Almost Addicted

The slippery slope of recreational drug use

Is Marijuana Addictive?

Addiction is more than having bad withdrawal symptoms when you stop

Is marijuana addictive?  Yes, but not in the way some might mean . . .

The question about whether or not marijuana is addictive comes in various forms. Will I experience physical withdrawal symptoms if I suddenly stop marijuana? Is there anything to the idea that I might be psychologically dependent on a drug?  Could I quit if I wanted to?

It goes without saying that lots of people use marijuana.  In 2009, marijuana was the primary drug of abuse for 61 percent of persons under 15, and marijuana was the primary drug of abuse for roughly 18 percent of people aged 12 or older who entered drug abuse treatment programs (1). 

Marijuana is different from a lot of other drugs of abuse in that although there usually are some subtle physiological signs of withdrawal when a chronic user stops smoking—mildly elevated pulse, irritability, and so on--these physical effects are generally fairly mild, and they are dramatically less obvious or powerful than those seen when a habitual user of alcohol, opiates (either heroin or any of the opioid pain pills), or benzodiazepines (such as Xanax or Klonopin) abruptly ceases use.  In these latter instances, individuals in withdrawal can hallucinate, have greatly increased pulse and blood pressures, be visibly and dramatically uncomfortable, and in worst cases have seizures and even die. 

Even though the physiological effects of cannabis withdrawal are generally mild, it is not correct to conclude that marijuana is not addictive, because being addicted to something is more than simply being physically dependent on a drug and experiencing physiological effects if the drug is stopped suddenly.  “Addiction” refers to behaviors that are compulsive, partially out of control or worse, and often escalating in severity and intensity. 

Given this definition of addiction, nobody should conclude that folks who are taking pain medications exactly as prescribed around the clock for legitimate health reasons--and are thus physiologically dependent on them--are addicted if they are taking their pills as prescribed, if they are not causing problems in the person’s life, if the individual is not engaging in dangerous behaviors in order to procure them, and if the use is not continually escalating to a point that is out of control.

There is obviously a realm between the casual user and the full-on addict that I label "almost addicted"--folks who don't meet anyone's definition of addiction but who might be having difficulties in their life as a result of their drug use nonetheless. For more on this in-between condition feel free to go here.

Obviously, the vast majority of marijuana users are neither addicted nor almost addicted to cannabis.  Their use doesn’t escalate over time, they can enjoy its effects without endangering some major element of their lives.

But the fact that most who smoke don’t get addicted to marijuana does not mean, however, that it isn’t potentially addictive.  Consider my patient who was in his late 20’s when he first came to see me.  He worked in construction, and smoked marijuana as soon as he woke up, on his way to work, at every break during the day, on his way home, and then all evening until he fell asleep.  He told me, “Marijuana is my life, family, my girlfriend and my hobby.” He’d vowed and tried to quit multiple times without success.  His marijuana use ended up isolating him from family and friends.  So, despite the fact that he never experienced any dramatic physiological withdrawal symptoms when he tried not to smoke, this individual was addicted to marijuana.  He couldn’t stop using it and, by his own estimation and that of folks around him, it was consuming his life.

Unlike this individual, most people who smoke marijuana do so the way most folks who drink alcohol do:  in moderation, once the day’s major responsibilities are done, and so on.  But just like with alcohol, some who use marijuana do so in a compulsive way that places major portions of their life in jeopardy and produces real, significant negative consequences in their lives, be in strained family relationships, compromised job performance or something else.  For those individuals marijuana is unquestionably addictive.

 

 

References:

 

  1. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Treatment Episode Data Set (TEDS) Highlights—2009: National Admissions to Substance Abuse Treatment Services. Office of Applied Studies, DASIS Series: S-45, DHHS Publication No. SMA 09–4360, Rockville, MD, 2008.

Wes Boyd is on faculty at Harvard Medical School and is an Attending Psychiatrist at Cambridge Health Alliance and Children’s Hospital Boston.

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