Marijuana Abuse and Dependency Brain Functions Treatment Options Paul Nims MA, CRADC, CCDP-D Co-Occurring Disorders Program Coordinator BJC Behavioral Health
Tetrahydrocannabinol (THC) • The main intoxicating chemical in Marijuana isTetrahydrocannabinolalso known as delta-9-tetrahydrocannabinol (Δ9-THC) is the principal psychoactive constituent of the cannabis plant. • Among the best known of these actions is the ability of marijuana, and congeners of its active ingredient, Δ9-tetrahydrocannabinol (Δ9-THC), to disrupt sensory processing and learning and memory in animals and humans (Deadwyler et al., 1990; Hampson & Deadwyler, 1999; Sullivan, 2000).
Change in THC Potency • Marijuana has been altered from its original form with gene manipulation to be more potent. (Mendal and his peas) • The potency of Marijuana varies greatly. • Some samples from 2008 were as high as 37.20%
Consumption Hazards • Inhaled smoke is a suboptimal delivery method for any agent intended to be health-promoting in any way. (ASAM-Public Policy Statement on Marijuana) • Smoked marijuana has the potential to be as, or more, harmful than cigarettes.
Consumption Hazards • It contains 50 to 70 percent more carcinogenic compounds, including tar, than cigarettes (NIDA, 2005; Hubbard et al., 1999). • Marijuana also produces high levels of a particular enzyme which converts certain hydrocarbons into their carcinogenic or malignant forms (NIDA, 2005).
THC in the Brain • In 1988, Allyn Howlett and William Devane used radioimmunoassay techniques to characterize the existence of a cannabinoid receptor in a rat brain. In 1990, Miles Herkenham and his team mapped the locations of a cannabinoid receptor system in several mammalian species, including man. Receptors are most dense in the basal ganglia, hippocampus, and cerebellum
THC in the Brain • Pic of brain with THC Receptors
Brain Function The Reward Pathway (ventral tegmental area)
Cannabis (THC) Dependence • Based on this substantial body of empirical research, the American Psychiatric Association (APA) has long recognized cannabis dependence as a valid and reliable psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In a survey conducted by NIDA in 1994, epidemiologist James Anthony found that of those who tried marijuana at least once, about 9 percent eventually became addicted.
Perspective for Abuse and Dependency Identification • 8 Major Life Areas • Psychological • Physical • Family • Legal • Financial • School or Work • Friends • Interpersonal Relationships
Perspective for Abuse and Dependency Identification • Basic guidelines • Substance Abuse • Clinically Significant Impairment in Psychological plus 3 other major life areas • Substance Dependence • Clinically Significant Impairment in Psychological and Physical plus 3 other major life areas
Substance Abuse • Activities center around the use of substance • Occasional intoxication – increasing frequency • PSYCHOLOGICAL relief use • View drug as a friend
Substance Abuse • Physical tolerance mild to moderate • Mood swings • Pre- and post- using • Fragmented Blackout Makes poor/dangerous choices around substances
Dependency • “must have the substance to function normally.” • Attempts to control fail • Moderate to Severe Tolerance
Dependency • Geographical Escapes • Significant impairment in social and School/occupational functioning • Withdrawal symptoms pronounced
Tolerance • A physiological change resulting from repeated drug use that requires the user to take larger amounts of the drug to get the same effects initially felt from a smaller dose.
Withdrawal Symptoms • When marijuana-dependent individuals stop using the drug, they experience symptoms of: • irritability • anger • cravings • decreased appetite • insomnia • interpersonal hypersensitivity • yawning and/or fatigue (Budney et al., 2001; Preuss et al., 2010)
Treatment Options • Residential • Hospital • Medical Assisted Detox • Inpatient Treatment • Out Patient Treatment • Partial Hospitalization or Intensive Out Patient • Traditional Out Patient • Relapse Prevention
Treatment Options • Treatment Works • People Recover
Finding Help • NCADA-Helpline: • (314) 962-3456 • MO Dept. of Mental Health • (573) 751-4942 or (800) 575-7480 • ACT Missouri • (573)-635-6669