____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
MARIJUANA AND HASHISH Marijuana does not fit neatly into any one category in terms of its impact on the central nervous system and the brain, and thus it is listed separately. Its impact depends greatly on the amount of tetrahydrocannabinol (THC), the active ingre- dient found in marijuana plants. Thus, the impact of using marijuana with low THC levels may resemble the use of CNS depressants, such as alcohol, while using marijuana contain- ing high levels of THC may have an impact resembling that of a psychedelic substance (Doweiko, 2015). Frequent use of marijuana by adolescents and young adults has been correlated with the development of the so-called amotivational syndrome, characterized by passivity and lack of ambition, leading to poor school and work performance and personality deterioration. Marijuana’s immediate effects include distorted perception, difficulty with thinking and problem solving, and loss of motor coordination. Long-term use of the drug can contribute to respiratory infection, impaired memory, and exposure to cancer-causing compounds. Heavy marijuana use in youth has also been linked to increased risk for developing mental illness and poorer cognitive functioning (NIDA, 2021b). According to government data, more people use marijuana than all other illicit drugs combined, and there was a 62% increase in marijuana-related emergency department visits between 2004 and 2011 (U.S. Drug Enforcement Administra- tion [DEA], 2014). Although marijuana possession and dis- tribution still violate federal law, individual states, along with the District of Columbia, are increasingly legalizing marijuana in some form of medicinal or recreational use (Kain, 2021). Research studies have shown that marijuana can alleviate symptoms of a wide range of debilitating medical conditions, including cancer, HIV/AIDS, multiple sclerosis, PTSD, epi- lepsy, Crohn’s disease, and glaucoma and may be an effective alternative to narcotic painkillers (Kain, 2021). However, it is important to remember that even if a state law allows it for medicinal use, federal law prohibits physicians from prescribing marijuana, rendering those state laws invalid. Consequently, physicians can legally write only a recommenda- tion for medical marijuana, which is different from a prescrip- tion (Marijuana Policy Project, n.d.). Hashish, or hash, is an extracted product composed of com- pressed or purified preparations of stalked resin glands from the cannabis plant. It contains the same active ingredients as marijuana but often in higher concentrations, with a THC content that varies from 20% to 60% (Columbia University, 2015). Hashish can be consumed by oral ingestion or smok- ing—typically, in a pipe or vaporizer, normally mixed with tobacco. The abuse of marijuana or hashish concentrates (e.g., “wax,” “butane honey oil”) is increasing, and these high- potency THC levels are typically delivered in e-cigarettes or consumed in food. In 2013, the THC content of leaf marijuana
Amphetamine use has different effects at low and high doses. Individuals typically take low doses of amphetamines to stay awake longer or to complete tasks (e.g., students and truck drivers may use amphetamines for this reason), but even this type of use can result in a “crash” when the effects of the drug wear off. Large doses of amphetamines can result in psychotic symptoms that are similar to schizophrenia and can include symptoms such as hallucinations, paranoia, and hypersexuality (Baier et al., 2014). Use of cocaine and other stimulants can result in depression, heart attacks, suicidal behavior, and violent behavior. Snort- ing stimulant drugs can cause permanent damage to the nasal cavity and sense of smell; many individuals also experience chronic runny nose and difficulty swallowing. Symptoms of withdrawal from stimulants can include fatigue, unpleasant dreams or nightmares, voracious appetite, agitation, depres- sion, and irritability. Although unpleasant, withdrawal from stimulants is not generally life-threatening; however, as with all withdrawal symptoms, it is important for a medical professional to assess the seriousness of the withdrawal effects to determine if admission to a medical facility is warranted. Among the stimulants, a common and extremely addictive drug is nicotine. Most people seeking nicotine get it through cigarette smoking. Cigarette smoking kills more people than the use of any other drug and is the leading cause of preventable morbidity and mortality in the United States (U.S. Department of Health and Human Services, 2022). Moreover, tobacco use is highly comorbid with the use of other substances, particularly alcohol (NIDA, 2021c). Nicotine has been found to reduce stress by affecting the stress response systems of the brain (Anderson & Brunzell, 2012), making it a difficult substance to give up, especially for individuals with high levels of anxiety and other severe mental health problems, such as schizophrenia. PSYCHEDELICS AND HALLUCINOGENS Psychedelics and hallucinogens can result in symptoms similar to psychosis, including distorted cognitions and sensations and visual hallucinations. Drugs in this class include lysergic acid diethylamide (LSD), phencyclidine (PCP), 2,5-dimethoxy- 4-methylamphetamine (DOM, STP), mescaline, psilocybin, and large or highly potent doses of cannabinoids or marijuana. According to DSM-5 , symptoms of intoxication from these sub- stances can include anxiety, depression, fear of going insane, paranoia, and impaired judgment (APA, 2023). Psychedelics are less physiologically addictive than other sub- stances; however, they may precipitate psychosis in vulnerable individuals. They also result in feelings of extreme anxiety and misperception of reality, particularly for users of PCP (also known as “angel dust”), who frequently experience distorted body image, depersonalization, depression, suicidality, and hostility that may be expressed through violence (APA, 2023).
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