by Harvey Widroe, M.D.
American Reporter Correspondent
October 23, 2007
'I'M STONED. SO WHAT?'
ORINDA, Calif. -- Divorced at 40, and now without a job, Charles' life was going nowhere. And that was why he had come to see me.
"But I'm fine," he said. And I knew he meant it, at least for the moment. He was spaced out on marijuana, and in that space, he really did feel good, even happy. Charles was a daily user, usually starting with a smoke before breakfast, and a joint or two in the evening "just to relax." He didn't remember when he'd first started using. But he guessed it was during high school.
At times I couldn't tell when Charles was high. But more often his relaxed facial muscles and inappropriate smile along with a drifty tone of voice gave it away. As far as I could tell, he rarely lied to me about his current usage whenever I asked him about it.
He sometimes got his supply from a dealer, to whom he referred as his very good friend (as long as he paid his dope bills). More often he got his stuff from a medical marijuana club. Supported by a letter from a doctor claiming that he had some kind of vague chronic pain problem. Charles, like so many others with totally bogus excuses, laid claim to a "medical marijuana" need for the drug. He asked me to provide a stronger letter, one that asserted that his use of marijuana was necessary to prevent an upsurge of an otherwise untreatable depression. When I refused, pointing out that marijuana addiction was his major problem rather than the solution to his problems, he said he wasn't very surprised at my refusal. "But it was worth a try to ask."
Charles dreaded that his cannabis club might one day be raided or closed down by federal marshals, or even by the local authorities who usually turned their backs on the club's very existence. But he had a list of several others as backups if his current supply lines were cut off.
Charles last job had been as a salesman, where he and others smoked away the tedious hours between customer visits. But even the tolerant sales manager had had his limits, and Charles' lackadaisical attitude, slow thinking, and, most important, his poor sales numbers, led to his being terminated. That was more than six months ago. He thought about looking for another job, but he couldn't get it together to get started. He awoke each morning with a resolve to think about it, a resolve that disappeared after a few puffs.
His ex wife, once his user buddy, had opted for a new life style that didn't involve drugs. But Charles had been unwilling or unable to make whatever changes might be required of him. And after a stormy year, the couple had split up and divorced.
Charles insisted that the marijuana had no effect on his thinking and behavior that lasted longer than the few hours he was high. It was on this issue that we most commonly disagreed. I explained that the active component of marijuana dissolved in certain areas of the brain and was slowly released over about six weeks. It would then always produce a dulling effect on thinking processes along with increased irritability, poor comprehension and defective judgment. He really couldn't see it. He insisted that when he wasn't high, his thinking was perfectly normal. He always found an excuse to blame others for everything that had gone wrong in his life.
Marijuana addicts usually don't want to give up their addiction. And they lie to themselves and make excuses to defend the belief that, at least for them, marijuana really is purely recreational and totally innocuous.
Hardin Jones in the 1960s, measuring CAT scan images of the brains of long term regular marijuana users, was the first scientist to detect and measure significant amounts of brain atrophy. His findings have been confirmed repeatedly by other researchers. Recent studies show a 50 to 200 percent increase in the incidence of psychotic illnesses in marijuana addicts. Regular marijuana users also have a 50 percent higher chance of developing a major depression than comparable non-marijuana users.
Some people who are marijuana dependent are able to stop of their own accord. Many others make pledges galore about cutting back or stopping altogether. But the urge to keep on smoking marijuana is strong. Alcoholic Anonymous and Narcotics Anonymous groups reach out to embrace addicts of all kinds. And some marijuana addicts use the AA and NA programs to clean up and stay clean.
Psychotherapy alone by therapists or psychiatrists to help marijuana dependence is far too weak a tool to dull or control the impact of resurgent drug cravings. Most marijuana addicts will drop out of treatment after a very short period of improvement. They may continue to seek psychiatric care only because of some other concurrent psychiatric problem.
Tranquillizers, antidepressants, or antipsychotic medications seem to have no significant impact on marijuana addiction.
But one medication, Campral, developed for dampening the cravings for alcohol, also appears to work with marijuana addicts. Those heavy marijuana users for whom I have prescribed Campral have all found Campral to be helpful in decreasing the intensity of the marijuana cravings. Yet every one of them has stopped the drug within a few weeks. They stop it, but not because it is ineffective. They stop because it is almost too effective.
Campral users will have a substantially decreased craving for marijuana and will actually stop or smoke a lot less. But with the resulting clearer thinking, they will then come to view the shambles they are making of their lives. And they don't like what they see. Their solution is to stop the Campral and get back to the comfort of being stoned.
Studies show that up to 40 percent of all high-school juniors have experimented with marijuana. Some will go on to become marijuana-dependent well into their adult lives with serious long-term, negative consequences. The optimal place and time to start dealing with the marijuana problem is in early adolescence. Marijuana use in our kids isn't harmless. What starts as recreation can easily go on to become dependence and then addiction.
And parents must take a strong stand to educate, to provide a positive example, to provide limits, and treatment if necessary.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "The Smart Dieter's Cheating Guide: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press)