Medical Marijuana (Part Three): The Psychological and Social Aspects
The use of Marijuana for medical treatment has been under consideration for several decades. However, within the past ten years, the push has intensified, and a number of states have legalized Medical Marijuana. The push has not gone through the normal evidence-based scientific research where the substance is tested under many conditions in order to identify and minimize any side effects and the research ends with an approval by the Food and Drug Administration. The process to legalize Marijuana for medical use has taken the legislative route with persistent public advocacy and media advertisement. The process might create the appearance that the legislation was written for a segment of the society already self-medicating. Such a reversal of roles leaves the need for serious research to be conducted to examine the true benefits and risks of Marijuana issues over various periods of time among differing populations (Fitcharies and Eiserberg). Nonetheless, in 2017 West Virginia became the 30th state to legalize Medical Marijuana, and New Hampshire voted to decriminalize possession of small amounts of the drug.
To date, voters in eight states have legalized recreational Marijuana and regulate sales of the drug (Breitenback). Much of the legislative success was influenced by organizations like MUM’s the Word (MUM stands for Medical Use Marijuana). These grassroots efforts would arrange testimonials from patients or family members that would stand to benefit from Medical Marijuana (Tabachnick 2). The following quote from The Harvard Mental Health Letter sums up the dilemma: “The movement to legalize Marijuana for medical use in the United States has renewed discussion about how this drug affects the brain, and whether it might be useful in treating psychiatric disorders. Unfortunately, the limited research on Marijuana that has been conducted is based on people who smoked the drug for recreational rather than medical purposes.” It will be this writer’s purpose to share research focused on the psychological and social aspect of the use of Marijuana for medical purposes. Likely, compassionate, caring people would have little opposition to the use of Marijuana for such purposes as providing cancer patients with temporary escape from pain or nausea, if thorough research verified its safe use and appropriate administration. However, like any drug that can be developed for legitimate medical purposes, it can also be abused, produce psychological addictions, or be used more for social or recreational purposes. Though it was illegal, the social acceptance and recreational use of Marijuana was already in place, to a large degree, which propelled the legislative legalization process. Nevertheless, the fact that Marijuana can have a profound effect on the user’s mental and emotional state thus leading to psychosis should not be ignored. Some of the clinical signs associated with psychosis are confusion, delusion, hallucination, agitation, and paranoid ideation (Mohamed, Potvin 132). As we consider the psychological and social aspects of Marijuana use, we will be addressing the mental senses, their function, their emotional influences, and their impact on one’s behavior and social interaction.
The Psychological Effects of Marijuana
Though Marijuana is purported to relieve pain and nausea in some people by reducing anxiety and improving mood while acting as a kind of sedative, the research is lacking to demonstrate its use in treating psychiatric disorders (Harvard 2). However, research has revealed an increased risk for psychiatric disorders linked to Marijuana (Cannabis) use. In fact, there has been enough research evidence to produce an official diagnosis of “Cannabis-Related Disorders” in the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Individuals with Cannabis use disorder often experience impaired cognitive functions which negatively affect behavior and interferes with the user’s ability to proficiently perform at work, school, or home (DSM-5, 511). When Marijuana is being used for a medical condition, clinicians are advised not to use the symptoms of tolerance and withdrawal as the primary criteria for diagnosis of a substance use disorder (511-12). For the purpose of providing clarity to the psychological and social effect of Marijuana use, a summary of the diagnostic criteria of Marijuana (Cannabis) use disorder is included. In order to diagnosis Cannabis use leading to significant impairment or distress, at least two of the following must occur within a 12-month period:
1. The substance is taken in larger amounts over longer periods of time.
2. There is a persistent desire or unsuccessful effort to control the use of the substance.
3. A great deal of time is spent in an effort to acquire, use, or recover from the use of the substance.
4. Craving, or strong desire to use the substance.
5. Recurrent use of the substance resulting in failure to fulfill major role obligations at work, school, or home.
6. Continued use despite having persistent or recurrent social or interpersonal problems caused by the use of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of the use of the substance.
8. Recurrent use in situations in which it is physically hazardous.
9. Continued use despite the knowledge of having a persistent or recurrent physical or psychological problem likely caused by the use of the substance.
10. Tolerance is defined by either a need for marked increased amounts of the substance to achieve the desired effect or a markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, manifested by either withdrawal characteristic of the use of the substance or the substance (or closely related substance) is taken to relieve the withdrawal symptoms.
The National Institute on Drug Abuse reports that in 2015 about 4.0 million people in the United States met the diagnostic criteria for Marijuana (Cannabis) use disorder which is thought to be about 30 percent of those that use Marijuana (Is Marijuana Addictive? 14). Marijuana use can impair short-term memory, alertness, perceptions, concentration, coordination, and reaction time. Marijuana contains more than 600 known substances with the principle psychoactive constituent being delta-9-tetrahydro-cannabinol, commonly called THC (Mohamed, Potvin 132). They estimated that every year there are 2 or 3 million new users of Marijuana. It is the most widely used illicit substance in the world and it is estimated that one out of 12 users will eventually become Marijuana dependent and will continue its use despite the negative consequences that are produced (Sofuoglu, Sugarman, and Carroll 109).
Social Effects of Marijuana Use
The immediate social issue with Marijuana used for medical purposes is that Federally it is still illegal. However, the main active ingredient, THC, is legal, approved by the Food and Drug Administration (FDA) in the form of dronabinol and nabilone. It is important to note that the manner by which legal ingredients are administered affects the social perception (Ruska 309). When given in pill form to AIDS patients to address anorexia or to chemo patients to relieve nausea there does not seem to be much social resistance. However, if those same patients were to receive their Marijuana treatment via cigarettes or water pipes there already exists a recreational stigma. It would appear to be wise to administer Medical Marijuana more like traditional medicine (309).
One of the common fears of a caring society concerning the legalization of Medical Marijuana is that it will lead to widespread recreational use. There does not seem to be clear or consistent research evidence to confirm or alleviate the fear (Woodruff and Shillington 365). In the state of California, the approval of medical use of Marijuana has not necessarily automatically translated into recreational use. Since California’s medical legalization in 1996, the attitudes toward Marijuana are slightly more positive, but there is very little change in behavior. The more consistent variable contributing to recreational use of Marijuana is an effort for social meaning through associations of specific types of persons, roles, and social groups especially with youth seeking a social identity (15). Among those often referred to as “emerging adults” (18-25 age group), Marijuana use is motivated by a desire for conformity, to reduce the possibility of being socially excluded and to aid social cohesion. Among this same age group, those who promote a greater use of Marijuana to cope with distress may be masking mental health issues and thus use Marijuana to self-medicate (Moitra, et al. 627). A study of attitude ambivalence and adolescent drug use found that half of the high school students in the U. S. have used Marijuana at least once before they complete high school and that such Marijuana use has been associated with a range of harmful consequences, including delinquency, developmental and cognitive impairment (Hohman, et al. 65).
There are conflicting claims as to whether Marijuana relieves or produces social anxiety. What does appear to be true is that nearly one third of those diagnosed with Marijuana dependence also have Social Anxiety Disorder (SAD). Buckner, Heimberg, Matthews, and Silgado, used a new measure designed to simultaneously assess social avoidance and using Marijuana to cope in situations previously identified as anxiety-provoking among those with elevated social anxiety. They discovered that “individuals with clinically meaningful social anxiety were more likely to use Marijuana to cope in social situations and to avoid social situations if Marijuana was unavailable” (151). Their finding also underscored the importance of context when assessing high-risk populations for Marijuana-related behaviors.
A serious and ever-increasing social concern is the annual cost of drug abuse in the United States, estimated to be $193 billion. This staggering cost is due to crime, lost productivity, and health care. The increased availability and abuse of Marijuana figures into this social challenge. One can only guess what the ramification of the decisions of 30 states might be that have legalized Medical Marijuana, 8 of those states legalizing it for recreational use. We are just now beginning to see research attempting to measure the difference between Medical Marijuana users and non-medical users. One such research project by Susan Woodruff and Audrey Shillington sought to see if there were more Emergency Department visits from recreational users than those using Marijuana for medical purposes. To this writer, one of the more interesting findings was the revelation that there had been some unanticipated consequences in Colorado’s legalization of recreational Marijuana. There has been an increase in Marijuana related visits to Emergency Departments. The Emergency Departments reported that frequent intake of high-concentrations of increased THC produced cyclic vomiting. Other Marijuana related emergencies were due to burns from THC extraction processes and children ingesting edibles. Also revealed in the Woodruff and Shillington study was that the “National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) longitudinal epidemiological study found that, between 2001 and 2002 and a decade later in 2012-2013, Marijuana use doubled, as did the DSM-IV Marijuana disorder prevalence.”
The Biblical View of Man’s Mental Well-Being
The Scriptures often use the word “heart” to refer to “man’s entire mental and moral activity, both the rational and the emotional elements” (Vine 297); “the supposed seat of the intellect” (Smith 125). The first and great command requires that man love God with all of his heart, soul, mind and strength (Mark 12:30. All Scripture references are taken from the King James Version.). The Proverbs writer emphatically declared, “Keep thy heart with all diligence; for out of it are the issues of life” (Proverbs 4:24). Proverbs further reveals that as a man “thinketh in his heart, so is he” (Proverbs 23:7). The Lord distinguished between good and evil in the following contrast: “O generation of vipers, how can ye, being evil, speak good things? For out of the abundance of the heart the mouth speaketh. A good man out of the good treasure of the heart bringeth forth good things: and an evil man out of the evil treasure bringeth forth evil things” (Matthew 12:34-35).
Man’s psychological state can become undisciplined, unrestrained, and produce destructive thought patterns. The Scriptures reveal that if enough individuals develop faulty thinking patterns they can influence the thinking of an entire society. In Noah’s day, God’s assessment of the perverted mind of that generation is summed up in these words: “And God saw that the wickedness of man was great in the earth, and that every imagination of the thoughts of his heart was only evil continually” (Genesis 6:5). In contrast, Noah was able and willing to listen carefully, think clearly, reason wisely and respond obediently to God (Genesis 6:22; 7:5; Hebrews 11:7). It should be obvious how important a clear and sober mind is to the mental health of an individual and a society. A healthy psychological state can be identified, understood, experienced, and safeguarded through the following inspired instructions: “And the peace of God, which passeth all understanding shall keep your hearts and minds through Christ Jesus. Finally, brethren, whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, think on these things” (Philippians 4:7-8).
The use of Marijuana for medical purposes should be viewed in the same context as the apostle Paul’s advice to Timothy: “Drink no longer water, but use a little wine for thy stomach’s sake and thine often infirmities” (1 Timothy 5:23). Note, the wine was to be taken for Timothy’s chronic infirmities, not to be the cause of his infirmities (Proverbs 23:29-35). The anecdotal evidence gleaned from 40 years in ministry, with 20 of those years as a licensed professional counselor, has taught this writer to compassionately support those who legitimately need to take medication for diagnosable infirmities. Under such circumstances, the writer views professionally prescribed medication not as a sign of weakness but as an available blessing which allows the suffering individual to experience a measure of life that otherwise would be unavailable to them. However, the same anecdotal evidence over the same number of years has taught this writer that recreational use of any drug is of no physical, medical, social or spiritual benefit. The anguished voices from the wasted lives, broken families, and negated spiritual influences of those who are enslaved to addictive substances echo so loudly in this writer’s ear! His eyes could never forget the psychological carnage he has seen, nor could his heart ever trust the recreational or social use of any substance that so impairs the mind’s ability to think, fully reason, and execute clear and healthy decisions.
Jerry L. Martin received the Ph.D. in Marriage and Family Therapy, and he holds a Master of Science in Counseling from Amridge University. He presently works as Associate Professor and Clinical Coordinator at Amridge.
Works Cited:
Breitenback, Sarah. “Despite Growing Support for Marijuana, Legalization Faces Rocky Road.” The Pugh Charitable Trusts, 2017.
Buckner, Julia, D., Heimberg, Richard, G., Matthews, Russell, A., and Silgado, Jose “Marijuana-Related and Social Anxiety: The Role of Marijuana Behaviors in Social Situations.” Psychology of Additive Behaviors (2012) 26.1; 151-56.
Fitzcharles, MA, and Eiserberg, E “Medical Cannabis: A Forward Vision for the Clinician.” Eur J Pain. 2018 Mar. 22(3):485-91. doi: 10.1002/ejp.1185. Epub 2018 Jan 2.
Harvard Health Publications. “Medical Marijuana and the Mind.” The Harvard Mental Health Letter. Boston (Apr 2010).
Moitra, Ethan, Christopher, Paul, P., Anderson, Bradley, J., and Stein, Michael, D. “Coping-Motivated Marijuana Use Correlates With DSM-5 Cannabis Disorder and Psychological Distress Among Emerging Adults.” Psychology of Addiction Behaviors (2015) 29. 3: 627-32.
Ruska, Jeffrey, M. “Treatment Acceptability, Stigma, and Legal Concerns of Medical Marijuana Are Affected by Method of Administration.” Journal of Drug Issues. Thousand Oaks. 44.3 (Jul 2014): 308-20.
Smith, William. Smith Bible Dictionary. 1863. Philadelphia: Holman, 1993.
Sofuoglu, Mehmet, Sugarman, Dawn, E., and Carroll, Kathleen, M. “Cognitive Function as a Emerging Treatment Target for Marijuana Addiction.” Experimental and Clinical Psychopharmacology. (2010) 18.2: 109-19
Tabachnick, Toby “As Smoke Clears from Medical Marijuana Debate, Relief Sets in for Advocates.” Jewish Chronicle. Pittsburgh [Pittsburgh]12 May 2016: 2, 4.
Vine, W. E. Vine’s Complete Expository Dictionary of Old and New Testament Words. 1984. Nashville: Nelson, 1996.
Woodruff, Susan, I., and Shillington, Audrey, M. “Sociodemographic and Drug Use Severity Differences Between Medical Marijuana Users and Non-Medical Users Visit the Emergency Department.” The American Journal on Addictions (2016) 25: 385-91 ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/ajad.12401