Marijuana

Summary

• Mix of substance use disorders and mental health disorders
• Treatment should be well planned and client-centered

The term co-occurring disorders or COD means having at least one mental illness along with one or more substance use disorder. But there is nothing simple about having this condition. The two or more disorders will negatively impact each other. This requires that each disorder be treated separately but also at the same time. Recovery is not an easy process, but it is a goal that can be reached.

Types of COD

Substance use disorder can occur along with any mental illness. Some of the more common mental health issues linked with COD include:

• Depression
• Anxiety
• Schizophrenia
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Other disorders related to mood, anxiety, sleep, eating, and personality also often occur with COD.

Some common classes of substance use disorders include:

• Alcohol
• Nicotine
• Caffeine
• Cannabis
• Cocaine
• Amphetamines
• Sedatives
• Opioids

People with COD can have any mixture of substance use disorders and mental health disorders, but at least one of each.

Risks of COD

People with COD have certain higher risks than people with a single disorder. They also tend to be in poorer health and have a greater chance of relapse. Some of this is due to not taking or responding to treatment as well. The time and cost involved in this treatment is also higher.

Among these increased risks are:

• Violence
• Physical illness
• Psychosis
• Hospitalization
• Homelessness
• Unemployment
• Incarceration
• HIV/AIDS

Screening for COD

About half of all people with severe mental illnesses also have substance use disorders. The rate of people with substance use disorders who have mental illnesses is even higher. Despite these facts, screening for COD can be a challenge. A mental health service may not be able to spot substance use disorder. A substance use treatment center may not be able to spot mental illness. The screening process should decide whether or not the person needs to be further assessed. This assessment is then performed by a mental health doctor or other trained health care worker.

Treatment and recovery

Treatment for COD must target each disorder by itself and at the same time. This may occur in one setting or a number of settings. Treatment should be well planned and client-centered. This means the person with COD needs to be involved with all aspects of care. The type of care will depend on the types of substance use and mental disorders. It should also be tailored to the person’s unique needs and goals.

COD takes a toll on those who have it and on those around them. Coping skills must be taught to the individual as well as to her support group. Progress may be slow and sometimes hard to measure. The chance of relapse seems to always be right around the corner. Setbacks should be met with support rather than blame. The person will respond to praise much more than to guilt. Recovery is a long process that will require a group effort. It is not an easy task but it is well worth it.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2022 Carelon Behavioral Health

Summary

• There is a high rate of depression and alcohol use.
• Bipolar disorder and marijuana use co-occur frequently.
• Schizophrenia and tobacco use is very common.

Co-occurring disorders (COD) means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder. There are many types of COD. Some, though, are more common than others.

Depression and alcohol use

Depression is a mental illness that is often ignored. Sometimes it is from some other health issue. Symptoms can be weight loss, lack of sleep and lack of energy.

A third of people with low spirits also have a substance or alcohol use disorder. Many people drink as a way of dealing with depression. While it may give short-term help, drinking makes things worse in the long run. It can even cause a person to feel even lower. Alcohol use often hinders a person’s mental health care. The person who is drinking is less likely to stick to her doctor’s plan. She may forget to take her pills and miss doctor visits.

Alcohol use has its own set of risk factors. Short-term can include bad judgment and motor skills as well as more risk taking. This can lead to alcohol-linked car crashes, injuries and death. Long-term issues can include liver and heart disease.

Bipolar disorder and marijuana use

A person with bipolar disorder has mood swings that get in the way of his normal life. These mood shifts can cause problems at home, at school, or at work. The low stages are much like states of depression. The difference is that people with bipolar disorder also have high stages called mania. Mania symptoms include high energy, rapid thoughts and speech, and reckless actions.

As with depression, there is a high rate of alcohol use among people who have bipolar disorder. Studies show an even higher rate of marijuana use among these same people. Marijuana is believed to be a trigger for those who are prone to the disease. It is not known if marijuana is a cause of the illness. It does appear to make the risk of getting such disorders higher.

Schizophrenia and tobacco use

Schizophrenia is a long-term mental illness that touches millions of adults. It upsets a person’s thinking, which can cause strange outward actions. People with the illness often hear voices. They may also see things that aren’t really there. These voices and visions are very real to the person. This can cause great fear within the person. It can also cause other people to be fearful of them and to stay away from them.

It is very common for people with schizophrenia to also use tobacco. Smokers with this illness have a greater dependence and a harder time quitting. When they do stop smoking, the withdrawal symptoms are worse than for those without the disease. The link between these disorders is thought to be the central nervous system. People with schizophrenia can have a hard time with memory and staying focused. Nicotine may make them feel better, but the long-term hazards of smoking greatly offsets any benefit.

Treating COD

No matter what type of COD you have, you should be treated for each issue separately. This is because one will affect the other. Treatment will most likely be talk therapy as well as taking meds. A 12-step program might be needed for substance use issues. Treatment may be long-term, but if you stick with it, you will get better.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC2215390/ www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144/ and www.ncbi.nlm.nih.gov/pubmed/21288470; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Treatment should be client-centered.
• You may also need help with housing, child care, or finding a job.
   

Having a mental illness or a substance use disorder can be hard to deal with. Having both is even harder. Studies show that people with co-occurring disorders (COD) are less likely to comply with or respond to treatment. This puts them at a greater risk for relapse. They are also more likely to become violent, experience homelessness, or go to jail. The risk of getting AIDS and other illnesses is higher as well.

There is hope though. You can improve with proper treatment. This means being treated for both issues separately but at the same time. This is because the disorders not only co-exist, but they also co-affect each other. For instance, someone with depression may drink alcohol to try to feel better. A person who drinks may do so because he feels depressed. If only one issue is being addressed, the other issue can disrupt its treatment.

Before you can begin feeling better, you must first realize the need for treatment. You may not want to admit to your family or yourself that you have a mental illness. You may be afraid to tell your doctor or your boss about your substance use. You may be trying to hide one or both issues from your friends or co-workers. Maybe you simply are not sure if you have any serious issues or not.

Signs of mental illness

The symptoms of mental illness will vary depending on the disease. Often a person may not realize she is impaired. This is true whether it is the onset of a disease or a relapse. It is therefore good to have friends or family nearby looking out for you.

Some of the signs that could indicate a mental illness include:

• Extreme moodiness
• Depression
• Nervousness
• Paranoia
• Withdrawal
• Apathy
• High-risk taking
• High sensitivity
• Extreme irritation
• Inattention
• Trouble with eating or sleeping
• Sexual dysfunction

Signs of substance use disorder

Substance use disorder can have some of the same symptoms of mental illness. Some other signs that you may have a substance use disorder include:

• Getting drunk or high regularly
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to alcohol or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or alcohol
• Passing out or being hung over often

If you think your drinking or drug use may be an issue, get help right away. Do not try to carry the burden all by yourself. Seek out a trusted friend or loved one. Speak to a pastor or counselor. Then find a substance use treatment center and get involved in a 12-step program.

Client-centered treatment

To be successful, both disorders should be treated at the same time. Once you have reached out for help, you must stay involved in the treatment process. This means being active in the planning and decision making. Other people can give you advice but you should make your own choices. This will help empower you to better promote your own recovery.

Talk therapy will be a big part of your treatment. This may include one-on-one, group and family counseling. A 12-step program may be needed for help with substance use issues. Social skills and stress coping skills should be addressed. You may also need help with housing, child care or finding a job. Though you have the lead role, you will need the support of many others. Welcome the input from your doctor or health care worker, as well as family and friends. Realize that they all want what is best for you.

Be aware that recovery may take months or even years. Your progress may be slow at times and there could be setbacks. Do not lose hope. Instead, focus on short-term goals and ask for extra support. Distance yourself from negative influences and surround yourself with positive people. Believe that if you stay on course with your treatment, you can and will get better.

By Kevin Rizzo

©2014-2021 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth

Summary

• Attend doctor appointments and support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.

No one likes to see someone they care about go through hard times. A friend with a substance use disorder is hard to be around. A child with a mental illness is tough on the whole family. If you know someone with both issues, then you know it is even harder. As taxing as it may be, your support is a vital part of their recovery.

Identify the issues

The first step is to realize there is a co-occurring disorder (COD). Your friend or loved one may be in denial about her own situation. Her doctor or health care worker may not be aware of the other issue either. Therefore, the person is only getting treated for one issue. This is less than ideal since the two conditions affect each other. For instance, someone being treated for depression may drink alcohol to try to feel better. A person attending Alcoholics Anonymous meetings may continue drinking because she feels depressed. If only one issue is being addressed, the other issue can get in the way of its treatment. For treatment to work, it must be given for both disorders at the same time.

You may know your friend or loved one better than anyone. Therefore, you may be the first one to notice when he isn’t acting like himself. Watch out for sudden changes that may indicate mental illness or substance use or both.

Some of these changes may include:

• Extreme moodiness, touchiness or irritation
• High-risk drinking
• Violence
• Depression
• Apathy
• Inattention
• Nervousness
• Paranoia
• Withdrawal
• Eating, sleeping, or sexual troubles

Ways to promote recovery

When someone you care about has COD, you may feel helpless. This is a normal feeling, but it is far from the truth. Not only can you help, but your friend or loved one needs your help. Helping does not mean taking on the burden yourself. It does not mean you become the person’s enabler or watchdog either. A person with COD has to first be willing to get help. Recovery is hard work and no one can do the work for her. Your job is to show your support throughout the process. This means during both the good times and the bad times.

Sometimes, the best way to help someone with COD is just to be there for him. This allows your friend or loved one to open up about his struggles. You don’t need to have all the answers. You just need to give encouragement and support. Listen to him, and let him know he is not alone.

Here are other ways to help a friend or loved one recover:

• Go with her to doctor appointments.
• Attend support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.
• Be patient with her.
• Encourage her by staying positive yourself.
• Invite her to partake in healthy activities.
• Stay informed about the disorders.
• Don’t ignore thoughts of suicide—call their doctor or 911.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Institute of Mental Health, www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Screening for both issues can be difficult
• Certain mental illnesses occur more commonly with substance use disorders
• Alcohol and nicotine are common drugs linked with COD

Checking for a mental illness is often fairly clear-cut. That is because a lot of research has been done to make this process better. The same can be said for substance use disorders. We now know a great deal more about this field than we ever did before.

It is harder to screen for more than one issue at the same time. One reason for this is a lack of dual training. A mental health service may not be able to spot a substance use disorder. A substance use treatment center may not be able to spot a mental illness. So just how does one know if he has a co-occurring disorder (COD)?

COD means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder, but some are more common with COD.

Depression and COD

Depression is a mental illness that is often ignored. Sometimes it is the result of another health matter. Symptoms can be weight loss, lack of sleep, and lack of energy. These signs are also common among other health issues. Studies show that a third of people with depression also have a substance use disorder.

Bipolar disorder and COD

Roughly 60 percent of people with bipolar disorder also have a substance use issue. It is thought that these two disorders affect the same chemicals in the brain. Studies suggest that people with this illness may try to medicate themselves through alcohol use. It is also believed that bipolar disorder may be a risk factor for substance use. Marijuana use can be very common with this disorder.

Schizophrenia and COD

Substance use disorder happens quite often with schizophrenia. Drinking and drug use can also mask some of its symptoms. This is true both during times of use as well as times of withdrawal. Marijuana use can even make the symptoms worse.

Obsessive-compulsive disorder and post-traumatic stress disorder also happen often with COD. Other disorders linked to mood, anxiety, sleep, eating, and personality can be common as well.

Substance use disorders and COD

Any drug can be the source of a substance use disorder. This can range from caffeine and nicotine to cocaine and heroin. When the drug use causes harm or makes normal living hard it is a disorder. Social, legal, and physical problems are often the result.

Alcohol and nicotine are among the most common drugs linked with COD. These types of addictions are very hard to break, but it can be done. Recovery requires a strong support group. Substance use must be treated apart from, but at the same time as, mental disorders.

Signs of substance use disorder

Substance use disorder has a broad range of symptoms based on the drug or drugs. Many of these are the same as those for a mental illness. Here is a list of some of the more common signs to look for:

• Moodiness
• Nervousness
• Touchiness
• Low spirits
• Numbness
• Forgetfulness
• High-risk taking
• Withdrawal

You may not realize that your drinking or substance use is an issue. You may be in denial about your need for help. Here are some other signs that you may have a substance use disorder:

• Getting drunk or high all the time
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to drinking or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or drinking
• Passing out or being hung over often

Get treatment

If you think you may have COD you should tell your doctor right away. You can then be evaluated to see if you need to be looked at further. If you do have COD, early care will help with your recovery. You should also notice feeling much better when you are being treated for both issues. With the right help and support, people can and do recover.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression and www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth; National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• You don’t have to be addicted to have a problem.
• The longer you wait to take care of it, the worse it will get.
• You might not see your problem, but others will.

If you use marijuana, you may or may not have a problem. It depends on how often you use it and why.

Do I have a problem?

Start by asking yourself some questions:

Is your use of marijuana getting in the way of your life, your relationships, your job, your future?

Have you quit school, flunked tests or missed out on promotions because you were too stoned to do a good job, or just did not care enough to try to succeed?

Marijuana is sometimes called the Great Un-Motivator. Like many drugs, it works on the part of the brain that controls attention, memory and learning, and does not let those areas work properly. That sloppy-brain effect can last for days or weeks after the more pleasant effects of pot wear off, according to the National Institute on Drug Abuse (NIDA).

“Someone who smokes marijuana daily may be functioning at a reduced intellectual level most or all of the time,” according to the NIDA. Research shows that students who smoke marijuana are more likely to drop out of school or to get lower grades than those who do not use it.

Are you missing work or not doing a good job at what you do? Are you not paying attention to getting or staying healthy? Are you eating poorly, not getting any exercise or not socializing with people outside of those you may like to use pot with?

“Marijuana saps your energy. It takes away your ‘get up and go’,” says Jenny Karstad, who supervises a treatment program at a New England mental health center.

When you first started smoking marijuana, maybe you felt giddy and mellow. But, after a while, you only felt good when you were high. Then, your life started falling apart because you were missing work or doing poorly at school, getting into arguments with parents or loved ones. The worse you felt, the more your smoked, until getting high became the most important part of your day.

There is such a thing as too much of a good thing. We often celebrate by indulging in alcohol and rich food, but too much booze, chocolate or even broccoli, can make you sick. Again, it’s not always what you use, but how much and why.

“Marijuana may not cause cancer but it can wreck your plans and interfere with your life,” warns Joseph Lee, M.D., medical director for Hazelden Youth Services.

Is someone nagging you to quit?

Karstad says people do not always come to her center for drug or alcohol treatment, but rather because they sense there is something wrong in their life.

Often, someone has told them to get help, and they want to stop the nagging more than they want to stop drinking. Eventually, they see it is all connected.

Are you coughing a lot?

Marijuana contains tars and other substances that can damage your lungs. There are at least 50 toxins in the marijuana that people smoke, but there may be other, even more dangerous chemicals in it that were sprayed on by growers.

Are you forgetting important dates and promises?

Marijuana affects the memory centers of the brain. It screws up your perception of the passage of time. One of the pleasures and perils of the drug is it makes you lose track of time.

Are you having trouble driving or using machinery?

Marijuana upsets balance and coordination, which could lead to accidents. You might hurt yourself or someone else, even long after you have used the drug.

Would you rather stay home and smoke pot than participate in the world around you?

“Long-term marijuana use can lead to depression,” says Karstad. She sees many people who started using pot when they were young teens. Over the years, they increased the amount they smoked, while they increased their misery.

“If you are 30 years old, still living at home, stoned every day, playing video games or generally not functioning as an adult, you have a serious disorder,” says Tessina. “Your use is compulsive enough that it interferes with your life and maybe with your overall health.”

Are you always uncomfortable? Are you only at ease when you are smoking pot?

It may be time for you to find out why you are so unhappy. Drug use often covers over signs of depression, low self-esteem, anxiety or other mental health issues that you can deal with under the guidance of a skilled professional. Why be miserable? Life is flying past you. Stop and take control of your today and tomorrows. No one needs to be unhappy all the time.

Are you concerned about your children using pot or other drugs?

If you want your kids to stay away from pot and other drugs, be a good role model. Children learn values, in part, by looking at the way their parents live, says Dr. Lee.

Am I addicted?

“The definition of any kind of addiction—whether sex, alcohol, drugs or overwork—is not cut-and-dried. It’s based on an evaluation of whether the person is ruining his or her life to satisfy the need,” says psychotherapist and author Tina Tessina. “If a person is jeopardizing his or her health, job, or family to smoke grass, that person needs to get help, and get it fast.”

If you answer yes to any of these questions, your use of marijuana may be a problem. You may not be addicted, but you could be on your way to a more serious dependency.

There are many places to get help. Do it now before your problem causes other problems.

Resources

National Institute on Drug Abuse
www.drugabuse.gov/

National Institute on Drug Abuse for Teens
http://teens.drugabuse.gov/

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, MD, PhD, MPH, VP Medical Director, Beacon Health Options

Summary

• Tell him you care about him.
• Do not preach.
• Be a good role model.
• Help him find healthy, positive ways to spend his time.

You and your friend go way back. Over the years, you two have been through thick and thin together. But, recently, he has changed. He no longer wants to go out and do things with you, but just stays home, smoking pot, watching television or playing video games. Long ago, you shared laughs and a few dreams, but today, you are lucky if he ever responds to your calls or emails. It’s as if he were drifting through life on a small life raft. Fortunately, for him, his parents support him.

It could be worse. Your friend might be using pot with other drugs, or drinking alcohol at the same time. Once a real go-getter, he no longer seems interested in anything but getting high.

You think your friend has a serious problem, but do not know how to help, or if you should.

Marijuana use disorder is not life-threatening, but life-limiting. Your friend may be throwing away the best years of his life. He may also be putting himself at risk for serious medical conditions, such as lung cancer, serious mental illness or injury from an accident he has while high.

Your friend needs two kinds of help:

1. The assurance that you care about and support him
2. The help with a drug problem that only a professional can give

You may not be able to cure him, but you might be able to move him in the direction of getting the help he needs.

What to do and say

Here are ways you can help your friend—before, during or after he is in a treatment program:

1. Don’t moralize. He probably never intended to turn over his life and dreams to pot. If he inherited a genetic vulnerability to addiction, he had little control over getting addicted.
2. Be a role model. Let him see what a healthy, well-balanced life looks like and how good it can be to be sober.
3. Don’t enable his drug use or tempt him with other substances. Do not offer her a beer in place of a joint.
4. Listen to him. Don’t preach, but let him do most of the talking.
5. Do not tell him jokes about getting high. Avoid movies and music that glorify substance use or abuse.
6. Know that he may need medical help.
7. Follow good hygiene, sleep and nutrition practices. He will notice.
8. Get him into healthy surroundings. Don’t meet your friend in a bar or any place where people drink or use drugs. Go to a park, movie theater, beach or a family restaurant, instead.
9. Let your friend talk, and talk and talk.
10. Don’t ask too many questions or analyze the situation.
11. Stress that a drug problem is nothing to be ashamed of.
12. Help him ask for help. Offer to find places to get help, such as support groups, local helplines and treatment programs. Offer to go with your friend on the first visit, if he likes.
13. Be positive. There are millions of people who have overcome problems with drugs.
14. Remind him that he is not alone, and may have more people who love him than he realizes
15. Help him find joy and build self-esteem in places and situations that do not involve drugs or alcohol.
16. Ask, what can I do for you as a friend? You might want to develop a crisis plan and discuss it together. Tell him you will check in on him every now and then.

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Summary

Those drawn to marijuana often already have:

• Problems with motivation and ambition
• Feelings of being left out
• Some level of depression

“People who are happy being themselves don’t like being stoned,” says Tina Tessina, a psychologist and author of a book on recovery from drug addiction.

Most marijuana users, as well as those who are drawn to any substance, have something going on in their lives they want to escape from. It could be:

• Stress
• Panic
• Depression
• Obsessive thoughts or actions
• Responsibility
• Trauma
• Anxiety
• A physical disability
• A learning disability
• Low self-esteem
• Sexual or emotional abuse
• Childhood neglect

If they want to stop using marijuana, they must deal with their underlying problems, as well. Most treatment programs address all of someone’s issues at the same time.

Marijuana tends to attract people who already have problems with motivation. They do not have a clear plan for the future or might not feel like they fit in.

“These are the lost kids, the loners, those left out of the parties and off the teams,” says Tessina. “They are good candidates for marijuana use.”

Unfortunately, the drug itself makes their problems even worse. After giving a brief high, marijuana alters that part of the brain that tells us to hurry up and get moving. When you use pot, you can be as lazy and unmotivated as you want to be without caring about what anyone thinks, even yourself. That lack of motivation lasts much longer than the effect of the drug, because the active ingredient in the drug, THC, stays in your body for a while and physically alters your brain.

“The kids who know they want to go to college and know what they want to do don’t want to interfere with their goal,” Tessina says. And, the same holds true for adults. They have responsibilities and people counting on them to come through with money or time or effort.

But people who are not fully engaged in life are a likely target for marijuana use. And, they could get in trouble if they use it too much.

When you are high, you never have to work at ignoring the demands of the world around you. The THC in marijuana does it for you.

Marijuana stunts emotional growth

Marijuana stunts emotional growth, Tessina points out. You will not learn when your brain is muddled. “You stop taking risks, learning about life and experiencing its normal ups and downs, and even if you do, your brain is not recording it fully. If you’re stoned for a good part of the day that will have a big effect on your emotional development.”

“If you have anxiety or phobias, you are at risk for substance abuse,” says Bill Shryer, clinical director of a mental health center. “People are drawn to what they can use to reduce the symptoms of mental illness, whether it’s weed or booze. They end up sedating themselves instead of dealing with the problems.”

Those who use multiple drugs—which is often the case for people with obsessive-compulsive disorder—do not feel comfortable in their own skin, Shryer says. “They want to be altered all the time.” Some were abused as children, so they have learned to dampen down their feelings. When feelings start to bubble up, they look for something they can take to block them. That could be pills, alcohol or pot.

Marijuana is a depressant

Marijuana is a depressant, so if you already have some level of depression—even seasonal affective disorder—pot will make it worse. Then, you can find yourself using the drug to make you feel better. And, so begins a vicious cycle of drug use and worsening mental health.

Also, marijuana interferes with the way drugs used to treat mental illness work. If you know you have a mental illness, stay away from recreational drugs, including marijuana. It contains a powerful drug, THC, which can undo all the benefits of the medicine you take, while it alters the way your brain operates.

The important thing to remember is there are ways to get off this merry-go-round. Good drug treatment programs will help you address underlying mental issues while you learn to face life without hiding behind substances.

Resources

Faces & Voices of Recovery
www.facesandvoicesofrecovery.org/

National Institute on Drug Abuse
www.drugabuse.gov/

National Institute on Drug Abuse Teen Page
http://teens.drugabuse.gov/

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, MD, PhD, MPH, VP Medical Director, Beacon Health Options

Summary

Any treatment problem requires:

• Time
• Effort
• Commitment

It is time. You need to do something about all the time and money you spend getting high, and instead spend it on living a full life. Your friends are pushing you into treatment, and so is your parent.

Now what happens?

Treatment for marijuana use varies with the characteristics of your use.

A professional, certified drug counselor can sort out what will work best for you. She will ask:

• When did you start smoking pot? If you started as a teenager, you may have a lot more work to do than if you started as an adult.
• How often do you smoke? If you smoke pot every day, you may be addicted. If you smoke less often, you might find it easier to change your patterns.
• When or why do you smoke? If you smoke to relax under stress, you need to find new ways to handle that stress. Cognitive-behavioral therapy—or talk therapy—can do that, along with the support of a 12-step program.
• How much do you use? If you have increased the amount you smoke over years and use a pipe to get the maximum amount of THC each time, you might experience more severe withdrawal when trying to stop.
• How has your use affected you? Has it ended relationships, jobs or your education? Are you 40 years old and still living in your parents’ house because you have lost your desire to support yourself?

People seeking treatment for marijuana also often use alcohol and other drugs, especially alcohol and cocaine. You will deal with all of your substance issues at the same time.

Also, most people who turn to marijuana or other drugs do so because they are looking for a way to deal with problems. Maybe they have anxiety, depression, obsessive-compulsive disorder or attention-deficit/hyperactivity disorder. Whatever it is, they know there is something not right with their life, and they self-medicate with something that makes them feel better. Drug treatment must go hand-in-hand with treatment for underlying problems.

Do not be surprised and do not be afraid if your search for drug treatment leads you to find out you have an underlying mental health problem. With help, you should be able to work toward a much better life.

Treatment options

1. Behavioral treatments. Talk out your problems with someone who can point you in a new direction.
2. Drug therapy. Prescribed medicine can reduce some of the anxiety that led to abuse.
3. Family therapy. It is usually not enough for one member of a family to change.
4. Residential treatment. Change the environment and change the habit.
5. Rehabilitation. Learn new ways to build self-esteem, handle stress and accept responsibility.
6. Group counseling. You can benefit from the experience of others.
7. Group support. Knowing you have a group behind you can help you make positive choices.
8. Recovery programs. Twelve-step programs, like Alcoholics Anonymous, have helped millions.

You may benefit from one, some or all of these options. All take time, effort and a commitment to change for the better.

“Therapy is a way of lining up one’s ducks in a row in a way that makes sense for you,” explains Joseph Lee, MD, in his book Recovering My Kid. “It helps [you] make peace with the past and gain hope for the future.”

“Everything comes crashing down when you give up whatever addictive substance you’ve been using to avoid problems,” says Tessina. You need treatment and recovery support to help you sort out all the stuff that addiction has left you unable to deal with, she adds.

You might ask yourself, what’s the big deal? It’s only marijuana, a natural plant that has been used by millions for centuries.

“But it is still a very powerful drug, and has been carefully grown to get stronger and stronger,” says Jenny Karstad, a drug counselor who oversees treatment at a mental health center. It is not sold as something to make you healthy, but as something to let you escape reality for a while.

Yes, but it has been decriminalized in my state and even used as medicine for some people who have terrible diseases.

“Just because marijuana use or medical marijuana use has been de-criminalized, doesn’t change the parameters or treatment of the addiction,” Tessina explains. “Being addicted has nothing to do with whether the substance is legal or illegal. Alcohol is legal, but one can still have alcohol use disorder.”

Will I go through withdrawal?

If you are physically addicted to the drug, yes, you will and it might be uncomfortable. but it might not be very noticeable.

If you break a leg and take painkillers for 2 weeks then stop, your legs might feel funny. A few days later, they are fine. You have gone through withdrawal without knowing it, says Jenny Karstad. “People who develop a drug dependency sometimes don’t realize they are dependent until they stop.”

If you stop using marijuana, you might get irritable or cranky, have stomach cramps or a little nausea. That will go away in a week or so. “If you use a drug long enough, you don’t know what normal is, after a while,” Karstad adds. “It can feel a little weird.”

If you are using other drugs or alcohol, your withdrawal may be more severe. A drug counselor will help you deal with it.

How will I keep sober after treatment?

Most people get help from a 12-step program like Alcoholics Anonymous or Marijuana Anonymous. There are programs for people of all ages. You can get a lot out of sharing your story, and learn from others. Also, it helps to know that you are not alone while you are learning to face life without marijuana.

Resources

Marijuana Anonymous
www.marijuana-anonymous.org/

Nar-Anon Family Groups
http://nar-anon.org/naranon/

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, M.D., Ph.D., M.P.H., VP Medical Director, Beacon Health Options

Summary

Marijuana:

• Can give you a pleasant high for a short time
• Affects memory, motivation, and motor coordination
• Can lead to birth defects in a user’s children

You may be a parent who suspects your child is using marijuana, or maybe an employer having trouble with an employee. Are there signs you should watch for to detect marijuana use?

Marijuana at home

For whatever reason, you think your son or daughter might be using drugs, specifically marijuana. Short of a confrontation or invasion of their privacy, is there any way to be sure?

Here are some physical signs to look for:

• Bloodshot eyes
• A lingering smell of sweet herbal smoke
• Stubs of tightly wound paper but no filters
• Residue of twigs, seeds, pods or leaves
• Bottles of eye drops
• Rolling papers, piles, bongs, clips. Drug paraphernalia is a good indicator of frequent use.
• Incense, to cover up the smell of marijuana smoke
• Mouth wash, air fresheners, or other scent maskers
• Small burns on thumb or forefinger

If you have found one or more of these signs, look for changes in behavior. They could signal a wide variety of problems, including marijuana use disorder.

Has your teen:

• Recently changed friends
• Dropped out of activities she once liked
• Suddenly run out of money, for no apparent reason
• Dropped in academic achievement or test scores
• Become newly interested in taking out the trash or walking the dog late at night

Have you noticed that your kid:

• Easily loses his train of thought
• Says teachers or other authority figures are out to get him
• Laughs inappropriately
• Is always hungry
• Seems confused and lethargic
• Is staying up or out much later than usual

If you answer yes to several of these questions, it is time for you to talk to your teen. She may be experimenting, which does not mean she is an addict. She might not go beyond that stage. Or, she could be smoking pot regularly, frequent enough to interfere with her grades, relationships and future plans, especially if she drives under the influence of drugs. If she uses pot regularly, it is time for you to get her drug counseling. If regular use goes on for a long time, she could develop a dependency on the drug and then she would need further substance use treatment.

Before you talk, choose a time when she is sober, when the two of you are alone and when will not be interrupted. Make sure you have your own negative feelings under control.

• Do not be confrontational.
• Show your interest in your child’s feelings and needs.
• Ask if there is something bothering her.
• Ask her if she is using drugs. If she says yes, ask her what kind, where, when, and with whom.
• Very important: Listen to what she has to say.
• Tell her your concerns. Be loving, but also honest.
• Ask her to stop.
• Tell her the facts about marijuana or other drugs. Be sure to educate yourself, first.

If your talk is not successful, do not waste time getting her the help she needs. Discuss the situation with a doctor. Join a support group for parents in similar situations. Find professional help for your child as quickly as possible. The longer you wait, the more likely she will become dependent on this or other drugs.

Marijuana at work

Marijuana use in the workplace can put everyone on edge or even at risk of injury. People who are high have accidents—in cars, with machinery, or in their dealings with customers or colleagues.

Laws may be changing in your state, but few employers are going to permit drug or alcohol use on the job. Chances are your company has rules. Review them. If you head a small business, you will have to decide how much you will or can tolerate when you suspect a worker is high on the job.

He may not be using marijuana at the workplace, but his off-premise use can affect his performance.

Here are some things to look for, if you suspect your employee of using pot.

Ask yourself, is your employee:

• Chronically late
• Unmotivated
• Depressed or withdrawn
• Slow, lethargic, or confused
• Unable to follow instructions
• Having financial problems
• Getting into trouble with the law
• Coming back late from lunch or breaks, then not accomplishing much
• Calling in sick frequently
• Complaining about supervisors picking on her
• Argumentative
• Suddenly coming to work sloppily dressed or poorly groomed
• Wearing clothes that smell like incense
• Losing coordination and motor skills
• Not as physically strong as he was when you hired him

We all lose our get-up-and-go once in a while. No single item on this list is an absolute sign of drug use. But, taken together, they describe an employee who may have a drug problem, especially a marijuana use problem. What you do about it will depend on your company’s policies.

Document what you see, as well as the employee’s work performance. A consultation with a doctor or drug counselor might be a good step to take, so you would know if you are on the right track. Or, you might want to go directly to your human resources director for instructions on how to handle the situation.

Resources

National Institute on Drug Abuse
www.nida.nih.gov

National Institute on Drug Abuse Teen Page
http://teens.drugabuse.gov/

Nar-Anon Family Groups
http://nar-anon.org/naranon/

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, MD, PhD, MPH, VP Medical Director, Beacon Health Options

Summary

• Drug and alcohol use is rising among older adults.
• They may misuse prescription drugs and alcohol.
• This is especially dangerous for this age group.

People may see drug use as a young person’s issue. But it is an issue for older adults, too. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) says it is “one of the fastest growing health problems facing the country.”

Substances

Alcohol is the most used and misused drug. Older adults may socialize with beer, wine, or cocktails. Happy hour is a common event in assisted living and retirement communities. SAMHSA advises no more than one drink a day. Some people should not drink at all.

Older adults use prescription drugs more than any other age group. Misuse of these drugs is growing. It can affect decision-making, create dependence, or cause other harm. Commonly misused drugs are:

• Opioid pain meds such as Vicodin®, OxyContin®, and Percocet®
• Benzodiazepine and anti-anxiety meds such as Ativan®, Valium®, and Xanax®
• Sleep meds such as Ambien® and Lunesta®

Medical marijuana is legal in some states. Older adults may use it to manage or treat health symptoms. There is no good estimate of how many people use illegal marijuana.

The same is true for illegal drugs, such as cocaine, methamphetamines, and heroin. In the past, it was thought that people stopped using substances as they aged. Recent hospital records show this may no longer be true. In fact, the National Study on Drug Use and Health shows that illegal drug use in people older than 50 has more than doubled between 2002 and 2013.

Who is at risk?

Drug use touches all ethnic and social groups. Men who have had drug issues in the past have the highest risk. Late onset issues are more common for women. People who deal with a long-term health problem, pain, trouble sleeping, or depression are also at risk.

Age-specific concerns

Older adults deal with a lot of loss. They may lose their sight or mobility. Their support networks shrink. Retirees may mourn their identity or financial security. They may miss their careers and work friends. Losing a spouse, a partner, or other loved ones can be painful. Older adults may use substances to self-medicate feelings of loneliness and loss.

As people age, drug use may have more consequences and risks. Bodies change with age. They lose muscle and body water. They digest and absorb things differently, often more slowly. Instead of leaving the body quickly, substances can build up to unsafe levels in the blood.

Also, older adults are more likely to deal with chronic health issues. Drugs and alcohol can make them worse. Common examples are:

• Diabetes
• Heart and liver issues
• Ulcers
• Cancer
• Sleep disorders
• Depression and anxiety

Drugs and alcohol do not mix well with medications. Some mixtures may not work well or may even be toxic. Examples include but are not limited to:

• Pain relievers
• Anti-inflammatory meds
• Heart and blood pressure meds
• Seizure meds
• Sleeping pills, tranquilizers, and sedatives
• Antidepressants
• Antibiotics
• Cold, flu, and allergy meds

It is vital for older adults to talk about their substance use with their doctors.

Signs of substance misuse in older adults

Drug misuse among older adults is not identified or reported enough:

• Clear signs like missing work or being drunk in public are not as common in older adults.
• Many people do not know substance use can be a problem for older adults.
• Loved ones may read signs of substance use as a normal part of aging.

Awareness is the key to identifying substance use and misuse among older adults. Symptoms to watch for include:

• Changes in appetite, personality, or behavior
• More health problems or confusion
• Decline in appearance or hygiene
• Unclear or slurred speech
• Anger or panic when asked about drug and alcohol use

Treatment

Treatment varies for older adults. The type and pace of care depend on a person’s situation. Experts advise a screening and intervention. This can include assessment, counseling, education, and goal setting. Professionals may offer referrals to medical and other services if needed.

Successful treatment plans are:

• Supportive and age specific
• Helpful in building support networks
• Focused on developing coping skills
• Run by qualified and skilled professionals
• Take place in individual or group settings

By Beth Landau

©2015-2021 Carelon Behavioral Health

Source: American Psychological Association’s “Elder Abuse and Neglect: A Search for Solutions.” (2012), www.apa.org/pi/aging/resources/guides/elder-abuse.aspx; Castle, Nicholas G., Ferguson-Rome, Jamie C., Handler, Steven M., Smith, Mary Lindsey, Wagner, Laura M. (2012) “Alcohol Misuse and Abuse Reported by Nurse Aides in Assisted Living.” Research on Aging. May 2012, 34: 321-336; Center for Substance Abuse Treatment. (2012) “Substance Abuse Among Older Adults.” Treatment Improvement Protocol (TIP) Series, No. 26. HHS Publication No. (SMA) 12-3918, www.ncbi.nlm.nih.gov/books/NBK64419/pdf/TOC.pdf; “Seniors and Alcohol.” (2015) West Virginia University School of Public Health, http://publichealth.hsc.wvu.edu/alcohol/effects-on-society/seniors-and-alcohol; Substance Abuse and Mental Health Services Administration. 2014. “Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, Md.: Substance Abuse and Mental Health Services Administration, 2014, www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf; Taylor, Matthew H. Grossberg, George T. (2012) “The Growing Problem of Illicit Substance Abuse in the Elderly: A Review.” Primary Care Companion for CNS Disorders. Vol. 14(4), PCC.11r01320; Wu, Li-Txy. Blazer, Dan G. (2011) “Illicit and Non-Medical Use Among Older Adults: A Review.” Journal of Aging Health, Vol. 23(3), 481-504.

Summary

Marijuana is:

• A potentially useful symptom reducer for some health problems
• Addictive to those at risk for addiction, or who use it often

It’s hard to open a newspaper, read a news website, or watch the TV news today without finding a story about marijuana.

Some states are legalizing it or thinking about dropping laws against recreational use. Farmers are talking about growing it as a cash crop and dispensaries are opening to sell it to people with serious illnesses like chronic pain, AIDS, or cancer.

Some people say, if it is used in small amounts once in a while, it’s as harmless as a glass of beer or wine.

Is it harmless?

Marijuana can be both harmless and dangerous, depending on how it is used and why. Marijuana use disorder and addiction are very different from marijuana use within reasonable bounds or prescribed for a health condition, says psychologist and author Tina Tessina.

What is it?

Marijuana—often called pot—is a mixture of dried leaves and flowers of a hemp plant that have been shredded or chopped to make it easy to smoke or eat. Usually made from parts of the cannabis sativa or cannabis indica plants, it contains the mind-altering chemicals THC and CBD. They affect the brain and can change the way you handle stress and self-control. In very low doses, THC also seems to reduce pain, swelling, or nausea in people who are very sick.

As more and more states legalize it or allow medical-marijuana dispensaries, the public has come to see it as harmless, or at least, no more harmful than booze, if used properly.

It may come from something natural, but so does alcohol. And just like alcohol, aspirin, and drugs used to treat mental illness, pot carries risks to users.

How is it used?

It can be smoked in a cigarette or pipe, or eaten in prepared food like cookies or brownies. For medical use, you can breathe in marijuana fumes from a vaporizer, or take capsules of cannabis oil.

If you roll it into a cigarette, called a joint, you breathe in about 10 percent to 20 percent of the THC.

If you empty out a cigar and fill it with pot, it is called a blunt. These are bigger than joints and carry more mind-altering drugs to your brain.

If you smoke it in a pipe, you get about 40 percent to 50 percent of the THC in your system.

Some people do not like the heat of a cigarette so they smoke pot through a water pipe. The water cools the smoke but the pipe is also designed to raise the amount of THC you inhale.

Some people brew tea from marijuana and drink it.

The quickest way to get high from pot is to heat it or burn it and breathe in the smoke. The slowest ways are eating, inhaling, or taking it in the form of a pill. In fact, medical marijuana is given in very low doses, so the person never feels high, but gets relief from pain, nausea, or insomnia.

Marijuana can be used:

Recreationally

People use pot to get high. If you are stressed out, it calms you. If you are unhappy, it lightens your mood. If you are worried about tomorrow, you might not think of tomorrow while you are high. In fact, you will lose track of time. If you have always been a focused and serious person, pot may make you playful or mellow.

But, not everyone has the same reaction to pot. It makes some people afraid. Others do not like the feeling of losing control of their thoughts. Feeling tipsy or acting silly is not everyone’s idea of a good time. In fact, some people may not like what they feel or do when their guard is lowered by a mind-altering drug.

Medicinally

Limited research shows that marijuana can be used to ease pain, help people sleep better, keep them from throwing up after chemo treatments, or lessen anxiety that goes along with some physical illnesses, with few side effects. It has been used in low doses by people with arthritis, multiple sclerosis, fibromyalgia, and even cancer, to make them feel better.

This is important: Marijuana will not cure those health problems, but it can lessen some of the irritating symptoms, like swelling and nausea.

Downsides to using it

There are many. Because it works to change part of the brain, it can:

• Be addicting. About 10 percent of people who use it recreationally will become hooked, in part, because they carry a gene that reacts to the THC.
• Damage young, unformed brains. It is especially bad for young teens whose brains haven’t fully developed.
• Make underlying—and, maybe, undiagnosed—mental health conditions worse. When the high wears off, it increases depression and anxiety in those who already have it. Pot can also trigger psychosis. For some people, the symptoms of their mental health problem become worse.
• Affect the development of an unborn child, if a woman uses during pregnancy.
• Make you drowsy, which can lead to accidents. You should never drive high.

“Even if marijuana is legalized in your state, driving stoned will never be legal,” says Tina Tessina, a psychotherapist who helps many people deal with addiction.

There are physical risks as well:

• It raises your heart rate for as long as three hours, increasing your risk of stroke or heart attack.
• THC and CBD can stay in your body for as long as a month.
• A joint combining pot and tobacco has more toxic substances in it than a cigarette made with tobacco only, raising your risk of lung and other cancers.
• Pot smoke irritates the throat and lungs, setting you up for infections in those areas and beyond.
• When you smoke or eat pot, you do not really know what you are putting in your body. Plants could have been sprayed with poisons or growth hormones. Rats or insects sometimes live in the dried leaves before they are sold.

Bill Shryer, Clinical Director of a mental health clinic in California, says the average marijuana plant grown today has been bred to have 10 times as much THC as plants grown 30 years ago. People may not know what they are getting into when they smoke pot, he says.

Also, levels of THC and CBD vary from plant to plant. You may have no problem with pot one day, but big problems the next time you use it.

Resources

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

National Institute on Drug Abuse
www.nida.nih.gov

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, MD, PhD, MPH, VP Medical Director, Beacon Health Options

Summary

Marijuana:

• Can give you a pleasant high for a short time
• Affects memory, motivation, and motor coordination
• Can lead to birth defects in a user’s children

Some people say smoking a joint of marijuana is not harmful because it is a natural substance.

What happens when you smoke a joint?

1. THC, the ingredient in marijuana that makes you feel high, goes through your lungs (or stomach, if you eat it in food) into your bloodstream and to the part of your brain that lights up when you do or ingest something pleasurable, like have sex or eat chocolate. THC overstimulates the brain to get it to release dopamine, a chemical that makes you feel good. The same process is at work when you use other recreational drugs, alcohol or do some physical exercise.
2. You begin to feel high and very relaxed. You might laugh for no reason or do something silly because you feel good and your inhibitions are low.
3. Colors, flavors and smells might seem unusually strong.
4. Time may seem to slow down or speed up. Details of things you have done in the recent past may slip away. You lose coordination, which impairs your ability to drive.
5. You could feel hungry and want to eat.
6. Eventually, the effect of THC wears off, leaving you sleepy or maybe depressed.

Not everyone enjoys the experience. Some people have bad reactions to the drug. They can get fearful or go into a panic and even become psychotic. If you have depression, anxiety or another serious health condition, using pot can make that condition worse.

THC works on the parts of the brain that control memory, motor coordination and ability to learn. Long after your high wears off, those areas may not work properly. This means you could have trouble following directions or doing schoolwork. According to research, people who smoke pot daily for a long period of time may have limited thinking ability whether they are high or not, and whether they realize it or not.

Those who start using the drug when they are teens have the most to lose. If they use it regularly, they lose their ability to learn and may stay like that for years. In fact, research shows that the brains of teens who are heavy pot users do not develop or function the way they should, long after adolescence.

According to the National Institute on Drug Abuse, long-term marijuana use can lead to addiction; that is, people have difficulty controlling their drug use and cannot stop even though it interferes with many aspects of their lives.

Here is what happens in the rest of your body:

1. Bronchial tubes leading to your lungs relax and let more smoke into your lungs. Smoke irritates the inside of your nose, throat and lungs, whether you cool it through a bong or not, because it is filled with harsh, scratchy unburned material. Injured tissue is a choice spot for bacteria to take root and give you an infection. The more you smoke, the more likely you are to get bronchitis, or a chronic condition such as emphysema or bronchial asthma.
2. Your heart beats faster, maybe even twice as fast as usual. Your rapid pulse raises your blood pressure, putting you at high risk of a heart attack or stroke, even if you are young. If you have a weakness somewhere in your cardiovascular system, high blood pressure could cause problems.
3. The blood vessels in your eyes expand, making your eyes look red.
4. THC only stays in the blood a few hours, but then it is stored in your fat cells. Little by little, your body gets rid of it through urine. If you only smoke a small amount once in a long while, signs of marijuana may stay in your system for about 13 days. But if you are a heavy user or a long-time user, your urine may show it 30-45 days after you stop.
5. If you smoke marijuana while you are pregnant, you can harm your unborn child. Studies have linked a mother’s pot use with her child’s hyperactivity and learning disabilities. At least one study shows that, if a woman smokes marijuana before or during a pregnancy, she is at risk for pre-term labor, premature delivery, a low-weight baby or one with birth defects serious enough to require intensive care.  If you smoke marijuana while breastfeeding, THC will go into the breast milk and be passed to your baby.

What happens if you mix alcohol and marijuana?

1. Both alcohol and marijuana depress your central nervous system. When you use them at the same time, you get a walloping depressant going into your brain. It is hard to predict how much that combo will interfere with the way your brain works.
2. You may handle alcohol differently than people you know. The same is true for pot. No one can predict in advance how you will handle the two together. You might vomit, or get so dizzy you cannot stand up. Or, you might pass out.
3. Word of caution: Alcohol does not mix well with many drugs—legal, illegal, recreational or prescribed by your doctor. It is best not to take a chance on having a bad reaction, or worse.
4. If you already use insulin, a painkiller or medicine prescribed to treat a mental illness, do not add alcohol or marijuana to the mix. The best thing is to err on the side of caution. Do not take a chance on having a bad reaction, or worse.
5. If you drink too much alcohol, your body will force you to vomit to avoid alcohol poisoning. It is not a pretty remedy, but it could save your life. Marijuana, on the other hand, settles the stomach and reduces the urge to vomit. That is why doctors sometimes prescribe pot for people undergoing chemotherapy. If you put pot and alcohol together, you may miss the very important signal your body sends to tell you not to drink more alcohol.

Using marijuana with other drugs or medicines

Marijuana increases the strength of some drugs, and lessens the power of others. No matter what the drug, having marijuana in your system will alter whatever else you use.

Best advice: Do not mix drugs. You may be playing with fire.

By Paula Hartman Cohen

©2013-2019 Carelon Behavioral Health

Source: Jenny Karstad, MA, LADC, LCMHC, clinical supervisor, Brattleboro Retreat Mental Health and Addiction Treatment Center, Brattleboro, VT; Joseph Lee, MD, psychiatrist, medical director for youth services and national advocate for adolescent addiction and mental health issues, Hazelden Addiction Treatment Centers, Minneapolis, MN; William Shryer, DCSW, LCSW, clinical director, Diablo Behavioral Healthcare Centers, Danville, CA; Tina B. Tessina, PhD, psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance, and Independence Beyond the 12-Step Programs, Long Beach, CA

Reviewed by Sandrine Pirard, M.D., Ph.D., M.P.H., VP Medical Director, Beacon Health Options