to find out what works for each patient.
One of the problems practitioners encounter is that people now hear about many medications due to the hype of pharmaceutical company advertising and the promises made on TV commercials, and they think that’s the solution to their problem. Just take a pill and that will “solve my depression.” People often learn the hard way that there’s a lot more to getting through depression than just taking a pill. No two patients are the same; everybody’s an individual, so you have to do a comprehensive assessment to see what methodology can best be utilized with that client to help them with their recovery from depression.
While there are a lot of different drugs out there, you don’t have to be an expert on every single one of them because basically there are just five classes of mind-altering drugs. So whether you’re a counselor, a physician, nurse, or therapist, when you’re dealing with substance problems, you are always dealing with five classes of chemicals. The five classes of drugs all exhibit different effects. What they all have in common is that they stimulate the reward/pleasure center of the brain. They are
People often ask me, “Isn’t marijuana a harmless drug?” My answer is that anytime you smoke something, it’s harmful. When you inhale smoke, whether it’s tobacco smoke or marijuana smoke, inhaling heated smoke is inherently unhealthy.
In addition, since, along with alcohol, marijuana is often a so-called gateway drug that people begin using in adolescence or even in latency age, we must ask ourselves how marijuana affects kids’ development. We know that the marijuana being used today is many times more potent than it was in the sixties and seventies.
We used to believe that the human brain was structurally complete at birth, that it had all of the neurons it would ever have, and that while these brain cells could die through damage or aging, more could never be added. We know now that the human brain is not fully formed until people are in their mid-twenties, and that it can continue to grow, evolve, and add neurons throughout one’s lifespan. The question is, exactly what is in the high-dose cannabinoids that contemporary, highly potent marijuana contains? We really don’t know what kind of negative impact these chemicals have on growing brains. We know that it leads to amotivational syndrome where users don’t feel like doing much of anything, whether going to school, doing schoolwork, doing chores, going to work, or taking care of other responsibilities. From a research perspective related to marijuana, one of the most important issues is to understand the vulnerability of young, developing brains to cannabis.
So despite the public’s perception that marijuana is relatively harmless, the numbers clearly tell us that it is an addictive drug. I tell people who don’t believe marijuana is addictive to go to a Marijuana Anonymous meeting, where they will see and hear people whose lives have been ruined by marijuana. There is no question that marijuana can be addictive. That argument is over. Add to this the marijuana withdrawal syndrome. It’s not so severe that we have to use medications for it, but its symptoms include irritability, anger, depression, difficulty sleeping, cravings, and decreased appetite. The withdrawal symptoms adversely impact attempts to quit and also motivate the use of marijuana or other drugs for relief of the discomfort of withdrawal.
This is especially relevant because more and more states have decriminalized marijuana and some have even moved toward legalizing it, often for medical purposes—both legitimate and concocted—including California where I practice. You just go to a “marijuana doctor” and walk in the door, where the only criterion for giving you a prescription is that you walked through the door. This is comparable to the old “snake oil salesmen” who used to travel from town to town and sell “miracle cures” for whatever ailed people. The Pure Food and Drug Act was launched in 1906 because these traveling salesmen would make absurd and false claims that their products could cure everything from hemorrhoids to dandruff and everything in-between.
Unfortunately, marijuana has become the latest version of snake oil in the sense that you can go into a medical marijuana clinic, claim virtually any compliant or ailment, and come out with a marijuana card—the equivalent of a prescription that gives you legalized access to pot. You have a headache, you get a marijuana card. You have stomach problems, you get a marijuana card. You have occasional back pain, you get a marijuana card. You have anxiety, you get a marijuana card. You’re a little depressed, you get a marijuana card. And a lot of people do this with a nod and a wink because we know that most of the people that go to “clinics” to get their marijuana don’t really have any medical problem at all.
That being said, I’m against the so-called “war on drugs,” and think it is actually a war on people. The “war on drugs” hasn’t made any real dent in the use of drugs in our society, and it’s often an extravagant waste of money. We should be putting this money into drug treatment and education programs. Personally, I’m in favor of decriminalization rather than legalization. It makes little sense to arrest, prosecute, and incarcerate people for possession of small amounts of marijuana (or other drugs people may possess for personal use), and subject them to expulsion from school, loss of financial aid, etc. Instead, we should be advocating education and treatment. We have zero tolerance in high schools where kids get thrown out of school because they were caught with one marijuana joint. This is not good for our kids. In fact, it’s not good for society.
Counselors or therapists in the field of addiction treatment need to know the medical aspects as well as the deleterious health impacts of marijuana. It can reasonably be viewed as similar to alcohol, where many people may have a glass of wine with dinner or a beer at a ball game and it’s no big deal. If somebody wants to smoke pot once in a blue moon, aside from the smoke-inhalation aspect of it, I don’t see it as analogous to smoking crack or crystal meth, or shooting heroin. No one smokes crack or crystal meth, or shoots heroin recreationally. But, marijuana also has a serious potential downside to it.
I had a patient who smoked pot because she was going through chemotherapy for cancer. It helped her appetite because cannabinoids increase appetite. However, there are other delivery systems available besides smoking it. If I were dying of lung cancer I don’t think I’d want to smoke anything. Marinol is basically tetrahydrocannabinol or THC, the main psychoactive ingredient in marijuana, in pill form and it can be taken by mouth. In addition to the tar and other impurities in the smoke, there are other psychoactive chemicals in marijuana smoke, so you’re not just getting THC.
