Marijuana Addiction, Abuse, and Treatment
Marijuana Addiction, Abuse, and Treatment
Table of Contents
About Marijuana Use
Nearly half of all Americans aged 12 and older have tried marijuana in their lifetime, according to the Pew Research Center.1 Classified as a cannabinoid, marijuana is most commonly used by 18- to 25-year-olds, with twenty percent of that age group reporting using it in the past month, and more than 32 percent reporting using it in the past year. Steadily on the rise in the U.S. since the 1970s, marijuana use is second in prevalence only to alcohol use. Do you, or a loved one, struggle with marijuana use? Get the answers to your questions about marijuana addiction, dependence, detox, withdrawal, and treatment.
Federal Drug Schedules
While marijuana is federally classified as a Schedule I drug under the Controlled Substances Act, it’s been decriminalized in most states, and some states have legalized medical or recreational use. Schedule I drugs are those that have a high risk for abuse but no established medical value. However, a growing body of research shows that cannabinoids, the 85 active compounds found in the cannabis plant, do have medicinal value for a range of ailments. Non-psychoactive cannabinoids, including cannabidiol, or CBD, are also used as complementary or alternative treatments for a variety of conditions.
Commonly known as “pot” or “weed,” marijuana is the dried flowers of the cannabis plant. The active psychoactive ingredient in marijuana is a cannabinoid known as tetrahydrocannabinol, or THC, which produces a relatively mild high.
How Is It Used?
When used recreationally, it’s typically smoked in a pipe or bong or baked into food to produce an “edible.” In legal dispensaries, edibles take the form of many treats, including candy, baked goods, and butter. The THC activates receptors in the endocannabinoid system in the brain, which plays a role in appetite, mood, emotion, sleep, and movement.
A Brief History of Marijuana Use in the U.S.
Weed has a long history in the U.S. In the 17th century, and the U.S. government encouraged citizens to grow hemp, which is the term for a cannabis plant that contains less than 0.3 percent THC. Hemp was a legal tender in Maryland, Virginia, and Pennsylvania. After the Civil War, marijuana was an ingredient in numerous popular medicinal products sold in pharmacies.
Marijuana at the Turn of the Century
Between 1900 and 1920, Mexican immigrants introduced weed as a recreational drug. The fear and prejudice surrounding these immigrants led to anti-drug campaigns against weed. During the Depression, public resentment of Mexican immigrants flared, and the use of weed was linked to violence and crime. By 1931, marijuana was illegal in 29 states.
In 1936, the propaganda film “Reefer Madness” hit the screens, and in 1937, after a heavy-handed propaganda campaign, Congress passed the Marijuana Tax Act, which criminalized marijuana and restricted possession of it to people who paid a tax for medical and industrial uses.
In 1944, after extensive research, the New York Academy of Medicine found that using weed did not incite violence, cause insanity, or lead to sex crimes. But in 1956, the Narcotics Control Act set mandatory sentences of two to ten years and a fine of up to $20,000 for a first-offense marijuana possession.
In the 1960s, it became a popular counter-culture drug, and in 1970, the mandatory penalties for marijuana possession were repealed. Marijuana was categorized separately from other narcotics. In 1972, Nixon rejected a move to decriminalize it, but by the end of the 1970s, 11 states had decriminalized it anyway.
The War on Drugs
In 1976, parents’ groups lobbied for stricter regulation, and this paved the way for the War on Drugs of the 1980s. In 1986, President Reagan signed the Anti-Drug Abuse Act, which raised the federal penalties for marijuana possession, so that possession of 100 plants earned the same penalty as possession of 100 grams of heroin.
During the 1990s, public opinion about weed began to relax, and in 1996, California passed Proposition 215, which legalized medical weed in that state. Alaska followed suit in 1998, and Maine in 1999. More states followed, and in 2012, Colorado became the first state to legalize weed for recreational use. Today, recreational marijuana use is legal in eleven states, and medical marijuana use is legal in 33 states.
According to a book published by the National Academies Press in 2017, weed use has decreased among 12- to 17-year olds while significantly increasing among the 55-and-over crowd. Over 22 million Americans aged 12 and over report current marijuana use.2
Is Marijuana Safe?
In terms of overdose mortality, it’s one of the safest psychoactive substances of abuse. Fatal overdose of marijuana is extremely unlikely. The Centers for Disease Control reports that no reports have linked its use to an overdose death. However, using too much can cause an unpleasant experience marked by fear, paranoia, confusion, hallucinations and an increase in blood pressure. Deaths and injuries involving weed typically stem from accidents, like a fall or an automobile crash.
In the process of smoking weed, the THC passes into the bloodstream from the lungs. The blood carries it to the brain, where it acts on specific brain receptors to produce the high that is desired. The effects include altered senses, a skewed sense of time, mood changes, and impaired memory, and problem-solving. When taken in high doses, weed can cause hallucinations, delusions and psychosis.
For around three hours after smoking weed, an increase in heart rate may increase the risk of a heart attack, particularly in people who are older or who have a heart condition.
Long-term health effects of marijuana include lung problems from smoking it, an increased risk of heart attack, and new or worsened symptoms of mental illnesses like anxiety and depression. Long-term use has also been linked to temporary paranoia or hallucinations and worsening symptoms of schizophrenia.
According to a study cited by NIDA, teenagers who heavily abuse marijuana lost an average of eight IQ points by the time they were 38.3 These lost IQ points didn’t fully return in people who quit using as adults. However, people who start smoking it as adults don’t show significant declines in IQ.
Research hasn’t linked weed smoking to a higher risk for lung cancer, but smoking it can cause the same breathing problems associated with smoking tobacco. In rare cases, long-term use can cause Cannabinoid Hyperemesis Syndrome. This condition causes intense nausea and cyclical vomiting, which may lead to severe dehydration requiring urgent medical attention.
Although some tout weed as a “gateway drug” that leads to using other, harder drugs, the majority of people who use weed don’t go on to use other drugs, according to NIDA. However, heavy, frequent marijuana users report overall lower life satisfaction, poorer physical and mental health, and more relationship problems than people who don’t use marijuana.
Is Marijuana Addictive?
It’s a common myth that you can’t get addicted to marijuana. Around 30 percent of people who use marijuana may have a marijuana use disorder, according to the National Institute on Drug Abuse (NIDA.)4 People who use it before the age of 18 are four to seven times more likely to develop an addiction than those who start using it in adulthood.
Addiction is frequently identified by compulsive substance abuse, even when it’s causing problems, and there is a desire to quit or previous attempts to stop. Addiction is the result of brain changes that occur with heavy drug abuse. Marijuana, like other psychoactive drugs, acts on the neurotransmitter dopamine, which produces feelings of pleasure. Dopamine is also a major player in the memory, learning, and reward centers of the brain. Heavy marijuana abuse can lead these brain regions to communicate with each other in a way that causes intense cravings and compulsive marijuana-seeking and using behaviors.
Addiction almost always has underlying causes, often including a history of trauma, chronic stress, or mental illness. Many people use it to self-medicate uncomfortable symptoms, such as anxiety or depression. While marijuana addiction is milder than other drug addictions and doesn’t cause the health and social problems associated with other drugs, it’s a serious problem for many people who can’t quit on their own.
Weed dependence isn’t the same thing as addiction. Dependence, like addiction, is caused by changes in chemical activity in the brain as it tries to compensate for the presence of THC in the brain. Heavy weed abuse causes tolerance, which means more weed is required to get the same effects a smaller dose once produced. At some point, tolerance may lead to dependence, which is characterized by unpleasant symptoms of withdrawal when it is ceased.
Marijuana Use Disorder
Marijuana abuse, addiction, and dependence are diagnosed under the umbrella of “marijuana use disorder” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, or DSM-V. If two or three of these criteria are met, a mild marijuana use disorder may be diagnosed. Meeting four or five criteria indicates a moderate disorder, and meeting six or more denotes a severe disorder.
The criteria cover past-year use and are as follows:
According to NIDA, good intentions and willpower are rarely enough to end an addiction, which is a complex disease of the brain. Professional help is almost always needed to end it for the long-term.
Treating Marijuana Use Disorder
Living with a marijuana use disorder can cause a range of negative consequences, including problems with relationships, finances, and physical and mental health. In some states, using or possessing it is a crime that can result in permanent criminal charges. Addiction is a complex disease that results in dysfunctional patterns of thinking and behaving that perpetuate drug abuse. Re-learning healthier thought and behavior patterns and developing coping skills is central to a successful recovery.
Detoxification is the process of allowing all traces of a drug to leave the body so that brain function can begin to return to normal. When one suddenly stops using substances once dependence has developed, normal brain function rebounds, and this produces physical symptoms. Withdrawal symptoms associated with marijuana are far less intense than those associated with drugs like heroin and cocaine. Still, these symptoms can be uncomfortable and distracting. Symptoms of marijuana withdrawal include:
No medications have been approved to treat marijuana dependence, so detox is largely a matter of providing comfort and emotional support during withdrawal. During the detox process, a range of assessments help care providers develop a comprehensive, personalized treatment plan to address the addiction once detox is complete.
Therapy and Treatment
Once brain function has begun to return to normal, and it’s time to focus on addressing the addiction, treatment begins. A high-quality addiction treatment program provides a holistic approach to recovery. A combination of traditional “talk” therapies and complementary “hands-on” therapies help people in treatment:
Learn skills and strategies for coping with negative emotions, cravings and other relapse triggers
Address underlying causes of the addiction
Change dysfunctional thoughts and behaviors
Make healthy lifestyle changes that support recovery
Repair damaged relationships and develop healthier new ones
Restore function at home
Learn how to have fun and relax without marijuana
Find purpose and meaning in a life of sobriety
Traditional therapies include cognitive-behavioral therapy, which is the cornerstone of most addiction treatment programs. Cognitive-behavioral therapy helps people identify unhealthy distortions in thinking, such as all-or-nothing thinking and catastrophizing, which involves turning molehills into mountains. These and other common thought distortions help keep people stuck in addiction, but replacing them with healthier ways of thinking helps people cope with the effects of quitting. Other therapies commonly used in addiction treatment include acceptance and commitment therapy and dialectical behavior therapy, which help people heal from trauma and improve their relationships.
Complementary therapies are generally hands-on or experiential therapies that include yoga, art therapy, mindfulness meditation and biofeedback. Complementary therapies help people gain self-confidence, improve their self-awareness, develop coping skills, and reduce negative emotions that can trigger a relapse.
Other services and interventions are provided as needed during treatment, depending on your unique needs and issues. These may include vocational rehabilitation, educational or housing assistance, legal help, life skills classes, and psychoeducational groups that help you better understand addiction and recovery.
Inpatient or Outpatient Setting
Treatment can take place at an inpatient or outpatient treatment facility. Inpatient treatment involves living at a residential center while in rehab. Outpatient treatment involves living at home while attending programming at the center during the day. The assessments during detox will help providers place you in the care setting that’s right for each individual
Progression and success through initial treatment will allow advancement into a solo recovery for most.
Once treatment is complete, an individualized aftercare plan is developed to maintain sobriety in the early weeks and months of recovery. The aftercare plan typically includes ongoing individual or group therapy and monitoring of any co-occurring mental illnesses and the medications used to treat them. Other components may be added as needed. A case manager periodically reviews the aftercare plan and makes necessary changes to reflect new and emerging needs.
Treatment can be of great help to those who have a marijuana use disorder and find that they can’t quit using it even though they want to or have tried to. High quality, holistic treatment helps end an addiction and reclaim control over normal life. Treatment works for most people who engage with their program and who stay in rehab for an adequate period of time, typically 90 days. Engaging in treatment means attending all sessions, keeping an open mind, staying honest with themselves and others, and putting to use right away the skills and strategies learned in therapy. Treatment works and can help to quit marijuana for good.