The Anatomy of Addiction (9 page)

Extreme use of stimulants and the subsequent lack of sleep
and nutrition may result in someone spending hours searching through his clothes or bedding with a magnifying glass for evidence of bugs. Some resort to microscopes in their quest, and it is common for those suffering from this delusion to bring evidence to doctors, pest controllers, or skin specialists. Believing they have captured one or more of these bugs, they are often upset when a doctor informs them that their evidence is nothing more than a piece of their own skin, a remnant of a scab, or a piece of lint.

In more advanced stages of this delusion, people cut their skin open to find the bugs or pluck all the hair follicles out of various areas of their body. I had one female patient who was convinced that not only she had these bugs but her dog had them too. The innocent creature was subjected to hour on hour of her plucking away at it with tweezers until the poor thing was virtually hairless.

PARANOIA

When people are paranoid, they distrust the behavior and motives of others. They view even the most innocent actions with suspicion. Among the drugs that can cause paranoia are corticosteroid medications, H
2
blockers (cimetidine, ranitidine, famotidine), some muscle relaxants (baclofen), antiviral/anti-Parkinson's drugs (amantadine), some amphetamines (methylphenidate, or Ritalin), anti-HIV medications and antidepressants (Nardil). Paranoia can be prompted by the abuse of alcohol, cocaine, marijuana, ecstasy (MDMA), amphetamines (including Ritalin), LSD, and PCP (angel dust).

A common symptom of stimulant overuse is paranoia coupled with hypervigilance. This is known in the drug world as
tweaking
. Affected people actually stand at the door and peer through the peep hole, attempting to see if someone is sneaking up on them or stand and stare out the window blinds as if anticipating an attack.

While this is often described as a negative effect of cocaine or other stimulant use, research shows that some people actually enjoy hypervigilance and paranoid delusions. Stop and think about this for a moment. When you read a list of the ill effects of using stimulants for recreation, one of the bad things is paranoid delusions and fear, along with elevated heart rate. The same could be said for scary movies, and it is precisely to heighten the intensity of these fears that some people indulge in the misuse of these drugs.

“I like being paranoid,” confessed one of my patients. “I know that my fear isn't really real any more than the fear from watching a horror movie. I know in the back of my head that this feeling is temporary, like the scary rides at an amusement park. Lots of folks don't like the feeling, but I do. In fact, the scary feeling is the reason I like to get high.”

Most people who have paranoid delusions, however, do not find it entertaining, and these delusions can result in violence against people whom the paranoid person imagines as enemies.

MARIJUANA

When alcohol was illegal in the United States, marijuana was the only legal recreational drug available. The roles were soon reversed, and marijuana's reputation went into stark decline for several
decades. Today, however, marijuana is the most commonly used drug among teenagers in the United States, and it is destined to become more popular as the legalization movement takes hold in Colorado, Washington, and other states. While alcohol is far and away the most destructive intoxicant, the combination of alcohol and marijuana is especially harmful to the developing brains of adolescents.

The human brain develops up to 400 percent more receptors for the active ingredients in marijuana if use begins in the early teenage years, and consistent use during this critical period may give rise to various neurological and psychological issues, including problems with verbal skills, sequential memory processing, motivation, and task completion.

Frequent adolescent marijuana users manifest significant impairments to important cognitive brain functions, and the negative effect of marijuana on memory and concentration is well documented. Those who begin marijuana use at the age when the brain is still developing may be more vulnerable to various neurological and psychological issues, including problems with their verbal skills.

Marijuana smokers also have a lower rate of college acceptance and a higher dropout rate, although poor academic performance often comes before the marijuana use and is one of the triggers for the onset of drug use. Once started, however, the usage combines with collateral sociological and emotional factors to further undermine the student's academic career. While it is true that there are pot smokers at Harvard and Yale, these are incredibly bright achievers who were always top academic performers,
and they certainly did not spend their adolescence “wasted” instead of studying.

Another result of prolonged use of marijuana is reduced sperm count, verified by a study conducted by the American Society for Reproductive Medicine. “The bottom line is, the active ingredients in marijuana are doing something to sperm, and the numbers are in the direction toward infertility,” said Lani J. Burkman, lead author on the study. “The sperm from marijuana smokers were moving too fast too early,” she added. “The timing was all wrong. These sperm will experience burnout before they reach the egg and would not be capable of fertilization.”

As an addiction specialist, I've treated patients with marijuana withdrawal symptoms of anxiety, agitation, insomnia, and even violent behavior. These patients struggle to stay away from marijuana with the same challenges as those who have battles with alcohol or other drugs, and their psychological pain is obviously visible and confirmed by the patients themselves.

MEDICAL MARIJUANA

In my opinion, medical marijuana continues to make a mockery of medicine. Let me begin with the fact that the approval process is outright laughable. Anyone with a checkbook can get a recommendation letter for marijuana.

Under normal standards of professional care, a doctor performs a complete physical examination and diagnosis of the patient and then prescribes appropriate medication. Once the medical treatment begins, there is continual interaction between doctor and patient to ascertain the progress and efficacy of the treatment.

In the case of medical marijuana, there is no standard medical procedure performed, no special training for the physicians, and no guidelines. There is also no prescription written, nor are there any specifics as to dose and frequency. You can get a marijuana card for as little as $35 if your complaint is “hair pain” or something equally dubious.

Anyone with any symptom can go to a marijuana doctor and can get a recommendation letter stating that the person will medically benefit from marijuana. The patient then takes this letter to a marijuana dispensary and picks out the flavor of marijuana he or she finds most appealing.

This isn't a prescription such as “take 500 milligrams 3 times a day for 30 days,” and no one in the dispensary, including the patient, has any idea what it is he or she is getting.

Rather than further disgrace the medical profession with absurd claims of medical marijuana, it would make more sense to legalize marijuana as a recreational intoxicant, tax it, and use the revenue for public education and medical rehabilitation of those who have suffered marijuana's negative consequences.

Just as the vast majority of people who drink are neither problem drinkers nor alcoholics, the majority of adults who smoke marijuana are not problem smokers or drug addicts. My concerns are in two categories.

First, because marijuana is illegal, there are no regulatory standards of production and manufacture regarding content and potency. Hence, one cannot state that marijuana used properly is safe because there is no definition of
properly
nor is there a
standard safe dosage. Second, there is a predictable percentage of people who, due to genetics and other factors, will manifest the disease of addiction. One out of six people who smoke marijuana regularly develop problems requiring some type of medical intervention.

Like all other mind-altering drugs, marijuana is definitely dangerous in combination with any motor vehicle. It affects alertness, concentration, coordination, and reaction time. Marijuana also makes it hard to judge distances. The worst-case scenario is combining marijuana with even a small amount of alcohol. The two together are more dangerous on the road than either drug alone.

BARBITURATES AND TRANQUILIZERS

Barbiturates were first used in medicine in the early 1900s and became popular in the 1960s and 1970s for treatment of anxiety, insomnia, and seizure disorders. They evolved into recreational drugs that some people used to reduce inhibitions, decrease anxiety, and to treat unwanted side effects of other illicit drugs.

Barbiturate use and abuse has declined dramatically since the 1970s, mainly because a safer group of sedative-hypnotics called benzodiazepines is being prescribed. In the day, barbiturates abuse caused, or was significantly involved, in many of the most high-profile overdose deaths in the entertainment industry including those of Judy Garland (1969), Jimi Hendrix (1970), and Elvis Presley (1977).

Medications such as Valium and Xanax are some of the most commonly prescribed benzodiazepine medications, also known as
tranquilizers, in the United States. There are numerous uses for these medications, but when people take them who don't need them, there are problems. People at risk for addiction to these substances are also at risk for alcoholism. The combination of the two is deadly.

Withdrawal from benzodiazepines is similar to alcohol withdrawal and can be a dangerous process if not done properly. One should never stop these drugs cold turkey but instead taper off the doses, as directed by a physician.

While benzodiazepine was designed as a safer alternative to barbiturates, it too was involved in some high-profile overdose deaths in Hollywood, including those of Michael Jackson (2009) and Anna Nicole Smith (2007).

Social Consequences

The idea that there are social consequences for indulging in recreational drug use has come under intense research and professional scrutiny in recent years. In the United States, the biggest social consequence risk for the nonaddict drug user is arrest and or coerced “treatment” for possession of a controlled substance.

According to the National Institute on Drug Abuse (NIDA), “Among young people in drug abuse treatment, marijuana accounts for the largest percentage of admissions: 61 percent of those under age 15 and 56 percent of those 15–19.” According to the U.S. government study from which NIDA gets this figure, the majority of these teens were not in treatment because of dependence or addiction. They were given a choice of treatment or juvenile detention
after being caught in possession of marijuana. There was no medical diagnosis of dependence or addiction.

The National Institute on Drug Abuse doesn't mention this fact because, as an official representative of federal drug policy, it wants the reader to infer the admissions are due to dependence and addiction. Sadly, this is exactly the type of thing that causes teens not to trust antidrug pamphlets. Once again, we see research studies used not as education but as propaganda. While the intent may be honorable, the methods undermine credibility and perpetuate harmful exaggerations.

Because of my role as a doctor who treats patients with the medical condition of addiction, you might think I would approve of any method that proposes to decrease drug use. Proposing isn't the same as accomplishing, and falsely labeling people as drug addicts when they do not have the disease of addiction diminishes the credibility of the condition itself and makes a mockery of treatment.

A 2004 conference on special designer drugs and cocaine held in Bern, Switzerland, prominently featured extensive research by Peter Cohen, author of “The Social and Health Consequences of Cocaine Use.” In his final analysis, and in his words, “For all drug use and drug users, social exclusion and marginalization are the worst settings. The best harm and crime reduction money can buy is to lower marginalization and exclusion of drug users, even if this would mean that the drugs they (still) like to use have to be made available to them at acceptable costs. In my view, daily and regular use is far less of a danger to people than social exclusion.”

We must deal with what is real, and the reality is that I
practice addiction medicine in the United States, where the stigma against addicts is widespread, punitive legal measures are still instituted against disease sufferers, and millions of people who could avoid addiction or be treated successfully receive no help beyond a good scolding, shame, a jail sentence, and marginally helpful support group meetings.