Benito Díaz
The debate around cannabis reaches many levels of interpretation, to the point there is no consensus amongst experts regarding the risk of addiction to the substance. Scientists, psychologists, and psychiatrists are divided: some claim it is a dangerous substance and others describe it as almost innocuous.
The aim of this article is to expose the arguments in an organised way through the voice of two sources of authority who maintain opposite points of view. This way, we seek to avoid the bias of other media on the subject.
Different concepts
Before we engage in exposing the arguments, we should understand some terms so that we do not get disoriented. To begin with, the difference between dependence and addiction. José Antonio Sánchez, psychiatrist doctor from Madrid’s Universidad Complutense, explains: “It is commonly thought that addiction is a physical phenomenon and dependence a psychologic state, and it is the exact opposite. Addiction refers to a compulsive behaviour that makes the person seek a specific stimulus, and dependence refers to a physiological stimulus in which the person cannot operate without a specific substance”. This means that dependence of a substance necessarily implies a corporal response, consequence of the absence of that substance.
“There are different ways of using substances, psychoactive or not”, explains Paula Borrego, teacher and Psychology graduate by Universidad de Málaga. “The term ‘use’ of substances refers to using these elements in a sporadic way, socially, between long periods of time. ‘Consumption’ is characterised by having a routine that involves the substance. For instance, taking it to sleep some days or consuming it socially on weekends. Lastly, the ‘abuse’ of substances is defined by an out-of-control use, which results in an interference in the person’s life. It prevents them from leading their social, family or work life. That’s the case with alcoholism”.
Withdrawal syndrome
The first disagreement point between experts is the definition of the group of physical or body reactions that happen when a person reduces the dose or stops consuming substances they are addicted to. “The percentage of patients that develop dependency is not known. It has been described that 10% of cannabis consumers are at risk of developing dependence. Sometimes it is hard to tell whether there is a real abuse of cannabis, since the concept of abusing substances is not the same in all classifications, for example in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Statistical Classification of Diseases (ICD-10). In the DSM, in contrast to the ICD-10, it is not accepted that cannabis can cause a withdrawal syndrome. That said, there are plenty descriptions of clinical pictures of abstinence after intense consumption”, says Dr Sánchez. “The symptoms appear after 1-3 days, reaching their highest intensity between days 2 and 6, and they disappear between day 4 and 14. Such symptoms are: dysphoria, irritability, anxiety, shaking, nausea, abdominalgia, sweating, anorexia and insomnia”.
Doctor Borrego, on the other hand, claims that cannabis does not create withdrawal syndrome. “It does not have physiological effects. Even though nowadays the term “addiction” has been trivialised, I think I should use it to refer an impulse control disorder, rather than something related to a withdrawal syndrome. This refers to physical features mainly, as in the case of heroine, where patients suffer pain, fever, post flu symptoms, a whole pathology that requires hospitalisation. Alcoholism is a similar case. If the patient interrupts the consumption, they can be affected by delirium tremens, and even die”. In the impulse control disorder, like addiction to the mobile phone, to gambling or cannabis, ceasing consumption does not lead to the clinical picture of a withdrawal syndrome, “these substances are not necessary to live”, the psychologist explains.
“Why do these withdrawal syndromes appear?”, asks Borrego. “The cause is the deterioration of the central and peripheral nervous system. In the example of cannabis, different to other substances like heroin or cocaine, the brain possesses specific cells, the cannabinoid receivers, that process it, without causing harm. All this provided that it is a pure sample, not adulterated. Many cases considered serious in hashish consumption are the result of this problem. This product is frequently adulterated with glues, benzenes, fertilisers, etc”.
Cannabis is not addictive
“Physiologic dependence of cannabis, in its use and consumption, has not been proven. Only a 2% of cases of consumption considered abusive reveal symptoms on a physiologic level”, claims Borrego. “On the psychologic level, we can compare it to the addiction one could have to coffee. When consumption ceases, anxiety or nervousness can appear, but the anxiety itself is coming from not having that substance, which we had turned into a routine”. It strongly depends on the specific individual and their habits. It can be really hard for some people while, for others, it is something unpleasant that is overcome without major issues, the doctor reveals.
Cannabis is addictive
Dr Sánchez believes that a risk of addiction does exist, because there are physical consequences, although “not like the ones in other drugs, of course”. The doctor is open to the regulation of medicinal cannabis but offers a warning: “from a medical point of view, cannabis has serious secondary effects on health: presents withdrawal syndrome and in serious cases, intervention and treatment would be necessary. As appalling as it is, there is no consensus in the medical community to this regard. There is a lack of investigation and studies that would provide security”.
Management of the withdrawal syndrome
“Many patients do not require a specific pharmacologic intervention. In other cases, the treatments proposed are psychotherapy and psychiatry drugs. The psychologic treatments used are psychotherapies of behavioural cognitive orientation, including relapse prevention techniques, motivational interviews and family therapy”, Sánchez explains. “In patients suffering serious clinical pictures of withdrawal a somatic treatment must be carried out, with benzodiazepines if the anxiety prevails for two to four weeks, adjusting the dose according to the intensity of the symptoms and avoiding a prolonged use”.
Doctor Borrego, on the other hand, claims not having ever had to treat a cessation of the flower of cannabis, although she did treat one of hashish. “We should keep in mind that, to quit a substance, a detoxification first is necessary. This, when dealing with a physical withdrawal syndrome, is usually done in a couple days in the hospital, monitoring the patient, in the mentioned cases of heroin and alcohol, for instance. After that, the difficult part is the cessation, a process that can last months or years, during which the person needs to avoid reverting to their habits. This is not done in hospitals. The help of support groups is sought and therapies that vary with each person”, says Borrego.
“From my experience, I would recommend a substitution therapy, replacing the habit with a different thing that is pleasant. Eating sugary food, playing sports and letting off steam, for instance. Cannabis will not get you so hooked that you need to take drastic measures and I would rather exhaust all options before recommending the use of drug-based treatment”. Borrego also reminds us that the worst dangers of cannabis consumption are linked to personal responsibility. The main concern should be preventing certain accidents that can occur under the influence of cannabis. For instance, older people with low pressure who, after taking cannabis, can feel dizzy and fall over, resulting in head injuries. Same goes for driving after consuming cannabis, which causes a decline of the driver’s reflexes.