Cannabis and Mental Health: Substance Use Disorder

Substance use disorder is a serious issue. Can cannabis help heal those who suffer?
Cannabis and Mental Health: Substance Use Disorder

Substance use disorder (SUD) is a significant global issue. In 2017, 19.7 million Americans ranging from age 12 and up suffered from SUD. Of them, 74% struggled with alcohol use disorder, while 38% of addictions related to illicit drugs. In the same period, one in eight were addicted to both substances. 

SUD affects both your mind and body, impacting daily life until you are unable to perform everyday functions. A person suffering from substance use disorder often cannot control their consumption, leading to ingesting excessive levels. Depending on the substance, such activity can lead to a person overdosing, resulting in thousands of deaths each year. 

Since 2000, the U.S. has seen its overdose death rates increase to alarming numbers. Prescription opioid addiction caused just over 17,000 deaths in 2017. Heroin deaths exceeded 15,000 during the same period. Cocaine killed nearly 14,000, while antidepressants resulted in the loss of roughly 5,200 lives. 

A person can become addicted to a variety of substances, including hard drugs, alcohol, and tobacco. One’s environment and genetics can lead to the development of SUD. Risk factors include a family’s history of addiction or a lack of involvement in a person’s life. Peer pressure is a common cause, especially when coupled with starting at an early age. 

In other cases, the person with substance use disorder is introduced to drugs through medical treatment. Often, this form of addiction begins when a person is prescribed opioid medication after an injury or surgery. Once the prescription ends, their addiction lives on and manifests over time. In turn, numerous lives have succumbed to SUD just for seeking treatment to common pains. 

Mental health disorders can also affect the likelihood of an addiction developing. Those with ADHD, depression, and PTSD may face a higher risk as substances are often used by patients to cope with painful thoughts and feelings. There exists a high comorbidity, or the presence of two diseases in a patient, between substance use disorder and other mental illnesses. That said, one cannot be considered the cause for the other. At this point, it is still uncertain to what degree of influence each has on the other’s development. 

A cannabis dependence is a reality for some consumers. Those suffering from cannabis use disorder may experience irritability, sleep issues, and physical discomfort, among minor-to-moderate other effects. 

A 2015 study cited by the National Institute for Drug Abuse found that 30% of cannabis consumers may have some degree of cannabis use disorder (CUD). 

Can You Treat Substance Use Disorder With Cannabis?

While cannabis dependence is a concern for some, the topic of marijuana as a possible aid in treating substance abuse has circulated for years. However, it needs to be made clear that cannabis is not seen as a cure for any form of substance abuse. Instead, some believe that cannabis can serve as a means of harm reduction, or any type of policy, program, or practice aimed at reducing the effects of substance abuse. 

“Here we need to make a clear distinction: harm reduction does not equate with recovery,” stated DeAnna Jordan Crosby, AMFT, LAADC, Psy.D. Student, and clinical director of New Method Wellness in California.

The past decade has begun to answer if cannabis fits as a harm reduction tool. A 2010 exploratory study found that marijuana appeared consistent with other drug treatment forms. Researchers noted its possible efficacy, stating that “[cannabis] may not adversely affect positive treatment outcomes,” while calling for extensive sampling in future research. 

Substituting cannabis for alcohol had been studied in recent years. A 2014 review of literature found that “no clear pattern of outcomes” could be determined. While not writing off the practice, researchers stated, “Most importantly, the recommendation to prescribe alcohol-dependent individuals cannabis to help reduce drinking is premature.”

Analysis conducted in the earlier part of the decade appeared to suggest, in large part, that using cannabis as harm reduction proved uncertain and inconsistent. However, select results in recent years may have provided further insight. 

A 2016 review from the University of British Columbia acknowledged the potential of cannabis in harm reduction. “In reviewing the limited evidence on medical cannabis, it appears that patients and others who have advocated for cannabis as a tool for harm reduction and mental health have some valid points,” wrote associate professor of psychology Zach Walsh.  

Noting the lack of clear guidance for mental health professionals, Walsh suggested that abstinence doesn’t seem feasible in today’s world. “Knowing how to consider cannabis in the treatment equation will become a necessity,” Walsh wrote of future guidance in the field. 

More recently, a 2018 study did not confirm marijuana’s role in aiding those with SUD but did note the compelling nature of its findings and the “relative safety profile” of cannabis in justifying additional research.

Matthew Ratz, M.Ed., CPRS, RPS Matthew Ratz, M.Ed., CPRS, RPS is the executive director of On Our Own, a wellness and recovery center in Maryland. Ratz, who uses medical cannabis to ease his own anxiety and inflammation, is torn on cannabis as a harm reduction tool. 

The Peer Support Specialist said that he supports the multiple routes to recovery approach. “The multiple pathways paradigm states that anything that helps should be used to help. So, if pot can be used safely, great,” Ratz explained. However, he cautioned that people with addictive tendencies must exercise additional caution when around psychoactive substances.  

New Method Wellness’ Crosby, a recovering addict herself, voiced concerns about cross-addiction and how marijuana can exacerbate a person’s condition. “I have personally seen many people come into treatment for a substance use disorder and have the idea that they can compartmentalize the use of cannabis, and very few succeed in doing so for any length of time,” relayed Crosby. 

Crosby believes that abstinence-based recovery programs are the way to go. She thinks that harm reduction does not solve the core problem, calling it “a bandage on a bullet hole.” 

While some promise appears to exist, the evidence is far from conclusive. Each case is different, and no guarantees can be made from anecdotal or lab reports at this time. Those considering cannabis as a method of harm reduction are strongly advised to consult with a medical professional and/or addiction specialist before doing so.

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