Cannabis and related disorders Health Article

Diagnosis

Diagnosis of cannabis-related disorders is made in a number of ways. Intoxication is easiest to diagnose because of clinically observable signs, including reddened eye membranes, increased appetite, dry mouth, and increased heart rate. It is also diagnosed by the presence of problematic behavioral or psychological changes such as impaired motor coordination, judgment, anxiety, euphoria, and social withdrawal. Occasionally, panic attacks may occur, and there may be impairment of short-term memory. Lowered immune system resistance, lowered testosterone levels in males, and chromosomal damage may also occur. Psychologically, chronic use of marijuana has been associated with a loss of ambition known as the "amotivational syndrome."

Cannabis use is often paired with the use of other addictive substances, especially nicotine, alcohol, and cocaine. Marijuana may be mixed and smoked with opiates, phencyclidine ("PCP" or "angel dust"), or hallucinogenic drugs. Individuals who regularly use cannabis often report physical and mental lethargy and an inability to experience pleasure when not intoxicated (known as "anhedonia"). If taken in sufficiently high dosages, cannabinoids have psychoactive effects similar to hallucinogens such as lysergic acid diethylamide (LSD), and individuals using high doses may experience adverse effects that resemble hallucinogen-induced "bad trips." Paranoid ideation is another possible effect of heavy use, and, occasionally, hallucinations and delusions occur. Highly intoxicated individuals may feel as if they are out-side their body ("depersonalization") or as if what they are experiencing isn't real ("derealization"). Fatal traffic accidents are more common among individuals testing positive for cannabis use.

Urine tests can usually identify metabolites of cannabinoids. Because cannabinoids are fat soluble, they remain in the body for extended periods. Individuals who have used cannabis may show positive urine tests for as long as two to four weeks after using.

Examination of the nasopharynx and bronchial lining may also show clinical changes due to cannabis use. Marijuana smoke is known to contain even larger amounts of carcinogens than tobacco smoke. Sometimes cannabis use is associated with weight gain.

Treatments

Treatment options for individuals with cannabis-related disorders are identical to those available for people with alcohol and other substance abuse disorders. The goal of treatment is abstinence. Treatment approaches range from in-patient hospitalization, drug and alcohol rehabilitation facilities, and various outpatient programs. Twelve-step programs such as Narcotics Anonymous are also treatment options. For heavy users suffering from withdrawal symptoms, treatment with anti-anxiety and/or antidepressant medication may assist in the treatment process.

Prognosis

According to the DSM-IV-TR, cannabis dependence and abuse tend to develop over a period of time. It may, however, develop more rapidly among young people with other emotional problems. Most people who become dependent begin using regularly. Gradually, over time, both frequency and amount increase. With chronic use, there can sometimes be a decrease in or loss of the pleasurable effects of the substance, along with increased feelings of anxiety and/or depression. As with alcohol and nicotine, cannabis use tends to begin early in the course of substance abuse and many people later go on to develop dependence on other illicit substances. Because of this, cannabis has been referred to as a "gateway" drug, although this view remains highly controversial. There is much that remains unknown about the social, psychological, and neurochemical basis of drug use progression, and it is unclear whether marijuana use actually causes individuals to go on to use other illicit substances.

One long-term effect of chronic use has been termed the "amotivational syndrome." This refers to the observation that many heavy, chronic users seem unambitious in relation to school and/or career.

Prevention

Many drug education programs focus strongly on discouraging marijuana experimentation among young teenagers. Recent research reported by the NIDA indicates that high-sensation-seekers—that is, individuals who seek out new, emotionally intense experiences and are willing to take risks to obtain these experiences— are at greater risk for using marijuana and other drugs, and for using them at an earlier age. As a result, the NIDA developed a series of public service announcements (PSAs) for national television. These PSAs were dramatic and attention getting, and were aired during programs that would appeal to high sensation-seekers, such as action-oriented television shows. These PSAs were aired in a limited television area and the results monitored. Marijuana use declined substantially among teens during the PSA campaigns, and long-term effects were shown for several months afterwards. In one county, marijuana use decreased by 38%, and in another, by 26.7%.

Drug education programs such as the "DARE" (Drug Awareness and Resistance Education) programs target fifth graders. These and other antidrug programs focus on peer pressure resistance and the use of older teens who oppose drug use as models of a drug-free lifestyle. These programs show mixed results.

See also Addiction; Disease concept of chemical dependency; Dual diagnosis; Nicotine and related disorders; Opioids and related disorders; Relapse and relapse prevention; Self-help groups; Substance abuse and related disorders; Support groups