Self-Medicating with Cannabis

In a number of Family Connection groups, the topic of self-medicating with marijuana has been raised. Should we be concerned or should we just treat our loved one’s habit as a harmless attempt to reduce their pain and suffering?

I think all family members wish that they could enable this use with a clear conscience. Why would someone wish to deny their loved one a vacation from the pain, when there are apparently little or no side affects or risks? Unfortunately, however, the issue is not that simple.

Aside from the legal issue, the use of cannabis to reduce anxiety or provide a vacation from reality has both a psychological and physiological price. On the psychological level, instead of recognizing their difficulties and taking action to better themselves, our loved ones are hiding out in a drug-induced haze that will eventually have to end. When it ends, they will feel worse about the additional time and money they have wasted, and they will still have to deal with reality.

From a physiological perspective, Oren Amseeli, MCSW (founder of the Comorbidity Program at the Kfar-Shaul-Eitanim Medical Center) and Dr. Malkah Lazar (a psychiatrist at the Israeli Ministry of Health’s Medical Cannabis Unit) made several salient points at a recent, MILAM seminar on the comorbidity of mental illness and addiction in the Israeli and global contexts:

While most people believe that cannabis is only mildly addictive, the 1990s studies they are relying upon were conducted on a product that had a concentration of 5-8% of THC, not one with a concentration of up to 25% like today’s product, so today’s cannabis may be far more addictive than is widely presumed. (Amseeli & Lazar)
Since the percentage of canniboids in any given part of the plant ranges from five to twenty percent and different strains have different percentages, it is hard to distinguish between hard and soft use by counting the number of joints smoked or product eaten. What may seem like occasional use may actually be introducing far more canniboids into your body than you realize. (Lazar)
The younger the users, the more likely they are to build pleasure pathways in their brains that will be extraordinarily difficult to uproot, even if they do not become addicted or even become regular users. In general, the risk of addiction is considerably greater for adolescent brains (Lazar). These pleasure pathways are so powerful that full-blown addicts who have come clean consider themselves to be in recovery until the day they die.
“Between 19 and 44 percent of psychotic patients in closed wards in the West are there due to psychosis caused by marijuana or polydrug use [taking a mix of psychoactive drugs, such as LSD and prescription drugs]. The figure for Jerusalem is a whopping 60%” (Amseeli). So the decision to take a psychoactive drug should not be made lightly.
In those with Bipolar Disorder or a history of psychosis, cannabis has been shown to increase the incidence of psychosis (Lazar). Or as NIDA (National Institute for Drug Abuse) puts it “long-term marijuana use has been linked to mental illness in some people, such as temporary hallucinations, temporary paranoia, and the worsening of symptoms in patients with schizophrenia—a severe mental disorder with symptoms such as hallucinations, paranoia, and disorganized thinking.”

While the discussion surrounding the long term effects of marijuana has become highly politicized and hotly debated, it is still worth mentioning the scientific evidence concerning its effect on brain development. Studies have shown that “when people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. [As NIDA puts, it] researchers are still studying how long marijuana’s effects last and whether some changes may be permanent.”

To this I might add, the understated warning of Igor Weinberg, PhD, an expert on the comorbidity of BPD and Substance Use Disorder (SUD), on the question of medicating BPD with cannabis: There are “no empirical studies that cannabis is effective. People with BPD have a vulnerability (whether genetic or environmental) to addiction, so they are more likely to develop a [substance use] disorder. There is a high risk of becoming dependent (whether physiologically or psychologically) on the substance, so people should keep this in mind” (The Comorbidity of BPD and Substance Abuse, at 43 minutes). While Dr. Weinberg, does not shout his opinion from the rooftops, clearly choosing to risk suffering from BPD and SUD (and/or psychoses), as opposed to BPD alone, should not require much thought. Unfortunately, while family members may validate their loved one’s desire to use, clearly the decision to do is fraught with risk that most would deem unacceptable.