ROUGHLY one-third of Australians have tried it. Half of all people aged 20 to 29 have used it and some of those, like Jade, have smoked so much cannabis that their mental health has crumbled, triggering depression, psychosis, panic attacks, paranoia and even suicidal thoughts.
Former cannabis user Jade experienced paranoia and psychosis before she successfully sought treatment. “It was very scary. I thought people could read my mind. I was getting messages from watching TV. I was very paranoid. I felt like there was a big conspiracy and that everyone was in on this agenda and it was all about me. Cameras were on me. It was something I’ll remember forever and I wouldn’t wish it on anyone,” recalls Jade, now 29, off “bongs” and studying for a career in youth work.
Jade — who began smoking when she was only 13 — says the psychosis she experienced from using and eventually abusing cannabis landed her in Melbourne University’s Orygen Youth Health in-patient clinic for eight days. She wishes someone had helped her recognise that she had a serious cannabis use problem before she hit the wall. Unfortunately, if anybody noticed, they did nothing.
Now somebody is doing something, if not for Jade then for other young people at risk of cannabis-induced mental health problems. The Orygen Youth Health Research Centre has teamed up with the National Cannabis Prevention and Information Centre — based at the University of NSW — to produce the first evidence-based guidelines to help people such as Jade’s friends and family identify and assist users who may be sliding down the slope to mental illness. The so-called “first aid” guidelines reflect NCPIC’s job description, says its director Jan Copeland. “There’s a lot of community misinformation about cannabis and only a small proportion of people with problems seek treatment”. And that’s a worry, claims Copeland, a research psychologist specialising in drug and alcohol addiction: “The earlier the intervention the better the outcome.”
Not only can heavy cannabis use lead to the kind of mental illness Jade suffered, it can worsen problems associated with the use of alcohol and other illicit drugs. The resulting emotional cocktail has a host of consequences: impaired judgment, breakdown of families and social connections, legal problems and injuries from car crashes and other accidents. While many of such difficulties can be alleviated by getting off cannabis, others may persist for years, or even life. That’s especially true if people being using very early.
Neuroscientists have learned that different parts of a young brain develop at different rates. Final “wiring” is not complete until the mid-20s, addiction psychiatrist Dan Lubman says. According to Lubman, with Orygen and Melbourne University, that discovery goes a long way to explain why 75 per cent of mental disorders commence before age 25. “It’s a time of huge developmental growth,” he says, noting that stress, drugs and genetic predispositions can make developing brains even more vulnerable.
Most experts agree that developmental mis-wiring involves the brain’s endocannabinoid system. That’s so, as it appears to modulate brain chemicals called neurotransmitters, which relay and regulate signals between brain cells. Lubman says: “Certainly, there’s some evidence from animals that early use of cannabis can cause cognitive problems and problems with social interaction that persist and aren’t seen in adult animals.” There’s also solid evidence that young humans with abnormal brain development often experience a cascade of problems. For instance, cognitive difficulties may lead to poor school performance which may drive poor self-esteem, mixing with other uses, dropping out of school, multi-drug problems and so it goes.
Moreover, Jade’s raging paranoia may have been heightened by the increased potency of cannabis. Unlike the pot smoked by 60s hippies, today’s plants have been selectively bred to increase the amount of the active ingredient of euphoria and mood alteration, tetrahydrocannabinol, or THC. In a gardening twist, the rise in THC has been accompanied by a reduction of another cannabis ingredient, cannabidiol. Lubman says cannabidiol reduces anxiety and has been trialled as an anti-psychotic drug for conditions such as schizophrenia.
Little wonder that Jade found herself going from “giggling on the floor for hours” at 13 to full-blown psychosis at 20. As she escalated her intake of cannabis from light use to “a gram or two per day shared between friends”, her brain and behaviour went haywire. It’s quite possible that people close to Jade noticed that she had a problem. It’s also likely that they didn’t want to get involved, wished to keep the matter quiet or simply believed, incorrectly, it was a matter of morality. “A problem is the notion of hedonism, that users should be punished. They brought it on themselves and they don’t deserve help,” Lubman says. Hence, “Helping Someone with problem Cannabis Use: Mental Health First Aid Guidelines”. As well as simple information about cannabis abuse problems, the guidelines provide practical advice about issues such as approaching a person about their cannabis use, what to do if the person does not want professional help, how to find professional help and where to go for support.
Critically, every bit of information was identified and scrutinised for effectiveness and accuracy by 87 participants, divided into three panels: clinicians, carers of users and former users. Co-ordinated by Lubman’s group, the experts came from Australia, Canada, New Zealand, the US and Britain. Copeland claims this extensive process was necessary as much of the advice online and in books and other literature is inaccurate, useless or in some cases downright dangerous. While many suggestions are very specific — stay calm, don’t criticise the persons’ cannabis use, don’t bully or nag, ask about the person’s use instead of making assumptions, offer to help find professional help and the like — there are key things to keep in mind, claim both Lubman and Copeland. The key one being that many good treatments are available, from counselling to self-help groups.
Lubman ticks off important basics: “Be realistic about the outcomes. It may be the first time a person has been approached or thought about a problem. Be aware of local options. “Be prepared that the person may not want help and decide how you’ll respond, and understand what you will and won’t do to support the person.” Do the guidelines make sense? “Absolutely,” says Jade. In fact, right now she’s doing a placement with Orygen, working as a peer-support person. “When you’ve got somebody who’s been through it it’s good. They know what’s in your head. That’s why I’m here at Orygen. I’m trying to give back and be here for anyone else going through it.”
Source www.ncpic.org.au, www.mhfa.com.au 19 June 2009