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Ed Mosshart, LMHC, a Seattle therapist and substance-abuse expert, who has worked as a clinical director in both outpatient and residential treatment programs, told me in a recent conversation:
I think [medical marijuana] can be legitimate, but like many medicines, in fact many medicines for anxiety have significant side effect profiles. I don’t think it’s a panacea and I don’t think people should go into it thinking that it’s going to be some medical revelation, because its use is problematic.
He cites some of the most common side-effects seen with marijuana use: reduced motivation, short-term memory loss and withdrawal from relationships. “In my experience, people who smoke on a daily basis get out of touch with reality and have memory problems. They can’t see the destruction they’re causing their family by checking out on them,” Mosshart said.
Other colleagues who did not want to be named in this article had similar concerns. Two therapists I know, both of whom have been practicing for over 20 years, told me that they have seen long-term frequent marijuana use interfere with their clients’ ability to realize their hopes for their own lives.
“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.”
On the other hand, a third highly experienced colleague told me that she is cautiously optimistic about one client’s use of marijuana as medication for post-traumatic stress disorder.
“Right now, he’s using it just to help him sleep,” she said. “It seems to be helping.”
Mosshart said that he too had seen some cases where people self-medicated with marijuana and on the whole felt that it helped enough to be worth the side effects.
“One thing I would say,” he added, “is that it’s not so much about the substance, it’s about how the person uses it, what’s their relationship to it. Alcohol, for example, is legal and in grocery stores, and more people die of alcoholism every year than all other addictions combined. Alcohol is the big offender. I hate to see marijuana vilified when alcohol is more devastating, I see marijuana as being relatively benign, compared to alcohol.”
In practical terms, the line between addiction and self-medication is murky. Once viewed as a moral weakness, addiction is now understood as a neurobiologically complex condition in which the underlying problem is chronic emotional pain. Dr. Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction, is one of the leading advocates today for a more neurobiologically sophisticated and empathetic approach to treating addiction. In a 2007 article in the Globe and Mail, he wrote:
Addictions always originate in unhappiness, even if hidden. They are emotional anesthetics; they numb pain. The first question — always — is not ‘Why the addiction?’ but ‘Why the pain?’
Increasingly, neuroscience is offering models for understanding why some people suffer more than others do from emotional and psychological pain. The idea of the unconscious is being reinterpreted in terms of the limbic system and the autonomous nervous system, powerful shapers of our emotional lives that operate outside our conscious control. An overactive amygdala, an underdeveloped orbitofrontal cortex — these are the kinds of models researchers are identifying as likely causes of chronic emotional dysregulation.
It is a humbling shift from an earlier generation’s belief that if a problem was “all in your head,” that meant it could be dealt with by a dose of vigorous commonsense thinking.
Today, we often treat pain in the mind with medications that appear to alter levels of key neurotransmitters, including dopamine and serotonin. These medications often come with side-effects, and individuals’ experience with their effectiveness varies. Clearly, we do not yet know enough about the extremely complex neural activity involved in any mental illness, let alone how best to treat it.
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