Description, Causes and Risk Factors:
Cannabis, more commonly called marijuana, refers to the several varieties of Cannabis sativa, or Indian hemp plant, that contains the psychoactive drug delta-9-tetrahydrocannabinol (THC). Cannabis-related disorders refer to problems associated with the use of substances derived from this plant.
Cannabis — in the form of marijuana, hashish (a dried resinous material that seeps from cannabis leaves and is more potent than marijuana), or other cannabinoids — is considered the most commonly used illegal substance in the world. Its effects have been known for thousands of years, and were described as early as the fifth century B.C., when the Greek historian Herodotus told of a tribe of nomads who, after inhaling the smoke of roasted hemp seeds, emerged from their tent excited and shouting for joy.
Cannabis is the abbreviation for the Latin name for the hemp plant — Cannabis sativa. All parts of the plant contain psychoactive substances, with THC making up the highest percentage. The most potent parts are the flowering tops and the dried, blackish-brown residue that comes from the leaves known as hashish, or "hash."
There are more than 200 slang terms for marijuana, including "pot," "herb," "weed," "Mary Jane," "grass," "tea," and "ganja." It is usually chopped and/or shredded and rolled into a cigarette, or "joint," or placed in a pipe (sometimes called a "bong") and smoked. An alternative method of using marijuana involves adding it to foods and eating it, such as baking it into brownies. It can also be brewed as a tea. Marijuana has appeared in the form of "blunts" — cigarettes emptied of their tobacco content and filled with a combination of marijuana and another drug such as crack cocaine.
Cannabis abuse share many of the same root causes with other addictive substances. The initial desire for a "high," combined with the widely held perception that cannabis use is not dangerous, often leads to experimentation in the teen years.
According to the DSM-IV-TR , cannabis dependence and abuse tend to develop over a period of time. It may, however, develop more rapidly among young people with other emotional problems. Most people who become dependent begin using regularly. Gradually, over time, both frequency and amount increase. With chronic use, there can sometimes be a decrease in or loss of the pleasurable effects of the substance, along with increased feelings of anxiety and/or depression. As with alcohol and nicotine, cannabis use tends to begin early in the course of substance abuse and many people later go on to develop dependence on other illicit substances. Because of this, cannabis has been referred to as a "gateway" drug, although this view remains highly controversial. There is much that remains unknown about the social, psychological, and neurochemical basis of drug use progression, and it is unclear whether marijuana use actually causes individuals to go on to use other illicit substances.
Recent research challenges the notion that cannabis use is not physically addictive. According to the National Institute of Drug Abuse (NIDA), daily cannabis users experience withdrawal symptoms including irritability, stomach pain, aggression, and anxiety. Many frequent cannabis users are believed to continue using in order to avoid these unpleasant symptoms. Long-term use may lead to changes in the brain similar to those seen with long-term use of other addictive substances. It is believed that the greater availability, higher potency, and lower price for cannabis in recent years all contribute to the increase in cannabis abuse.
Beginning in the 1990s, researchers began to discover that cannabis-like compounds are naturally produced in various parts of the human body. These compounds, called "endocannabinoids," appear to suppress inflammation and other responses of the immune system. One of these endocannabinoids — anandamide — appears to help regulate the early stages of pregnancy.
Between 1840 and 1900, European and American medical journals published numerous articles on the therapeutic uses of marijuana. It was recommended as an appetite stimulant, muscle relaxant, painkiller, sedative, and anticonvulsant. As late as 1913, Sir William Osler recommended it highly for treatment of migraine. Public opinion changed, however, in the early 1900s, as alternative medications such as aspirin, opiates, and barbiturates became available.
By the year 2000, the debate over the use of marijuana as a medicine continued. THC is known to successfully treat nausea caused by cancer treatment drugs, stimulate the appetites of persons diagnosed with acquired immune deficiency syndrome (AIDS), and possibly assist in the treatment of glaucoma. Its use as a medicinal agent is still, however, highly controversial.
The essential feature of cannabis abuse is the development of behavioral and psychological disturbances (e.g. impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, and social withdrawal) during, or shortly after, cannabis use. The psychoactive effects are accompanied by two (or more) of the following signs, developing within two hours of cannabis use: conjunctival injection (bloodshot eyes), increased appetite, dry mouth, and tachycardia (rapid heart rate). These symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
The pattern of onset and duration of cannabis abuse is variable. If cannabis is smoked, intoxication usually occurs within minutes and lasts approximately three to four hours. Onset may take hours and the effects may be longer lasting, however, when cannabis is consumed orally. The DSM-IV-TR notes that the magnitude of effects will vary with dose, administration route, and personal characteristics, such as tolerance of and sensitivity to cannabis.
Diagnosis of cannabis abuse is made in a number of ways. Intoxication is easiest to diagnose because of clinically observable signs, including reddened eye membranes, increased appetite, dry mouth, and increased heart rate. It is also diagnosed by the presence of problematic behavioral or psychological changes such as impaired motor coordination, judgment, anxiety, euphoria, and social withdrawal. Occasionally, panic attacks may occur, and there may be impairment of short-term memory. Lowered immune system resistance, lowered testosterone levels in males, and chromosomal damage may also occur. Psychologically, chronic use of cannabis has been associated with a loss of ambition known as the "amotivational syndrome."
Cannabis use is often paired with the use of other addictive substances, especially nicotine, alcohol, and cocaine. Individuals who regularly use cannabis often report physical and mental lethargy and an inability to experience pleasure when not intoxicated (known as "anhedonia"). If taken in sufficiently high dosages, cannabinoids have psychoactive effects similar to hallucinogens such as lysergic acid diethylamide (LSD), and individuals using high doses may experience adverse effects that resemble hallucinogen-induced "bad trips." Paranoid ideation is another possible effect of heavy use, and, occasionally, hallucinations and delusions occur. Highly intoxicated individuals may feel as if they are out-side their body ("depersonalization") or as if what they are experiencing isn't real ("derealization"). Fatal traffic accidents are more common among individuals testing positive for cannabis use.
Urine tests can usually identify metabolites of cannabinoids. Because cannabinoids are fat soluble, they remain in the body for extended periods. Individuals who have used cannabis may show positive urine tests for as long as two to four weeks after using.
Examination of the nasopharynx and bronchial lining may also show clinical changes due to cannabis use. Cannabis smoke is known to contain even larger amounts of carcinogens than tobacco smoke. Sometimes cannabis use is associated with weight gain.
To date, nine randomized trials for adults with cannabis abuse/dependence have been reported in the published literature. Results indicate that behaviorally based outpatient treatments are effective for reducing cannabis consumption and engendering abstinence. Cognitive behavioral therapy (CBT) has been the cornerstone of most interventions. CBT includes teaching and practice of behavioral and cognitive skills to deal with risk factors (drug refusal, coping with craving, managing mood, avoiding environments offering high risk of drug use, finding alternative activities, etc.). It essentially focuses on how the person feels about and responds to thoughts and experiences and on ways of tackling negative thoughts.
A range of behavior-based treatment options have been shown to be efficacious in the treatment of cannabis dependence. These include Motivational Enhancement Therapies (MET) and a combination of Cognitive Behavioral Therapy (CBT) and Contingency Management (CM).
Pharmacological interventions: Currently, there are no approved medications for cannabis abuse or withdrawal-related symptoms. Research over the past 10 years has begun to explore medications that may either block the symptoms of cannabis withdrawal or block the effects of cannabis. These types of medications are still in an experimental stage.
Self-help/mutual-support groups: Whilst there are no outcome studies, cannabis users may find peer-support programs helpful as has been reported by those with alcohol and other drug problems. A self-help group is any group that has the aim of providing support, practical help, and care for group members who share a common problem. The two most widely available types of support groups are (1) Marijuana Anonymous/Narcotics Anonymous and (2) Self Management and Recovery Training (SMART) groups. Narcotics Anonymous (NA) and the specifically designed Marijuana Anonymous (MA) are 12-step, spiritually-based groups. The primary purpose of MA is “to stay free of cannabis and to help the cannabis addict who still suffers achieve the same freedom.” No experimental studies unequivocally demonstrated the effectiveness of alcoholics anonymous or 12-step approaches for reducing alcohol dependence or problems and none exist for cannabis. Clients wishing to attend such groups should not be discouraged from doing so.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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