Cannabis has been in use for many centuries. The widespread use in the population of the United States, however, is a recent phenomenon. Marijuana is the most widely used controlled substance in the United States (Indiana Prevention Resource Center, 1998). According to the National Household Survey on Drug Abuse (1996), about 68.5 million Americans (32%) have tried marijuana at least once in their lifetimes and about 18 million had used within the last year. For younger people, those in their 20’s and 30’s, about 70% have had some experience with this drug. While still illegal, its recreational use seems to be accepted in our society, given the current statistics.

The negative impact of this drug has been underestimated by most users, who do not usually experience ill effects early in use. Even later on, when use may be heavy and on a daily basis, the effects are more subtle – not dramatic and obvious, as they might be with cocaine or alcohol. However, research and anecdotal experience are slowly showing a dangerous underbelly to this seemingly harmless drug.

Smokers enjoy the relaxing effects of marijuana and talk about feeling “laid back.” They may enjoy an altered sense of time and find some boring tasks easier to endure. They often report a sense of being in touch with their emotions and may claim an aphrodisiac effect from the drug. Marijuana does seem to increase self-preoccupation and to impair short-term memory. Some of the physical effects are increased heart rate, dry mouth, bloodshot eyes and impaired coordination and reaction time.

Research on the long-term effects has not been conclusive, but has pointed to a variety of risks that long-term users may face. These include psychological damage, changes in the reproductive system, gynecomastia (abnormal breast enlargement in men,) impairment of the immune system, and without a doubt, damage to the pulmonary system. The tendency of regular, heavy smokers to become too “laid back,” leaving them with little motivation to work or accomplish, has become known as “amotivational syndrome.”

The risks to children and adolescents are compounded by the fact that marijuana use interferes with their learning and ultimately, with mastery of key developmental tasks. Of course, there are legal problems attached to the use and sale of this drug.

Is marijuana really addictive? Users have claimed that there is no physical withdrawal from this drug, but that is apparently not the case. The symptoms are more subtle, in part because marijuana is fat soluble, rather than water soluble, as alcohol is. This means that the primary active ingredient, tetrahydrocannabinol (THC), is released from the body more slowly. For that reason, drug withdrawal is protracted – perhaps even months for long-term users.

Marijuana Anonymous, a 12 Step program specific to this drug, is growing in the United States and abroad. In a pamphlet on detoxification from marijuana, a number of symptoms are listed which have been reported by MA members (Marijuana Anonymous 1992). Withdrawal symptoms reported anecdotally by MA members are:

• Insomnia
• Vivid dreams or nightmares
• Restlessness
• Irritability and anger
• Loss of appetite
• Night sweats
• Tremor
• Nausea, diarrhea

More research is being conducted that should help clarify some of the important questions about whether this drug has medicinal uses superior to other available prescription drugs and whether legalization makes sense.

Inhalants are gaseous substances, which are inhaled and absorbed through the lungs. Some are anesthetics, such as ether or chloroform. Many Americans regularly use nitrous oxide (“laughing gas”) in dentists’ offices as a mild anesthesia and relaxant. Nitrous oxide has become a drug of abuse in recent years and has been associated with a number of deaths, particularly among young people.

Amyl nitrate, an inhalant used to treat angina, also has sexual stimulant qualities and has become a drug of abuse to enhance sexual pleasure, perhaps particularly among gay men. A variety of over-the-counter nitrate inhalants have been on the market and used for that purpose.

Other inhalants include glues, gasoline, metallic paints and a variety of household sprays. There are numerous chemical substances which can be inhaled for their mind-altering effect. Adolescents are particularly vulnerable because of the combination of ready availability and their poor understanding of the potentially serious side-effects.

Physical Effects vary with the drug, but one thing is clear: the effects come quickly – within 7-10 seconds. There is usually CNS (Central Nervous System) depression and there may be dizziness, slurred speech, lowered blood pressure, unsteady gait and drowsiness. There can also be impulsiveness, excitement, irritability and even hallucinations or delirium, depending on the drug. The effects can be grave. Inhalants can do permanent damage to many of the body systems – lungs, liver, kidney and of course, to the brain.

There are other drugs which can be abused and may be seen in clinical practice. These include antihistamines, skeletal muscle relaxants, bromides, steroids and sports drugs. Clients sometimes present with addiction to over-the-counter medications, such as Robitussin, Nyquil, or other cough preparations.

It is important to understand the specific effects of the drugs used, particularly when safe withdrawal is a concern. However, we must remember that today, polydrug abuse is highly likely. No matter what the client’s drug of choice, we will often find a history of using drug combinations or several drugs used in tandem over time. Sometimes the client cannot tell us all the drugs they have used because they do not know. Anyone who buys drugs illegally may be buying drugs which are adulterated or cut with other substances.

No matter what drugs are used, there is a constellation of problems which tend to show up again and again that indicates the presence of addiction. When addiction has taken hold, it is time for a new approach to these drugs – and abstinence seems to be the only safe approach.