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Overview
Marijuana—or weed, pot, grass, MJ, Mary Jane, reefer, cannabis, or hemp among dozens of other names—has a long, colorful history dating back more than 2,000 years as the one of the most sought-after mood-altering substances in the world. Societal opinion about the drug has dramatically swayed over the years, from viewing it as a grave danger to society in the 1930s film Reefer Madness, to a harmless recreational high in the ’60s, to an addictive substance and gateway to such “hard” drugs as heroin today. The myths and misinformation about marijuana have only multiplied over the years as the controversy over legalization and medical marijuana grows.
A nationally recognized clinical expert and leading researcher on marijuana, Kevin P. Hill provides a comprehensive guide to understanding the drug in Marijuana: The Unbiased Truth about the World’s Most Popular Weed. Through research-based historical, scientific, and medical information, Hill will help you sort through what you hear on the streets and in the media and cut straight to the facts. Whether you’re a parent concerned about your child’s use, someone with an illness considering medical marijuana as a treatment option, a user who has questions about its effect on your health, or if you’re just trying to make up your mind about legalization, this book will give you the most current and unbiased information you need to make informed decisions about marijuana.
Product Details
| ISBN-13: | 9781616495596 |
|---|---|
| Publisher: | Hazelden Publishing |
| Publication date: | 02/23/2015 |
| Pages: | 240 |
| Sales rank: | 551,108 |
| Product dimensions: | 5.40(w) x 8.30(h) x 0.70(d) |
About the Author
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Annotated Table of Contents
Section 1: The Problem
Chapter 1. Introduction: Why is Marijuana So Misunderstood?
Marijuana has been in the news constantly as states have been forced to make important decisions about medical marijuana and legalization of marijuana. Many of today's celebrities seem to go out of their way to publicize their use of the drug. Unfortunately, media coverage tends to promote common misperceptions about marijuana which may be contributing to the recent 2012 Monitoring the Future data showing that, unlike usage trends for other drugs, use of marijuana among young people is on the rise and, perhaps even more alarmingly, perception of risk is on the decline. In the Introduction, we review the three major reasons that people have difficulty understanding the data on marijuana and explore this knowledge gap. We then look at its pharmacology, history, and the changing cultural attitudes toward its use in the U.S. and world wide.
Chapter 2. Epidemiology: The 9% Problem: A Small Fraction of a Large Number Can Be a Very Large Number
More people use marijuana than any other illicit drug and more people meet criteria for marijuana addiction than any other illicit drug. And it's not even close. Yet we hear about the opioid epidemic, with misuse of prescription opioids like Percocet and Oxycontin increasing and large numbers of opioid users eventually beginning to inject heroin because heroin is much cheaper than prescription opioids. While the concern about the opioid problem is both warranted and understandable, it is puzzling that we do not hear more about the potential dangers of marijuana, especially when one considers the large numbers of Americans affected by marijuana. Part of this may be due to the insidious nature of the effects of marijuana addiction. When treating those with addictions, we do not see people come into treatment for marijuana addiction as a result of catastrophic events. It is true that no one overdoses on marijuana like they do on opioids, for example. In the chapter, we discuss the three ways that patients end up receiving treatment for marijuana addiction.
Section 2: The Three Myths
Chapter 3. Myth #1: Marijuana Is Not Harmful
As a society, we do not consider marijuana to be a potentially dangerous drug like we do heroin, cocaine, and methamphetamine. Perhaps this is because marijuana occurs naturally or because many of us have had experiences with marijuana without major consequences. In this critical section, we translate the scientific literature that shows the dangers of marijuana use. We review recent studies, including brain imaging studies that show negative impact of regular marijuana use on cognitive function. These studies underscore the significant risk of regular marijuana use on the developing brains of adolescents. Rigorous research also documents the association between marijuana use and both anxiety and depression. While many smoke marijuana to relieve anxiety, we show how marijuana actually worsens anxiety and we enlist the help of a patient's story to help us illustrate this point. Finally, we address the chilling research that shows that, for those who are at risk for developing psychosis-for practical purposes, almost all of us are unless we have had extensive genetic work done-marijuana use increases the likelihood that one will develop psychosis and corresponding illnesses like schizophrenia.
Chapter 4. Myth #2: Marijuana Use Cannot Lead to Addiction
The science illustrates that marijuana--considered a "soft drug" by many--is much more similar to "hard drugs" like heroin and cocaine than it is different. We review marijuana's effects upon brain chemistry, including how use of marijuana leads to surges of dopamine in the brain. Other addictive things, like food, sex, and "hard drugs" cause the same type of surges. These surges help to explain why some smoke marijuana every day to the detriment of other areas of their lives. In this section, we will hear from patients directly as they talk about why they smoke every day and how hard it has been for them to stop.
Chapter 5. Myth #3: Stopping Use of Marijuana Does Not Cause Withdrawal
Very few people are aware that stopping use of marijuana can cause withdrawal. A patient will describe the anxiety, irritability, and insomnia associated with marijuana withdrawal in vivid detail. We will also review the scientific studies that lucidly demonstrate a marijuana withdrawal syndrome as distinct as that associated with nicotine withdrawal. These withdrawal symptoms--feeling absolutely miserable--often lead to relapse. When patients learn about marijuana withdrawal they are relieved as it validates their difficulties in stopping use of marijuana.
Section 3: Policy
Chapter 6. Decriminalization and Legalization of Marijuana
Decriminalization of marijuana and legalization of marijuana have become popular topics of conversation in recent years. Despite the fact that marijuana remains an illegal drug according to the United States government, several states have decriminalized marijuana and recently the first 2 states, Washington and Oregon, legalized marijuana. Decriminalization of marijuana usually means that possession of an amount of marijuana associated with "personal use" only carries the threat of a civil penalty. In Massachusetts, for example, possession of less than 1 ounce of marijuana--this is actually enough to roll 80 joints--results in only a civil penalty. The result of a statute which many find to be toothless is that law enforcement personnel often do not bother enforcing marijuana-related offenses. While most of our book describes the potential dangers of marijuana, we are careful to acknowledge the merits of arguments put forth by others. Therefore, we review in detail the rationale offered by those who believe that marijuana should be legalized and taxed.
Chapter 7. Medical Marijuana: Theoretical Basis and Practical Implications
Eighteen states have passed laws to implement medical marijuana programs. Thus, it is important to understand the pros and cons of medical marijuana from a theoretical standpoint. There are patients with terminal cancer and other terrible diseases who feel that marijuana provides relief that other medications, including dronabinol (oral delta-9-tetrahydrocannabinol, THC, the active ingredient responsible for the euphoric effects of marijuana), cannot provide, and this may be due in part to the presence of cannabidiol, one of the active ingredients in marijuana, in the plant. For those opposed to medical marijuana, 3 words come to mind when trying to understand the overwhelming support for medical marijuana among voters--easier, stronger, and cheaper. Marijuana users who do not have a serious medical condition vote in favor of medical marijuana because they see it as a way to make access to marijuana easier, the marijuana available will become stronger due to increased use of the latest horticulture technology, and the increased availability of marijuana will make it cheaper to buy. We present data from our own surveys to support this idea. We also review the medical marijuana laws that have been passed around the country. Clinicians are eager to know how to respond when approached by patients about medical marijuana and we offer practical advice on what to do in this situation.
Section 4. Treatment of Marijuana Addiction
Chapter 8. Never Worry Alone: How to Approach Someone Who May Have a Problem
Most people with addiction problems do not seek treatment, and those with marijuana addiction are no different. Many Americans do not think of marijuana addiction as something that would require treatment for the reasons we discussed previously (see Chapter III). Furthermore, if it is decided that someone may require treatment, most people do not know what treatment actually entails. If you or someone you care about may be addicted to marijuana, never worry alone. Reach out to treatment facilities, your primary care doctor, or your child's school nurse. They can help you figure out what type of evaluation and treatment is necessary. Insurance-based treatment usually means an evaluation with an addictions clinician: a psychiatrist, psychologist, or licensed clinical social worker. Patients for whom marijuana use is causing significant problems usually end up in outpatient care, either with an individual therapist or in a structured treatment program like an intensive outpatient program. In this section, we also describe other elements of treatment such as family support and self-help groups like Marijuana Anonymous.
Chapter 9. Behavioral Interventions
Behavioral interventions, or "talk therapies", can help people make significant reductions in their smoking. We review the recent scientific literature on behavioral interventions for marijuana addiction in this section. Motivational interviewing is a strategy that is helpful for engaging prospective patients in treatment when they are ambivalent or unsure about whether they need or want treatment. Successful motivational interviewing involves acknowledging that there are aspects of marijuana use that patients enjoy while also attempting to help the patient articulate in their own words why it may be wise for them to either reduce their use of marijuana or stop altogether. Once the patient is able to see that treatment would be useful to them, I prefer to start talk therapy on a weekly basis. The data suggests that the type of talk therapy a clinician chooses at this juncture is not as important as is the duration of treatment and the skill level of the therapist. In such instances, I usually prefer to use cognitive behavioral therapy (CBT), a type of therapy in which the therapist and patient explore the specific instances in which the patient typically uses marijuana and the thoughts, feelings, and behaviors involved in these instances. A clinical example will show how the CBT protocol I developed (Hill et al. 2013) can help patients make clinically significant reductions in smoking.
Chapter 10. Medications
Despite the alarming numbers of Americans addicted to marijuana and the ominous trends that suggest that those numbers are increasing, there are no FDA-approved medications for marijuana addiction. There are research groups at prominent universities, including our research group at McLean/Harvard, that are working feverishly to develop medications that may help people change their marijuana habits. Some studies that have been done or are ongoing use "agonist" medications to help people reduce their use. "Agonist" medications, as opposed to "antagonists" or blockers, provide some effects similar to those provided by the drug of abuse, marijuana in this case. In Section III we saw that those who use marijuana daily or nearly every day can have powerful and unpleasant withdrawal symptoms if they try to stop smoking abruptly, and those withdrawal symptoms often lead to relapse. Medications like nabilone and dronabinol are being studied in clinical trials in an effort to reduce or eliminate some of the withdrawal symptoms associated with stopping marijuana use. While such medications are not FDA-approved as treatments for marijuana addiction and can only be used off-label for this indication, many energetic groups are working hard to make effective medications available. Ultimately, we expect that a combination of a behavioral intervention and a medication will be the treatment of choice for marijuana addiction. Research on other mental illnesses like depression suggests that patients fare better on a combination of a behavioral therapy and a medication than they would with treatment with either one alone.
Section 5. A Prescription
Chapter 11. Conclusion: Where Do We Go From Here?
There is a long road ahead in the battle to help those with marijuana addiction make significant reductions in their use. The Monitoring the Future data is ominous--among our young people, use of marijuana is on the rise and the perception of risk is declining. However, the data showing the potential harms of marijuana is clear and strong. Although most people who use marijuana do not develop problems with addiction, for those that do, it is very serious. We are fighting an uphill battle in 2 ways: 1) most people are not aware of how dangerous marijuana can be, and 2) there is no consensus, effective treatment for marijuana addiction. We want people to know the facts so they can make educated choices about whether to use marijuana or how they will vote on the issues of medical marijuana and legalization of marijuana. We also want to let those who may want treatment know that we are here to help them.
Table of Contents
Preface xi
Acknowledgments xv
Introduction 1
Section I The Problem
Chapter 1 Why Is Marijuana So Misunderstood? 13
Chapter 2 A Small Fraction of a Large Number Can Be a Very Large Number 33
Section II The Three Myths
Chapter 3 Myth #1: Marijuana Is Not Harmful 43
Chapter 4 Myth #2: Marijuana Use Cannot Lead to Addiction 55
Chapter 5 Myth #3: Stopping Use of Marijuana Does Not Cause Withdrawal 65
Section III Policy
Chapter 6 Decriminalization and Legalization of Recreational Marijuana 73
Chapter 7 Medical Marijuana: The Science and Practical Implications 99
Section IV Treatment
Chapter 8 Never Worry Alone: Finding Help for Someone Who May Have a Problem 119
Chapter 9 Behavioral Interventions as Treatment for Marijuana Addiction 139
Chapter 10 Using Medications to Treat Marijuana Addiction 155
Chapter 11 The Effect of Marijuana Addiction on Loved Ones 163
Conclusion: Where Do We Go from Here? 173
Appendix A Promising Medications for Treating Marijuana Addiction 185
Appendix B Signs That a Child May Be Using 193
Recommended Reading 195
Notes 197
About the Author 206