By Dr. Fernando Caudevilla
In the first part of this article we described a series of general considerations about substance dependence throughout history and we defined the criteria to correctly diagnose this disease.
Let’s use these standards to analyze the habits of cannabis users:
The first criterion, pharmacologic tolerance, is a classic trait in regular users of cannabis. If a newcomer and an experimented user are smoking a very potent variety of marijuana, the former will experience the effects in a more intense way. Furthermore, if a person smokes exactly the same amount of cannabis for some time, he will notice how the effects are reduced in just a few months. Therefore, tolerance to cannabis is a characteristic inherent in the substance and a dependence sign that affects almost all users.
You cannot say the same thing about the cannabis abstinence syndrome, the existence of which is very debatable. When a regular consumer of alcohol, opiates or benzodiazepines suddenly stops their consumption, a series of objective symptoms appear (fever, changes in pupil size, diarrhea, convulsions). It is the symptom that defines the syndrome. In the case of cannabis what symptoms such a syndrome would possess have not been described exactly. Moreover, cannabis is a very fat-soluble substance, meaning it remains in the body fat and fades away very slowly, so its sudden elimination is never easy. Some scientists describe cases of irritability, restlessness, insomnia, and a need to smoke cannabis appearing a few days after having stopped its use. This is probably experienced by teenagers caught smoking by their parents and dragged by the ears into an association like Proyecto Hombre where they are taught to change their friends and forced to pee in a pot as therapy to fight the syndrome.
The rest of the criteria refer, in essence, to the control that an individual has over the substance. In this regard, for most people, it is easier to keep control over marijuana than it is with other drugs. Think about a tobacco smoker who has used up every last cigarette at eleven at night. Most of them would run to the nearest pub, or even get the car to drive to a gas station. For the average cannabis smoker in the same situation it is easier just to wait until the next day. You could say the same thing about compulsive use. Many people with alcohol problems or cocaine habits can abstain when they are not exposed to the drug, but once they start taking it is really difficult for them to stop. This kind of lack of control can happen also to cannabis users, but statistically it is less frequent.
Another aspect to take into account is the way the substance is administered. The ways that make the substance reach the brain quickly (up the nose, through injection or smoking) generate dependence in a faster and easier way than those who take the drug orally. When smoking a spliff the absorptive surface is large (remember what we were taught in biology at school: the surface of pulmonary alveoli equals a football pitch in size). But in addition a great majority of cannabis smokers are also tobacco smokers, a substance with a high addiction potential. Spliffs are usually made with hash or marijuana mixed with tobacco, and independently of the cannabinoids’ addiction potential, that of nicotine is not up for debate. Some people who have difficulty in quitting cannabis are actually missing the pharmacologic effects and the rituals related to tobacco.
On the other hand, it is true that at a neurobiological level cannabis acts in brain areas linked to conducts basic for the survival of the species, the reward and pleasure circuits and nervous system areas that are inherent in addiction and dependence. But the relation is not as clear as it is in the case of cocaine, opiates, nicotine, alcohol or other substances. Even so, it is possible to train animals in laboratories to be cannabis addicts, which is often used as proof of its addictive potential. Nevertheless, in general, human beings display more complex conducts than rats, squirrels or monkeys. Readers should observe the sexual behavior or table manners of their pets and compare them to their own.
The majority of studies in humans in which the cannabis dependence is researched under strict criteria find rates of 4 to 10% of all consumers. In other words, for the vast majority of users cannabis doesn’t bring about addiction problems. But a small proportion of them find it difficult to control or handle their consumption habits. In these cases we have to look at different factors like age, relationship with the drug, consumption context, motivations, individual characteristics… all of which can be just as important as composition of the drug to properly evaluate the problem.
In addiction cases it’s important to reflect on what place the drug holds in one’s life and whether its use prevents one from doing the things one wants to do or leading the life one wishes. In many cases, behind the addiction to any substance there are other problems, or stressful situations of an emotional or psychological kind. The drug problem is often just the tip of the iceberg.