Legalization of Marijuana
And How This Will Affect
Substance Abuse and Mental Health Counseling
Voters in Colorado and Washington made history on Election Day in 2012 when they became the first to legalize the recreational use of marijuana. While many voters in both states are celebrating, there are some with concerns about how the new stance on marijuana could affect substance abuse within those states.
Marijuana laws are changing at a rapid pace across all 50 states, making things a bit confusing at times.
The significant terms used surrounding the topic of marijuana include legalization, decriminalization, and medical marijuana. Below are very general definitions for these terms:
Marijuana Legalization-Laws or policies that make the possession and use of marijuana legal under state law.
Marijuana Decriminalization-Laws or policies adopted in several state and local jurisdictions that reduce the penalties for possession and use of small amounts of marijuana from criminal sanctions to fines or civil penalties.
Medical Marijuana-State laws allow an individual to defend himself or herself against criminal charges of marijuana possession if the defendant can prove a medical need for marijuana under state law.
The rise of marijuana as an adult pastime is a victory for those who’ve always felt that its hazards were overblown. Proponents of legalization argue that marijuana is much safer to use than alcohol, pointing out that it is virtually impossible to overdose on marijuana.
While marijuana can be addictive, scientists generally agree that fewer than 10 percent of marijuana smokers become dependent on the drug, compared with 15 percent for alcohol, 23 percent for heroin, and 32 percent for tobacco. Marijuana does contain carcinogens, including tar and other toxins, similar to those found in tobacco, but people generally do not smoke marijuana in the same amounts as cigarettes.
Still, legalization takes health consumers into murky territory. Even though marijuana is the most commonly used illegal drug in the United States, questions about its health effects remain.
Increased potency may be having unforeseen consequences. The human brains cannabinoid receptors are typically activated by naturally occurring chemicals in the body called endocannabinoids, which are similar to THC. There is a high density of cannabinoid receptors in parts of the brain that affect pleasure, memory and concentration. Some research suggests that these areas continue to be affected by marijuana use even after the high dissipates.
Those in favor of legalizing marijuana say the increase in potency has been exaggerated, and that when users have more powerful pot, they adjust their consumption and actually smoke less.
Marijuana is classified as a Schedule I drug. Schedule I substances are those that have the following findings:
A. The drug or other substance has a high potential for abuse.
B. The drug or other substance has no currently accepted medical use in treatment in the United States.
C. There is a lack of accepted safety for use of the drug or other substance under medical supervision.
The main active chemical in marijuana is delta-9-tetrahydrocannabinol, more commonly called THC. THC acts upon specific sites in the brain, called cannabinoid receptors, starting off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana. Some brain areas have many cannabinoid receptors; others have few or none. The highest density of cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thinking, concentrating, sensory and time perception, and coordinated movement.
Marijuana’s high can affect these functions in a variety of ways, causing distorted perceptions, impairing coordination, causing difficulty with thinking and problem solving, and creating problems with learning and memory. Research has demonstrated that among chronic heavy users these effects on memory can last at least seven days after discontinuing use of the drug.
These aren’t the only problems connected to marijuana use. Research tells us that chronic marijuana use may increase the risk of schizophrenia in vulnerable individuals, and high doses of the drug can produce acute psychotic reactions. Researchers have also found that adolescents long-term use of marijuana may be linked with lower IQ(as much as an 8 point drop) later in life.
We also know that marijuana affects heart and respiratory functions. In fact, one study found that marijuana users have a nearly five-fold increase in the risk of heart attack in the first hour after smoking the drug. A study of 452 marijuana smokers (but who did not smoke tobacco) and 450 non-smokers (of either marijuana or tobacco) found that people who smoke marijuana frequently but do not smoke tobacco have more health problems, including respiratory illnesses, than nonsmokers.
All that stated, a recent study published in the Journal of the American Medical Association (JAMA) found that low levels of marijuana use (with no tobacco use) produced no detrimental effect in lung function among study participants. In fact, exposure led to a mild, but not clinically significant, beneficial effect albeit among those who smoked only one joint per day. While these findings have received wide attention from the media and from advocates of marijuana legalization, it is important to consider them in the context of the extensive body of research indicating that smoking marijuana is harmful to health. Additionally, while the study did not include a sufficient number of heavy users of marijuana to confirm a detrimental effect of such use on pulmonary function, the findings suggest this possibility.
The harms of marijuana use can manifest in users quality of life. In one study, heavy marijuana users reported that the drug impaired several important measures of health and quality of life.
Research clearly supports these reports demonstrating that marijuana use has the potential to cause problems in daily life or make a person’s existing problems worse. Furthermore, marijuana users generally report lower life satisfaction, poorer mental and physical health, relationship problems, and less academic and career success compared to their peers who came from similar backgrounds. For example, marijuana use is associated with a higher likelihood of dropping out from school. Several studies also associate workers’ marijuana smoking with increased absences, tardiness, accidents, workers’ compensation claims, and job turnover.
Concerns have been raised about the potential for long-term cannabis consumption to increase risk for schizophrenia, bipolar disorders, and major depression, but the ultimate conclusions on these factors are disputed. The evidence of long-term effects on memory is preliminary and hindered by confounding factors.
For every single person who has a concern though, there is a proponent who stipulates that marijuana improves their quality of life through relaxation and a decrease in pain both physical and emotional.
Marijuana is the most commonly used illicit drug in the United States although calling illicit is not entirely accurate as of 2020. In 2011 alone, more than 18 million Americans age 12 and older reported using the drug within the past month. These numbers are going to increase with the increase in availability that legalization creates. With the government looking the other way and voters legalizing it the stigma also changes.
ABUSE, DEPENDENCE and the COSTS ASSOCIATED
Approximately 4.2 million people met the diagnostic criteria for abuse of or dependence on this drug. This is more than pain relievers, cocaine, tranquilizers, hallucinogens, and heroin combined.
There are very real consequences associated with marijuana use. In 2010, marijuana was involved in more than 461,000 emergency department visits nationwide. This is nearly 39 percent of all emergency department visits involving illicit drugs, and highlights the very real dangers than can accompany use of the drug.
And in 2011, approximately 872,000 Americans 12 or older reported receiving treatment for marijuana use, more than any other illicit drug. Despite some viewpoints that marijuana is harmless, these figures present a sobering picture of this drugs very real and serious harms.
Marijuana places a significant strain on our health care system, and poses considerable danger to the health and safety of the users themselves, their families, and our communities. Marijuana presents a major challenge for health care providers, public safety professionals, and leaders in communities and all levels of government seeking to reduce the drug use and its consequences throughout the country.
We know that marijuana use, particularly long-term, chronic use or use starting at a young age, can lead to dependence and addiction. Long-term marijuana use can lead to compulsive drug seeking and abuse despite the known harmful effects upon functioning in the context of family, school, work, and recreational activities.
Research finds that approximately 9 percent (1 in 11) of marijuana users become dependent. Research also indicates that the earlier young people start using marijuana, the more likely they are to become dependent on marijuana or other drugs later in life.
Both Colorado and Washington restricted marijuana use to adults age 21 and over when they legalized recreational use in November of 2012. Experts worry that the perception of marijuana is changing because its stigma as an outlawed drug has eroded.
When people can go to a clinic or cafe and buy pot, that creates the perception that its safe, said Dr. A Eden Evins, director of the Center for Addiction Medicine at Massachusetts General Hospital in Boston.
Many substance abuse professionals believe marijuana to be a gateway drug. A gateway drug means that the use of marijuana suggests the future use of stronger drugs such as cocaine. A person who smokes marijuana is more than 104 times more likely to use cocaine than a person who never tries marijuana, according to the National Institute on Drug Abuse. Although others point out that correlation isnt cause and for that you cant say using marijuana causes you to use other substances. Taking a middle ground, although everyone who uses marijuana is not likely to think, well if this is goodI wonder what Heroin is like!, but at the same time someone who gets over the sticker shock of the first few car dealerships is more likely to stretch their budget at the next one. The concept has been introduced and inhibitions have been lowered. Pointing out that marijuana is a gateway to a behavior of using substances to change the way you feel isnt suggesting cause but rather the suggestion of a mindset. We have spent decades teaching our children not to smoke and not to use marijuana. The message this sends is contradictory.
Teenagers may be more vulnerable to addiction and those who start smoking marijuana at earlier ages also tend to smoke much more, and more often, than those who start in their later teens, researchers say.
Heavy marijuana use is associated with cognitive decline in about 5% of teens, according to a new study, which suggests that the heaviest users could lose 8 IQ points.
The hypothesis is that we see this IQ decline in adolescence because the adolescent brain is still developing and if you introduce cannabis, it might interrupt these critical developmental processes.
So, if we let go of the argument of whether it should or should not be legal and look at what the already legalized marijuana will mean to substance about and mental health treatment, we can make the leap that there will likely be an increased need for behavioral care. The question surrounding treatment is what can be done to help people become and remain abstinent. For those who cannot remain abstinent, an initial goal is measurable improvement. The first step for clinicians is to help the patient become motivated to change his relationship to drugs.
Recent changes in the stigma and availability will make people becoming and remaining abstinent more challenging. For those that use and then decide they no longer want to use having more access to the drug will make it more difficult it is to stay away from it.
Over the last two decades, treatment admissions for marijuana have increased significantly. This increase in admissions for marijuana coincides with the sharp rise in the potency of marijuana.
Adults seeking treatment for marijuana abuse or dependence average more than 10 years of near-daily use and more than six serious attempts at quitting. They continue to smoke the drug despite social, psychological, and physical impairments, commonly citing consequences such as relationship and family problems, guilt associated with use of the drug, financial difficulties, low energy and self-esteem, dissatisfaction with productivity levels, sleep and memory problems, and low life satisfaction. Most perceive themselves as unable to stop, and most experience a withdrawal syndrome upon cessation.
Approximately half of the individuals who enter treatment for marijuana use are under 25 years of age. These patients report a distinctive profile of associated problems, perhaps due to their age and involvement in other risky behaviors.
Most treatment, unless in conjunctions with other issues, is done on an outpatient basis or in a partial hospitalization program.
The most commonly tested interventions are adaptations of interventions initially developed to treat alcohol or cocaine dependence, in particular Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT).
Marijuana abuse or dependence typically co-occurs with use of other drugs, such as cocaine and alcohol. Available studies indicate that effectively treating the mental health disorder with standard treatments involving medications and behavioral therapies may help reduce cannabis use, particularly among heavy users and those with more chronic mental disorders. Unfortunately, the success rates of treatment are rather modest. Even with the most effective treatment for adults, only about 50 percent of enrollees achieve an initial 2-week period of abstinence, and among those who do, approximately half will resume use within a year.
Increased marijuana use will also lead to a higher need for mental health counseling even if marijuana isnt the reason for counseling. Research in the past decade has focused on whether marijuana use actually causes other mental illnesses. The strongest evidence to date suggests a link between cannabis use and psychosis. Marijuana use also worsens the course of illness in patients with schizophrenia and can produce a brief psychotic reaction in some users that fades as the drug wears off. The amount of drug used, the age at first use, and genetic vulnerability can all influence this relationship. One example is a study that found an increased risk of psychosis among adults who had used marijuana in adolescence and who also carried a specific variant of the gene for catechol-O-methyltransferase (COMT), an enzyme that degrades neurotransmitters such as dopamine and norepinephrine.
In addition to the observed links between marijuana use and schizophrenia, other less consistent associations have been reported between marijuana use and depression, anxiety, suicidal thoughts among adolescents, and personality disturbances. One of the most frequently cited, albeit still controversial, is an amotivational syndrome, defined as a diminished or absent drive to engage in typically rewarding activities. Because of the role of the endocannabinoid system in regulating mood, these associations make a certain amount of sense; however, more research is needed to confirm and better understand these linkages.
In users who develop a dependence or addiction, quitting can cause intense withdrawal symptoms, like anxiety, trouble sleeping, lack of appetite, mood swings, irritability and depression experts say.
Without a doubt, with these potential symptoms, increased availability and use, can lead to marriage and family issues that could require counseling.
TAKING TREATMENT FOR MARIJUANA BEYOND THE RIGHT VERSUS WRONG OF IT
Understanding addiction as a psychological symptom allows us to separate the drug from its use, and its use from addiction.
Addiction is addiction no matter which substance or activity comprises its narcotic alcohol, other drugs, shopping and eating can all act in the same functional way. This is the reason that so many addicts switch throughout their lives from one drug to another, or even from a drug to a non-drug addiction like gambling. It is nonsensical to speak of such people as being dually addicted or even being multiply addicted; the inner engine of addiction its meaning is consistent for each individual, namely an effort to relieve feelings of being trapped, unhappy or helpless and to establish a sense of control. “I may have to go to this stinkin’ job Monday through Friday”, is a common example, “but I’m going to get drunk or smoke a few joints this weekend, and nobody is going to stop me.”
All compulsive or addictive behaviors are substitutions, or displacements, for a direct action that is felt in some sense to be deserved but not received, impossible or forbidden. The particular form this substitute action takes can be almost anything. We need to understand that addiction lies in the individual psychology of each person why he uses the drug and not in the nature of any, or all, drugs. (Of course, one can develop physical dependency through the heavy use of certain drugs, but physical addiction, being short term and treatable, has little to do with the problem of addiction.
It is crucial for us as addiction professionals to look outside of the substance and treat the addiction. We may also be faced with helping families who disagree on the subject find peaceful, middle ground.
As stated, naturally, increasing the availability of any drug will increase its use and will increase the problems arising from that use.
If marijuana is more accessible, more people will experiment with it, including young people whose brains are still developing, and seem to be most susceptible to addiction.
While Washington has outlined use of tax revenue toward substance-abuse prevention, there is still the worry that legalization will lead to further abuse. Additionally, some fear that the states will receive more tourists because of this. Some worry about what affect drug-seeking tourists will have the local communities.
The hard reality is that we are in the midst of a protracted drug crisis in this culture with an extraordinary number of people regularly under the influence of alcohol and other drugs. And when peoples brains are chemically altered, they are more likely to break laws, drive dangerously, get violent, argue with family members and so forth.
Perhaps in light of these policy changes, whether we are pro or con on the subject, we turn our focus away from legal punishments for alcohol and drug issues, punishments which have not work very well at reducing abuse and addiction, and focus on better and more available education and treatment approaches. We currently spend an estimated 75 billion dollars yearly on the War on Drugs. These funds could be put into the drug and mental health treatment industry with a sophisticated psychological approach.
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