Cannabis use, abuse and dependency have long been an area of confusion and contention. In some countries its use is legal, in others it has been de-criminalised or it’s illegal. The true facts seem hard to come by yet it has been used in some societies since way back in history. Cannabis is a naturally occurring extract from a variety of the Hemp plant which is used recreationally and may have medicinal use. It is relatively easy to grow and ingenious man has developed ways of increasing the potency of the drug by careful regulating the amount of light and water it receives along with a little bit of ‘engineering’. It is these developments in the production of cannabis that has brought into spotlight the possible harmful effects that cannabis use brings. In simple terms the strength of the drug has greatly increased in the past 30 – 40 years.
The chemical in the plant that makes cannabis attractive to users and gives it its psychoactive component is delta 9-tetrahyrocannabniol (THC) and is found mainly in the flowers of the female plant along with lesser quantities in the leaves and stalks. There are however over 400 other compounds in the plant some of which contribute to the sensory effects of using the drug. While many drugs fall into the category of either stimulant, depressant, or hallucinogen, cannabis exhibits a mix of all properties, perhaps leaning the most towards hallucinogenic or psychedelic properties, though with other effects quite pronounced as well.
Like all drugs and alcohol Cannabis works on the brain acting on specific receptors thus changing the way we feel. The usual route is by smoking which allows up to 50% of the THC to be inhaled and to rapidly reach the brain where it quickly gives the desired effect. Occasionally cannabis can be found in baked cakes but this oral route usually only results in about 30% of the THC being absorbed and a much slower way of reaching the brain. Cannabis has psychoactive and physiological effects when consumed.
Effects on the body and brain.
As well as a subjective change in perception and, most notably, mood, the most common short-term physical and neurological effects include increased heart rate, dilation of the eye blood vessels causing red eyes, lowered blood pressure, impairment of short-term and working memory, psychomotor coordination, concentration, increase in anxiety and panic (particularly in new users), changes in perception, increase in appetite (the ‘munchies’). The long-term effects are less clear.
In recent years there has been more awareness of the effects on mental health with evidence of the development of paranoid delusional states and schizophrenia being attributed to previous heavy cannabis use. A particular damaging affects is for those who already suffer from a psychotic disorder where the prognosis deteriorates and increasing amounts of medication are needed. Cannabis has also been shown to induce depersonalisation disorder. There are case reports where chronic depersonalisation is induced by only shortterm cannabis ingestion. There are cases where individuals have gotten depersonalisation disorder when trying cannabis for the first time. Chronic depersonalisation disorder can last an entire lifetime and to date there are no specific medical treatments for this disorder.
Cannabis is fat-soluble and accumulates in the fatty tissues of the body remaining there for some time. The half-life of the THC blood level is about 7 days and detection of use can be as long as a month after last use in heavy users.
Cannabis Dependence (Addiction)
Any drug, which causes changes to the mind, can cause a dependence syndrome. This means there are symptoms and behavioural patterns which form a recognised illness:
- There is a strong desire or compulsion to use, which overrides other everyday activities.
- There is a degree of tolerance requiring higher doses to have the same psychological effect.
- The user persists in consuming the substance despite evidence of harmful consequences.
The major symptoms of dependency in cannabis use are more psychological than physical particularly those with difficulty dealing with their emotions and who have trouble in facing everyday life. It is used as an “escape mechanism” for life’s problems rather than confronting them. There is an increased risk for those who are shy, with low self-esteem and have problems with family/work. There are genetic risks for susceptibility to addiction and therefore an increased risk of dependency if there are other addicts or alcoholics in the family. Cannabis also features in cross addiction where the addiction to cannabis is hidden by a stronger addiction to, for example, alcohol.
Occasional users of cannabis who have no obvious mental health consequences may not need intensive inpatient treatment. If their use is linked to emotional issues some 1:1 sessions with a trained addictions or CBT therapist are usually sufficient.
If consumption follows a steadily increasing regularity of use and increased quantity with the beginnings of harmful consequences then it may be necessary for some formal in patient treatment. There is however seldom any marked withdrawal and the dependent cannabis user needs support in the early days of abstinence followed by a therapeutic programme addressing the associated underlying personal issues that have prompted the ever increasing use. Once a stage of dependency has been reached it is inevitable that abstinence is the only way to arrest the illness of addiction and the many issues surrounding a total abstinence for life regime can be best addressed in a residential treatment regime.
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