Whenever I bring up the topic of medical marijuana, whether openly asking people to bring up myths and questions, or discussing it with someone who knows about my own use, the first topic to come up is invariably the one of addiction. People are concerned about the addictive properties, and like anytime a patient takes treatment for pain, there are the inevitable questions about whether we are worried about becoming addicted.
I’ve addressed some aspects of addiction and addictive properties in the first MMJ 101 post. Most importantly I discussed the fact that no one pauses to consider the importance of ending pain. It is such an important point that it bears stressing again. Chronic pain has severe long term consequences, and causes long term changes to the body. Treating it is a high priority. To question whether we are sure we have to treat pain, is to underestimate its importance, and this is something that most people, unless they’ve experienced it themselves, can have a hard time comprehending. To them, it’s just pain.
To have an honest discussion of addiction, we must first understand what it is. The social perception of addiction is that it is a series of bad decisions that lead to a chemical dependency. Some views stop there and collapse addiction entirely into chemical dependency, often joking of being “addicted” to caffeine or sugar. At some point one becomes physically dependant on the chemical, creating a driving need, and ultimately the addicted person has to make another choice, this time to give up their addiction and begin the long hard road to recovery. This view often fails to distinguish between addiction and any craving or yearning for something that one enjoys, and thus regards addiction as an act of irresponsibility. There are some variations on this perception, ranging between people believing that addiction is wholly the result of some internal flaw within a person, and others believing that it is entirely the result of a chemical dependency. Neither view grasps the true nature of this phenomenon.
One of of the myths surrounding addiction is the dichotomy between so-called chemical addiction and psychological addiction. To begin with, all addictions are psychological. They may feature a chemical dependency, but that is not always the case.
A chemical dependency on its own does not constitute addiction. If it did, a diabetic requiring insulin could be considered to be addicted to insulin. Similarly, patients who take certain medications, like prednisone, will develop a physical tolerance to medications, as their bodies start using the presence of a certain amount of the drug as a normal baseline, requiring more to yield the same therapeutic effect. In some cases, this will manifest as a series of negative side-effects when the medication is not taken regularly, rather than as a requirement for higher doses.
Chemical dependency, however, can encourage the psychological component of addiction by adding a negative stimulus, such as in the case of people who experience severe withdrawal symptoms. In addition to the shot of dopamine created by the brain when the stimulus is ingested, the patient might have to deal with severe negative consequences for not interacting with the stimulus. Chemical dependency and the resulting physical tolerance can also make addiction more dangerous, as it increases the doses necessary to achieve the same reaction. This is when over-dosing becomes a serious risk.
So if addiction is not a chemical dependency on its own, what is it?
Addiction is the compulsive engaging in either action or consumables that yields a positive stimulus, in which the continued engagements causes distress by interfering with life responsibilities or otherwise adversely affecting wellbeing.
But what does that mean? This is actually an extremely difficult question in and of itself, and in the field of psychology, one which frequently causes problems. The reason for this has to do with the nature of distress and the nature of compulsion.
To better explain it, I want to approach it from a different direction. I want to use a different psychological consideration: paraphilia. A very simplistic explanation of paraphilia would be as fetishes. One example is cross-dressing (which is not the same thing as being transgender, to be perfectly clear).
One of the conversations that took place around the publication of the 5th edition of the Diagnostic and Statistical Manual was whether to include paraphilia. The cause for the debate has to do in part with the same discussion taking place here: understanding the psychological component of “distress” in determining whether something is a problem.
Let’s take cross-dressing as an example. Imagine Ted. Ted likes to cross-dress in the privacy of his own home. He likes the way hose and silk feel, and he likes the little thrill of the forbidden he gets when he wears it. His wife knows and is ok with it. He has a good job, where he is never late, and has been a good steady employee for 15 years. Clearly his cross-dressing isn’t a problem, and is not causing distress. His emotional well-being is good. Everything is great.
Except one, he is home alone engaging in his little fetish in the privacy of his own home. He doesn’t realize that his curtain was flapping a little in the wind just as his boss happened to be walking down the street. The boss peeks in and sees Ted in his outfit.
The boss has a problem with cross-dressing. He thinks it is disgusting and that anyone who engages in it is a bad person. Now that he knows about Ted, he can’t stand him. He fires him within the month on some trumped-up charge. Stressed by the lack of work, Ted has a fight with his wife who leaves him. Because he is out of work, he can’t afford to see friends as often as he would like to. The cross-dressing has now created distress, so is it a problem?
On the one hand we have a clear link between Ted’s cross-dressing and his distress. On the other hand, the distress is not the result of him seeking a certain stimulus regardless of consequences, but is the result of someone else’s problem with what he does. So is the cross-dressing to blame, or is the person who holds bigoted opinions the one who has a problem?
So how does this relate to addiction? In determining whether someone has a problem with an action or substance, it can be difficult to isolate the root impetus behind the distress.
Take my own pot use for example. Due to my disability, I am unable to work. This is in part due to the need for frequent pain treatment, while by no means is it the only or even the most pressing reason for why I am unable to work. In fact, even if it were 100% not an issue, I would still be far from being able to work.
Pot use, even when legal, exposes people to a large amount of shaming. This can put medical users like me in a position where we are forced to choose between being able to medicate and going out somewhere. Since often the symptoms can be debilitating in and of themselves, it could mean that the choice is not much of one either way.
So in my case we have an instance in which distress is caused: my social life is limited and I struggle financially. On the surface this might suggest that the medical marijuana is a problem. However, in truth the root cause of both of these circumstances is not my pot use but rather my disability to begin with. The perception becomes one of a person taking advantage of so-called “free money” to sit around and get high. What this ignores is the severity of circumstance that put me in that position.
The existence of symptoms creating a need for treatment means that the impetus behind seeking a certain stimulus can be nearly impossible to determine. Is it addiction, or is it a need to be able to eat dinner for the first time in three days? Is it addiction, or is it trying to make some of your pain go away? Determining the truth can be nearly impossible from the outside, since there is a strong motivation to use either way.
Some people might point to the fact that some medical marijuana patients are not able to use legally. As a result they are risking jail time in order to continue using. Clearly this must be indication of a problem such as addiction right? Wrong. Once again, the nature of disability and pain gets in the way. The person in question might not be seeking marijuana because they feel the drive to consume it regardless of the consequences, but because the alternative is experiencing severe symptoms. It might be that the symptoms of the disease themselves might be worse than the risk of jail time. The choice is not: risk jail or not, the choice might actually be risk jail or torture/death. To put it another way: would you consider a diabetic an addict if insulin were illegal?
In answer to the question of whether marijuana can be addictive, the answer is yes. Marijuana can be addictive. While it can foster some physical tolerance, it does not really create a chemical dependency which is why many will insist that it isn’t.
That is not enough of a reason to make it illegal. Caffeine, sex, sugar, shopping, gambling,alcohol, tobacco, anything that causes your brain to produce dopamine can become addictive. The reason our society has this perception that addictive things must be made illegal is because of a study several years ago, featuring rats isolated in cages, which suggested that availability was all that needed to encourage addiction.
This study formulated our entire social opinion of addiction. It was used to instigate extreme laws banning a series of narcotic substances in order to prevent addiction. Any slight attention to drug statistics of the last several years will confirm that those laws were an absolute failure. The draconian drug laws have actually lead to higher levels of addiction rather than lower.
Why is this?
The study failed to take into account that rats are social creatures. Applying it to humans, it was the equivalent of giving drugs to inmates in solitary confinement. The psychological impact of this was not taken into account. A second series of studies compared results with rats that were kept in a more pleasing community environment. Although the study was shut down before enough data could be collected, the gathered results show evidence that in a positive psychological environment simple availability is not enough to foster or maintain addiction. This comic does a great job of explaining the experiment and the results.
While not enough information has been gathered as of yet, countries that have implemented more progressive drug policies suggest that legalization is significantly more effective in eliminating addiction. This is in part since it reduces the likelihood that an addiction would mean complete social isolation and an inability to seek treatment.
This suggests that the biggest risk factors for addiction are different forms of isolation. So shaming medical marijuana users, and thus isolating them further than their disability already does, increases the possibility for addiction to occur. Isolating drug addicts, in the form of imprisonment, can make the hold of addiction stronger.
So how do we prevent addiction in disabled patients taking potentially addictive medications?
By reducing the causes of isolation imposed on those of us who have them. These include poverty, social stigma and shaming of medication use, ableism, and so forth. And it doesn’t stop there. In order to truly protect people from addiction, we would have to address racism, sexism, transantagonism, and all of the other oppressions intersecting within the broader concept of kyriarchy. That’s a tall order, but not half as costly as the damage done by our society’s deep misunderstanding of chronic illness and “addiction.”
As for whether I am afraid to become addicted to marijuana, the answer is yes. I worry about it sometimes. But what scares me more is the long-term results of pain. I am afraid of the depression that I slip into when my body hurts so much that killing myself seems like a logical solution to make the pain stop. I am afraid of watching myself waste away again. I am afraid of needing to have my bowels removed and needing surgery after countless surgery because my body won’t stop attacking itself. In other words, like many people who use medicine to treat their conditions, I am more afraid of my illness than I am of some potential risk of becoming addicted.