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The double-edged sword of marijuana self-medication

Counselors often see the people who don't seem to benefit from marijuana. Can legalization put a different light on the drug?
Photo: Unai Mateo

Photo: Unai Mateo

A marijuana plant growing in a national wildlife refuge.

A marijuana plant growing in a national wildlife refuge. U.S. Fish and Wildlife Service

On the night of Dec. 6, as hundreds of pot smokers were celebrating the passage of I-502 by lighting up en masse for the second night in a row at the Space Needle, I wondered if any of my former clients were there. I could imagine the relief some of them might feel at being able to smoke in public, not at the margins but right in the thick of a crowd of like-minded others.

During my training some years ago at a community counseling center, I got to know people whose relationships with marijuana seemed to straddle a hard-to-navigate line between addiction and self-medication. I remember people who couldn’t afford to buy vegetables — or to pay $15 for a therapy session with a trainee  — who managed to come up with $300 per month for their dealers.

Typically, the people I worked with at the counseling center felt a fondness for marijuana that they did not feel for prescribed psychiatric medications. Zyprexa and Lamictal were difficult facts of life, but pot was a friend.

Many said they found cannabis relieved their anxiety and depression, made it possible for them to leave the house and face the world. Judging by my own experience and that of many of my colleagues, as well as a host of online message boards, marijuana is one of the most popular and widely-used unprescribed treatments for mental health problems, ranging from anxiety and depression to attention-deficit and bipolar disorders.

Yet using marijuana is also considered a diagnosable mental-health disorder. In the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (the DSM-IVTR), use of a substance is considered to be “abuse” if the user engages in risky or self-damaging behavior in order to use it. By definition, using an illegal substance is risky. And other risks have been identified, including that the main psychoactive compound in marijuana may induce or worsen psychosis.

Now that marijuana is at least a big step closer to being legal in Washington — legal by state law, with federal authorities deciding which if any steps to take to enforce federal prohibitions — is it any closer to becoming a recognized treatment for depression, anxiety or other mental health conditions? And should it be? Does marijuana have the potential to serve as a valuable, reasonably safe addition to the available medications for mental health?

This question is, in part, being fought out in the political process, where advocates make their cases in black and white. Meanwhile, those of us who work in the mental-health profession are considering it in the same way we are trained to approach most questions: by trying to be thoughtful, trying to allow for reasonable doubts and concerns, aiming for a more complete understanding of a complex reality. When I talk with colleagues about the question of marijuana as a treatment for mental-health conditions, I don’t hear any easy answers.

Therapy is a conversation between a person who is there to voice needs, fears and desires, and another person whose job is to be a benign skeptic, listening with an active interest in the other’s well-being but without personal agendas or judgments.

In my role as a therapist, I see reasons to doubt the claims of political advocates on either side of the marijuana debate. My counseling-center clients who used marijuana typically suffered from side effects, but then the same was true for many who took prescribed medications.

Some things are known about marijuana’s effects on the human nervous system. Its main psychoactive compound, called THC, closely mimics a neurotransmitter called anandamide, which is named for the Sanskrit word for “bliss.” THC molecules attach to anadamide receptors in various parts of the nervous system, including the dopamine-generating so-called “pleasure center,” the nucleus accumbens.

Depending on many intricate and unpredictable factors, the THC-mediated boost in dopamine activity can make a person feel imaginative, brilliant, comfortable, painless — or it can fuel paranoia and set the heart racing. Or interfere with memory. Other compounds in marijuana are thought to have anxiety-quelling tendencies to counter THC’s anxiety-provoking effect, and marijuana dispensaries advertise unverifiable claims as to the potency and pharmacological effects of different cannabis cultivars.


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Comments:

Posted Thu, Dec 27, 8:47 a.m. Inappropriate

I'm all for legalized marijuana and could care less about any medical benefits. Legalization will accomplish two things. First we'll not fill jails and prisons will people whose only crime is smoking a joint. Secondly the world won't end. Those who oppose legalization remind me of the believers in the Mayan calendar and we see how that worked out.

Djinn

Posted Thu, Dec 27, 12:03 p.m. Inappropriate

The questions raised here are superb, including the observation that current Federal Law is obstructing research into a drug, in the right quantities, is beneficial to many, patients and non-patients.

I believe the target result for these studies is the political and scientific determination of metabolite blood levels - certainly someone smoking enough to raise that level to an as yet undetermined threshold is likely suffering side effects.

That said, for the chronic addictive multi-substance abuser alcoholic I'd bet marijuana usage, even unlimited, is a positive factor for reducing drug inspired violence.

Posted Thu, Dec 27, 3:37 p.m. Inappropriate

If you mean we might not see the level of crime and violence associated with getting money to obtain drugs, then I think you could very well be correct. However, being high doesn't rule out being violent. Cannabis was one of the main ingredients in the snuff that Zulu warriors used before going into battle. Thousands of GIs in Viet Nam used it, so there's a history associated with it and only time will tell.

Djinn

Posted Fri, Dec 28, 5:13 p.m. Inappropriate

the 'Nam vets I knew at the time always said that they didn't get stoned when on patrol, for the obvious reasons. But once they were off . . .

Steve E.

Posted Thu, Dec 27, 11:15 p.m. Inappropriate

I'm struggling to wend my way through the verbiage to find the writer's real message in this piece. I think it is basically a statement of concern that broader availability of marijuana may prove to further complicate the lives of some current (ab)users.

That makes sense. The repeal of alcohol prohibition certainly led to more overuse, abuse, and dependence. And there are certainly DSM-IV diagnostic codes for alcohol-related problems as well as for overuse of marijuana and other drugs.

Just as prohibition didn't prevent alcohol use, the prohibition of marijuana (probably the world's longest-used consciousness-expanding plant material) hasn't prevented humans from seeking it out. In both cases, there are people who can use with enjoyment and restraint, and some who just can't. In both cases, some people whose mental lives are disordered in some fashion (whether they are 'diagnosable' or not) may find that using complicates, rather than furthers, their attempts to find stability.

The sporadic, small-scale efforts to legalize formerly prohibited substances is probably the beginning of a turnaround in a century-long political, legal, and cultural war. In my "partial libertarian" view, that's a good thing--and other consciousness-expanding drugs should also be legally available.

But there's a cost and a down-side, and I think that's what the writer is musing about, with specific remembrance of those troubled people for whom weed means more trouble. I muse about it, too. The near certainty is that with marijuana more freely available, we'll see more of the dysfunctional effects mentioned in this article--and we'll see more auto accidents caused by misuse, and we'll see injuries and deaths. "And so on," as the late Mr. Vonnegut would say.

This doesn't lead me to review my meager knowledge of neuroanatomy and neuroreceptors, but to rummage around in my meager knowledge of philosophy. In particular, I recall the thinkers who looked most intently at the joys, sorrows and potential of human existence--and concluded that life has no element of fairness and is best confronted fully and with such courage as each person can muster. That seems to be a good strategy for embarking on a world of greater freedom, risk, and possibility.

Seneca

Posted Fri, Dec 28, 5:18 p.m. Inappropriate

“I’ve seen it again and again,” one of them told me. “Really bright people, but they just never get around to doing the things they want to do.”

And as we well know, this doesn't happen to people who don't smoke or drink. LOL. How many memoirs are there from upstanding citizens, titans of industry, etc., who lament not climbing the mountain, trying to play music professionally, running the marathon, spending more time with the kids, etc.

Steve E.

Posted Wed, Jan 23, 6 p.m. Inappropriate

i am bipolar and smoked marijuana for my symptoms for 20+yrs. it wasnt until i decided to try prescribed medications that i begun to have more serious problems. these drugs have almost killed me. they have caused me to try and almost succeed in killing myself twice in a yrs time. i did not have these issues before i started taking them. i want so badly to get off my prescribed medications and go back to smoking marijuana. i want to be ok again. but im considered a criminal if i do. marijuana makes me happy. it gives me energy to get up and do the things that need to be done. it helps me eat and sleep. the medications that i am on makes me unfunctionable and miserable. it also has an effect on my heart. they are not at all good, where as i believe that marijuana is good and the answer. it may be that it is not for everyone. nothing is. and as far as short term and long term memory, well, depression has a huge effect on memory. try drinking , which is very dangerous and legal. it can cause you to not be able to remember anything. anything can be abused. but i dont sit around on my rump getting stoned all day. i have a life, or i had a life before all these messed up prescriptions. my life is more meaningful when i smoke, whereas all i want to do most days now is die. but the government doesnt seem to care about the welfare of the people because i am not alone in my beliefs. the proof is out there. i just dont understand why it is a problem. i dont understand why the government depries innocent people of this GOD MADE MEDICATION.

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