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Marijuana: A wolf in sheep’s clothing

In the past, the tobacco industry reaped enormous profits while denying the harm of cigarettes. History must not repeat itself with a powerful cannabis lobby.

Marijuana plants are seen in Montevideo, Uruguay, July 16, 2017. (CNS photo/Andres Stapff, Reuters)

While lawmakers are moving to legalize the recreational use of marijuana in many states, psychological science is demonstrating its serious risks to the mental health of youth and adults.

The use of marijuana has been identified in numerous other international studies as a major cause of psychosis, violence, and crime. Three meta-analyses have concluded that cannabis use is associated with a three-fold increased risk of developing psychosis, primarily with paranoid symptoms that can be associated with the risk of violent reactions (Moore T.H., et al., 2007).

The 2017 Report of the National Academy of Sciences, Engineering and Medicine showed that cannabis use is likely to increase the risk of developing psychoses; the higher the use, the greater the risk. The researchers also noted that there’s evidence marijuana can exacerbate bipolar disorder and increase the risk of suicide, depression, and social anxiety disorders.

As a psychiatrist, I have seen increased numbers of young adults who have developed psychotic illness without the usual psychological risk factors. Instead, their histories often revealed one strikingly common factor—daily use of cannabis.

Now, whenever I see a young adult patient who has psychotic symptoms, the leading risk factor I explore is the person’s history of marijuana use.

Marijuana, psychosis, and violence

In the important new book Tell Your Children the Truth About Marijuana, Mental Illness, and Violence (Free Press, 2019) Alex Berensen, former New York Times reporter and award-winning novelist, has made a major contribution to marriages, families, the mental health field, and the larger culture. Parents, educators, and health professionals should be aware of the studies of severe psychiatric illness, violent behavior, and crime related to marijuana use that he cites.

A 2018 study of people with psychosis in Switzerland found that almost half of the cannabis users became violent over a three-year period; their risk of violence was four times that of psychotic people who did not use cannabis.

The psychological dynamic at work in paranoid thinking leads people to believe that others plan to harm them. Under this cognitive distortion/delusion, paranoid persons commit violent acts to protect themselves from others whom they believe are a threat to them. In fact, the most dangerous psychiatric patients are those who are paranoid.

A 2012 study of 12,000 high school students across the United States showed that those who used cannabis were more than three times as likely to become violent as those who didn’t, surpassing the risk of alcohol use.

Studies of children who have died from abuse and neglect consistently show that the adults responsible for their deaths use marijuana far more frequently than alcohol or other drugs—and far, far more than the general population.

All four states that legalized cannabis in 2014 and 2015—Alaska, Colorado, Oregon, and Washington—have seen a sharp rise in murders and aggravated assaults since legalization. Combined, the four states saw a 35 percent increase in murders and a 25 percent increase in assaults between 2013 and 2017, far outpacing the national trend.

A 2010 study of 3,801 participants in Australia demonstrated that using cannabis beginning at age 15 raised the risk of hallucinations by almost three times at age 21.

A 2018 study of 5,300 participants in England revealed that teenage cannabis use roughly tripled the risk of psychotic symptoms.

A 2018 Finnish study with 6,534 participants showed that using cannabis more than five times raised the risk of psychotic disorders almost sevenfold.

The number of people showing up at hospitals with psychosis has soared since 2006, alongside marijuana use. By 2014, the most recent year for which data is available, 11 percent of Americans who showed up in emergency rooms with a psychotic disorder also had a secondary diagnosis of marijuana abuse.

Berenson states that the casual use of cannabis has risen only moderately in the last decade, but heavy use has soared—almost tripling. Through the mid-1970s, most marijuana consumed in the United States contained less than 2 percent tetrahydrocannabinol, or THC.  Today’s users wouldn’t even recognize that drug as marijuana. Marijuana sold at legal dispensaries now routinely contains 25 percent THC.

A major international 2019 study of first-episode psychosis at 11 European sites and Brazil reported in The Lancet that daily cannabis use was associated with increased psychotic disorder, increasing to nearly five-times increased odds for daily use of high-potency types of cannabis.

In the three sites with the greatest consumption of high-potency cannabis, daily use of high-potency cannabis was associated with the greatest increase in the odds for psychotic disorder compared with never having used: four times greater in Paris, five times greater in London, and more than nine times greater in Amsterdam.

In addition, a large meta-analysis from McGill University published in the Journal of the American Medical Association concluded that marijuana consumption in adolescence is associated with increased risk of developing major depression in young adulthood and suicidal thoughts in young adulthood.

As a result of its widespread use, today cannabis may be the greatest threat to the mental health of youth and young adults and to the physical health of those victimized by the violence arising from paranoid thinking.

The appeal and the trap

Cannabis users often state that it helps them to relax after a stressful day which, of course, is cited also as a benefit of alcohol use. Its use early in the day is an unconscious attempt to diminish the anxiety that arises from insecurity, loneliness, or excessive anger. Its effects are powerful making the drug difficult to give up.

When I expressed a concern to a young adult patient that his daily use of marijuana may have played a role in his several recent and long psychiatric hospitalizations for psychosis, he responded with an expression of total disbelief that his weed could be harming him. He had always felt that it had helped him to cope with stress, and it was a source of pleasure for him.

He asked me with a very sad and troubled expression on his face whether if I was asking him to stop smoking weed daily.

My response was that we had to talk further about the findings that cannabis could cause paranoid thinking. Then I shared with him a composite description of several young adult patients in which their paranoid thinking ceased after the use of anti-psychotic medication and cessation from cannabis use.

While marijuana initially reduces anxiety in its regular users, it also can lead to social withdrawal. As with other drugs, alcohol and pornography use, it can also lead to a person becoming a prisoner within himself, and to the undermining healthy self-giving in relationships.

Warning signs for parents

The American Academy of Child and Adolescent Psychiatry has cited the following signs that parents should consider in regard to marijuana use by a child:

  • increased irritability
  • losing interest in and motivation to do usual activities
  • spending time with peers who use marijuana
  • coming home with red eyes
  • stealing money or having money that cannot be accounted for
  • carrying pipes, lighters, or rolling papers
  • worsening of underlying mental health conditions including mood changes and suicidal ideation
  • increased aggression

Additional signs we recommend parents and spouses look for are:

  • mistrust of parents or spouse
  • explosive anger
  • pervasive irresponsibility
  • false accusations
  • work or employment far below one’s abilities
  • paranoid thoughts
  • difficulty in maintaining friendships
  • failure to consider reasonable plans for the future
  • excessive time in solitary activities such as excessive video-gaming, especially violent video-gaming.

Treatment plan

Cannabis, like opioids, alcohol, and pornography, is used to diminish or cover-up the emotional pain of anxiety, sadness and loneliness, mistrust of others, strong anger, insecurity, hopelessness, or trauma. As with substance abuse or pornography, it also can be a manifestation of strong selfishness and an obsession with comfort-seeking behaviors.

These psychological conflicts can be addressed by the use of forgiveness therapy, which reduces the anger associated with all psychological conflicts and facilitates their resolution. In addition, growth in virtues can reduce the painful feelings and the obsession with self and pleasure.

When paranoid thinking is the result of the use of marijuana, the first intervention needs to be the cessation of the drug and initiation of antipsychotic medication. However, the cultural attempts to normalize the use of a dangerous drug and the dependence upon it often combine to produce a strong denial in patients, family members, and even mental health professionals that the use of cannabis could be a cause of paranoid thinking, excessive anger, and violent behavior.

In marriages or cohabiting relationships, when paranoid thinking is intense, separation should be strongly considered for protection from possible severe anger. Reconciliation should depend upon the cessation of marijuana use, clear urine screening, and the use of antipsychotic medication.

Participation in a 12-step recovery program is also an important part of the treatment plan.

If a person is able to maintain a prolonged period of sobriety and a resolution of paranoid thinking, a trial off medication should be considered.

Also, being raised in a family with faith, regular church attendance, and prayer has been shown to have benefits, in a 2018 Harvard School of Public Health study of 5,000 youth followed into adulthood.

Such faith-based practices are associated with lower probabilities of marijuana use, greater life satisfaction, and character strengths, compared with those who have no church attendance. The authors of this study, Chen and Vanderweele, wrote that, “Although decisions about religion are not shaped principally by health, encouraging service attendance and private practices (prayer) in adolescents who already hold religious beliefs may be meaningful avenues of development and support, possibly leading to better health and well-being.”

Many years of clinical experience support the recommendations in Berenson’s book to address the epidemic of marijuana-induced psychosis. It strongly indicates the importance of fighting the drug’s legalization.

A major challenge to an effective treatment plan is the cultural attempt to normalize the use of marijuana as a recreational drug. Such an agenda about this dangerous drug is a manifestation of severe denial and, ultimately, delusional thinking of influential and powerful segments of the culture. It is a denial of the scientific studies that show the negative effects of marijuana use.

End the cover-up

In the past, the tobacco industry reaped enormous profits while denying the harm of cigarettes. History must not repeat itself, this time with a powerful cannabis lobby that also stands to make enormous financial gain.

In fact, the tobacco industry has an interest in marijuana, according to the New York Times. The maker of Marlboro and other cigarettes paid $1.8 billion for almost half of Cronos Group, a cannabis company in Toronto.

In August 2014, Constellation Brands, which owns Corona and other beers, paid $4 billion for a major stake in Canopy Growth, another Canadian marijuana company. That month, Molson Coors, another brewer, formed a joint venture with a cannabis company in Quebec.

In an interview, Berensen claimed that George Soros was reported to be the largest backer of the Drug Policy Alliance, a major supporter of the legalization of marijuana.

Readers who rely on science for sound conclusions should read Berensen’s book, and speak with mental health professionals who have seen first-hand the devastation wrought by cannabis and who know the history of the psychosis and violence that it has caused for centuries.

The marijuana cover-up must end.


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About Richard Fitzgibbons, M.D. 2 Articles
Rick Fitzgibbons, M.D., is a psychiatrist in Conshohocken, PA, who is the director of the Institute for Marital Healing outside Philadelphia and has worked with hundreds of Catholic couples over the past 40 years. He is the co-author of Forgiveness Therapy: An Empirical Guide for Resolving Anger and Restoring Hope. He addresses marital infidelity in his forthcoming Ignatius Press book titled Habits for a Healthy Marriage.

27 Comments

  1. This article is thick with smoke!! Many strong assertions by the Doctor but paints a picture that is inaccurate and doesn’t help discernment. He cites many studies and makes it seem like the wolf man is lurking behind every puff, even claiming, but this time without a study, that it makes parents even more dangerous ‘than alcohol and other drugs’!! More than heroin, cocaine, prescription opioids, it will induce a parent to neglect their offspring according to him!! When one actually reads the cited reports and many others you get a different story though: One of more ambiguity. At the very least, the very inaccurate statement about increase of violence in States that legalized needs to be checked: https://www.snopes.com/fact-check/marijuana-legalization-violent-crime/
    The scare tactics sound hysterical and, frankly, unbalanced. He has a captive audience to be sure but this one needs to be combed over a little more. His conclusions are far too assertive from those of several of the studies he writes, and doesn’t take into account co-founders that skew, and publication bias, which is not uncommon, especially in circles of professions whose job it is to prescribe pharmaceutical drugs.

    • People’s views regarding the use of marijuana and other mind-altering substance ultimately boil down to their commitment to intellectual integrity and spiritual/psychological maturity. A commitment to intellectual integrity requires me to follow the evidence where it leads and honor the truth, whether it agrees with my position or not. In this instance, the growing body of empirical evidence supports the conclusion that marijuana may not be as harmless as people first believed. I honor that truth by putting my own beliefs and preferences aside. I have an intellectual responsibility to build my beliefs on a foundation of truth rather than personal preferences.

      Secondly, a commitment to spiritual and psychological maturity requires me to put aside all of the various ways I run from life and try to anaesthetize myself from the pain of living in an imperfect world. Our faith equips us to deal with life honestly and in a way that is ultimately productive and life-giving.

      So the use of marijuana is never justified, regardless of all the creative ways we can think of to rationalize it.

      • The commitment to intellectual integrity is exactly why this article is bothersome, as it exceeds the limit of the empirical evidence. No one said it was harmless, only that empirically it is less harmful than alcohol so it should not be considered more dangerous than alcohol. There was a time when alcohol was banned from legal consumption. They had their reasons and evidence of its deleterious effects.
        Your view of spiritual/moral integrity leans towards rejection of created goods which are meant to be a help and consolation on the pilgrimage through life. Would you counsel against anti-depressants if someone suffered from strong PTSD, despite the dangerous side effects or would you counsel the soldier to simply take up his cross? Either way it is not illicit to seek relaxation and relief from stress by using wine and tobacco, it might be imperfect, but you have no right to condemn those who use substances to relieve the high tension of life’s burden. Faith equips us with wisdom to know how to use the goods of the earth proportionately, it never demanded total abstinence: the Cathars did though. The ‘beliefs and preferences’ of the author reveal an unbalanced and unscientific exaggeration of the data and this ultimately leaves the individual Catholic without a balanced body of knowledge to make informed consent or rejection. You have simply assumed that he was right without doing any research yourself! You must be more creative in the ways you rationalize your position.

        • I actually do research for a living and counsel people, so I am more than qualified to make these assessments and assertions. Your argument is ultimately an excuse and justification for drug use, a measure of self-deception perpetuated by far too many people who are drug-seeking. You have a right to your perspective, but do not make any arguments that using drugs is appropriate from a spiritual perspective.

      • I found that interesting as well. Unfortunately Snopes is rarely a reliable source. Sometimes they get it right on urban legends…. but even there they’ve been demonstrably wrong at times. Cameron is addicted to his drug of choice and must justify his addiction. Seen that too many times. I will pray for him to be released from the chains that bind him to addiction.

    • Marijuana has been documented to negatively impact educational achievement. This goes back to the old days of lower THC & is more true today than in the past. Want to take a long time to finish college, get discouraged, run out of money, get depressed: Use marijuana on a regular basis. Even the most pro-marijuana advocates acknowledge “paranoia” after marijuana use. Additionally, it remains in the system 10-45 days.Why would a student accept this? The media has glamorized pot, & there is a lot of money promoting it. I teach nursing school. Would you want a pot head for your nurse?

  2. Don’t use marijuana.
    But it is a medical issue, not a police issue.
    Tax it and regulate it. Just as is done with tobacco, spirits, wine and beer.
    The “war on drugs” is a never ending scam. Simply follow the money.

  3. The irony is that the same politicians and activists who support the legalization of marijuana because prohibition has “failed” and the individual has the right of free choice, will usually support banning guns even though prohibition of guns has not been any more successful than when applied to drugs (less, even).

  4. I work in retail liquor and I see cannabis sales approaching the industry at lightning speed. Most of my coworkers are all for it, I think because it’s liberal and young and freewheeling and cool. The rationale if there is one is “it doesn’t cause cancer like cigarettes,” “it’s not addictive like heroin,” “it’s only addictive like sugar,” “it’s the whole plant without additives,” or my favorite, “jazz musicians need it to stay off heavier drugs.” Relieving pain for cancer patients is now an afterthought, probably because the game is won. The upshot: liberals want what they want, and what they want is to move the goalposts.

  5. Dr. Fitzgibbons is right on here, in my opinion. I have 5 sons of whom 3 have lost their way via the MJ path. One has spent most of his life in state prison, another is in residential treatment mandated by the state as a condition of probation from county incarceration and the third is incarcerated in a county facility. All three have suffered psychological disturbances…delusions of grandeur, paranoia, anhedonia… Sober while incarcerated. Experience is a tough teacher! Prayer is all I have.

    • Sandy, Thank you for having the courage to share your heart-rending story of the tragic consequences of MJ use upon three of your sons.

      I hope that consideration can be given in their psychiatric treatment to the use of antipsychotic medication given by intramuscular injection. At the proper dose, this medication is often effective for many weeks. Its use also has motivated people to pursue sobriety from MJ, to maintain stable relationships and to work.

      Perhaps you might consider sharing your family epidemic of MJ induced psychotic illness with those in states, like New Jersey, that are considering its legalization for “recreational” use.

      My family will pray for your three sons and you.

      • Thank you Dr. Rick for all you do!!! People….Don’t give up praying for your loved ones! I too have a 33 yr. old son who is highly addicted to MJ. He is divorced w/ 2 sons. He has come to hate me but I keep asking him why and he can’t tell me. I am a good Catholic Mom to him and my daughter. She doesn’t use. Since the age of 17 my son has had all the symptoms. He has stolen from my husband (his father) and I, both money and my prescription drugs. He is combative and angry all the time. I thought by now he would have grown out of this. He has no plans for his or his children’s future and barely gets by with a low paying job. He thinks very highly of himself and quit school after High School. He was the big man on campus and all around great athlete in High School. But no college made offers for him, his heart was devastated/ broken. I think this has a lot to do with his start in drug use. We love him and have tried to help him doing novenas for him. But we stopped the help (Not the prayers) because he was taking advantage of us left and right. Stopped giving him money too. His hatred is over whelming for me and I can no longer trust him and it shows. I used to be able to hide my feelings but I can’t any more. I hardly talk to him when I see him. He won’t let us see the grand kids when he feels we are doing him wrong (especially when we try to talk w/ him about his Catholic faith, this REALLY angers him). It hurts so much. He thinks MJ is the only way he can get through life. Please pray for us, son and 2 grandsons!! God Bless you all!

    • Prayers. this is why I am going to become the marijuana story teller. Hope you keep telling people about this.

  6. Honestly there is not enough evidence to make any conclusions about cannabis at this time. The government currently outlaws any research studies that may be in favor of the drug. There are many studies done outside the US that show very promising results using cannabis … BTW, God put this lovely plant on Earth for his children to enjoy & medicate with. We’ve been doing it for 1000’s of years!! I have been using medical cannabis for nearly 40 years … no mental health issues, no psychosis … great job & a pillar in the community.

    • G_d also put respiratory illness, cancer,heart attacks on this earth. G_d also gave us free will and good judgement. If you are untouched but pot, bless your heart but I have seen a different side of pot. I am a nurse.

  7. Alcohol can be consumed to get a buzz or to get mindlessly drunk. For many it becomes a slippery slope. Berenson’s wife treats psychotic patients; his argument and Dr. Fitzgibbons’ clinical observations boil down to a similar insight into the danger of cannabis use. Insecure people turn to it for relief, but the drug can create dependency while complicating their emotional problems with paranoia.
    Dr. F. sharply contrasts the profit motive vs. public health and safety.

    • I have been using cannabis for several months now, sublingual CBD and a CBD/THC ratio. I wanted a way to stop taking tramadal. I have 10 herniated disc tears. I had 11 but one has been fused. I also suffer TMJ,chronic sinusitis,muscle spasm due to a fall that caused me to become disabled. Rectocil also due to fall. chronic migraines that exacerbates pain issues. I have acid reflex. IBS since the fall and it has helped me to be able to think clearer. So I am better able to keep my thoughts clearer. I do understand others opinions, especially the recreational use. I use heat and ice, tens unit as well as medication I’ve also been unable to sit due to the pain. If I should start having psychotic episodes I will go back to tramadol. I think that we should always balance the use of meds, use just enough to a point where the pain is endurable. I’m just thankful that I have a high tolerance for pain. I also go to a counselor to help me to live life on Lifes terms. I’ll be praying for all those in need on this blog and all those in need around the World. Prayer is my favorite form in helping me to cope.

  8. May I ask if using CBD oil for pain relief is as deleterious as smoking MJ? I was to understand within medical circles that the THC is removed and only the good effects are left. Is this true? Does it prevent cancer and is it an anti-inflammatory?

    • My understanding is that when the THC is reduced or removed, it does not have the same effect. You can probably google this and then call your physician to ask about this. Bravo to you for asking.

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