The Myth of Marijuana
by Dr. Loving
When I admit a new patient to the hospital (an inpatient
chemical dependency and dual diagnosis program), I do an evaluation
and ask a lot of questions about substance abuse. The new
patients come here because they are out of control with drugs
and/or alcohol, usually need medical detoxification, and also need
rehabilitation to change the way they are living. To detoxify
them safely I need to know what drugs they are using, how much and
how often. The drugs are cocaine, methamphetamine, opiates
(heroin, oxycontin, hydrocodone, etc.), benzodiazepines (Xanax,
Klonopin, and others including Soma), hallucinogens, alcohol, and
last but not least – marijuana. The patients are quick to
identify their problem when it is shooting heroin daily, smoking
$100 of crack per day, drinking a fifth of whiskey per day, or
taking 30 Vicodin a day. I always ask “what else?” or “how
much?” several times because most underestimate their amounts, and
many are using 2 or 3 different drugs. When I ask, “Do you
smoke pot?”, 90% answer “yes.”
In going back through the patient histories, 85% started their
drug use with pot and the other 15% started with
alcohol. Marijuana is usually their first experience with a
chemical high, and many move on to various other drugs searching
for a stronger or better euphoria. If I don’t ask specifically
“Are you smoking pot?” most will not mention it because they take
it for granted, as they have usually been smoking since age 10, 11,
or 16. They haven’t looked at it as the problem, but rather as
a given in their life. It’s easier to see cocaine or alcohol
as problems because behavior is disinhibited and dramatically out
of control, involving car wrecks and fights. Marijuana is not
so dramatic and in fact it causes people to sit on the couch, watch
TV, and eat. How can that be a problem?
Well, marijuana is a problem - a big problem - for the patient
and society, yet denial in our society and in the individual
patient is huge. In our culture today many people say things
like, “It’s not addictive”; “It’s natural and so it’s okay”; “It
just mellows me out”; and “I can keep smoking pot, I just need to
quit the dangerous stuff.” It’s so common for patients to
continue to stick with marijuana use after treatment for addiction,
that clinicians have coined the term “marijuana maintenance
program” for this misguided recovery plan.
Besides working in an inpatient chemical dependency program, I
am a psychiatric consultant for an adolescent residential treatment
center. 98% of these patients start with marijuana (usually
called “weed” these days), and end up in the program because while
on probation for truancy, possession, or petty theft, they
repeatedly test positive for marijuana on their probation officers’
drug screens. They can’t quit smoking even when
monitored. These adolescents and the previously mentioned
adult patients do not think they are addicted even though they
smoke daily - sometimes for years. None believe they will
become addicted to marijuana or get out of control with other
substances.
Marijuana has an inaccurate reputation that it is not addictive
because there is not a significant physical withdrawal syndrome
when it is stopped. When alcohol is stopped abruptly, visual
hallucinations, tremors, seizures, or DTs will occur. Stopping
opiates abruptly causes an intensely uncomfortable flu-like
syndrome. To avoid these withdrawal problems we give a cross
tolerant drug and taper the patient gradually off of that
detoxification medicine. Marijuana has a built-in taper when
stopped abruptly. Because THC (the active ingredient in pot)
is stored in the fat cells and because fat cells have such poor
blood circulation, THC is slowly released from the body over a few
weeks. This becomes a natural, undramatic withdrawal and
explains why marijuana cessation does not cause a lot of physical
discomfort. But, just because no withdrawal syndrome occurs
doesn’t mean it is not addictive. Addiction is compulsive use
and obsession with the drug. I have seen many patients who
smoke every day, even though problems and losses pile up; they
don’t get high like they used to; and even though they get anxious
and paranoid when they smoke – they still use. This is
addiction.
Some people distinguish between “psychological” and “physical”
addiction. Addiction is both psychological and
physical. Marijuana is addictive but because of the built-in
taper with this drug, people have a hard time believing
it. Just like other addictive substances, not everyone becomes
addicted. Denial is particularly strong with marijuana users,
and society’s attitude strengthens this denial.
The harm marijuana causes is passive rather than dramatic, and
comes from what this drug takes away. All of the experts agree
it causes the amotivational syndrome and decreases
memory. Recently, I attended a family group session involving
15-20 likeable and hard-working parents of pot smoking teenagers.
All of the parents said they were against their teenager smoking
marijuana, but half of the parents were pretty soft on the
issue. These parents had the attitude “teenagers will be
teenagers,” “everybody does it,” “it’s not addictive,” and “look at
me, I smoked through school and it didn’t hurt me.” One said,
“I smoked all through college, it was the best 8 years of my
life.” Isn’t college supposed to be 4 years? All of these
parents are also encouraging their kids to make good grades, work
hard in school, aim toward college, and enter a good
profession. Passively condoning marijuana use works in the
exactly opposite direction.
Many of these parents smoked pot 20 or 30 years ago when the
marijuana was about 1/5th as strong as today’s
“weed.” The product has been “new and improved.” Kids
also tend to start smoking earlier in their lives. It’s not
unusual for children to start in middle school or the early
teens. Just as any salesman has new and improved products;
dealers also have access to a variety of other products. Where
pot is bought many dealers also have stronger and different drugs
like Xanax “bars”, “oxy”, cocaine, etc, etc. If a person
really likes the vanilla ice cream, it’s not long before cookies
and cream ice cream, sorbet, or sundaes are tried. Some people
pooh- pooh the term “gateway drug,” but once a person likes getting
high, it is natural to move on to “the better stuff.”
A percentage of drug and alcohol users (about 15-20%) will go on
to true addiction. The majority won’t become addicts or
alcoholics, but the harmful effects of marijuana affect all who
use. The 15 year old who is smoking has lower motivation,
becomes more withdrawn, and doesn’t concentrate or remember as
well. This interferes with achievement and with
development. The brain isn’t fully developed until age 24 or
25. This drug that profoundly affects the brain and
neurotransmitters especially causes big problems in the developing
brain. Richard Hawley says in his book, The Purposes of
Pleasure, that “not only does marijuana change the personality,
but what’s worse it changes the thing that makes personality—the
brain.” Marijuana use in the teenage brain may cause
irreversible changes and losses.
When a young person learns he or she can get high by just
ingesting a substance they tend to not learn the valuable
things natural highs (non-chemically induced) teach
us. Natural highs teach us mastery, problem solving, stress
management, and make us healthier and happier human animals.
Self-esteem is increased with these pleasures and coping
skills. Highs from marijuana and other drugs teach us nothing,
and decrease self-esteem along the way. Emotional and
psychological growth is short-circuited by marijuana and other drug
use. In the short run the chemical highs seem like a great
deal, but in the long run they are terrible deals. Marijuana
is one of the most dangerous of drugs because it has such a benign
reputation, and yet takes away so much from our young
people. It “dumbs down” our youth and our society, and the
myth that marijuana is “not a big deal” is just that – a
myth. In American we will either have to greatly lower our
expectations of future generations, or take off the blinders and
admit that marijuana is a very dangerous
drug.
