Anyone following the legalization and decriminalization of marijuana knows that public opinion has been shifting a lot over the years. As of early 2015, 27 U.S. states and the District of Columbia had legalized or decriminalized marijuana, and four states plus D.C. have gone on to approve it for recreational use, according to the National Organization for the Reform of Marijuana Laws (NORML). So it’s not a stretch to say that it’s likely only a matter of time until other states follow suit. A 2013 Gallup poll showed that 58% of Americans support legalization — a nearly five-fold increase since the research company first asked the question, “Do you think pot should be made legal, or not?” back in 1969.
The multimillion-dollar-question, of course, is: What will the repercussions be, as more states allow pot to be used in much the same way as alcohol? Will there be more abuse? Less? Will addiction rates skyrocket, especially among young people? Or will they remain or level off to much the same as they are now?
These are the questions Addiction.com asked two major players in the field of addiction treatment: David Sack, MD, a board-certified physician in psychiatry, addiction psychiatry and addiction medicine, and CEO of Elements Behavioral Health, and Stanton Peele, PhD, JD, author of Love and Addiction and, most recently, Recover! Stop Thinking Like an Addict with The PERFECT Program. Here’s what Drs. Sack and Peele had to say about whether they believe that expanded access to marijuana will or will not mean greater abuse and rates of addiction:
Dr. David Sack: “It’s not an accident that alcohol is the most widely abused drug; it’s also the most available by virtue of being legal. In just about every drug epidemic, a period of increased access has been followed by increased abuse … Right now, we’re in the middle of an opioid epidemic and the door to the epidemic was really opened by a widespread change and prescribing practices by doctors who had been re-educated to treat pain more aggressively. Starting in the 1980s and 1990s, there was a widespread recognition in the medical community that pain was not adequately treated and doctors were encouraged to use opioid medication more liberally. The net result was that they became more available, so now every family had a bottle of Vicodin or Percocet in the cabinet.
At the beginning of every [drug] epidemic there is a collective denial about how addicting the drug is — we saw it in the 1980s when people were disputing whether cocaine was addictive because the physical withdrawal wasn’t as severe as it was with heroin or opioids. Marijuana advocates want the public to believe that marijuana and cannabinoids [the psychoactive ingredient in marijuana] are not addictive, but all the evidence shows that they are addictive … [and] there is a very high failure rate in treatment [for marijuana addiction]. Most drugs of abuse only last a short while; they get into the nervous system, kick in for a few hours and then they are excreted or inactivated by the liver. Cannabinoids hang around for a very long time and regular smokers store cannabinoids in their fat tissues; they can be excreting them for a month … so we can expect the person who smokes pot regularly to have panic, lack of motivation and concentration at times when they don’t perceive they’re high.
[When considering the consequences of legalizing marijuana] on one hand, you have societal issues: Do you want to ban drugs and restrict drugs as a way of controlling use because it’s safer for the population? Or do you want to legalize them so you don’t make criminals out of citizens and [make] thugs and gangs rich? From a mental health and substance abuse treatment level, the evidence and history of drug use is very clear: We’re going to see more addicts [to marijuana] and more widespread use, and typically the levels of funding necessary to appropriately treat and support this have never been high, so we’re going to wind up with a gap in services.”
Dr. Stanton Peele: “Even I couldn’t say exactly [that] if you legalize pot, it will become more widespread — or what exactly will be the consequence … I look at it that the social context, more than anything else, determines the behaviors. So when you bring underground behavior above ground — that is, making something legal that was illegal — it offers the possibility of regulating it and particularly not even by law but by social regulations … As a backdrop, they did a study at the University at Buffalo Research Institute on Addictions (RIA) and now that gambling is legalized pretty well across the country, they haven’t noticed an upsurge in compulsive gambling.
In Colorado, where they have an upscale marijuana trade, and also in California, where in 2010 they decriminalized marijuana, the results are startlingly positive. In Colorado, they have these very boutique-like marijuana stores and you get an upper middle class clientele that is very good at regulating themselves. If you have a high-standard quality of delivering the products and a clientele that’s upscale, you set up social standards and patterns that you’re going to have pretty good control of your use. I can’t emphasize enough, that in general, upper middle class people in America have learned to be pretty good at delaying gratification and controlling themselves. The same is true with marijuana. Poor people are penalized more legally for use of marijuana, which is totally unfair, however, in general when doctors and New York Times editors and people like that smoke marijuana they are going to tend to regulate their use because they have more to lose if they don’t.
In California, it was even a more interesting experiment … they found a decline in marijuana arrests but also a decline in all arrests for youthful offenders. In 2014, California reduced possession of every drug — heroine, cocaine and meth — to misdemeanors, and they’ve also done this in Portugal. Some people are like, ‘we’re going to have a million heroin addicts,’ but instead people who take the drug may use it in a more normally socially acceptable way: keep a job and try to lead a normal life. The best antidote to addiction is to lead a normal life.
One reason why we do so poorly with addiction and substance abuse is that we don’t give people enough stakes in life and in the community. The best overall answer is to have a social policy that gives people the greatest connection to life. If you give someone a life — if they have a residence and a chance to make meals and get their family better — that’s better treatment than treatment.”
What will greater, easier access to marijuana mean for young people specifically?
Dr. Sack: “The biggest challenge right now is that the way in which pot is being sold — whether medical marijuana or, now, recreational marijuana — is changing dramatically. So the fastest-growing segment, for instance, is edibles. Clearly, these edibles appeal to a younger audience and there’s real reason to be concerned. Although the statutes are written for adults ages 18 and above, the controls to limit that access will be lacking, much in the way that it was for alcohol for many years and for cigarettes. The effects of cannabinoids on the developing brain are very piercing. If you look at the human cortical development, it continues into the mid-20s and what you see is that adolescents who start smoking at a younger age have memory problems, school failure, other psychiatric disorders and are at a significantly greater risk of developing schizophrenia. So we’re not only going to see more kids presenting [to a health care provider] with substance abuse, but with complex psychiatric histories that may be preceded by substance abuse. This becomes a challenge for traditional drug and alcohol treatment centers that may not have psychiatrists or licensed therapists fully integrated into their programs.
Drugs like marijuana seem to be preferentially attractive to adolescents and young adults, so when they see adults smoking pot, they see it as a normal behavior. I think they are going to feel encouraged and less deterred from using. In other words, you can sort of see the stoned parent trying to have a conversation with his/her kid, saying, ‘you’re too young to get stoned,’ and the kid thinking, I’ll just light up two blocks from home.
We are already seeing more young adults coming in [for treatment] who clearly have cannabis dependency as part of their primary problem and I think we’re going to continue to see this increase. There are also a lot more poly-drug [using more than one drug] users than there were in the past. In these cases, detox is more complicated and poly-drug users are harder to treat and harder to keep motivated and engaged in treatment. We have to brace ourselves with better prevention.”
Dr. Peele: “The social regulation of how something is used, the message of use and how you think about yourself using are really critical elements. If you’re not sneaking around doing something — getting back to the youths in California — well, then all of sudden you’re a solid citizen and maybe you can get a better job and maybe you don’t want to get involved in petty crimes because you’re not a criminal and you’re not even ‘bad.’ It’s like sex; most people today try to teach their children that sex isn’t bad and one reason to do that is because people generally tend to have sex. And people generally tend to get intoxicated, one way or another. If you look at the history of the world, it has been going on for quite a long time. Instead of saying, ‘Oh my God, let’s stamp it out, and why would you want to do that?’, it’s harder to say, ‘We know you are going to [smoke pot], but we expect you to behave when you do this.’ When you believe you deserve not to be addicted — and have the right and ability to control your life and have good things — that’s when people are most likely to overcome addiction.
Everyone is going to drink alcohol, more or less, and everyone is going to have a painkiller. If your whole shtick is, ‘My kid will never drink or take drugs,’ you really need a back-up plan, and the back-up plan is how to prevent a person from going overboard.”
What do you think: Will greater access to marijuana lead to more abuse and addiction, or not?