Post-its from Practice:
What can we offer cannabis users? (Sep 2007)
Michael aged 19 years came to see me. I had known him since birth. He started the conversation with "I don't think you can help me and I'm probably wasting your time but my mother said I should speak to you". He went on to tell me he was smoking a lot of cannabis, mostly skunk and he was finding work more difficult. The final straw for him was when he had been very verbally aggressive to his girlfriend whilst he was suffering withdrawals. Michael said that his skunk use had increased from once or twice a week at the weekend to every evening and now during the day as well. He had tried to stop several times by himself but he hadn't managed it. He said he didn't take any other drugs, confirmed on urine testing and only very occasional alcohol. I said we could help him and I gave him some basic harm reduction advice and then introduced him to James our specialist drugs counsellor.
James began to work with Michael to initiate positive behaviour change by completing a full assessment and providing clear information about the risks of cannabis use and in particular skunk. His high frequency of use combined with the strength of the cannabis that he smokes increases the chance of negative consequences of harm and it was important to take his problems seriously.
The assessment information suggested that he had developed tolerance and was experiencing withdrawal symptoms. Preparing him with knowledge of likely withdrawal effects helped him to understand and prepare. These effects can include irritability, restlessness, anger, aggression, sleep difficulty, decreased appetite and weight loss (Ref 1).
Re-assuring him that these will pass in 2 to 4 weeks helped him to deal with them in the short term. Activities that absorb or relax him were discussed and encouraged. The "4 Ds" were used as a helpful reminder of what to do when he was craving: 1) Delay for at least 5 minutes - the urge will pass; 2) Drink water - take time out, sip slowly; 3) Deep breathe - slow full and deep breaths and 4) Do something else - keep your hands busy.
Variables such as peer pressure, low self-esteem and deficient life skills seemed to be contributing factors influencing Michael's motivation to change and making him vulnerable to relapse (Ref 2). These factors were identified and Michael was directed to www.knowcannabis.org which provides an online support programme.
We don't have a local young person's service but they can be helpful if there is one. We were able to give Michael clear information about the risks and negative effects of his cannabis use which he was able to use and support his behaviour change. However scaring him would likely prove counter productive and we instead attempted to create a sense of hope and positive expectancy about the change using.
Cannabis is a psychoactive drug and can undoubtedly cause paranoia and exacerbate mental health problems. There is sufficient evidence to warn young people that cannabis use could increase their chances of developing a psychotic illness in the future (Ref 3). However, the mechanisms involved are still not clear and there were other negative effects which seemed more relevant to Michael. These included the negative effects on his self perceptions, for example, feeling bad about using, lowered self-esteem and reduced self-confidence as well as perceived impacts on energy level and procrastination and concerns about memory loss (Ref 2).
As more cannabis/skunk users present to us in practice we need to see and support them regularly as cannabis dependence can have serious consequences for the individual and for the wider community.
1. Budney A. J. Hughes J. R. Moore B. A. & Novy P. L. Marijuana abstinence effects in marijuana smokers maintained in their home environment. Archives of General Psychiatry, 58, 917-924 (2001).
1. Donovan D. M. & Marlatt G. (eds.) Assessment of addictive behaviours 2nd edition. New York: Guildford Press, (2005).
1. Moore T. H. M. Zammit S. Lingford-Hughes A. Barnes T. R. E. Jones P. B. Burke M. Lewis G. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370, 319-28 (2007).