We Talked to a Doctor Who Treats 'Cannabis Use Disorder'

By Manisha Krishnan

You apparently can have too much of a good thing. Photo via Flickr user Katheirne Hitt

With the exception of a few sober stints, Jeffrey has been waking and baking every day for the last six years.

The 24-year-old script supervisor, who grew up in a small town outside of Seattle, told VICE he started smoking weed when he was 18, introduced to it by a friend at a campfire.

Within six months, he said he was going through a couple grams a day. 

"For me it felt like about as classical of an addiction as you could get. It really kind of changed and took over everything. Every morning I woke up and it was the first thing you thought about." 

Marijuana is the most popular "illicit" drug in the world. With legalization set to take place in Canada next year, Dr. Jonathan Bertram, an addictions physician at Toronto's Centre for Addiction and Mental Health, told VICE the "law of averages" means more and more people are likely to run into it at some point in their lives. Advocates point out that it is far less harmful than legal substances like tobacco and alcohol. But, according to Bertram, that doesn't mean it's immune to being abused.

While the idea of being addicted to marijuana is highly contentious—many people believe it's impossible—doctors actually have a term for weed dependency: cannabis use disorder. The diagnosis itself is only three years old—it was first referenced in the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders. The US-based National Institute on Drug Abuse says 9 percent of marijuana users will abuse it. 

According to Bertram, many of his patients say they started using cannabis either for recreational reasons or because it helped them with a physical condition—like insomnia—but that over time the benefit they received from cannabis began to diminish and in some cases the habit started having a negative impact on their lives.

"Their use ends up dominating a big part of their lifestyle and their day. Because of their use they can't carry out things they normally would," he said, including attending school, work, and completing homework or tasks. Teenagers are more susceptible to developing a problem.

"They have a lot of trouble keeping up with their relationships except for the ones that revolve around cannabis use."

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Jeffrey said his chronic use led him to feel more depressed and emotional.

"I was just much more self critical. I had all these feelings of insecurity and they were very much heightened." 

He also said he stayed indoors alone more, stopped hanging out with friends who didn't also smoke, and stopped caring about his diet or his interest as a musician. Three years ago, he posted a thread on Reddit titled "How heavy-marijuana smoking ruined my life," where he described "scouring the disgusting carpet for weed crumbs, sneaking nugglets from my friends when they weren't looking, lying to my parents about needing more money, and having panic-attacks when I couldn't find weed."

Bertram told VICE he sees patients who use weed to ease their anxiety; it works at first, but eventually, as they build up a tolerance and consume more and more to achieve the same effect, some experience "rebound anxiety" where their symptoms actually worsen due to the marijuana. While it's rarer, he said people also have physical withdrawal symptoms stemming from marijuana dependence, including breaking into sweats and vomiting.

The primary treatment, he said, is cognitive behavior therapy—a form of psychotherapy that helps people develop specific techniques to deal with their everyday thoughts and problems. A secondary option is a drug called nabilone, which mimics the therapeutic effects of the cannabidiol (cbd) in cannabis but not the psychoactive one.

But Bertram said there's far less evidence of the effectiveness of such treatments than there is for treatment for addictions to other substances, i.e. methadone for opioid addiction. 

When Jeffrey felt his weed addiction was out of control, he reached out to his family for help. He said his parents took turns living with him for a couple weeks at a time. 

"I would get anxiety, but I'm with my mom so I couldn't smoke. So I had to just deal with that and talk through it." 

He went cold turkey for a month and a half. But, more than three years later, he said he's still blazing every day.

"(Before) it was a lot more 'I need to normalize my emotions, I need to mask this pain.' Now I do it much more like 'Hey, let's throw on a trippy movie.' I'm kinda more just having fun with it." 

Bertram said it is possible to treat people with cannabis use disorder by having them smoke up more moderately—but only if their reasoning, impulsivity, and ability to manage emotions haven't been impacted by using the drug. 

Overall, he said he sees far fewer patients with cannabis use disorder than those dealing with other addictions, like alcohol and opioids. But he said more research on cannabis dependency is needed. 

"It definitely has to be studied more because people are using it and people have all kinds of different opinions on it," he said.