It’s been several centuries since the Sunni Persian poet Rumi waxed lyrical about the value of wine. Intoxication, escapism from anxiety: these were venerated effects once, before the medical or psychological problems related to drugs were apparent or widely known. Ancients bemoaned excess, thinking drunkenness shameful, but they also observed in humans the drive to change consciousness, as important perhaps as our drives towards sex and aggression. We seek freedom from oppressive thoughts, inhibitions…that problem of what others think.
I’ve long felt ambivalent about what intoxicants promise, regardless of what the medical or psychological consequences are. The tacit principles of psychotherapy extol the values of altered consciousness, but through natural means, not via the imbibing or inhalation of a foreign substance. Further, therapy implicitly encourages the exploration of anxiety or depression—the staying with pain—not so much its alleviation, or the substitution of it with pleasure-seeking. These values place my professional (or at least certain sections of it) at odds with many who are not interested in learning about their pain, and therefore addiction or dependency treatment represents a huge faction within mental health services. Implicitly, most of us in this field are wedded to sobriety, and professionally at least, suspicious of so-called altered consciousness, as induced by chemicals. Fortunately, growing knowledge about marijuana, for example, enables a different discussion: one that focuses upon pain, not consciousness. Increasingly, intelligent choices can be made about the types of pain that should be medicated, and those that shouldn’t.
Medical marijuana, or Cannabidiol (CBD), is one of a hundred plus cannabinoids that binds to cannabinoid receptors within the immune system, whereas Tetrahydrocannabinol (THC) binds to receptors only within the central nervous system. That distinction has only been known for a few years. THC has intoxicant qualities—a ‘high’—and impacts various areas of the brain, including the basal ganglia (impacting movement), the hypothalamus (hunger), the hippocampus (memory), the cerebral cortex (reality testing and perception), as well as the medulla, which mediates the experience of pain. That marijuana disaffects short-term memory should remind us that in the context of PTSD, for example, or even certain aspects of grief, we might consider that ‘forgetting’—ordinarily an aversive symptom—is a propitious, as in welcome option. CBD does not get a user ‘high’, nor does it increase appetite, and can (unlike THC) treat rather than stir anxiety or psychosis. As an anti-convulsant, it can also be effective in the treatment of epilepsy. However, it can be counterproductive with respect to eating disorders (because it doesn’t stimulate appetite), and ineffective in treating depression, because it blocks THC from producing feelings well-being.
Research indicates that marijuana, whether in configurations of THC or other cannabinoids like CBD, places teenagers, and specifically males aged 16-24, most at risk for addiction, as that is assessed via DSM criteria. Adolescence is a tender period of life, for sure. We all remember what it is (or was) to worry about what others think, especially as a teen, and perhaps males are less socialized to talk about this–that’s the chestnut theory, anyway. But this vulnerable population constitutes just less than 10% of estimated marijuana users in this country. Now that 28 states have legalized use and possession of marijuana, and that legitimate medical uses for CBD have been established, it seems time to remove non-habit forming marijuana from the federal list of Schedule 1 narcotics (for which lack of medical application, plus abuse potential, is a criteria), and to block what has long seemed a tertiary, social effect: the indirect persecution of the black community via the pretext of illegal marijuana use and possession.
As a therapist specializing in addictions treatment, I have long dodged the legalization debate, especially when speaking to clients who are externally motivated to abstain. The legality question has always been in the way, it seems. The real questions—the ones that will persist over time, are the following: what do you want to do about pain? How do you want to raise consciousness?