Cannabis is a drug of both ancient and modern times. Cannabis is obtained from the end leaves and seed of the cannabis Sativa plant. Cannabis, which has an average length of 1 meter, is planted in May and June and harvested in October. There are two different genera of this plant, separated as male and female. Although the main active ingredient of the cannabis plant is Delta-9 Tetrahydrocannabinol, it also contains nearly 60 cannabinoid compounds and is not evenly distributed throughout the plant, so its density is different in the leaf, resin, and flower. Cannabis use can lead to cannabis use disorder in the long term.
Common effects of cannabis use disorder are dry mouth, hunger, redness of the eyes, increased blood pressure, and palpitations depending on the amount taken. In chronic use, a decrease in testosterone level and sperm count, infertility in women, and low birth weight of the newborn can be seen. It is known that cannabis, which has psychological effects such as relaxation, increased self-confidence, pleasure, and general well-being, also affects the perception of time and color. It causes a slowdown in attention and reactions. In some people, on the contrary, it can sometimes lead to anxiety, distress, intense fear, and panic attacks.
For years it was known that intolerance to the effects of cannabis does not develop, as long-term users of cannabis reported that they were ‘high’ even after the first cigarette. However, recent studies show that this is not the case, tolerance develops and both biological and psychological addiction can develop. As a matter of fact, in a study, it was observed that individuals using high amounts of cannabis for a few weeks had withdrawal symptoms such as restlessness, insomnia, decreased appetite, weight loss, and intolerance.
Emotion-thought disorders related to marijuana use are a condition that psychiatrists have started to see frequently in recent years. Especially in people who use cannabis for a long time and large amounts of cannabis, a sudden onset of hallucinations, emotional ebb and flow, confusion, and hallucinations develops. Sometimes, it can cause schizophrenia-like pictures. There are many hypotheses trying to explain this, the most important of which suggest that patients have an underlying genetic predisposition.
Some studies show that cannabis use directly affects the brain, causing a schizophrenia-like picture. It has been reported that the risk of developing schizophrenia in cannabis users is almost 2 times higher in the last year. The effect of marijuana on the brain is not limited to this. There is also a decrease and destruction of the brain volume called atrophy in the brain due to cannabis use.
The misconception among the general public is that cannabis addiction is less severe than other addictions. However, like other substances, cannabis causes social, behavioral, and psychological problems. Marijuana use may trigger the development of psychosis in susceptible individuals and cause the first episode of schizophrenic patients to appear at an early age. It is also a fact that individuals who use cannabis frequently abuse or become addicted to other substances.
There is no specific treatment yet to reduce cannabis withdrawal symptoms as drug therapy. Drugs such as bupropion, Divalproex, naltrexone, and nefazodone were tried in the studies, but no positive response was obtained. Therefore, the treatment of cannabis withdrawal is symptomatic. Among the psychotherapeutic methods to treat cannabis withdrawal symptoms, short motivational approaches, skill-building therapies, and relapse prevention therapies are the most frequently used methods.
Detailed Information About Cannabis Use Disorder
Cannabis is a psychoactive drug derived from the dried leaves and flowers of the cannabis plant. It contains over 400 chemicals. The main active ingredient of these is THC (tetrahydrocannabinol). Apart from dried cannabis, different varieties are sold as resin cannabis and liquid cannabis (hashish oil). It can be smoked as a cigarette or with apparatus such as pipes and cigars. It is also common to consume it with methods similar to hookahs, such as bongs. There are also alternative forms of consumption such as coffee, tea, or cake. The potency of cannabis also varies according to the consumption pattern.
Cannabinoid receptors in the brain are more intense in the regions responsible for functions such as pleasure, memory, thought, concentration, sense, time, perception, and motor movement. Therefore, cannabis shows its effect mostly in these areas. Within half an hour of smoking marijuana: leads to an increase in heart rate, a decrease in blood pressure, and a relaxation of the muscles. Redness of the eyes, dry mouth, overheating, or feeling cold. After a while, slow down in time, sensory perception disorders (especially exaggerated perception) occur. Memory and learning are weakened, thinking and problem-solving speed slow down. The person relaxes and coordination is impaired. There is an extreme state of euphoria, characterized by fits of laughter. People can talk a lot compared to normal. After use, the appetite may be observed, especially towards sugary foods.
Sometimes, after these symptoms, intense negative emotions such as anxiety, fear, restlessness, or depression may also occur. The severity of these feelings varies depending on the dosage used, the way of use, and the current mood of the person. Permanent drowsiness, emotional instability, impairment in motor movements, chest tightness (especially in those who consume with bong, etc.) can be seen in some people. The duration of action of marijuana varies according to the amount and type of use. Its effect lasts for an average of 3 hours in cigarette use. Contrary to popular belief, when the effect period expires, it is not quickly removed from the body.
The length of time that traces of cannabis are found in the body depends on many factors such as metabolic rate, frequency of smoking, the amount smoked, and how long it has been smoked. Similar variables also affect how long cannabis appears in a urine test. For example, a person who has consumed cannabis for the first time is unlikely to have a positive urinalysis 3-4 days after use. However, this period will be much more difficult to detect for long-time heavy marijuana consuming users. There are some studies showing that some users who consume heavy cannabis have positive urine tests for 3 months after the last use. Moreover, urinalysis is not the only option; With hair analysis, detailed information about past use can be obtained. Especially for those who use cannabis frequently and heavily, the most guaranteed way to ensure that cannabis does not appear in tests, especially in cases where a legal process is operating (probation, etc.), is to not use it at all.
Effects of Cannabis Use Disorder on the Brain
Cannabis is a substance that makes the mind blur rather than open. During the use of cannabis, the person feels that he can focus more on his current occupation as the time slows down, the colors are perceived more vividly, the sounds are felt more intensely, and the interest in the environment decreases. Many details that wouldn’t normally get his attention when under the influence of cannabis sound fascinating. The person captures the thoughts and associations passing through his mind more because the mind slows down and evaluates them as if they are more meaningful than they are. Even in group usage, mutual conversations are perceived deeper than they are for the moment. It is from these illusions that many people say that cannabis increases creativity.
Walter Benjamin describes this situation in his book “On Cannabis”, written on his own experiences of use (1927-1934): “You follow the same paths of thought as before. But this time, roses are scattered on the paths.” “Similarly, in another of his experiences: “Bloch (the friend he used with) wanted to tap my knee. I was able to feel this touch long before it occurred and felt it as an extremely disgusting violation of my aura. To understand this, it is important to be aware that with cannabis, all movements seem to acquire some intensity and purposefulness and are therefore uncomfortable.”
For those who consume regularly and by increasing the dose in order to make these illusions permanent, the magical focusing state of the first time disappears, on the contrary, indifference, and unwillingness occurs against everything. The person does not want to work and create something. There are fluctuations in focusing attention. Closing home and smoking marijuana, sleeping, and doing nothing else from morning to night is common in such situations. This depressed and reluctant mood that evokes depression is called “The Amotivational Syndrome”. It is not possible to get out of the lethargic nature of the amotivational syndrome unless the use is discontinued and healthy contact with life is not established. This cumulative process, which can be thought of as temporary introversion, can make the person more vulnerable to other psychological diseases and disorders, with every responsibility he neglected as a burden.
How Bad Can Cannabis Use Disorder Get?
The potency of cannabis has increased gradually compared to previous years. The average THC content in cannabis samples seized in the early 1990s in the United States consisted of roughly 3.7 percent marijuana and 7.5 percent sinsemilla (especially the higher potency marijuana from female plants). By 2013, this rate rose to 9.6 percent marijuana and 16 percent sinsemilla. In addition, different usage methods of cannabis can increase its potency and thus its addiction potential. For example, some cannabis samples obtained by the method (dabbing) where the oil of cannabis is extracted contains THC on average 50 percent and some more than 80 percent. These trends carry the negative consequences of cannabis use to more serious levels than in the past, especially in new users or youth with ongoing brain development.
Many studies in rodents and humans show that cannabis use increases a person’s potential to abuse or become dependent on other substances later in life. For example, according to a study on mice, mice previously treated with THC showed increased behavioral response not only when exposed to THC in later stages, but also when exposed to other drugs such as morphine (see cross-sensitivity phenomenon). However, this is not unique to cannabis. A similar situation to cannabis also applies to alcohol and nicotine. According to research, these substances also prepare the brain to respond to other substances at a higher rate.
In line with these findings, many studies in the field support the idea that alcohol and cannabis may be the first step towards harder substances, especially in the young population. All this is consistent with the idea that cannabis is a “transition substance”; It is also observed that many cannabis users do not start using different and harsher substances later in life. Similarly, we also encounter people who start with substances that are considered more “harsh” without using cannabis and develop addiction only to those substances.
The fact that a substance is legal, easily accessible, and cheap is of course a factor that increases its use. It may be inevitable for a young person who has easy access to cannabis due to the social environment (for example, if he has a parent who smokes cannabis at home), his substance use history starts with cannabis. Or it may be observed that a healthcare professional abuses prescription drugs without using any other substance. As another alternative to the transition substance hypothesis, it can be thought that people who are more genetically susceptible to substance use are more likely to switch to other drugs after a while, even if they start with substances such as cigarettes and cannabis. All of these give us the context, personality structure, social support, predispositions, etc., as well as biological factors. It shows that other factors are also critical in terms of evaluating an individual’s substance use risk.
Cannabis Use Disorder Means Addiction
Long-term cannabis use negatively affects the function of the brain to connect the related areas by reducing thinking, memory, and learning functions, especially when it begins in youth. Marijuana smoke irritates the lungs, so people who frequently consume cannabis may experience breathing problems such as persistent coughing, phlegm, or bronchitis. These individuals are at greater risk for a heart attack, as cannabis raises the heart rate. Mental disorders can also occur as a result of the long-term use of cannabis.
These disorders can occur during marijuana use or after prolonged marijuana use. Amotivational syndrome, social withdrawal, depression, anxiety disorders (panic attacks, etc.), and suicidal thoughts can be seen. Marijuana can cause temporary symptoms such as hallucinations and paranoia in people using it, as well as increase existing symptoms in schizophrenia patients. It is known that cannabis, even if it does not directly lead to a psychiatric disorder, can trigger the emergence of discomfort in people susceptible to any psychiatric disorder.
Overstimulation of the endogenous cannabinoid system with marijuana use causes changes in the brain that can lead to addiction in the process. The person in such a situation begins to determine his priorities according to cannabis and even if it causes negativity in his life, he cannot prevent its use. Since some users experience milder physical withdrawal symptoms (sometimes associated with depression) when cannabis is stopped, it can be overlooked by the user. Despite this, craving, which users often describe as a “habit” or “psychological addiction”, that is, an intense desire to use it again is common. Contrary to popular belief, this situation is at least as biological as physical deprivation symptoms.
In the medical field, cannabis has been used in the past centuries for migraine treatment, bleeding, births, and diseases such as epilepsy, due to its pain-relieving and relaxing effects. Today, there are some studies on the effectiveness of cancer in the treatment of chronic pain, anorexia, and nausea. Similarly, some research findings have been obtained indicating that there is an improvement in weight loss, anorexia, nausea, and general mood due to AIDS. Its reducing effects on sleep disorders, multiple sclerosis, premenstrual syndrome, mood disorders, and opioid withdrawal symptoms have also been found in some studies.
Of course, the use of cannabis in the medical field is not meant for regular cigarette use. Its use as an alternative treatment, especially for the side effects of various diseases, is being investigated over a period of time under the supervision of a doctor in optimal doses. The long-term effects of cannabis use on diseases are not yet known. At present, the addictive effect of cannabis remains a risk factor.
Treatment of cannabis addiction includes studies such as decontamination of the person from the substance, reducing the withdrawal symptoms experienced, preventing relapse, treatment of possible psychological disorders accompanying addiction, eliminating vital problems that may trigger use, and gaining a healthy coping skill with emotions. All these studies are planned individually within the framework of the person’s usage history and personal predispositions-needs.
Stopping use alone is not a sufficient treatment. Every addiction has gaps in a person’s life. As the disease becomes chronic, the areas filled with addiction expand, swallowing all the other resources the person feeds on, such as black holes. Taking a person in such a situation away from his dependency is like taking a piece of himself; The broken part must be filled with healthy equivalents. Otherwise, after a while, the person may lose their recovery motivation and return to their old habit. Psychotherapy is one of the cornerstones of permanent healing so that the person can access the internal resources that already exist and acquire new vital skills.
Mechanism of Action of Cannabis Use Disorder
Apart from tobacco, the substance most commonly used in the form of a cigarette is cannabis. Cannabis is known as Marijuana (herbal cannabis) in the world and consists of dried leaves and flowers of the Cannabis sativa plant. It has been found that 50% of Americans have used marijuana at least once in their lives. It has been stated that the rate of cannabis use among young people in Australia is 7% in the 13 age group and 40% in the 17 age group.
Although the figures for 2003 in our country show that this rate is around 4% for young people studying at high school and equivalent schools, it is estimated that this figure has increased. People who start using cannabis initially use it to get the euphoria (joy, vitality, happiness) the substance gives off. It can be said that approximately 4% of the users meet the addiction criteria within the first two years. The low average income level, the fact that different substances have been tried before cannabis, and the use of cannabis in the early stages of adolescence are important risk factors for addiction. Showing someone older than their age, smoking, looseness in contact and relationship with parents at home, school absenteeism, low self-esteem, and underestimating or underestimating school success also put the person in the risk group in terms of cannabis addiction.
Marijuana can also be taken orally by sucking and chewing, but the most common way of use is ingestion as a cigarette. Its main psychoactive substance is delta 9 tetrahydrocannabinol (THC). In addition to delta 9 tetrahydrocannabinol, which is the main psychoactive component in marijuana smoke, 400 other chemicals have been reported. Central nervous system effects are directly related to the rate at which the substance reaches the brain, smoking is one of the fastest ways to achieve this, with cannabis reaching the brain a few seconds after inhalation.
It has been claimed that cannabis affects the reward and stress system of the brain just like opiate (heroin), cocaine, and nicotine. Like nicotine and cocaine, cannabis (cannabis) also increases dopamine in the mesolimbic region. THC accumulates in the brain and adipose tissue, its ability to dissolve in fat gives THC (cannabis) a kind of storage feature, therefore the rate of excretion is low. Sometimes, the body’s clearance period from cannabis can take between 3 weeks and a month.
Psychological and physiological changes begin to be seen within half an hour following the use of cannabis. The first to appear is a feeling of euphoria and relaxation. Motor coordination (balance) gradually deteriorates, a perception of slowing arises in time. Although it varies according to the amount of the substance taken, the route of use (for example, the effects of oral intake are delayed), the individual tolerance and the rate of absorbing the substance, the onset of the effects is between a few minutes and half an hour and may take 3-4 hours. The appearance of at least two of the symptoms of flushing, increased appetite, dry mouth, and tachycardia within two hours after use leads to the diagnosis. Acute cannabis intoxication (cannabis poisoning) sometimes requires immediate intervention. Often, it can be applied to the emergency room with a feeling of intense psychological stress, anxiety, and fear. Cannabis can trigger panic attacks, paranoia, anxiety, and even schizophrenia.
Young people in whom cannabis is tolerated in some Western European countries are often perceived as evidence that the substance is less harmful and less addictive. However, the truth is not so, the reason for this tolerance is the idea that substance tracking and addiction can be controlled more easily in this way. Recently, some scientific studies conducted in the Netherlands revealed that cannabis use is responsible for almost all of the schizophrenia cases in the world. Because of this evidence, cannabis will become an increasingly regulated substance. It has been observed that there are school and learning difficulties due to memory and concentration impairment, and these increase with the length of the use. Depression and suicide attempts are also eight times more common in the group with cannabis addiction than in those without.
There is no specific treatment for acute poisoning, and it is symptomatic. Benzodiazepines can be beneficial for reducing intense anxiety. If paranoia and psychotic symptoms do not subside after benzodiazepine use, it may be necessary to use antipsychotics for a certain period of time. Combined treatment strategies including some antidepressants, divalproex sodium, and THC antagonist (action blocker) rimonabant hydrochloride are promising. The treatment should be continued for at least 6-8 months with a combination of psychotherapy and medication, changes in setting, school, environment, and lifestyle are very helpful for permanent recovery.
Cannabis Use Disorder and Its Treatment
Cannabis sativa, the cannabis plant used in Central Asia and China for at least 4000 years, is a durable, aromatic annual plant. The bioactive substance derived from it is called cannabis. According to estimates, cannabis is the most used illicit substance in the world. All cannabis Sativa segments contain psychoactive cannabinoids, with (-) – Δ9-tetrahydrocannabinol (Δ9-THC) being the most abundant. The most effective form of cannabis is obtained from the flower part of the plant called hash or hash, or from the dry, brown-black, resinous leak in the leaves. The marijuana plant is usually cut, dried, cut into small pieces, wrapped in a cigarette (called a joint), and smoked.
According to the “Monitoring the future” monitoring studies conducted in adolescents in schools, as a continuation of a trend that started in the early 1990s, the new use of marijuana in the 8th and 10th grades daily, lifelong, annually, and recently (in the last 30 days) It was found that there was an increase. Another measure of the prevalence of marijuana use is the National Household Study on Substance Abuse conducted on population-based random households in the USA. According to the study, marijuana is the most commonly used illegal substance. Its lifetime prevalence increases in all age groups up to the age of 34 and decreases gradually in later ages. In the 18-21 age group, marijuana use is highest in the last year (25%) and last month (14%), while it is lowest (1% and below) over 50 years old.
According to DSM-IV-TR, the lifelong rate of cannabis abuse and addiction is 5%. Race and ethnic groups are also associated with marijuana use, but this relationship varies by age group. In the 12-17 age group, whites have a higher lifetime and last year use rate than blacks. In adults 17-34 years, the lifetime use rate is higher in whites than blacks and Hispanics. However, it has been reported that the usage rates are the same in black and white people aged 35 and over. The lifetime usage rate in black adults is significantly higher than in Spaniards. When cannabis is smoked like a cigarette, its euphoric effect appears within minutes, reaches its highest level in 30 minutes, and lasts in 2-4 hours.
Some of its motor and cognitive effects last 5-12 hours. Marijuana can be taken orally in foods such as brownies and muffins. The oral intake of cannabis should be 2-3 times that of the inhaled, in order to achieve the effect obtained by inhalation of its smoke. The psychoactive effects of cannabis vary depending on the strength of the cannabis used, the method of use, the using technique, the effects of pyrolysis on the cannabinoid content, the dose, the place used, the end experience of the user, the user’s biological predisposition to the effects of cannabis.
Dry mouth, hunger, reddening of the eyes due to cannabis use, increased blood pressure, and palpitations depending on the amount taken are common effects. In chronic use, a decrease in testosterone level and sperm count, infertility in women, and low birth weight of the newborn can be seen. It causes a slowdown in attention and reactions. In some people, on the contrary, it can sometimes lead to anxiety, distress, intense fear, and panic attacks. The effect of cannabis on a person depends on many factors such as the strength of the cannabis to be smoked, what the drinker expects from cannabis, the presence of alcohol or other substance that is taken with it, and the way the cannabis is taken. Marijuana has psychological and physiological withdrawal symptoms, such as restlessness, insomnia, decreased appetite, weight loss, and intolerance.
It is observed that the person laughs unnecessarily while under the influence of cannabis. Sometimes, on the contrary, fear, and panic prevail. Loss of balance, reddening of the eyes, slowing of reflexes, and forgetfulness can also be seen. After the effect of marijuana wears off, sleepiness, fatigue, and restlessness are observed. Emotion-thought disorders related to cannabis use are a condition that we psychiatrists have frequently seen in recent years. Especially in people who use cannabis for a long time and large amounts of cannabis, a sudden onset of hallucinations, emotional ebb and flow, confusion, and hallucinations develops. Sometimes, it can cause schizophrenia-like pictures. The effect of marijuana on the brain is not limited to this. There is also a decrease and destruction of the brain volume called atrophy in the brain due to cannabis use.
Treatment of marijuana use (abstinence and support) includes the same principles as the treatment of other abuses: Abstinence is achieved by outpatient monitoring, which is controlled by either a direct approach, such as hospitalization, or urine tests that detect cannabis within 4 weeks of use. Supportive treatment is provided by the individual, family, and group therapies. Education is an important point in deprivation and support programs. Patients who do not understand the intellectual reasons for a substance use problem treatment show little motivation to leave. In some patients, it may be beneficial to use short-term anxiolytics to relieve withdrawal symptoms. In some patients, cannabis use, which may be associated with underlying depression, responds to antidepressant treatment.