated marijuana use (Table A.19A). About 1.1 million to 1.4 million adolescents per year in 2002 to 2016 were recent marijuana initiates. The 2017 estimate was similar to the estimates in most years from 2002 to 2016.

In 2017, 1.3 million young adults aged 18 to 25 initiated marijuana use in the past year (Figure 28), or an average of about 3,600 recent initiates per day in this age group (Table A.19A). The 2017 estimate for the number of young adults who initiated marijuana use in the past year was higher than the estimates in all years from 2002 to 2016.

An estimated 525,000 adults aged 26 or older in 2017 initiated marijuana use in the past year, which rounds to the estimate of 0.5 million initiates in this age group in Figure 28. This number averages to about 1,400 recent initiates per day in this age group (Table A.19A). The number of recent marijuana initiates in this age group in 2017 was higher than the numbers of initiates in all years from 2002 to 2014, but it was similar to the numbers in 2015 and 2016. Consistent with the pattern for cigarette and alcohol use, the majority of people in 2017 who initiated marijuana use in the past year were aged 12 to 25.

DOES THE POTENCY MAKE A DIFFERENCE? WHAT ABOUT VAPING THC?

Recent information suggests that higher potency THC marijuana and THC for vaping may actually make this a different drug in terms of its effects on people. As the article linked mentions, “I think most people are aware of the phenomenon that ‘this is not your grand daddy’s weed,’ Gruber says. “I hear this all the time.” What is important to note is that high potency cannabis can actually have the opposite effect from what people associate with the effects of marijuana with low THC levels.

As an old hippie, I remember when people would actively counsel their friends, “you’re not the right kind of personality to do that drug,” or “You’re not in the right head space to do that right now.” Taking powerful psychotropic substances, medical or recreational, has risks. To do so without paying attention to the dosage, frequency, or environmental considerations only increases the risks. If you’re going to do it, who has your back?

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About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
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