Marijuana Withdrawal: Interview with Dirk Hanson

March 12th, 2010

The following is an interview of Dirk Hansen, blogger at Addiction Inbox.  Dirk is the author of “The Chemical Carousel,” which looks at addiction as a chemical disease with biological effects on our psychology.  Dirk’s opinions are challenging and well researched, so we hope you enjoy reading and reacting to his interview on marijuana withdrawal.  Without further ado, here’s Dirk’s interview:

1. What is the definition of addiction, and does pot fit that definition? Is everything addictive?

Addicts are the possessors of a biochemical disorder for which, at present, there is no reliable lifetime cure. Hard-core addicts must “treat it for life,” as the commercials say about high blood pressure. Drugs are everywhere, and yet drugs are not precisely the problem. The problem is the wide scope of reactions that they produce in people. The reason the reaction varies so much is that people are different from one other.  Metabolic chauvinism will get us into trouble, just like chauvinism of any other kind.

Addiction can be defined as loss of control over use of the drug, continued use despite adverse consequences, compulsive use, and craving in the absence of the drug. Some alcohol specialists have formulated their own corollary: a “primary, chronic disease, characterized by…. impaired control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.” (We’re not talking here of the so-called behavioral addictions such as gambling and excessive sex.)

There are other definitions, all with their own set of limitations. And any definition can be contorted into a shape that allows for sex, chocolate, and jumping on trampolines. It is an imprecise definition, much like “clinical depression” in that respect. Is marijuana withdrawal easier than heroin? Harder than cigarettes? About like coffee? Comparisons like that don’t really make any sense—it depends on whose nervous system we are talking about. Metabolisms vary.

The fact that metabolisms vary is the essence of addiction. “Why can some take it or leave it while some get hooked?” I choose to go with the scientists who believe it is because of innate differences in susceptibility. Different metabolisms, different genes. At the extreme ends of the spectrum, there are people who are born to be addicts, and people who are born to be non-addictive. Is marijuana addictive? “Probably not, for most people,” a former director of the University of Minnesota’s Chemical Dependency Program told me, years ago. “But there may be some small percentage of people who are on the same wavelength with it chemically, and who end up in some way hooked to it physically. It’s a complicated molecule.”

2. What are the symptoms of marijuana withdrawal and do they relate to the withdrawal symptoms from other drugs, like heroin or alcohol?

Many readers may be old enough to recall when cocaine was widely considered a non-addictive drug. LSD and Ecstasy, which have consistently been lumped in with addictive drugs, have no addictive properties at all.  And the damage done by two lethal but legal addictive drugs—alcohol and nicotine—outdoes all the illegal substances put together when it comes to death and mayhem due to addiction.

An expanding body of clinical evidence now supports the existence of a clinically significant marijuana withdrawal syndrome in a subset of marijuana smokers. Marijuana withdrawal, which typically affects only heavy smokers, has not been well studied or characterized in the scientific community. Very few tokers will ever experience it, the same way very few drinkers will ever experience alcohol addiction.

What has emerged is a consistent profile of marijuana withdrawal. The syndrome is marked by irritability, restlessness, generalized anxiety, hostility, depression, difficulty sleeping, excessive sweating, loose stools, loss of appetite, and a general “blah” feeling. Many patients complain of feeling like they have a low-grade flu, and they describe a psychological state of existential uncertainty—“inner unrest,” as one researcher calls it.

The most common marijuana withdrawal symptom is low-grade anxiety. It is not, in every case, simply a matter of pre-existing anxiety or depression reasserting itself. Anxiety of this sort has a firm biochemical substrate, produced by withdrawal, craving, and detoxification from almost all drugs of abuse.

3. If pot is addictive, when does someone need formal treatment for marijuana dependence?

We don’t know how many people experience a cannabis withdrawal syndrome, because people who suffer acute cannabis withdrawal don’t broadcast that news, and the people who are in treatment for pot addiction aren’t necessarily addicted to anything—a sad commentary on the related problem of drugs and our criminal justice system.

The idea that marijuana is not and can never be physically addictive is deeply engrained in the thinking of many non-addicted pot smokers. However, several hundred self-identified cannabis smokers in withdrawal have posted at my blog site. A reader would have to be a very cynical person indeed to believe that such heartfelt and at times heartbreaking stories are inevitably the result of deceit or delusion. Addiction is a science now. It is about helping sick people find a way to arrest a medical disorder than can seriously disrupt their lives. For a long time, this nation looked down on drug addicts and tolerated, even joked about, rampant alcoholism. That hypocrisy is largely in the past. But a related hypocrisy sets marijuana apart from other psychoactive drugs that meet the addiction criteria.

I’m betting that most people who suffer severe cannabis withdrawal manage to quit on their own, just as the majority of alcoholics who quit manage to do so without formal intervention. That is not an argument against treatment; it’s an argument for better outreach and more effective treatment. Addicts shouldn’t have to quit on their own–nor should they be coerced into treatment. They should have a choice. However, the long-term existence and popularity of Marijuana Anonymous suggests that a largely unrecorded demand for treatment exists.

4. Should our policy and legislation about marijuana, both used medically and recreationally, change in any way because of these conclusions?

Absolutely. I favor the legalization of marijuana without reservation, qualification or hesitation. So it is all the more troubling when legalization advocates feel threatened by the facts about the way in which pot affects a minority of users. It’s not a big deal—unless you are among that minority, or have a friend or family member who is.

Why wasn’t this syndrome documented earlier? Why are we arguing about this now? The counterargument seems compelling: People have been smoking this harmless herb for centuries. Now, all of a sudden, we’re supposed to believe it’s addictive?

Yes, we are—for the same fractional group of the population that is vulnerable to alcohol, heroin, cigarettes, and other substances. It is true today, and there is every reason to suspect it was true of a minority of marijuana users a hundred years ago. It may be somewhat fashionable nowadays to announce one’s addiction and head for rehab, but historically, most people who suffer from addiction have been forced to deal with the shame, trauma, and social stigma still attached to drug addiction—regardless of the drug in question. This goes double for aggravated withdrawal symptoms from a drug everybody says cannot be addictive.

5.  Please summarize your final conclusions

Marijuana can be addictive for people who have a built-in propensity for addiction.  The overriding priority in all this should be research. Marijuana studies have been blocked for dubious political reasons over the years.  That research floodgate must be opened. One quick result would be the recognition of alcohol as a more dangerous drug than pot.  At the same time, we need to recognize the cannabis withdrawal syndrome for what it is—the end product of a particular kind of substance addiction.