Evidence, Causes, Prevalence, and Treatment of Marijuana Addiction

Abstract

Marijuana is arguably the most controversial illicit substance in United States history.  Indeed, marijuana is currently the most popular illicit drug of abuse in the United States.  This article will present evidence of the addictive properties of marijuana, detail the prevalence of marijuana use, explore the causes of marijuana addiction, and suggest possible treatments for marijuana addiction.  The goal of this article is to provide useful information that will aid in understanding and treating marijuana addiction.  The spirit of this article is to assist the reader in dispelling several myths surrounding marijuana use and addiction.  Finally, the desired outcome of this article is to encourage more research in this field of study.
    Keywords: marijuana, evidence, causes, addiction, prevalence, treatment

Introduction, Original

    This article will present evidence of the addictive properties of marijuana, explore the causes of marijuana addiction, detail the prevalence of marijuana use, and suggest possible treatments for marijuana addiction.

Introduction, For the Layperson

    This article was written for a bachelor's level class on Substance Abuse, and received a 94% grade.  This introduction was not part of the original document.  (The original document is in a different font.)  I added it later because of common misconceptions about marijuana.  I will briefly shoot down some of the misconceptions about recreational marijuana use.
  1. Recreational marijuana (or just "marijuana") is the plant, in smoked and ingested form.  Medical THC and/or CBD are extracts of the plant, similar to how codeine is an extract of the poppy plant.  This paper is about recreational marijuana use.  I am not against medical THC/CBD or other extracts when and if proven through medical research that they can help.
  2. All my sources are from published medical or psychological journals, and almost every one within the last 5 years, a requirement for this article.
  3. "Addiction" has been redefined by the pro pot media to make it look like marijuana isn't bad for you.  They often use this to mean "physically" addictive, i.e. dependency.  This is not how psychology defines the subject.  It uses three terms: substance use disorder, substance abuse, and addiction.  Withdrawals are necessary for addiction.  However, you can become addicted to food, gambling, or sex.  It's necessary for you, the reader, to understand that while the media might blur these lines, I will use the DSM and ICD definitions.  For the sake of public speaking, however, they're all "addiction."
  4. Doweiko (2014) lists the DSM-5 description of a substance use disorder: "1. impaired control over substance use; 2. multiple attempts to quit or desire to quit/reduce substance use; 3. most of the individual's activities center around (a) obtaining the substance (b) using the substance, or (c) recovering from the effects of the substance, including social, vocational, and legal consequences of substance use or using a substance(s) under 'risky' conditions; (d) pharmacological effects of the drug(s) on the individual, including 'craving' for the substance when it is not actively being used."
  5. Doweiko (2014) lists the International Statistical Classification of Disease and Related Health Problems, 10th edition (ICD-10) definition of a substance use disorder: "(2) that it has multiple manifestations in the person’s life, including the social, psychological, spiritual, vocational, interpersonal, and economic spheres of their lives, (3) it is often progressive, (4) it is potentially fatal, (5) it is marked by the individual’s inability to control (or, at least inconsistent control) of their substance use, (6) is marked by preoccupation with drug use, (7) the individual develops a distorted way of looking at the world so that it supports his/her continued use of that compound(s), (8) the individual becomes tolerant to the effects of that compound(s), and s/he either must go through “drug holidays” in which s/he loses some of the tolerance to that substance, or must use larger and larger amounts in a manner designed to overcome his/her tolerance, and finally, (9) that the individual will experience a characteristic withdrawal syndrome if s/he should discontinue the use of that compound(s)."
  6. There is no scientific evidence of concepts such as the "gateway drug" or an "addictive personality".
  7. This paper has been slightly modified in that I have put some useful definitions in parenthesis that were not part of the original paper.

    If you're here for the logical (not medical or psychological) reasons why marijuana legalization and/or use are bad, skip down to the bottom past the References heading.

Evidence of Marijuana Addiction

    Despite public opinion to the contrary, several research studies show that marijuana is addictive.  A study by Goldman et al. (2013) presented evidence that marijuana addicts experience the same cravings and brain patterns as users of other addictive drugs.  Budney, Sargent and Lee (2015) found that, although marijuana’s addictive potential is slightly lower, marijuana poses the same addiction risk factors and characteristics as other drugs of abuse.  In addition, Volkow, Baler, Compton and Weiss (2014) found that around 9% of marijuana users become addicted, and that the odds increase dramatically if the individual began using marijuana as a teenager and/or the individual smokes marijuana daily.  The addictive nature of marijuana is easily established.

Prevalence of Marijuana Addiction

    Of all the drugs of abuse, marijuana is the highest in prevalence (how many people are doing it) and persistence (how long people use it) .  The Substance Abuse and Mental Health Services Administration (SAMSHA) (2014) reports that 2.4 million people are addicted to marijuana, and that “marijuana was the most commonly used illicit drug in 2013.”  Bedi, Cooper, and Haney (2012) reference SAMSHA’s 2010 report, pointing out that “the high prevalence of marijuana smoking means that the … number of individuals with problematic use of the drug is greater than that for illegal drugs with higher abuse liability.”

Causes of Marijuana Addiction

    Due to the variety of human behavior, experience, and biology, there are many reasons why an individual may develop or relapse back into a substance use disorder (SUD), which will be explored.
    It is important to understand the causes of marijuana addiction so that effective treatment plans may be enacted.  Many reasons people become addicted to substances, include, but are not limited to, expressing forbidden impulses, coping with emotional or physical pain, exploring alternative realities, substituting euphoria for reality, escaping the pain of social status, rebelling, indulging in hedonism, and fitting into a sub-culture (Doweiko, 2014).

Treating Marijuana Addiction

    The majority of treatments for marijuana fall under the category of therapy.  Interventions and 12-step programs like Narcotics Anonymous are currently the leading treatments for addiction.  Research is being done into pharmacological interventions, and some experimental drugs are showing mixed results.  But first, some myths should be dispelled.
    Two myths commonly heard in working with marijuana addicts are the “addictive personality” myth and the “only physical” addiction myth.  Current addictions research, summarized by Owens (2015), refutes both myths.  Owens shows the first myth to be false by pointing out that factors such as “genes, character traits, and early life experiences” combine to make up an individual.  Owens (2015) refutes the second myth by pointing out that behaviors can also be addictive.
    Therapy is still the leading intervention strategy for marijuana addiction.  Doweiko (2014) outlines the Johnson and ARISE models of intervention.  The Johnson model essentially involves educating and coaching those friends and family who will be involved in the intervention and then inviting the addict to the intervention.  The ARISE Model essentially a more sequential, less abrupt intervention style that relies upon progressive detachment steps to try to help the addict (Doweiko, 2014).
    As part of therapy, Doweiko (2014) taught that warning the addict of the dangers of their addiction can aid in recovery.  Many research studies describe the negative effects of marijuana use.  Briefly, the negative effects of marijuana use include, but are not limited to, psychosis, memory problems, a lowered IQ, increased impulsivity (doing something before you think about it), and brain structure abnormalities (Levine, Clemenza, Rynn and Lieberman, 2017; Volkow, Baler, Compton, and Weiss, 2014; Shrivastava et al., 2014).
    In therapy, a major goal is to prevent relapse.  One influence that can cause an addict to relapse is stress.  Two studies (Johnson and Lovinger, 2016; Pizzimenti and Lattal, 2015) found stress can contribute to relapse.  Thus, it is recommended that addictions therapy include teaching coping skills using cognitive behavioral therapy.
    Another risk factor for relapse is a comorbid (having two diseases at the same time) disorder, such as a co-occurring SUD and post-traumatic stress disorder (PTSD).  Those who suffer from PTSD may have difficulties avoiding relapse in the presence of memories of traumatic events that are triggered by sensory cues or stress (Pizzimenti and Lattal, 2015).  Comorbid PTSD is a vital consideration in selecting what therapies to incorporate.  Pizzimenti and Lattal (2015)’s research that show a possible link between memories, stress, and relapse could potentially also be applied to all marijuana addicts.
    Currently, as stated by Bedi et al. (2012), there are no Food and Drug Administration (FDA)-approved medications for treating marijuana addiction.  Bedi et al. (2012) suggest that a combination of psychotherapy and pharmacotherapy (drugs) could be used to treat marijuana dependence, and that nabilone could be a part of the pharmacotherapy.
    Of particular interest are the drugs quetiapine and dronabinol.  Cooper et al. (2013) studied both drugs and concluded that quetiapine caused increased relapse (making it unsuitable), but dronabinol users “reported fewer withdrawal symptoms” than placebo.  This research team concluded that more testing is necessary.
    One complicating factor in treating marijuana addicts may be the presence of comorbid PTSD.  Pizzimenti and Lattal (2015) found a 21-43% prevalence of SUDs with individuals diagnosed with PTSD, compared to 8-25% for those without PTSD; and that individuals with PTSD were more likely to relapse.  Pizzimenti and Lattal (2015) called for more research to find drugs that could interrupt forming stressful and/or drug-taking memories, because this might help those with comorbid PTSD and SUDs.
    Another confounding factor in treating marijuana addiction may be the age at which the individual first used marijuana.  Levine et al. (2017) found that those who started using marijuana during adolescence had poorer treatment adherence (i.e. they quit therapy).
    Another useful healing tool in working with addicts are the 12 step programs.  Consider the finding of Christo and Franey (1995), who studied poly-drug users in London who attended Narcotics Anonymous: after 6 months, 46% of addicts were successfully sober and still attending.  More research needs to be done on the effectiveness of the 12 step programs, but data so far is promising.

Conclusion

    This article has attempted to provide evidence that marijuana use can lead to addiction, outline the prevalence of marijuana addiction, explore the many causes of marijuana addiction, and suggest treatment methods for marijuana addiction.  Hopefully, this information will provide useful in understanding and treating marijuana addiction, dispel several myths surrounding marijuana use and addiction, and encourage more research in this field of study.

References

Addendum

    Here are some other lies that the pro-pot media is telling, and why they're illogical.

  1. "Everyone knows...."  No, that's argumentum ad populum.  Basically, it's a lie that pretends to be true.  Just because "everyone" believes the same doesn't mean it's true.
  2. "The will of the masses...."  No, that's rule by mob.  If everyone, or a majority, of people voted to kill you, would that make it right?  If the will of the people is all that is required to be ethical or legal or moral, then Hitler just was a nice guy who just didn't like Jews.  But we know that's not true.  Basically, it doesn't matter if everyone thinks the same.  Morality and ethics do not hinge upon the whim of the masses.
  3. "Marijuana is about as harmful as alcohol, and that's legal."  First, medically speaking, this is comparing apples to oranges.  These two substances are not the same.  And second, while very low alcohol use (like a glass of organic wine at dinner) has been suggested to have health benefits, very low marijuana use has not, so far.  You can use alcohol responsibly and not be affected by the many health problems that alcoholism brings.  But recreational marijuana, on the other hand, no.  Smoking anything puts you at risk for cancer.  In addition, (see above), marijuana, due to the burning particles being larger, puts you at risk for vanishing lung syndrome, not just a higher risk of cancer.  Why?  Because you smoke marijuana unfiltered.
  4. "Medical marijuana has health uses."  Yes, but so far, those are very few.  One of the very few problems it helps with is epilepsy that has proven stubborn to the drugs that are available.  So basically the 1% of the 1%.  In addition, medical marijuana is processed THC and/or CBD, not the other 200+ unknown substances in marijuana.  So it's by far safer.  I am not against medical THC.  But processed THC is not recreational marijuana, and the two substances are completely different.  So no, this is not proof that marijuana is good.
  5. "Victimless crimes."  I disagree.  Alcohol, the compared substance, has caused many marital and relationship problems.  Growing up with an alcoholic causes emotional scarring of children.  Growing up with a parent who's always high is no different.  So the first victim is often the children.  Second, (read above) you are the victim because you can end up with lung cancer and/or vanishing lung syndrome.  Third, the public is the victim because they have to dole out money when you get fired for a drug test at work and/or because you're always high, and they also (now) have to dole out money to Obamacare/Trumpcare/nationalized health care to treat a problem that you could have prevented, had you just said "no."  So who are the victims?  The children, you, and the public.  There is almost no such thing as a victimless crime, because no one is an island.
  6. "The cops should arrest the real criminals."  First, pot users, if it is not legal where they live, are criminals by virtue of the fact that they broke the law.  They chose to break the law.  Second, marijuana is so widespread and easy to obtain that it statistically outnumbers the other drugs of abuse.  So seeing lots of marijuana busts is going to be normal due to how popular marijuana is.  See the SAMSHA statistics, above.
  7. "No one has ever responded to a domestic violence incident which involved marijuana."  First, if you are discussing why recreational marijuana is a bad idea and someone brings this up, they're distracting you from the discussion.  Whether or not a drug causes people to commit domestic violence is beside the point.  However, there is evidence that marijuana use can lead to violence.  Additionally, if one searches for this on Google, you can easily find stories of domestic disputes and/or violence leading to finding marijuana, so there is no scientific proof that marijuana makes people placid, like some would like you to believe.  And some of those domestic disputes that turn into violence are specifically over the couple arguing about growing it, so you could say marijuana contributed to it.  Second, preliminary research by Shorey, Stuart, Moore, and McNulty (2014) showed that "all three factors, acute alcohol use, marijuana use, and angry affect predicted increases in [interpersonal violence]."  The study points out that alcohol has a much stronger effect on increasing domestic violence than marijuana, but people often combine drinking and smoking marijuana, so it's pointless to try to say marijuana "never" causes domestic violence.