Thursday, April 10, 2008

Marijuana Withdrawal? What Marijuana Withdrawal?


AlterNet article calls pot addiction "laughable."

Wondering why you're feeling anxious, sleepless, irritable, sweaty, and scared when you stop daily pot smoking? Don't worry, Paul Armentano has the answer: You're full of bullshit.

Armentano, in an article for AlterNet entitled "B.S. on the idea of 'marijuana addiction'," asserts that "there's little consensus that such a syndrome is clinically relevant -- if it even exists at all."

The proof? "According to state and national statistics, up to 70 percent of all individuals in drug treatment for marijuana are placed there by the criminal justice system. Of those in treatment, some 36 percent had not even used marijuana in the 30 days prior to their admission. These are the 'addicts'?"

No, these are not necessarily the addicts. These are people undergoing mandatory treatment dictated by the criminal justice system. As Armentano points out, they may or may not have been using drugs before their court-mandated treatment sessions.

In contrast, marijuana addicts are people with a propensity for addiction who suffer a clearly delineated, verifiable, and vivid set of withdrawal symptoms when they try to quit. Armentano doesn't seem to have much interest in this cohort.

Armentano cites a study by the nonpartisan National Academy of Sciences Institute of Medicine--and then completely misses the point. According to the report, "[A]lthough [some] marijuana users develop dependence, they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs."

What part of "some marijuana users develop dependence" does Armentano not understand?

The author appears to be making the common mistake of assuming that if pot causes withdrawal in some people, then it must cause withdrawal in everybody. And if it doesn't, it's not very addictive. This kind of thinking has been overtaken by the growing understanding that a minority of people suffer a chemical propensity for addiction that puts them at high risk, compared to casual, recreational drug users. The fact that most people don't get addicted to pot and don't suffer from withdrawal is no more revealing than the fact that a majority of drinkers do not become alcoholics.

The author further suggests that, since the Institute of Medicine report characterizes symptoms of weed withdrawal as "mild and subtle," there is nothing to this subject but hot air. Another way to think of "mild and subtle" is: not potentially life threatening, as in the case of abrupt withdrawal from alcohol. Pot doesn't kill. But we knew that already.

In addition, the author highlights the Institute of Medicine's estimate that "fewer than 10 percent of those who try cannabis ever meet the clinical criteria for a diagnosis of "drug dependence" (based on DSM-III-R criteria)." But this common estimate falls right in line with overall estimates placing the total addictive population for all drugs at between 10 and 15 per cent of the population.

Perhaps the most egregious error in the piece is the assertion that "pot's mild after-effects do not appear to be either severe or long-lasting enough to perpetuate marijuana use in individuals who have decided to quit." This statement is simply not true, as an overwhelming number of heavy pot smokers can attest. (For dozens of case histories that refute this contention, see the comments section of my post, Marijuana Withdrawal.)

The author also asserts that "the concept of pot addiction is big business," but it is unclear what he means by this, beyond his dismissive vote-of-no-confidence on anti-craving medications as an adjunct to addiction treatment.

I do, however, agree completely with Armentano on one point: None of this justifies "the continued arrest of more than 800,000 Americans annually" for pot violations.

Photo Credit: Javno

17 comments:

Anonymous said...

"The author appears to be making the common mistake of assuming that if pot causes withdrawal in some people, then it must cause withdrawal in everybody. And if it doesn't, it's not very addictive. This kind of thinking has been overtaken by the growing understanding that a minority of people suffer a chemical propensity for addiction that puts them at high risk, compared to casual, recreational drug users. The fact that most people don't get addicted to pot and don't suffer from withdrawal is no more revealing than the fact that a majority of drinkers do not become alcoholics."

So can we not rank addictions? I would propose that the existence of some tiny proportion of pot smokers that appear to have some mild complications associated with discontinuing use does not make pot particularly addictive.

Sure, some few people have problems. But there aren't that many of them, and the problems are that bad. The fact that many few pot smokers, percentage-wise, develop problems than heroin users and alcohol users IS significant, and as such, marijuana addiction deserves the relative scorn heaped upon it.

And, finally, you cannot die from heroin withdrawal as you can from alcohol. http://www.drugrehab.co.uk/FAQ-heroin.htm

Anonymous said...

paragraph 3, line 1, should read:
"problems ARE that bad" = "probelms AREN'T that bad"

Apologies.

Dirk Hanson said...

"marijuana addiction deserves the relative scorn heaped upon it."
----
I don't believe that any true, clinical state of addiction deserves scorn--even the allegedly milder, "psychological" withdrawal effects of weed.

We can certainly rank addictions, but it's a tricky business--one addict's drug of choice is another addict's least favorite boost. We can say things like, the machine-rolled cigarette is the most addictive substance known to man--but if you are a nicotine "chipper" who smokes, say, one to three cigarettes a week,(such people exist), that's not going to mean very much. As a chipper, you're going to tend to believe that addicted cigarette smokers are weak. Or perhaps deserving of scorn?

Thanks for catching the misstatement about heroin withdrawal.

Anonymous said...

True: I perhaps overspated the case by using the word scorn. But the issue here, I think, is deeper than simply a ranking of addictions.

The issue hinges, I think, on the definition of addiction. Fundamentally, do we believe in an essentializing concept of addiction or a purely physiological one? I think you're trying to have it both ways. You don't delineate the specific symptoms of this condition--largely because, as Armentano suggests, it's not a physiological dependency distinguishable in some meaningful way from an addiction to chocolate, gambling, or masturbation. But you do suggest that research adn grant money are warranted, and that this is a "real" thing we're dealing with, which implicitly rejects the Armentano argument that marijuana addiction is fundamentally similar to that of other things that we simply "like" quite a bit.

If we can, as Stanton Peele (1995) suggests, be addicted to anything (as distinguishable from chemical dependency), then why devote time and money to a specific "cure" for marijuana addiction? It's not a chemical dependency per se, and thus is subject to the rules of regular addictions and does not require specific attention.

So, to further drill down the concept of ranking addictions (or more accurately, differentiating them), heroin and nicotine addictions are physiological problems--research can (and has) shown us ways combat the physiological symptoms they display. They, are, to use a more accurate word, dependencies, with an associated psychological component no different than other addictions. Marijuana, in Armentano's argument cannot meet this test and thus does not deserve the special treatment afforded it.

Let's be honest: it is in the interest of the government (i.e., DEA, ONDCP, and NIDA) to continue their propaganda campaign against marijuana--it's an easy target, and to maintain the public's focus upon it distracts from their current (e.g., meth) and historic (e.g., crack) failures to even stem the various drug problems, much less eradicate them. Addictionizing a marginal substance such as marijuana continues their historic wrongheaded trajectory, despite the violence it does to any meaningful concept of addiction.

vivzig@hotmail.com

Dirk Hanson said...

The specific symptoms of the condition are: insomnia, anxiety, extreme irritability, aggression, night sweats, lack of appetite, and depression. I think by any reasonable definition, those qualify as clinical withdrawal symptoms.

It was the similarity of these symptoms to nicotine withdrawal that prompted some admittedly misleading coverage of the "pot is as addictive as cigarettes" study you mentioned.

This goes far deeper than so-called addictions to behaviors like sky diving and sex. Pot makes specific alterations in limbic reward circuitry like all other psychoactive drugs.

I's unfortunate that the unfolding scientific understanding of marijuana withdrawal in addiction-prone individuals can be used as propaganda for government efforts at marijuana enforcement. As a proponent of decriminalization and harm reduction, I'm not pleased about that part, either.

But the truth is, the vast majority of marijuana smokers have no trouble quitting whenever they want to--that hasn't changed. The same is true of speed, for that matter, or else everybody who ever studied all night on diet pills would still be hopelessly addicted.

Only a minority of users ever have to worry about addiction of ANY kind--but that is a problematic form of Russian roulette.

Finally, I don't find Stanton Peele's arguments about the "myth of addiction" at all compelling. There are far better sources of information available.

charles queen said...

Marijuana cannot be called an addictive drug simply because it is nota physically addictive drug only mentally addictive

Anonymous said...

See, that's where I think a certain cognitive dissonance comes in--we have this physiological sounding explanation for pot addiction: "Pot makes specific alterations in limbic reward circuitry like all other psychoactive drugs."

Does LSD make these same changes? Does heroin make these changes? When I smoke on the weekends, is my limbic system altered? And the answer no--just certain people. But not the same people, since levels of addictive behavior obvious differ. And is it really roulette? Is everyone equally likely to get this "disease" Of course not. And, to be honest, true addicts--say, alcoholics--are hard to find. Much more likely are the Betty Ford kind.

The conservative way you've phrased it is admirable--but it still leaves us with a pathological (extreme) minority displaying randomly general symptoms that are not the same for everyone, rather vague, and would lead an MD to throw up his hands.

Anonymous said...

As for Peele, I don't buy every he has to say either. But it makes a heck of a lot more sense than addiction as a clinical disorder. The fact is that most people most of the time get over their addictions without the help of treatment, which is the raison de etre for labeling it a disease in the first place.

Dirk Hanson said...

"but it still leaves us with a pathological (extreme) minority displaying randomly general symptoms that are not the same for everyone, rather vague, and would lead an MD to throw up his hands."
-----

I don't really disagree. But MDs also routinely throw up their hands at the cornucopia of symptoms thrown their way by another extreme minority--alcoholics. The description you offer above would also fit the conditions known as clinical depression, acute anxiety, premenstrual syndrome, obsessive-compulsive disorder.... or almost any other physical disorder which happens to be accompanied by strong psychological symptoms.

Anonymous said...

Addiction is a nasty word nobody wants to see next to his/her name- especially in association with what cultural and artistic perspectives present as some herbal pleasure. I myself was one those people reluctant about calling it an "addiction". First hand experience and research I was able to follow suggest otherwise.

Not every addiction has to present itself with some nasty withdrawal symptoms like those commonly portrayed in the case of hard-drug abuse. Yet just because an 'herbalizer' is not going through withdrawal experience comparable to that of an abuser of opiates, it doesn't mean that the chronic smoking is free of somatic-dependency or easy to shake without physiological effects.

An example perhaps easier to follow: Statistics show that many post- industrial western countries have a TV viewing average of 4 hours a day per individual, affecting people's communication skills inside and outside home, eating and sleeping habits, perception of reality, and overall quality of lifestyle. Although that might not call for some television-holics anonymous, it is hard not to notice the addictive pattern to it.

My point? Suggesting that a substance that 1) affects one's hormonal system, 2) alters the functioning of endocannabinoid receptors and 3) gets to be stored in fat cells is not going to have any physiological effects due to its presence as well as absence is not only unscientific but also illogical. It is a prime example of juvenile ignorance.

Dirk Hanson said...

"Suggesting that a substance that 1) affects one's hormonal system, 2) alters the functioning of endocannabinoid receptors and 3) gets to be stored in fat cells is not going to have any physiological effects due to its presence as well as absence is not only unscientific but also illogical."
----------

Couldn't agree more.

As one doctor told me, “Why are we so surprised that when you take a drug a thousand times, it makes some changes in your head? It MAKES SENSE that drugs change things.”

Anonymous said...

[QUOTE] As one doctor told me, "Why are we so surprised that when you take a drug a thousand times, it makes some changes in your head? It MAKES SENSE that drugs change things." [END QUOTE]

Not only a witty way to put it, but also so very true.

The popular claim that the WD symptoms are just psychological and nothing somatic/ physiological with marijuana, lacks medical as well as philosophical understanding of what this system called human body is.

One's psychological fabric is not restricted to patterns of mentality , but is an organic complex. Organic in both senses of the word: 1) Subject to and responsible for continuous movement and capable of articulating change 2) Not exclusive to this or that organ or faculty, but in communication with the totality of organism. In other words, nothing is psychological in the sense of "being all in one's head"- hormonal balance and processes, functioning of internal organs like kidney and neurological mechanisms communicate with one another in continuous fashion, all affecting one's psychology, next to outside stimulants of material or immaterial kind. Every single psychological emotion or perception one experiences is nothing but bodily. Please understand that one's brain or psyche is not resting in some jar. And human body is not some nest indifferent to what it contains either. Just because some physiological changes or affects are not immediately perceptible to one's conscious, it doesn't mean that they don't exist. The history of medical pathology, along with bacteriology provide excellent examples to this.

I understand and know from first hand experience that it is very hard to find agreement even in one's close circle of friends on the subject of marijuana withdrawal. People either judge you and act in a reactionary fashion to distance themselves from what they perceive to be the dominant political take on marijuana, or they simply take resort in the romanticizing marijuana around popular myths of easy herbalism. As with everything, there's always a third, fourth, even fifth way to look at things.

In my case, I am against the legal abuse and discrimination marijuana smokers are subjected to, as much as I am against the illogical and unscientific arguments blind to the health-related problems of herbalism. Not all the medical research available on the subject are fed-funded and not all factual observations discussed in fed-funded research is refutable on the basis of who funds for what reason.

Dirk Hanson said...

"I am against the legal abuse and discrimination marijuana smokers are subjected to, as much as I am against the illogical and unscientific arguments blind to the health-related problems of herbalism."
-----------

That is exactly the line I try to walk.

It's tough because, as you point out, people are pretty binary about pot withdrawal--they either strongly believe it or absolutely don't.

sobriquet said...

We all know that the placebo effect can be fairly powerful, which is one of the reasons that there is such an emphasis on *double-blind*, *placebo-controlled* and peer-reviewed studies in order to demonstrate certain effects.
What is the role of the placebo effect in an imaginary addiction?

Sure, getting stoned/high is fun and everything which is fun can be fairly habitforming (work, sex, gambling, eating, etc..).
When you use cannabis excessively for prolonged periods and you suddenly quit, sure your body will probably let you know that it's missing out on something it has grown accustomed to.

But how on earth can we have a sensible discussion about the addictive potential of cannabis in the context of prohibition and years of government propaganda that has overstated the potential for harm associated with cannabis (ab)use?
http://www.pdxnorml.org/Exposing_index_1095.html

There are not even reliable statistics on cannabis addiction, since people are typically forced into treatment for imaginary cannabis problems in countries with an extremely hypocritical and fascistic policy with respect to cannabis use (given that it's perfectly legal for adults to wreck their brain on alcohol).

The facts are clear: Cannabis is not very addictive. It can be overused and excessive use can have negative consequences, but as far as drugs are concerned, cannabis is on the lower end of the scale in terms of addictive potential, similar to coffee or an activity like shopping or collecting porn.

http://www.drugwarfacts.org/cms/?q=node/28

As an ex-nicotine addict I know what an addiciton is like. Are there any addicts who have overcome their nicotine addiction who will still claim that they are addicted to cannabis?

I think cannabis is actually a good candidate for a substitute to get rid of a far more harmful tobacco addiction and I personally managed to quit tobacco over 10 years ago by smoking cannabis whenever I felt like smoking tobacco.
Currently I still love cannabis, but I have little problems regulating my usage, despite using it on a daily basis for prolonged periods.
With tobacco, I was unable to regulate or moderate my usage and this was one of the reasons for me to quit tobacco.
So you might claim I have an addictive nature (since I definitely was a tobacco addict) and sometimes I even have problems regulating my chocolate usage... but seriously.. cannabis, let's cut the bullshit and stop prohibition first to have a fair debate about its addictive potential.

Deepak said...

Marijuana is not physically addictive and you shouldn’t be having such side effects. I would say that it is probably in your head because you believe you will be going through all sorts of problems.It is not like in heroin addiction where your body can’t manage without these receptors being fed and if they don’t get fed, you start to hurt.but I would say that you may go through some mild withdrawal effects possible mental related like moodiness or maybe nausea or something but nothing as dramatic as you described it.
I will mention once again, marijuana is not physically addictive. I have also been smoking it for a few years and I had a year when I was on it nearly all the time and I did stop by tapering as I lost interest in it-I don’t know I guess I matured.
Your stomach problems may not be related to marijuana withdrawal and you may want to check it out.

Anonymous said...

I would like to thank Dirk for this project, as I have found it very helpful with my own withdrawal symptoms from 40 years of daily marijuana use. I've not smoked in 3 weeks, and so far, so good.

I'd like to respond to a couple of posts on here:

Sobriquet: "Are there any addicts who have overcome their nicotine addiction who will still claim that they are addicted to cannabis?"

Um, yes: me. As for the exact nature of this addiction, physical or psychological...or both, if there is no difference...I have no idea. All I know is: I had to smoke weed every day, period. I do not know why.

Dirk wrote: "This goes far deeper than so-called addictions to behaviors like sky diving and sex. Pot makes specific alterations in limbic reward circuitry like all other psychoactive drugs."

Dirk, everything you have said in your posts has been sensitive, illuminating, and very helpful...with the exception of this statement. It is a well known fact that sex can be highly addictive; ask any compulsive sex addict whose life has been profoundly affected by this addiction. And I suspect that sex addiction may also cause "specific alterations in limbic reward circuitry."

Sobriquet: "let's cut the bullshit and stop prohibition first to have a fair debate about its addictive potential." A careful readiing of all the posts here will show that there is not one single person here who has discussed prohibition has been in favor of the current government policies re: marijuana. In fact, it seem to me that everyone here agrees that marijuana prohibition is idiotic, counter productive, life destroying, and immoral. But to suggest we should not discuss the addictive qualities of pot until the prohibition is overturned is just plain silly.

And finally: Deepak: "Marijuana is not physically addictive and you shouldn’t be having such side effects. I would say that it is probably in your head because you believe you will be going through all sorts of problems." It's hard to respond to this without losing my temper, but I'll try. Maybe I "shouldn't" be having such side effects as night sweats, increased dreaming, depression, and sluggishness, but I am, Deepak. It is not in my head; I didn't read about these symptoms and then faked them or aped them. They are real, and you should respect the people who have opened up on here to talk about their symptoms instead of telling us we are imagining things.

No doubt the vast majority of pot users are not addicted and have no symptoms when they quit; this is another thing on which there is near universal agreement in these posts. But take it from someone who has been smoking weed on a daily basis for 40 years: the symptoms are real, and I am/was addicted.

Dirk Hanson said...

Nice thoughtful post, Anonymous, and thanks for the compliments.

I know it's hard for older, long-term smokers not to get angry when younger smokers tell them pot withdrawal is all in their head. I've seen people in marijuana withdrawal literally writhing on the floor and moaning, like a junkie getting clean. But as you say (and as I constantly strive to point out), this is only a problem for a small minority of tokers.

As for sex addiction: When I started researching addiction, it seemed clear that you can't suffer from substance abuse without a substance. But I think in the past few years, scientists have tentatively shown that gambling and compulsive sex may in fact be anchored in the same limbic chemical changes that supercharge the drug-seeking urge. Time will tell. I've given people guest posts on my blog in the past to make the case for gambling, shopping, and sex addictions. My own focus, for now, remains on addictions to drugs you ingest.

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