This is especially relevant because more and more states have decriminalized marijuana and some have even moved toward legalizing it, often for medical purposes—both legitimate and concocted—including California where I practice. You just go to a “marijuana doctor” and walk in the door, where the only criterion for giving you a prescription is that you walked through the door. This is comparable to the old “snake oil salesmen” who used to travel from town to town and sell “miracle cures” for whatever ailed people. The Pure Food and Drug Act was launched in 1906 because these traveling salesmen would make absurd and false claims that their products could cure everything from hemorrhoids to dandruff and everything in-between.
Unfortunately, marijuana has become the latest version of snake oil in the sense that you can go into a medical marijuana clinic, claim virtually any compliant or ailment, and come out with a marijuana card—the equivalent of a prescription that gives you legalized access to pot. You have a headache, you get a marijuana card. You have stomach problems, you get a marijuana card. You have occasional back pain, you get a marijuana card. You have anxiety, you get a marijuana card. You’re a little depressed, you get a marijuana card. And a lot of people do this with a nod and a wink because we know that most of the people that go to “clinics” to get their marijuana don’t really have any medical problem at all.
That being said, I’m against the so-called “war on drugs,” and think it is actually a war on people. The “war on drugs” hasn’t made any real dent in the use of drugs in our society, and it’s often an extravagant waste of money. We should be putting this money into drug treatment and education programs. Personally, I’m in favor of decriminalization rather than legalization. It makes little sense to arrest, prosecute, and incarcerate people for possession of small amounts of marijuana (or other drugs people may possess for personal use), and subject them to expulsion from school, loss of financial aid, etc. Instead, we should be advocating education and treatment. We have zero tolerance in high schools where kids get thrown out of school because they were caught with one marijuana joint. This is not good for our kids. In fact, it’s not good for society.
Counselors or therapists in the field of addiction treatment need to know the medical aspects as well as the deleterious health impacts of marijuana. It can reasonably be viewed as similar to alcohol, where many people may have a glass of wine with dinner or a beer at a ball game and it’s no big deal. If somebody wants to smoke pot once in a blue moon, aside from the smoke-inhalation aspect of it, I don’t see it as analogous to smoking crack or crystal meth, or shooting heroin. No one smokes crack or crystal meth, or shoots heroin recreationally. But, marijuana also has a serious potential downside to it.
I had a patient who smoked pot because she was going through chemotherapy for cancer. It helped her appetite because cannabinoids increase appetite. However, there are other delivery systems available besides smoking it. If I were dying of lung cancer I don’t think I’d want to smoke anything. Marinol is basically tetrahydrocannabinol or THC, the main psychoactive ingredient in marijuana, in pill form and it can be taken by mouth. In addition to the tar and other impurities in the smoke, there are other psychoactive chemicals in marijuana smoke, so you’re not just getting THC.
So what is addiction treatment? Why can’t most drug addicts just quit on their own? How effective is addiction treatment, when is it necessary, and is addiction treatment worth the cost? Why isn’t more treatment available? What can we all do to help? There are about five federal government agencies now tripping over each other trying to get a clearer grip on these issues. We’ve got the National Institute on Drug Abuse (NIDA) and the National Institute of Alcoholism and Alcohol Abuse (NIAAA), both of which are part of the National Institutes of Health (NIH); we’ve got the Substance Abuse and Mental Health Administration (SAMHSA), which is part of the US Department of Health and Human Services (HHS); we’ve got the White House Office of National Drug Control Policy (ONDCP); we’ve got the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF); and the Drug Enforcement Administration (DEA).
Some of these agencies focus on research, including research on treatment approaches, some focus on providing information and policy, and some are concerned specifically with law enforcement. As far as policy and law enforcement, among my favorite things to pick on is the “war on drugs” because, as I’ve said, it is not a war on drugs; it’s a war on people. Throwing somebody in jail for simply using drugs does little to nothing to change individual behavior and serves no socially useful purpose. Even in some jails and prisons drug use is widespread, and the cost in dollars and human terms of incarcerating people for drug use is absolutely preposterous.
Addiction is a complex illness. It persists in the face of extremely negative consequences. If somebody burns his hand on a hot stove he generally learns from his experience and doesn’t go close to that stove again. Even my basset hound won’t go near the stove because a while back he burned his nose jumping up there. But an active addict will keep putting his hand in the flame or his nose on the stove. His thinking has become so distorted that he rationalizes “this time I won’t burn myself.”
Addiction is a brain disease that has direct impacts on thinking. The thought processes of someone who is addicted can be bizarre, as evidenced by his or her continuing to put his or her hands in a hot flame, thinking that “this time it’s going to be different.” If every time you drink you wind up in trouble, end up in jail, bleed from your stomach, and yet keep doing it again and again, that’s a special type of twisted thinking. Two impressive examples of the cognitive warping that takes place in active addiction that I’m familiar with involve a man with a gambling addiction who moved to Las Vegas to quit gambling, and a woman addicted to cocaine for more than ten years who switched to crystal meth to stop using cocaine.
But distortions in thinking related to addiction are not exclusive to addicts. Society still commonly sees addiction as a disorder of willpower and personal choice, so addicts tend to be viewed and judged differently than people who struggle with other chronic illnesses. Because addiction is a chronic disease, relapse is possible even after long periods of abstinence. Sometimes professionals, as well as lay people, challenge me on this point, saying that I don’t “cure” anybody because addicts in recovery often relapse and end up coming back to treatment.
But then, so do patients with congestive heart failure. Those patients are on heart medications and do well for a few months or a few years, but then have to come back to the hospital for a “tune-up” due to a relapse—a recurrence of their heart failure. Heart failure is an excellent example of how chronic illness works. Asthmatics frequently go through cycles of remissions and exacerbations (or relapses) of their symptoms, and have to come back periodically for breathing treatments, but we don’t pass negative judgment on them or consider giving up on them. Asthma is a chronic illness.
Most people, including many medical and behavioral health professionals, have an understanding that chronic conditions are managed rather than cured. But for some reason they think that if somebody with addiction relapses and needs to return to treatment again, it’s a treatment failure. It is not a failure. It is the natural course of the disease as it often manifests in those who suffer from it just like heart disease, diabetes, and asthma. Treating alcoholism and addiction involves management of a chronic disease.
Successful recovery from addiction means a stop to using drugs including alcohol and maintenance of a drug-free lifestyle, while regaining/achieving productive functioning with regard to family, relationships, work, and in society generally. Some people think that recovery is just about not using, and, of course, to a certain extent it is about not using, but I could handcuff patients to the wall and they won’t use, but that doesn’t mean they would be in recovery.
So recovery is more than just not using; it involves being a contributing member of one’s community, and making progress toward internal states of acceptance—not only of the need for