Marijuana Is Addictive – So What?
The Stanton Peele Addiction Website, January 7, 2006.
Research increasingly shows that intensive marijuana use often meets the technical requirements for addiction (or dependence). Analysts use this as evidence of the need to maintain the drug’s illegal status. But the fact of addictiveness is irrelevant to legality – addictive drugs (e.g., cigarettes, alcohol) are legal and nonaddictive drugs (e.g., LSD, Ecstasy) are not. Indeed, the fastest growing category of illicit use is of legal, but controlled, pharmaceuticals – both addictive and not. Addiction is a sideline in outlawing drugs, a label applied conveniently by authorities and cooperating scientists in support of prior policy biases.
Although definitions of “addiction” are putatively rational and scientific, they are actually historical and political. Addiction is applied selectively, not based on pharmacological criteria, but in order to create a basis for disapproving of and proscribing drugs. Nonetheless, any real definition of addiction must include marijuana – addiction has subsumed marijuana in the past, and the classification of marijuana as addictive has again become accepted. Now, marijuana’s addictiveness is supported by clinical and epidemiological studies based on the American Psychiatric Association’s diagnostic manual. But marijuana for some time has been widely used as a countercultural recreational drug, and drug policy reformers in particular refuse to apply the addictive label to this substance. Political conservatives, on the other hand, insist on the harmfulness of marijuana as a tenet of their drug policy. The grounds are thus set for perpetual conflict around the drug, conflict that cannot be resolved by clinical designations or epidemiological research. Rules for nonaddictive use of marijuana are proposed – comparable to rules for nonaddictive use of any substance – and reasonable policy for marijuana, addictive as it is, is outlined.
Which Psychoactive Drugs Are Addictive?
I have been defining addiction for some time, beginning with my book, Love and Addiction (Peele & Brodsky, 1975). From this initial statement, through The Meaning of Addiction (Peele, 1985/1998), I have described addiction as a consequence of involvement with absorbing experiences that provide essential emotional satisfactions but that detract from people’s ability to cope with their lives. Since many substances (and other experiences) fit this definition, the label “addictive” is potentially widely applicable. Whether a given substance is defined as addictive in a given society has to do with social custom and political convenience.
In particular, addiction is a label society applies to substances it wishes to proscribe, or certainly to disapprove of. For many decades in this century, the wordaddiction was synonymous with heroin. This label signified that heroin was something thought to be totally outside ordinary human experience and middle class boundaries. Beginning in part with Love and Addiction, however, the label was expanded to apply to other disapproved substances and activities, including, for example, cigarettes and alcohol. Although both of these substances are legal, use of the term in connection with both indicates social opprobrium (in the case of alcohol expressing centuries of ambivalence in the United States).
That a wide variety of drugs can be addictive still strikes us as odd. Thus, the following description from Love and Addiction of 19th century tea use is often cited with amusement.
According to “Clifford Allbutt and W. E. Dixon, eminent British authorities on drugs around the turn of the century. . . . An hour or two after breakfast at which tea has been taken . . . a grievous sinking . . . may seize upon a sufferer, so that to speak is an effort. … The speech may become weak and vague…. By miseries such as these, the best years of life may be spoilt.” (p. 40)
The addictiveness of caffeine, for example in coffee, is periodically rediscovered (see Juliano & Griffiths, 2004), but ignored because people mainly don’t care about addiction to this popular, legal, accepted drug (unless, occasionally, someone is trying to quit). Moreover, caffeine dependence is not considered in the American Psychiatric Association’s diagnostic manual, DSM-IV (American Psychiatric Association, 2000).
An obvious redefinition — or refocusing — of the meaning of addiction occurred in the 1980s with cocaine. Cocaine was originally excluded from pharmacology’s “addiction” or “physical dependence” category because it rarely produced standard withdrawal symptoms and because cocaine use tends to occur in explosive bursts, compared with the more steady consumption of heroin et al. Thus, typical categorizations of drugs in the 1960s and 1970s by World Health Organization psychopharmacologists categorized cocaine as causing only “psychic” – but not physical – dependence (i.e., it was not addictive; cf. Cameron, 1971).
However, large-scale recreational use of cocaine by the 1980s – and proportional reports of negative consequences and difficulties in quitting the habit – seemed to demand a different view of the substance. As a direct result of the surge in cocaine use and reported problems, the definition of addiction was refocused on the intense urge to consume cocaine, particularly once use was begun, and the difficulty in terminating an individual session of cocaine use. Thus, after centuries of experience with the drug, a hundred years of medical usage with humans, and a half century of animal experimentation with cocaine, in the mid-1980s pharmacologists simply moved cocaine from the “nonaddictive” to the “addictive” drug column (Peele, 1998; Peele & DeGrandpre, 1998).
More recently, the World Health Organization has labeled antidepressants addictive, based on their ability to cause withdrawal. The National Institute on Drug Abuse does not track the prevalence of either the use or the abuse of this drug, which is the one most often taken in the U.S. — outside of alcohol and various pain killers — for the explicit goal of changing mood. Likewise, as with caffeine, DSM-IV does not include antidepressants.
Yet, antidepressants have been found frequently to produce withdrawal, and not a few individuals report excruciating reactions to cessation of antidepressant use (Haddad, 1999). If dependence means coming to rely on a substance to produce essential feelings of well being, and that these feelings become harder to acquire without the assistance of the drug, the person having increasingly lost the ability to combat depression without drug use, then antidepressants’ addictive potential is obvious. This is a national issue of some significance – according to the Health United States 2004 report, the use of antidepressants nearly tripled in the six years between 1994 and 2000 (National Center for Health Statistics, 2004). In 2002, more than one in three visits by women to a doctor involved a prescription for an antidepressant, and about 6 percent of all children were taking antidepressants, triple the rate in the period 1994-96. In our society’s balance sheet, whatever addictive potential antidepressants have is greatly outweighed by the emotional problems it is proposed to alleviate.
What Is The Basis of Addiction?
In short, any drug which is effective for the purposes of mood modification may be addictive, and this becomes apparent the more widely the drug is used and the more thoroughly the experiences of individual users are explored. As a general rule, addicted users come to rely – or depend – on the drug experience as an essential coping mechanism and way of navigating life. In this process the individual becomes unwilling or incapable (and these two traits/concepts can never be separated) of tolerating the absence of the experience produced by the drug. Addiction cannot be defined except in terms of an individuals’ incapacity to function without the drug and unwillingness to quit – that is, addiction must always be defined experientially or phenomenologically (Peele, 1985/1998).
One study of cocaine users purported to measure the center of the brain in which addiction occurred (cocaine addicts supposedly have smaller amygdalas than non-addicts, Makris et al., 2004). This study is typical of its type – the subjects were cocaine “addicts” and the comparison group non-users. What about cocaine users, even regular users, who are not addicted? Designed as it is, this study (ideally) could only measure the impact of the use of the drug on the brain. Do controlled users have larger or smaller amygdalas? (For one thing, NIDA researchers are not allowed to recognize there is such a thing as controlled cocaine use).
The actual experience of addiction, the severity of the attachment and difficulty of cessation, is an entirely individual and experiential matter. A measurement of addiction in the brain makes sense only when correlated with people acting and/or believing that they are addicted. Smaller amygdalas don’t determine how intensely people use cocaine – or whether users will continue, or accelerate, or diminish, or quit cocaine. And any time a person with a smaller amygdala ceases or reduces cocaine use (the typical course for problematic cocaine users; Peele & DeGrandpre, 1998; Erickson et al., 1987), he or she ceases to be addicted.
Defining marijuana as addictive
One of the interesting redefinitions of a drug as addictive has occurred with marijuana. That is, marijuana was grouped (legally and in the public mind) with heroin and other powerful illicit drugs in the first half of the twentieth century. This image of marijuana continued through the 1950s and 1960s. In the mid-1960s and the 1970s, however, marijuana became a popular social drug among college and other youth populations. In the process, it became hard for people to take seriously the idea that marijuana was dangerous, and especially that it might be addictive. After all, people thought, they used it without damaging their lives (although, certainly, many people used it heavily, some perhaps even virtually constantly – cf. the term “pothead”).
So, does this widespread cultural experience of largely innocuous marijuana use mean that the drug is not addictive? In Love and Addiction, I described Malcolm X’s addiction to marijuana – in his autobiography he reported he was constantly and irresistibly intoxicated on marijuana – as typical of the 1940s. I then detailed the changing cultural mood which decided by the 1970s that such experiences were not possible:
Another instructive example is marijuana. As long as this drug was novel and threatening and was associated with deviant minorities, it was defined as “addictive” and classed as a narcotic. That definition was accepted not only by the authorities, but by those who used the drug, as in the Harlem of the 1940s evoked in Malcolm X’s autobiography. In recent years, however, middle-class whites have discovered that marijuana is a relatively safe experience. Although we still get sporadic, alarmist reports on one or another harmful aspect of marijuana, respected organs of society are now calling for the decriminalization of the drug. We are near the end of a process of cultural acceptance of marijuana. Students and young professionals, many of whom lead very staid lives, have become comfortable with it, while still feeling sure that people who take heroin become addicted. They do not realize they are engaging in the cultural stereotyping which currently is removing marijuana from the locked “dope” cabinet and placing it on an open shelf alongside alcohol, tranquilizers, nicotine, and caffeine. (p. 46)
But, as is true with any historical analysis, this one turns out to have been premature. Here is the director of the NIDA’s read on the history of marijuana, picking up where Love and Addiction left off and extending through the 1990s and 2000s.
In the 1970s, the baby boom generation was coming of age, and its drug of choice was marijuana. By 1979, more than 60 percent of 12th-graders had tried marijuana at least once in their lives. From this peak, the percentage of 12th-graders who had ever used marijuana decreased for more than a decade, dropping to a low of 33 percent in 1992. However, in 1993, first-time marijuana use by 12th-graders was on the upswing, reaching 50 percent by 1997. . . . the percentage of 12th-graders who have experience with marijuana has remained roughly level since then, [and] [i]n 1999, more than 2 million Americans used marijuana for the first time. . . . The use of marijuana can produce adverse physical, mental, emotional, and behavioral changes, and – contrary to popular belief – it can be addictive. (Hanson, 2004)
Here, this powerful government agency carefully markets against the still-popular – but diminishing – notion that marijuana is not addictive. However, rather than simply decide that a popular and largely innocuous substance (probably Hanson is aware of many nonproblematic, noncompulsive marijuana users, perhaps dating from when he was in college himself), he feels a need to create an additional basis for declaring that marijuana is, really, now addictive. Thus he adds to his statement, in order to signal to middle-age people that the marijuana experiences with which they are familiar are no longer applicable, “the marijuana that is available today can be 5 times more potent than the marijuana of the 1970s.”
Data indicating marijuana is addictive
In a study following a cohort of 14-15 year-olds for seven years, Patton et al. (2002) found that 7 percent were daily users at the last follow up. Women who were daily users were five times as likely to report anxiety and depression. This and other studies finding mental illnesses (such as schizophrenia) associated with marijuana use attempt to point to the causative role of marijuana in mental illness. For example, Patton and his colleagues found that being anxious or depressed in the first place does not lead to marijuana use. The argument this supports – which is one now widely made by researchers in this area – is that marijuana abuse is not itself a response to emotional problems, but rather triggers them.
Nonetheless, by the experiential model of addiction that I have outlined, some marijuana users will experience unusual or aberrant anxiety or depression, and they will find that marijuana provides short-term relief from these emotional problems. At the same time, when they use marijuana regularly in this fashion in response to emotional difficulties or stress, their reliance on marijuana to regulate their mood exacerbates these emotional problems. This is the addictive cycle as it occurs with any substance or involvement.
Since marijuana is the most widely used psychoactive substance, aside from alcohol and prescription drugs, and is by far the most widely used illicit drug, it follows that it is the illicit drug which will be relied on addictively by the most people. Wilson et al. (2004) compared two national studies conducted 10 years apart (1992-2002), utilizing DMS-IV criteria for either abuse (a less severe substance use disorder) or dependence (the more severe diagnosis). They found current (prior twelve months) rates of marijuana abuse rates in the general population of .9% (1992) and 1.1% (2002) and dependence rates of .3% (1992) and .4% (2002).
Abuse and dependence are defined according to DSM-IV as follows:
One the following criterion: recurrent marijuana use resulting in (1) failure to fulfill major role obligations; (2) physically hazardous situations; (3) legal problems; and (4) persistent or recurrent social or interpersonal problems caused or exacerbated by use.
Three of the following six criteria: (1) need for increased amounts of marijuana to achieve the desired effect or markedly diminished effect with continued use of the same amount of marijuana; (2) using marijuana in larger amounts or over a longer period than intended; (3) persistent desire or unsuccessful efforts to cut down or reduce marijuana use; (4) a great deal of time spent obtaining, using, or recovering from the effects of marijuana; (5) giving up important social, occupational, or recreational activities in favor of using marijuana; and (6) continued marijuana use despite persistent or recurrent physical or psychological problems caused or exacerbated by use.
The proportion of abuse or dependence among users was quite high: Among past-year marijuana users, overall rates of past-year abuse or dependence were 30% in 1992 and 36% in 2002. Of course, the dependence diagnosis most resembles addiction. Of all users in 1992, 8 percent were dependent. Of 2002 users, 10 percent were dependent.
The authors noted that there was an increase in both abuse and dependence over the ten years, although rates of use, daily use rates, and quantities used did not increase. The greatest increases in problematic use were noted among young black men and women and Hispanic men. This finding follows a broad and deep pattern of drug addiction being most prevalent for people who lack alternative opportunities and reinforcement in their lives, such that drugs become the most present option for providing needed emotional relief.
Wilson and colleagues (writing for the Journal of the American Medial Association) concluded that the increased potency of marijuana caused the increase in abuse/dependence. However, it may also be that more users are aware of the addiction-producing qualities of marijuana, and that this “knowledge” itself contributed to the increase. The belief in a society that a substance can control one’s body and mood makes it more likely that that substance will be addictive, and publication of findings like Wilson et al.’s can thus themselves contribute to marijuana addiction.. Thus alcohol dependence symptoms were more commonly reported during a period of peak growth in awareness of alcohol’s addictive qualities (cf. Room, 1991).
The Marijuana Policy Debate
Drug policy reform usually begins with attempts to minimize punishment for marijuana use. Decriminalization of such personal use has been the policy for some time in the Netherlands (which allows the controlled sale of marijuana), and is currently being debated in the United Kingdom and Canada. In the United States, individual states have legalized the dispensing of marijuana to individuals with medical conditions for which marijuana brings relief, although such state laws, usually created by referenda, have been legally contested by the federal government.
The idea that personal drug use, particularly of marijuana, is not harmful and in any case should be permitted – if it is not the dominant view, is nonetheless fairly popular and widely held. In this context, research indicating that marijuana is associated with mental illness (such as schizophrenia) and other emotional problems is highly politicized. That is, such research is used, and perhaps conducted, in order to oppose initiatives for legalizing the drug. Thus there is constant conflict between politicians and policy makers in the United States, government-funded drug researchers and theorists, and drug theorists with counter-cultural backgrounds who seek to reform drug policy.
So marijuana is addictive; So what?
Of course, if marijuana is one of a range of things that may cause addiction, and roughly 10 percent of current users are addicted, this would seem to be within the range of the addictive potential of many substances and experiences, perhaps less than some. For one comparison, according to the Health Behavior of Adults(National Center for Health Statistics, 2004) the binge drinking (5 or more drinks) rate among all drinkers measured between 1999 and 2001 was 33 percent. This was exactly midway between the rates of abuse/dependence among marijuana users for 1992 and 2002. That is, while a broad view of addictive drugs includes marijuana, at the same time it makes the importance of the addictiveness of marijuana a less critical argument against marijuana use. Why should one of many addictive substances be singled out for disapproval and legal proscription?
Of course, there is a highly inexact relationship between the addictiveness and the legality of a substance. The two most widely used substances that are thought of as addictive are cigarettes and alcohol. These are legal, and there is no serious effort in place to proscribe them. These are joined by pain killers, which are also widely recognized as addictive (such as, most recently, Oxycontin; Peele, 2004). Obviously, we are prepared to accept addictive drugs in our legal pharmacopoeia. Thus, although the addictive label has been applied as a way to justify proscribing them, the addictiveness and illegality of drugs are quite unrelated.
In the case of marijuana, many Americans seem to feel this way. For example, in a poll of older (over 45) Americans by the AARP, nearly three-quarters (72%) of respondents favored legalizing medical marijuana (Reuters, 2004). This was true even though three quarters believed the drug was addictive (more than the percentage who felt it was medically beneficial). Only 30 percent of respondents had smoked marijuana. Americans 45 years and older apparently aren’t greatly concerned with whether marijuana is addictive, at least when it comes to using it for medical purposes. And it seems unlikely that young Americans, who are more likely to use the drug, would be any different.
Controlling marijuana use
What is the correct attitude towards marijuana’s addictive potential? We need to recognize that addiction is not so much bound up in the characteristics of drugs (aside from their ability to modify mood quickly and predictably), as it is in the situations of users. What causes people to become addicted is their need for addictive relief. At the same time, the absence of alternative reinforcers in users’ lives leads to problematic marijuana use. Thus, the best antidote to addiction is to provide humans beings in our society – as groups and as individuals – with the most options and abilities for obtaining emotional rewards. This is, of course, a large and difficult matter.
We can ask ourselves how well our society is doing this and whether emotional satisfaction is easier or harder to come by in contemporary America. Alternately, we can ask, “Is addiction likely to increase, decrease, or remain the same in the next twenty years?” Most professionals whom I ask do not think it will be decreasing, but more likely increasing. This is signaled, among other things, by relatively high rates of drug use and alcohol intoxication among American youth, along with rising rates of pharmaceutical prescription for the purpose of remedying depression and other emotional problems for younger Americans. Who does not think this will continue to fuel addiction rates in a variety of areas?
Instead of seeming to fuel addiction by providing a template for dependence, and symptoms to imitate and attain, the recognition of widespread addiction should prompt us as a society to create the conditions that best support human beings emotionally. One way to describe this is to say that our society needs to support communities, in neighborhoods, in schools, in all areas where human beings congregate and have a chance for social interaction and support. At the same time, we have to allow children the freedom, while providing enough (but not too great) support, to develop their interests and competence in pursuing these. These are large and complex tasks; but there is no other way to cap our ever-growing addiction problems.
Children (and adults) require sufficient confidence and motivation to pursue life on its own terms. When people are inclined to do this, they are less likely to be sidetracked by destructive involvements of any kind. This in turn enables them to control any drugs or other powerful experiences they are exposed to. Personal users of cannabis must make responsible decisions and use good judgment. The following guidelines help identify ways of using cannabis in a positive manner:
- Adults should use cannabis as part of a healthy, balanced, and responsible lifestyle.
- The decision to use cannabis should be made freely, and not as a result of social pressure.
- Cannabis users should be well informed about its effects on themselves and others. These effects should include both legal and health risks and personal consequences.
- Never use cannabis as an excuse or a cue for antisocial or irresponsible behavior.
- Cannabis users should model and reward responsible use, particularly with new users.
- Use cannabis as a part of positive social interactions, rather than primarily in isolation or as a remedy for negative feelings.
- Develop sensible cannabis use limits for yourself based on personal, health, situational, and cultural factors. It is important to be objective about your cannabis use and listen to the constructive advice of others.
- Avoid cannabis use that puts you or others at risk, such as when driving, at work, or in public places. Remember, personal use of cannabis is still illegal and penalties are stiff.
- Use of cannabis by children is inappropriate and should be discouraged.
- Cannabis use should contribute to, rather than detract from, users’ health, well-being, creativity, work, relationships, and social obligations. (Peele & Brodsky, 2000)
Like any other psychoactive substance, marijuana can be misused. In particular, since it directly and reliably modifies people’s experience and emotional states, marijuana has substantial addictive potential. Researchers and theorists have produced widely conflicting conclusions about the benefits and potential side effects of cannabis use. But a spate of recent studies have identified a marijuana dependence syndrome in about 10 percent of current users. Although the political climate surrounding cannabis research may cause us to view this clinical and epidemiological research with some caution, there seems little doubt that some people develop substantial negative dependencies on the drug. They do so with perhaps approximately the same frequency as they do with other psychoactive substances, licit and illicit.
Policy decisions about dealing with marijuana are not particularly a function of its addictive potential, since more addictive drugs (e.g., cigarettes) and drugs approximately as addictive (e.g., alcohol) are legal and widely used. At the same time, it is important to at least recognize marijuana’s addictiveness when contemplating drug reform measures to liberalize drug laws, for example by decriminalizing marijuana use. Such “truth in labeling” would identify marijuana’s addictive potential for the benefit of its users and potential users. At the same time, it is counterproductive to overemphasize marijuana’s addictiveness, since this may actually increase the rate of addiction to the drug.
Preventing marijuana addiction requires, at the societal level, creating a world worth living in and people capable of functioning in this world. Individuals who may use marijuana need to be aware of the signs of addiction and of the ways in which people avoid or reverse marijuana addiction. This involves diminishing or ceasing use through expanding and solidifying other connections to life – to people, recreational activities, work, family, et al. – which do not involve marijuana or drug use, and which in fact counteract such use.
For the most part, the debate over marijuana’s addictiveness is all flash and no substance. Certainly, marijuana is addictive – as are coffee, antidepressants, and tranquilizers. This, in itself, has no weight in policy decisions about marijuana. But marijuana’s – and other substances’ and activities’ – addictiveness does inform us that unless people have substantial moorings in life, there are many, many ways that they can go wrong.
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Best article on addiction EVER! We need to take a cue from this article and put addiction in its place, a nuisance that can be dealt with effectively. We need to design and deliver and emphasize and encourage useful means of meeting our emotional and other needs. Restricting substances does nothing to enlighten, engage, or motivate better behavior.