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Fact or Fiction

1. Marijuana is a very harmful, highly addictive, dangerous, illegal, gateway drug that currently has no accepted or proven medical use.

Or is it true that:

2. Marijuana is a safe, harmless, non-addictive, healthy drug that has healing qualities that should be promoted for our youth to partake for its mind developing effects and legalized as America s top cash crop.

Most would agree that both of the above statements are not absolutely true. However, if you have read most of the current published articles on the internet discussing the use of marijuana (where the majority of our youth get their information these days), the authors intended bias although not always explicit will

point you in one of the two above directions either pro-marijuana use or anti-marijuana use. Unfortunately, most of these sometimes well-crafted articles have little scientific evidence to validate their claims. We tend to expect this sort of thing from non-professional zealots and fanatical enthusiasts who have a deep passion to promote their cause, but it is very disappointing when we get information that directly contradicts scientific evidence from our paid government officials.

For example, the Food and Drug Administration announced in April, 2006 that no sound scientific studies supported the medical use of marijuana, contradicting a 1999 review by a panel of highly regarded scientists from the Institute of Medicine, a part of the

National Academy of Sciences, the nation s most prestigious scientific advisory agency. That review found marijuana to be moderately well suited for particular conditions, such as chemotherapy induced nausea and vomiting and AIDS wasting. This would not be so surprising if the FDA had made this policy change based on new scientific research data, but it made no mention of any new analysis or investigation activity.

National Confusion

To add to this confusion, eleven states have legalized the medical use of marijuana, but a Supreme Court decision last year allowed the federal government to arrest anyone using marijuana, even for medicinal purposes and even in states that have legalized its use. The U.S.

government has approved Marinol, a synthetic pill version of a marijuana component to treat anorexia associated with AIDS and the nausea and vomiting associated with cancer drug therapy and GW Pharmaceutical, a British company, has received F.D.A. approval to test a sprayed extract of marijuana in humans called Sativex. This drug is approved for sale in Canada.
Is it any wonder then why our young people seem to be so confused about the positive and negative effects of marijuana when our own government officials are undecided, ambivalent, and constantly changing State and national policies based on political pressure instead of scientific evidence.

Simple minds seek simple solutions for complex problems because they cannot understand

or don t believe that others are capable of understanding the complexity of comprehensive solutions. For example, the earth is a system made up of subsystems (atmosphere - air, lithosphere - land, hydrosphere - water, & biosphere life). Each subsystem directly affects and is affected directly by the other subsystems. Yet most of the earth s 6 billion people are unaware or indifferent to the fact that their daily behaviors may be causing a global warming effect that may some day destroy the earth. We humans are a system comprised of many subsystems and the little things we do and consume each day have a drastic effect on our present mental, emotional, and physical health, and our future quality and length of life.

Adolescent Brain Development

The human brain is also a system of subsystems and there is now overwhelming evidence that the development of the human brain continues well into adolescence up to age 20. We know that the brain is vulnerable to toxic substances that can cause cognitive dysfunctions in adults. There is substantial literature on the consequences of acute and chronic marijuana exposure in adults, including measures of cognitive and behavioral effects, as well as some measures of alterations in brain function, primarily in the domains of learning and memory. There have been relatively few studies, however, of the effects of exposure to marijuana during development,

when those areas that are known to be affected in adults are being sculpted by intrinsic and environmental
influences (e.g., exposure to other drugs, stress, interactions with peers, parenting, neighborhood factors, and other social variables).

Some have reported that a delay in adolescent brain development is common when alcohol and or other drug usage including marijuana - begins at a young age. Some frequent users feel a lack of initiative and concern about the future, find it hard to become or stay motivated, and think things will take care of them selves, (Wapner, Roger, 1995). As a result, the normal maturation process is interrupted. Development of coping skills, a code of ethics, acceptance of responsibility,

and other signs of maturity frequently cease or regress. A frequent user s emotional development may be delayed when he starts using, and may take much longer to develop once the user has become clean and sober for an extended period of time. Drug misuse usually leads to denial. Denial is one of the hallmarks of chemical dependency. Frequent users not only deny that their drug use is a problem; they may begin using denial to pretend other problems do not exist either. Forgotten birthdays, missed social engagements, and unmet commitments are all no big deal . (Wapner, Roger, 1995)

Jonathon Shedler and Jack Block (University of California, Berkeley) have done extensive

studies of teenagers, which included abstainers, occasional users, and frequent users. Frequent users are described (by family and peers) as not dependable or responsible, not productive or able to get things done, guileful and deceitful, opportunistic, unpredictable and changeable in attitudes and behavior, unable to delay gratification, rebellious and nonconforming, prone to push and stretch limits, self-indulgent, not ethically consistent, not having high aspirations, and prone to express hostile feelings directly. (Shedler and Block, 1990)

Marijuana Effects

The specific effects of marijuana, however, vary greatly, depending on the quality and dosage of the drug, the personality and mood of the user, the user s past experiences with the drug, the social setting, and the user s expectations.

Considerable consensus exists however among regular users that when marijuana is smoked and inhaled, a state of slight intoxication results. This state is one of mild euphoria distinguished by increased feelings of well-being, heightened perceptual acuity, and pleasant relaxation, often accompanied by a sensation of drifting or floating away. Sensory inputs are intensified. Often a person s sense of time is stretched or distorted, so that an event that lasts only a few seconds may seem to cover a much longer span. Short-term memory may also be affected, as one notices that a bite has been taken out of a sandwich but does not remember having taken it. For most users, pleasurable experiences, including sexual intercourse, are reportedly enhanced. When smoked, marijuana is rapidly absorbed and its effects appear within seconds to minutes but seldom last more than 2 to 3 hours (Butcher, Mineka, & Hooley, 2004).

Marijuana may lead to unpleasant as well as pleasant experiences. For example, if a person uses the drug while in an unhappy, angry, suspicious, or frightened mood, these feelings may be magnified. With higher dosages and with certain unstable or susceptible individuals, marijuana can produce extreme euphoria, hilarity, and over talkativeness, but it can also produce intense anxiety and depression as well as delusions, hallucinations, and other psychotic-like experiences. Evidence suggests a strong relationship between daily marijuana use and the occurrence of self-reported

psychotic symptoms (Tien & Anthony, 1990).

Marijuana s short-range physiological effects include a moderate increase in heart rate, a slowing of reaction time, a slight contraction of pupil size, bloodshot and itchy eyes, a dry mouth, and increased appetite. Furthermore, marijuana induces memory dysfunction and a slowing of information processing (Poe, Gruber, et al., 2001). Continued use of high dosages over time tends to produce lethargy and passivity. In such cases marijuana appears to have a hallucinogenic effect. The effects of long-term and habitual marijuana use are still under investigation, although a number of possible adverse side effects have been related to the prolonged, heavy use of marijuana. For example, marijuana tends to diminish self-control.

One study exploring past substance use history in incarcerated murderers reported that among men who committed murder, marijuana was the most commonly used drug. One-third indicated that they used the drug before the homicide, and two-thirds were experiencing some effects of the drug at the time of the murder (Spunt et al., 1994).

Marijuana does not lead to extreme physiological dependence, as heroin does. It can, however, lead to psychological dependence, in which the person experiences a strong need for the drug whenever he or she feels anxious or tense. In fact, recent research has reported that many marijuana use abstainers reported having withdrawal-like symptoms such as nervousness, tension, sleep problems, and appetite change (Budney, Hughes,

et al., 2001; Kouri and Pope, 2000). One recent study of substance abusers reported that marijuana users were more ambivalent and less confident about stopping use than were cocaine abusers (Budney, Radonovich, et al., 1998).

Self Diagnosis

1. Does your periodic marijuana use and intoxication interfere with your performance at work or school?

2. Is your periodic marijuana use and intoxication physically hazardous in situations such as driving a car?

3. Do you or have you had legal problems as a consequence of arrests for marijuana possession?

4. Do you or have you had arguments with spouses or parents over the possession of marijuana in the home or its use in the presence of children?

If you

answered Yes to any one of the above you may meet criteria for a diagnosis of Cannabis Abuse and I would recommend that you undergo an alcohol/ substance abuse evaluation by a Certified Substance Abuse Counselor (CSAC) and comply with all treatment recommendations.

If you are having psychological or physical problems associated with compulsively using marijuana, such as:

1. Craving;
2. Withdrawal symptoms;
3. Irritability;
4. Sleeplessness; and/ or
5. Anxiety

- when trying to quit, then a diagnosis of Cannabis Dependence should be considered rather than Cannabis Abuse. Likewise, I would recommend that you undergo an alcohol/ substance abuse evaluation by a Certified Substance Abuse Counselor (CSAC) and comply with all treatment recommendations.

Multiple

Addictions

In 2001, marijuana was a contributing factor in more than 110,000 emergency department visits in the United States. In a survey of drug-related visits to the emergency room (DAWN Report, 2001), 16 percent of drug-related visits were for marijuana abuse. Many of these emergency room visits, as one might suspect, involved the use of other substances along with marijuana. If you had trouble answering Yes to one of the above self-diagnosis questions, because you have used alcohol and/ or other drugs along with marijuana and you cannot contribute your problems to marijuana alone, then you may meet the criteria for Poly-substance Dependence and or Poly-behavioral Addiction, see below.

Since it is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist, the initial therapeutic intervention for any addiction needs to include an assessment for other addictions. National surveys revealed that very high correlation exists between cannabis abuse and/ or other substance abuse and behavioral addictions.

Poor Prognosis

We have come to realize today more than any other time in history that the treatment of Cannabis Dependence and other lifestyle diseases and behavioral addictions related to gambling, food, sex, and/ or religion, (etc.) are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why

do 47% of patients treated in private addiction treatment programs (for example) relapse within the first year following treatment (Gorski, T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?

Diagnostic Delineation

Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition s section (DSM-IV-TR, 2000); maladaptive health behaviors (e.g., unsafe sexual practices, excessive alcohol, drug use, and over eating, etc.) may be listed on Axis I, only if they are significantly affecting

the course of treatment of a medical or mental condition.

Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV-TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should

be specified for each separate addiction and dimension of an individuals life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.

New Proposed Diagnosis

To assist in resolving the limited DSM-IV-TRs diagnostic capability, a multidimensional diagnosis of Poly-behavioral Addiction, is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse.

They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.

Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an

overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

Multidimensional Treatment

Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction?

The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual

s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual s primary addiction. The ARMS theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual s life dimensions in addition to developing specific goals and objectives for each dimension.

Conclusion

This article was not written with the intent to demonize or glorify the most widely used illicit and top US cash crop (U.S. growers produce nearly $35 billion worth of marijuana annually, making the illegal drug the country’s largest cash crop, bigger than corn and wheat combined, an advocate of medical marijuana use said in a study released on 18 Dec. 06, WASHINGTON), Reuters. Nor was it written to advocate the use or non-use of marijuana whether legally for medicinal purposes or illegally.

There are numerous articles readily available that already accomplish that mission. It is my hope though, that the 10 to 15 percent of individuals that have multiple complex problems involving marijuana usage will find the help that they need. Considering the wide range of addictive behaviors in our world today, one should always take into account an individual s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - Poly-behavioral Addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions.

For more info see:
Poly-Behavioral Addiction and the Addictions Recovery Measurement System (ARMS)
By James Slobodzien, Psy.D. CSAC
http://www.geocities.com/drslbdzn/Behavioral_Addictions.html

James Slobodzien, Psy.D. CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.

Sources

National Institute on Drug Abuse, Marijuana Facts Parents Need to Know, September 2004, What is Marijuana, How

is Marijuana Used?
Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings, September 2006
Substance Abuse and Mental Health Service Administration, Initiation of Marijuana Use: Trends, Patterns and Implications, July 2002.
National Institute on Drug Abuse and University of Michigan, Monitoring the Future 2005 Data From In-School Surveys of 8th-, 10th-, and 12th-Grade Students, December 2005
Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance United States, 2005, June 2006
National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975 2005, Volume II: College Students & Adults Ages 19 45 (PDF), 2006
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National Institute on Drug Abuse, InfoFacts: Marijuana, April 2006
National Institute on Drug Abuse, Research Report Series Marijuana Abuse, October 2001.
Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits, April 2006
Substance Abuse and Mental Health Services Administration, Mortality Data from the Drug Abuse Warning Network, 2001 (PDF), January 2003.
Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Highlights 2004 (PDF), February 2006
Federal Bureau of Investigation, Crime in the United States, 2005, September 2006
National Drug Intelligence Center, National Drug Threat Assessment 2007, October 2006
Bureau of Justice Statistics, Drug Use and Dependence, State and Federal Prisoners, 2004, October 2006
United States Sentencing Commission, 2005 Sourcebook of Federal Sentencing Statistics, June 2006
National Drug Intelligence Center, National Drug Threat Assessment 2007

James Slobodzien, Psy.D. CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.