It is important to continuously evaluate new information when working in the addiction treatment and rehab area. Addiction treatment, rehab, and medical detox are life saving medicine to thousands of people suffering from substance use disorder, and some of those patients will naturally be THC/cannabis users. For the purposes of this article, I will refer to THC as the main psychoactive substance targeted by users of cannabis. The large amount of biologically active substances in cannabis and cannabis products makes this issue extremely complicated, but for our purposes we refer to THC because THC is the main ingredient in cannabis that causes the user to feel “high”. In the area of recovery and substance use disorder treatment, the issue of patients using THC can be complicated in various ways.
The traditions of organizations like Alcoholics Anonymous, as well as most of the literature available on recovery and sobriety in the 20th century, generally call for sober people to be abstinent from all drugs that are not properly prescribed by a physician who is aware of the patient’s medical history related to substance abuse. Therefore, many people working in the area of recovery and substance abuse treatment would like their patients to discontinue THC use. We will look at research that discusses the difficulty of staying abstinent from THC, and we will discuss research that shows successful methods of helping patients stop using THC. Patients who have a drug of choice that is exponentially more dangerous than THC, which would include heroin, fentanyl, alcohol, cocaine, and various other substances of abuse, are generally encouraged to abstain from the use of Cannabis or other THC products during recovery, but the number one priority will always be abstinence from those most deadly substances, so there are various complications when it comes to this issue from a treatment perspective. Research has shown contraindications between THC use and long-term sobriety from other substances, but much of the research around this issue is quite thin. According to Kroon et al., causality is very unclear, yet it is clear that,
“Heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders, or multiple mental health disorders that can complicate one another.”
Quitting Cannabis and THC
There is evidence to show that heavy use of THC could be associated with long term difficulties with learning new information and with mental health disorders other than substance use disorder (SUD), so people in the addiction treatment and rehab medicine field take THC use seriously. This evidence is not conclusive when it comes to causality, but there is a substantial amount of evidence that links heavy THC or marijuana usage to ill effects and risk factors for mental health problems. In the United States, the illegality of THC and marijuana products over the course of the 20th century made it natural for addiction disease medical care providers to recommend that sober and recovering people stop using THC and marijuana entirely. Not only were providers worried about the ill effects of cannabis on their patients, but smoking marijuana would put people with addiction issues in the crosshairs of law enforcement. I have discussed on this blog the statistics on recovery inside the US prison system. Only about 10% of people in jail and prison in the United States can receive mental health services that include treatment for addiction. The quality of prison-based addiction programs can be questioned as well, as basic ingredients of good treatment, such as medications for withdrawal and cravings, are almost entirely absent from addiction services for jailed patients. Therefore, it makes sense that health care providers would want patients to quit smoking cannabis, as involvement in the justice system can interrupt or end a patient’s otherwise successful treatment for addiction and alcoholism.
Most Important Research Findings
Now that cannabis and THC products are being legalized around the country to different degrees, the reasons that a health care provider would want a patient to stop using THC will be slightly different. A more patient-centered approach must take the place of less nuanced attitudes towards a drug like THC. A close look at research that investigates the effects of THC during addiction is needed. The study I mentioned before from Kroon et al. shows that the more serious side effects of THC, including those side effects which could be especially problematic for people with a substance use disorder, are mainly present in heavy users of the drug. Maybe more importantly, there is no evidence that serious side effects will remain with the patient after stopping THC use or even cutting back on the amount of use. This is the key. Research shows that patients in recovery or in treatment for substance use disorder are rarely able to stop using THC and cannabis altogether. Patients have had much more success cutting down on THC and cannabis use. Heavy THC use is closely linked to mood and anxiety issues, so cutting down on THC usage could be an important step in avoiding relapse, even if a patient does not stop using THC entirely.
In my opinion, these facts can serve as guiding principals when approaching this issue of THC and substance use disorder. It makes perfect sense for the goal to be quitting cannabis and THC use during sobriety, but the research shows that requiring immediate cessation of THC use will result in failure in a majority of cases. Asking too much of a patient during early sobriety can be a mistake, and it is important to understand the benefits that have been shown from reduced THC and cannabis use. The threat of law enforcement involvement in the states without legalized THC remain however, and all providers will likely know that people with substance use disorder are at much greater risk of being jailed to begin with. Providers should support patients in the difficult process of cutting down on and quitting THC entirely, but discomfort and stigma that is historically associated with cannabis for some people should not factor into these life-changing decisions. In my opinion, we should be honest with patients. If cutting down on the use of THC is successful and beneficial for many patients, and complete abstinence is much less successful for many patients in the early stages of recovery, we must take a more holistic approach to this issue. Patients in states with legal THC and patients in states without legal THC are not in the same exact situation when it comes to the risks of THC use. Patients leave otherwise promising addiction treatment programs because of this issue, and those patients are often then at risk of death from drugs of choice like alcohol and heroin. If heavy cannabis use is strongly correlated with serious psychiatric comorbidities, then helping patients reduce their use over time could save many lives, and help avoid many relapses into dangerous drug usage episodes.
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By T.A. Cannon (Contact me at TACannonWriting@gmail.com)