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.
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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