“Since marijuana is legalized in an increasing number of states for recreational purposes, I am observing more conflict flare up between couples about what it means to use marijuana and whether its use should be restricted to recreation. There are deeply-rooted beliefs and values about drug use in our country, but I don’t see anyone addressing legalization from the perspective of how it has affected relationships and couples. It would be very helpful to explore this topic further.”
It’s hard for couples to have a balanced discussion about cannabis use because it seems like there are only two options: pro or con. It can be tough to stay in the middle ground when there are such strong emotions involved, especially if someone in the relationship has a family history of substance abuse.
The continuous issues with the government and cannabis discussions arise from past misinformation campaigns as well as a lack of backing for research today. Furthermore, marijuana’s Schedule 1 classification by the Drug Enforcement Agency (DEA) creates many difficulties for researchers studying its medical value.
The unfortunate reality for researchers is that the federal government’s Scheduling 1 classification of cannabis as an illegal substance makes it difficult to access funding and grants, even though there is already a body of compelling research that challenges this misguided classification.
Medical and scientific agendas are being pushed aside by political ones, which is slowing down necessary research to comprehend the advantages and disadvantages of cannabis use. Since patients who could potentially benefit from medicinal cannabis, as well as the parents of sick children, are stuck trying to figure things out on their own instead of receiving help from policy-makers, this situation is both unnecessary and unethical.
Though it can be tough, opinions on cannabis are starting to shift as researchers uncover more information about the risks and benefits of its use. By understanding what current research says, couples can have a better conversation about cannabis and make informed decisions together.
Evolving legalization and evolving issues
In my graduate psychology class on addiction assessment and treatment at Santa Clara University, I ask the students about what they think people could get addicted to. This includes marijuana. The students are often split on whether people can be addicted to it. Even with the possibility of cannabis addiction, students are uncertain about how big of an issue it is compared to other substances.
With other drugs often causing more serious and pervasive issues, should we be concerned about cannabis? In recent decades there has been an resurgence of overdose deaths from stimulant use as well as the emerge of the opioid crisis.
Keep in mind, cannabis is the most popular illegal drug used in the USA with an assumed 22 million users per month.
Does marijuana have a role to play in healthcare, or is this just a way to make legalization more socially acceptable?
A political movement has rebranded cannabis, with enormous economic implications. An increasing number of states have either decriminalized or legalized its use for medical and/or recreational use. Perceptions are changing rapidly. A 2013 Fox poll found that 85% of Americans support medical marijuana when prescribed by a physician.
Conflicting reports cause confusion
The most frequent inquiries I receive from couple’s therapists during my consultation sessions and workshops are in regards to cannabis use. More specifically, they wonder “As a clinician, when should I be concerned about marijuana use?” and “How do I deal with a couple when one partner is concerned about their partner’s marijuana use?”. To be honest, these aren’t easy questions to answer as several factors play into safe recreational use, problematic drug abuse, legitimate medical need, and addictive behaviors.
Some reports claim that overusing cannabis could damage the brain’s pleasure center, make it harder to learn and remember things, impact reproductive systems, make someone dependent or addicted under some circumstances , worsen anxiety and panic symptoms ,and change a person’s mood (which is also a symptom people experience when they try to stop using pot).
With the cannabis plant trending in both its legalization and accessibility, counselors and couples are having complex conversations about whether use is problematic. Through these discussions, it has been difficult to understand if there more healing or harmful consequences that occur as a result of use. However, recent scientific strides have created a body of evidence which suggests cannabinoids may be therapeutic .
There are various benefits that have been reported from cannabis use, such as reducing anxiety levels and killing certain cancer cells in brain cancer patients. Cannabis has also been shown to help manage chronic pain, treat movement disorders effectively, and reduce eye pressure caused by glaucoma. Additionally, there is evidence that suggests cannabis could be useful in treating symptoms related to Alzheimer’s and Parkinson’s disease.
There is agreement among researchers that both positive and negative effects come from the body’s endocannabinoid system.
The endocannabinoid system
In the 1990s, researchers discovered that our bodies produce endocannabinoids. This system is located throughout our body and helps to activate two different receptors: CB1 in the brain, and CB2 outside of the brain (but still within the body). There are more than 60 types of cannabinoids.
The psychoactive compound in cannabis, tetrahydrocannabinol (THC ), activates CB1 receptors and produces the “high” while CB2 does not. However, there is much interest in studying CB2 for its potential therapeutic effects on a number of conditions, including acute pain, chronic inflammation-related pain, relieving symptoms from multiple sclerosis and other movement disorders, numerous cancer studies, and many other promising possibilities.
The CB1 and CB2 systems have led many researchers to believe that cannabis could be highly beneficial for treating a range of mental and physical issues. However, the challenge with using this as medication is the undesired psychoactive effects from THC. Interest has now shifted to cannabidiol (CBD) instead, which is receiving a lot of attention in medical research communities. While THC is the main active ingredient in cannabis, cannabidiol makes up around 40% of all extracted materials.
CBD is unique in that it doesn’t directly stimulate CB1 or CB2 receptors, but rather it changes how THC binds to those receptors. This significantly reduces the psychoactive effects of THC.
The “entourage effect” was first mentioned in 1988 and describes how different cannabinoids work together to address medical issues. Researchers are looking into CBD as a possible therapy, as well as the advantages of teaming up CBD with THC. This would let people use THC’s helpful properties without getting buzzed.
In 2018, the FDA approved for the first time a cannabis-based drug. Epidiolex is given orally to treat two rare and severe forms of childhood epilepsy. The formulation is highly purified CBD, which caused no resulting high feeling. This allowed the FDA to classify the drug as a Schedule V (no addiction potential and demonstrates therapeutic value).
Marinol and Nabilone are FDA approved synthetic cannabinoids used primarily to treat nausea and vomiting from chemotherapy, for anorexia from AIDS, and for chronic pain. Because they contain THC there can be withdrawal symptoms and addiction potential. Furthermore, the absence of the entourage effect (the synergistic reaction between cannabinoids) reduces mediation effectiveness to a limited number of symptom targets.
So is cannabis addictive?
Cannabis, similar to any other substance that affects the brain’s reward system, has the potential to be addictive. Risks for addiction include genetics, life style choices, potency of drug used, how it is consumed (smoking vs. eating), and if other substances are being abused as well. According to studies done by Addiction professionals , about 9% of cannabis users will meet the criteria for Cannabis Use Disorder (CUD) and may develop an addiction. However, we will not know for certain if numbers of problematic use increases until accessibility becomes more widespread.
Cannabis Use Disorder (CUD) is more likely to develop in people who have a history of other substance use disorders and start using cannabis with high THC levels, according to studies. With brain development still underway, adolescents are especially at risk for addiction if they heavily use cannabis. What may be safe for adults can be dangerous for teenagers and young adults.
A diagnosis of CUD (Compulsive Use Disorder) is given when a person meets at least two of the 11 symptoms listed in the DSM-V (Diagnostic and Statistical Manual, 5th edition). four symptoms indicate CUD Moderate, while six or moresymptoms signifyCUD Severe.
Addiction is a severe substance use or behavioral disorder that’s defined by an inability to stop, even when negative consequences arise. The science of addiction explains that this occurs due to changes in the brain impacting the circuitry associated with reward, impulse control, motivation, judgement, and emotions. Furthermore, addiction is characterized by a preoccupation with the substance that reorganizes the addict’s life.
Though it may seem similar, dependence is not the same as addiction. Dependence occurs when a person builds up a tolerance to a substance and experiences physical withdrawal symptoms after stopping use. It’s possible to be dependent without being addicted; treatment usually focuses on managing withdrawal symptoms in this case. Addiction, on the other hand, is characterized by constantly thinking about drug preoccupation and seeking out drugs even when doing so causes negative consequences.
Use disorder vs. addiction
The main difference between an addiction and a use disorder is that the symptoms of a use disorder, while still problematic, may not be drugs or alcohol-related later on in life. Many people who currently meet the criteria for CUD will not continue to do so later down the line. The same can be said for other substance abuse disorders. For example, research from the Center for Disease Control (CDC) found that 70% of patients who meet the Alcohol Use Disorder criteria today will not four years from now.
While it’s commonly understood that addiction and a use disorder are one in the same, I believe they should be differentiated. A use disorder is defined as an addiction, but the difference between the two is that addiction meets the criteria as a disease when changes in brain function and brain structure occurs. These changes may not be present with those who only have a use disorder, which would make it more temporary than addiction. People with use disorders may still be able to use substances regularly without any issues, however that is not the case for addiction. Those suffering from addiction cannot stop or control their usage, which leads to harmful consequences over time.
Some studies show that prolonged, substantial cannabis use can lead to changes in the brain’s mesocorticolimbic system (reward circuitry) and dopamine neurotransmitter levels. This change characterizes addiction and results in a loss of control over recreational use. The greater the alterations in reward circuitry and dopamine activity, the more significant family and relationship problems become for the individual addicted to cannabis. People addicted to cannabis often report using it just to feel normal again.
Although it’s hard to diagnose, approximately 2.5% of all adults have CUD (chronic undereating disorder), which equates to nearly 6 million people. Even though this number is high, less than 10% receiving treatment for the issue. In America, about 6% of the population will suffer from CUD at some point in their lives – and almost double the amount of men compared to women are affected by it.
CUD, or cannabis use disorder, is often comorbid with other substance abuse (particularly alcohol) and mental health disorders. Moreover, approximately 18% of addiction treatment admission patients identify as having CUD as their main drug. However, the silver lining is that research has shown those suffering from CUD have a high chance of making a full recovery in both the short- and long-term.
The average time span between the starting point of CUD and stable remission is approximately 2.5 years, with recovery being typical. Utilizing levels of severity do matter, those that took the route abstinence showed greater life satisfaction overall. At the more severe endpoints of CUD, recovery was often fragile and needed more time to stabilize fully. It’s not shocking that better results came from those who stuck with it for longer periods of time.
Synthetic cannabinoids: a separate category
Cannabinoids like “spice” or “K2,” otherwise known as synthetic street drugs, are man-made chemicals sprayed on plant leaves. They can be smoked like normal cigarettes, or sold in liquid form to be vaporized. Oftentimes, these drugs have more potent effects than cannabis.
Because these synthetics are unregulated, they are considered dangerous and can be unpredictable, often leading to emergency room visits. Because the content of these substances is unknown, those who use them regularly are at a high risk.
Questions for discussion
If you and your partner have trouble discussing cannabis, review this information together and explore each person’s feelings, reactions, and thoughts.
Although there are many more points to consider than what is covered in this article, it can serve as a starting point. To get reliable information from additional sources, look into the National Institute on Drug Abuse and the CDC.
It’s important to start with the goal of understanding each other. Postpone problem solving until you have achieved a better understanding through conversation.
Feel free to modify the following conversation starters below to fit your own personal situation. You may use terms such as “marijuana,” “weed,” “CBD,” or any other related word in place of “cannabis.”
- How do you see your/my/our relationship with cannabis?
- What is your experience with cannabis? What do you find helpful about it and what not so much?
- Ideally what would you like your relationship with cannabis to be?
- Is there anything worrying you? What would ease those worries?
- What are the benefits of using cannabis, and what are the benefits of not using it?
- What are the signs that you should be worried?
- Are there things we can do to better address any aspect of cannabis use?
If you feel the need to keep talking about cannabis, agree with your partner to continue doing so. If you can’t come to an agreement on your own, find a therapist or addiction professional who can help guide the conversation.