Addiction is a harmful disorder that involves an individual getting habitual to a drug. It involves an insistent need for a drug or habit that can have serious negative effects on the body. Repetitive use can lead to changes in brain functioning, increase dependency on the drug, and weaken the self-control of an individual (West & Brown, 2013). Many drugs provide an initial “hit” which is characterised by elation and loss of control over the senses. This can also be understood through Substance abuse and dependency. When the use of drugs leads to negative consequences in personal and professional life, it is termed substance abuse. It turns to substance dependency when an individual becomes physically and mentally reliant on the drugs (West & Brown, 2013). Cannabis or Marijuana is one such harmful drug that can lead an individual to become dependent on it because of the psychotic effects it produces, which induces euphoria in an individual. Keeping this in mind, this paper will analyse the case of Nav, a Cannabis addict who has been facing problems in his personal and professional life in reference to appropriate theories and research. Moreover, this paper will also discuss treatments and interventions that could target cannabis addiction.
Marijuana is associated with serious drug addiction throughout the world. It has been given many names like weed, grass, pot, ganja, and mary jane (Mechoulam, 2019). The drug is derived from the leaves, stems, flowers and seeds of the Cannabis sativa, containing a psychotic chemical known as delta-9-tetrahydrocannabinol (THC) and other associated compounds (Mechoulam, 2019). Cannabis intake is done through a joint or a hand-rolled cigarette or in a pipe. Cannabis is also used for medicinal purposes and targets problems such as pain and muscle spasms. Recently, it has also garnered attention for use as pain and nausea relief medication, especially for Cancer and HIV/AIDS patients (Lutge et al., 2013). The drug affects the cannabinoid receptors of the brain cell, which in turn affect memory, pleasure, time and sensory perception, thinking, and concentration (Mechoulam, 2019). An associated effect on the brain could create a feeling of elation or euphoria Thus, marijuana or cannabis has the potential to affect the brain and become an addiction.
Addiction or substance abuse and dependency on cannabis are probable and difficult to control. An overuse of marijuana could lead to several health issues, particularly, lung and heart diseases and mental health conditions. Cannabis smoke irritates the tissues of the lungs and can cause respiratory problems which are associated with coughing and production of phlegm, risk of lung infections, weakness of the immune system, fertility issues, and increased blood pressure and heart rate (Colizzi & Bhattacharyya, 2018). High doses of the drug also cause psychotic reactions. It is also associated with other mental health problems such as personality disturbances, psychosis, depression, anxiety, suicidal thoughts, and motivation to participate in personal and professional life (Curran et al., 2016). Moreover, the intake of cannabis by pregnant mothers can affect the attention, memory, and problem-solving of their children (Curran et al., 2016). An addiction to the drug is common and is characterised by behavioural changes such as impaired coordination, distorted perceptions, and problems with learning, memory, and problem-solving (Curran et al., 2016). Physical signs include bloodshot eyes, rapid heartbeat, paranoia, hunger, dry mouth, and slow reaction time (Curran et al., 2016). Thus, cannabis has serious implications on the mental health and body of an individual.
Keeping the effects of marijuana in mind, Nav showed similar symptoms. Nav has reported that he has been smoking joints and taking cannabis through a vaping pen for many years. He has been smoking for 27 years which has developed from a habit to smoke in social settings to an addiction with stronger cravings and has increased to daily smoking. While cannabis is targeting his anxiety and helping him fall asleep, there have been negative consequences of the drug as well. He has reported that he needs a higher dose to “take the edge off” and experiencing symptoms of paranoia. Moreover, he is unable to handle the responsibilities of his personal life such as the inability to be present for his family and take up the financial burden of their family. Moreover, he has also reported that he has not been able to attend social events, both related to his family and his children, which has also affected the lives of his family. Since he is unable to quit because of his body’s reaction to the deprivation of the drug such as poor and restless sleep, sweating, lack of appetite, irritability, anxiety, and cravings for Cannabis, his body has shown withdrawal symptoms for Cannabis. Thus, Nav has shown symptoms of Cannabis addiction.
After analysing Nav’s symptoms, it can be reported that he has Cannabis Use Disorder. According to DSM-V, Cannabis Use Disorder is an unhealthy pattern of cannabis use that might lead to significant clinical impairments or distress. To be diagnosed as a patient with cannabis use disorder, two of the following requirements should be met in the last 12 months (American Psychological Association, 2013). Intake of cannabis more than intended, unsuccessful efforts to stop its use, time spent in obtaining, using, and recovering cannabis, craving for the drug, inability to fulfil obligations in personal and professional life, the persistence of cannabis use despite interpersonal problems, loss of important social activities, intake during situations that might cause physical harm, use of cannabis despite understanding the problems, tolerance to Cannabis which increases the drug intake or does not give the same effect in usual amount, and showing withdrawal symptoms and relieving them through cannabis (American Psychological Association, 2013). Thus, Nav has cannabis use disorder since he is unable to stop cannabis intake, has cravings, is unable to fulfil social, personal, and professional obligations, and has shown tolerance and withdrawal to the drug, which should be treated through proper intervention.
The main interventions and treatments for Cannabis Use Disorder include medications, talk therapy, motivational incentives, and Motivational Enhancement Therapy (MET). Out of these, medications and motivational enhancement therapy (MET) would offer the most effective treatment to target Nav’s Cannabis Use Disorder. Medications or psychopharmacology ensure that an individual’s various symptoms and urges related to cannabis can be curbed through drugs (Cohen et al., 2013). This is ensured through a combination of different types of drugs. Weinstein and Gorelick (2012) cumulated different studies and trials that tested out different drugs for controlling cannabis use disorder on different groups of people. Anti-depressants such as nefazodone, fluoxetine, and lofexidine + THC improved anxiety, reduced cannabis use and reduced withdrawal respectively (Weinstein & Gorelick, 2012). Dopamine drugs such as Entacapone reduced craving while norepinephrine reuptake inhibitor reduced cannabis use when addiction is weak (Weinstein & Gorelick, 2012). Buspirone was found to be effective in reducing craving and irritability of cannabis withdrawal and overall cannabis use (Weinstein & Gorelick, 2012). Lithium was also found to be effective in reducing cannabis use (Weinstein & Gorelick, 2012). Thus, there are many drugs that have been found effective in treating an individual’s cannabis dependence.
Nav’s dependency on Cannabis could be targeted with a combination of drugs listed before. Firstly, fluoxetine, buspirone, and lithium should be administered between 20-40g, up to 60mg, and at least 500mg to reduce the initial cannabis use (Weinstein & Gorelick, 2012). At the same time, Entacapone should be administered in a dose of 200mg so that Nav has reduced cravings for the drug (Weinstein & Gorelick, 2012). While these dopamine agents would control the cravings for the drug, Nav would still show some withdrawal symptoms such as anxiety and irritability. Such symptoms as well as other symptoms could be curbed if Nav is administered with 450mg of nefazodone, 2.4mg and 60mg of lofexidine + THC, and up to 60mg of buspirone (Weinstein & Gorelick, 2012). Medications provide a short-term yet effective intervention for people with substance abuse. As seen in different trials and studies, cannabis use disorder can be controlled by the initial use of medicines since these drugs target the cannabinoid receptors of the brain cell and either nullify or reduce the effect of cannabis (Weinstein & Gorelick, 2012; Williams & Hill, 2019; Sherman & McRae-Clark, 2016). Thus, medications provide an important treatment strategy for cannabis use disorder.
Another useful intervention could be the use of motivational enhancement therapy. The therapy is a person-centred approach that focuses on changing an individual’s motivation to change their habits and behaviour (Almutairi, 2021). This therapy focuses on individuals who are aware of the negative impacts of their behaviour but are unable to modify their behaviour. There are several goals to this therapy. The primary one is to help people overcome their resistance to change of behaviour (Almutairi, 2021). This therapy increases the intrinsic motivation of individuals to make them aware of their problematic behaviour, adjust their self-defeating thoughts, and increase confidence in their ability to change. The therapist encourages the patient/client to recognise the problem and use self-motivating statements (Almutairi, 2021). While MET is used as a stand-alone treatment, it produces better effects when it is integrated with other therapies such as Cognitive Behavioural Therapy (CBT) (Wu et al., 2016; Lenz, 2016; Yonkers et al., 2012). Moreover, MET has five principles: empathy, discrepancy, argumentation, resistance, and self-efficacy. The therapist expresses their empathy and actively listens to the client’s issues while directing the client’s attention to the discrepancy in the client’s actual state of being and their desired state of being (Almutairi, 2021). While avoiding direct attacks on the client’s behaviour, the therapist tries to diffuse the client’s resistance (Almutairi, 2021). Lastly, the therapist makes the client aware of their self-efficacy so that there are better and faster changes in them. Thus, motivational enhancement therapy is a powerful tool to control an individual’s negative behaviour such as their cannabis dependency.
Nav’s cannabis dependency could be targeted through motivational enhancement therapy. This would support the initial intervention of medications in controlling Nav’s cannabis use disorder. This therapy has been found effective in reducing the severity of substance use (Lenz et al., 2016; Stockings et al., 2016). Since Nav is aware of his dependency and its negative consequences, this therapy would help him overcome his resistance to changing his habits and controlling his urges and cravings for cannabis. Moreover, with factors such as self-efficacy and a need for positive change, Nav would also realise the importance of his family and work for curbing his dependency for their sake. Thus, motivational enhancement therapy (MET) would provide Nav with the confidence and empowerment that is required to control his cannabis dependency.
To conclude, cannabis is a substance or drug which is made of components like delta-9-tetrahydrocannabinol (THC) and its related compounds which affect the cannabinoid receptors of the brain cell. This drug is derived from the Cannabis sativa plant and gives a momentary high to people. Cannabis or marijuana is also used for medicinal purposes to give pain relief to cancer and HIV/AIDS patients. The overuse of this drug culminates in cannabis addiction, also known as cannabis use disorder or cannabis dependency. When cannabis affects the physical and psychological functioning of an individual along with their personal, professional, and social lives, cannabis use has developed into cannabis use disorder. Some of the symptoms as depicted in DSM-V have also been found in Nav, making him a patient of this disorder. It is suggested that medications and motivational enhancement therapy (MET) should be used for intervention and treatment of Nav’s cannabis dependency. The use of medications would include preparing a range and combination of drugs which would target different facets of Nav’s dependency. On the other hand, motivational enhancement therapy would allow an individual to have the motivation and empowerment to change their negative behaviour.
References
Almutairi, A. M. M. (2021). Principles of drug addiction treatment. Int J Med Dev Ctries, 5(2), 1523-7. https://ijmdc.com/fulltext/51-1609883100.pdf
American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). American Psychological Association. http://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20%28%20PDFDrive.com%20%29.pdf
Cohen, L. M., Collins Jr, F. L., Young, A., McChargue, D. E., Leffingwell, T. R., & Cook, K. L. (2013). Pharmacology and treatment of substance abuse: Evidence and outcome based perspectives. Routledge.
Colizzi, M., & Bhattacharyya, S. (2018). Cannabis use and the development of tolerance: a systematic review of human evidence. Neuroscience & Biobehavioral Reviews, 93, 1-25.
Curran, H. V., Freeman, T. P., Mokrysz, C., Lewis, D. A., Morgan, C. J., & Parsons, L. H. (2016). Keep off the grass? Cannabis, cognition and addiction. Nature Reviews
Neuroscience, 17(5), 293-306. https://discovery.ucl.ac.uk/id/eprint/1489385/1/Curran%2520et%2520al%2520NRN-2016%2520pdf.pdf
Lenz, A. S., Rosenbaum, L., & Sheperis, D. (2016). Meta‐analysis of randomized controlled trials of motivational enhancement therapy for reducing substance use. Journal of Addictions & Offender Counseling, 37(2), 66-86. https://doi.org/10.1002/jaoc.12017
Lutge, E. E., Gray, A., & Siegfried, N. (2013). The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database of Systematic Reviews, (4). https://sativaisticated.com/wp-content/uploads/2017/06/e-medical-use-of-cannabis-for-reducing-morbidity-and-mortality-in-patients-with-HIV-AIDS-Cannabis-Marijuana-Research-for-HIV-AIDs.pdf
M Weinstein, A., & A Gorelick, D. (2011). Pharmacological treatment of cannabis dependence. Current pharmaceutical design, 17(14), 1351-1358. https://doi.org/10.2174%2F138161211796150846
Mechoulam, R. (2019). The pharmacohistory of Cannabis sativa. Cannabinoids as therapeutic agents, 1-20.
Sherman, B. J., & McRae‐Clark, A. L. (2016). Treatment of cannabis use disorder: current science and future outlook. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(5), 511-535. https://doi.org/10.1002%2Fphar.1747
Stockings, E., Hall, W. D., Lynskey, M., Morley, K. I., Reavley, N., Strang, J., ... & Degenhardt, L. (2016). Prevention, early intervention, harm reduction, and treatment of substance use in young people. The Lancet Psychiatry, 3(3), 280-296.
West, R., & Brown, J. (2013). Theory of addiction.
Williams, A. R., & Hill, K. P. (2019). Cannabis and the current state of treatment for cannabis use disorder. FOCUS, A Journal of the American Psychiatric Association, 17(2), 98-103. https://doi.org/10.1176/appi.focus.20180038
Wu, S. S., Schoenfelder, E., & Hsiao, R. C. J. (2016). Cognitive behavioral therapy and motivational enhancement therapy. Child and Adolescent Psychiatric Clinics, 25(4), 629-643. http://dx.doi.org/10.1016/j.chc.2016.06.002
Yonkers, K. A., Forray, A., Howell, H. B., Gotman, N., Kershaw, T., Rounsaville, B. J., & Carroll, K. M. (2012). Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery. General Hospital Psychiatry, 34(5), 439-449. https://doi.org/10.1016%2Fj.genhosppsych.2012.06.002
