The seemingly inexorable nationwide movement to legalize marijuana has recently stalled in New Jersey and New York, at least partly due to resurfaced associations of cannabis with negative emotional outcomes.
Widespread political attacks on marijuana have resumed; Jeff Sessions, Trump’s first attorney general, was virulently anti-marijuana. And this rearguard movement received further oxygen in January with the publication of Alex Berenson’s book, Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence. The subtitle presages a recounting of anti-marijuana findings connecting its use with mental illness (especially schizophrenia), violence, traffic accidents and cognitive decline—even as these claims are vigorously contested.
In supporting legalization, how can we communicate ways to reduce potential negative psychological and social outcomes in order to address the backlash?
Ignoring evidence that cannabis use can become addictive undermines legalization advocates’ credibility.
Considering this question, I recalled two vignettes from my past.
Firstly, in the early 2000s, I was giving a guest lecture to a large class on drugs being taught by a gifted teacher who also wanted to change the punitive laws concerning cannabis. At this point in history even medical marijuana was almost entirely verboten.
When I gave my standard definition of addiction as an overwhelming experience to which people become attached with increasingly negative consequences—a definition into which marijuana use might fit—the instructor visibly pooh-poohed my point. After class, a young woman approached me: “Professor — is very open-minded, but you’re not allowed to say marijuana can be addictive. I went to rehab for pot; it really screwed up my life. I could never say that in class.”
For this professor and policy wonk, the idea of marijuana addiction was a meme straight out of Reefer Madness used to attack a drug less harmful than legal cigarettes and alcohol.
The trouble is, ignoring evidence that cannabis use—like any powerful drug or other experience—can become addictive undermines legalization advocates’ credibility.
Quite simply, the cannabis genie is not going back into the bottle.
Secondly, decades earlier, living in the suburbs next door to a Columbia University professor, I asked his 17-year-old daughter about her and her friends smoking marijuana. She told me, “You know they found it’s much stronger now and not harmless like they used to think.”
She paused. “But I don’t care.” Meaning cannabis was accepted in her social group and she was going to continue to use it.
That social acceptance has greatly accelerated since—with signs that older Americans’ enthusiasm for the drug is outstripping that of younger cohorts. Legal recreational marijuana covers 10 states so far, or 38 percent of the US population. Over 60 percent of us support its expansion. Big business has become involved—when former Republican Speaker of the House John Boehner becomes an industry spokesperson, it’s clear that pot is mainstream.
It is still not quite as accepted as alcohol perhaps, but certainly separated from “bad” drugs like heroin, meth and cocaine. Quite simply, the cannabis genie is not going back into the bottle.
The recent attacks are reminiscent of the 1960s, when laundry lists of the dangers of marijuana (and drugs like LSD) were unfurled with little regard for truth or science. Remember those kids tripping on LSD who blinded themselves staring at the sun?
In response, those seeking more accurate portrayals of drugs took pains to refute these claims and to provide alternative data and arguments. Two turn-of-the-century books—Marijuana Myths Marijuana Facts (1997) by Lynn Zimmer and John Morgan, and Understanding Marijuana (2002) by Mitch Earleywine—were good examples.
If you search Amazon for marijuana today, there are scores of books on growing marijuana, cannabis strains, marijuana’s health benefits—along with cannabis storage devices and untold numbers of similar products. It’s a new world. Except, in this new world, that old debate has reappeared (really, it never left), led by Berenson’s book.
It may well be that people with greater susceptibility to mental disorders more often use marijuana regularly and intensely—rather than that marijuana use drives them to psychosis.
Among those contesting the “new” anti-marijuana charges has been the Drug Policy Alliance (DPA), which in February published a press release signed by “100 scholars and clinicians” refuting Berenson’s claims as being the result of “selection bias, cherry picking data, [and] attributing cause to mere associations.”
In making its case, however, DPA rightly conceded that “associations between marijuana use and mental illness have been established.”
It then argued that pot smokers’ greater incidence of mental illness says nothing about the causality of this connection. In other words, it may well be that people with greater susceptibility to mental disorders more often use marijuana regularly and intensely—rather than that marijuana use drives them to psychosis.
WebMD captures this indeterminant causality:
One analysis of several studies found that marijuana, also called cannabis, is one of the most commonly abused substances among people with schizophrenia. Young people with the condition, in particular, may abuse it more often than alcohol.
Researchers have puzzled over what that link means. Some say that people with schizophrenia may be more likely to use the drug because they’re looking for ways to ease their symptoms. But it’s unlikely that self-medication alone can explain the relationship between marijuana use and schizophrenia.
From this perspective, cannabis may help people with schizophrenia—that is, they use it therapeutically. The mechanism might be that they are more comfortable in the altered reality the drug creates.
But the other side to this advantage of cannabis for those more prone to schizophrenia can be that, in turning to marijuana as a recourse for their difficulty in processing real-world stimuli, they become less able and motivated to deal with these inputs. In this case, relying on marijuana’s protective experiential effects exacerbates the need for this protection in a potentially self-feeding cycle. As Filter contributor Zach Rhoads and I describe in our new book Outgrowing Addiction, this cycle defines addiction.
Instead of issuing warnings about marijuana’s detrimental psychiatric effects, a better policy is to help people to develop standards that encourage its sensible use.
No drugs are entirely without harmful effects—none. As for addiction, any drug (or other experientially potent involvement or activity—such as gambling, the internet, sex, or love) holds out the danger of a negative kickback. In this process, the individual clings more tightly to the involvement or experience due to its very effectiveness as a mood modifier, even as it has increasingly negative effects for the person.
But this observation doesn’t mark marijuana as uniquely addictive or schizophrenia-inducing. Rather, there is an ineluctable connection between a substance’s consciousness-altering effects and a potentially negative feedback loop.
And the correct societal response? It’s not to make one consciousness-altering thing illegal or to single it out as psychiatrically dangerous. Consider video games in that regard, as the International Classification of Diseases (ICD-11) now does in identifying gaming disorder, along with the disorder of compulsive sexuality (a condition Archie Brodsky and I described in Love and Addiction in 1975). So this modern diagnostic manual makes clear that marijuana isn’t exceptional in having addictive potential.
We aren’t going to issue psychiatric warnings to avoid love and sex since they can be addictive, in good part because people aren’t going to quit these activities on the grounds that they can have bad effects.
Rather, instead of issuing warnings about marijuana’s detrimental psychiatric effects, especially in light of the normalizing of cannabis use, a better policy is to help people to develop standards that encourage its sensible use. For that purpose, some time ago I developed the following guidelines with Archie Brodsky under the auspices of the Cannabis Action Network and Debby Goldsberry:
Guidelines for Sensible Cannabis Use
1. Adults should use cannabis as part of a healthy, balanced, and responsible lifestyle.
2. The decision to use cannabis should be made freely, and not as a result of social pressure.
3. Cannabis users should be well informed about its effects on themselves and others. These effects should include both legal and health risks and personal consequences.
4. Never use cannabis as an excuse or a cue for antisocial or irresponsible behavior.
5. Cannabis users should model and reward responsible use, particularly with new users.
6. Use cannabis as a part of positive social interactions, rather than primarily in isolation or as a remedy for negative feelings.
7. Develop sensible cannabis use limits for yourself based on personal, health, situational, and cultural factors. It is important to be objective about your cannabis use and to listen to the constructive advice of others.
8. Avoid cannabis use that puts you or others at risk, such as when driving, at work, or in public places.
9. Use of cannabis by children is inappropriate and should be discouraged.
10. Cannabis use should contribute to, rather than detract from, users’ health, well-being, creativity, work, relationships, and social obligations.
In other words, embrace marijuana—and every other powerful engagement you undertake—as part of your positive lived experience.