Cannabis. Relationship Between Cannabis and Mental Health. What is Cannabis Anyway?

Transcription

1 Relationship Between Cannabis and Mental Health Alison Penney and Sharon Cirankewitch AHS-AADAC Youth Services Calgary What is Cannabis Anyway? Weed, pot, grass are different names for the same drug. It comes from the Cannabis sativa plant. Hash and hash oil also come from this plant. Marijuana is a greenish or brownish material consisting of the dried flowering tops and leaves of the plant. Hashish or cannabis resin is the resinous secretion if the flowering tops of the cannabis plant. It is sold in solid pieces that very in texture from hard and dry to soft and gummy. It is generally more potent that marijuana. Hash Oil is a thick greenish-black or reddish-brown oil made by concentrating hashish with alcohol or some other solvent. It is more potent than marijuana or hashish. Drugs are classified as stimulants, depressants, hallucinogens. Cannabis fits into its own classification of drugs as it has properties of all three classifications. Cannabis 1

2 Short and Long Term Effects Short-Term Effects Using cannabis will probably make you feel more relaxed, free and open. Colors will seem brighter, sounds and smells more distinct. If you smoke cannabis, you will probably feel the high quickly, and it will last two to four hours. If you eat it, the high happens later, and you feel it for a longer time. Cannabis makes you clumsier and slow to react. Driving and operating machinery while under the influence is unsafe, especially if you combine cannabis with other drugs, including alcohol. Reduced ability to learn. You can forget things, and have trouble concentrating. Some users feel severe anxiety and high doses can cause panic attacks and paranoia. Effects of Long-Term Use Using cannabis heavily for a long time can have serious side effects. Cannabis smoke contains cancer-producing chemicals. Smoking cannabis damages the lungs and can lead to chronic coughing and lung infections. People who smoke both marijuana and tobacco may develop lung, neck and head cancers at a younger age than those who smoke only tobacco. Many people who use cannabis heavily for a long time have problems with short-term memory, concentration and abstract thinking. Some heavy cannabis users appear less active and ambitious than other people. We cannot say that cannabis causes this. However, frequent use can make people even less motivated. History of Cannabis While the cannabis plant has been used medicinally and recreationally for thousands of years, it wasn t until the early 19 th century that the use of cannabis spread from Asia and the Middle East to the population of Europe. Widespread cannabis use emerged in Australia and other Western countries in the early 1970s and has been rising since. Today, cannabis remains the most commonly used illicit drug in Canada. 15.5% of Albertans (14.1% of Canadians) age 15 and over reported using cannabis during the year prior to the survey. (Stats Canada 2004.) Interesting Facts 1923 The year marijuana became illegal in Canada. The decision to make pot illegal has been criticized because cannabis was added to the illegal drugs list without parliamentary debate The year the first marijuana-related charges were laid in Canada. It was also the year marijuana became illegal in the United States The year the United Nations made it a violation of international law to legalize marijuana The year Canada made it legal for some people to smoke marijuana for medical reasons. 582 The number of Canadians who have Ottawa's permission to smoke marijuana for medical reasons, as of July 9, Health Canada said it had received a total of 1,145 applications from people wishing to legally smoke since the medical marijuana access regulations came into effect in Thirty-five to 50 new applications are received each month. 2

3 Fact or Fiction 30% of youth smoke Cannabis every day. T/F Cannabis is not addictive. T/F Cannabis is less harmful than other drugs. T/F Doctors prescribe cannabis so it can t be that bad. T/F Cannabis is all the same. T/F It can t hurt because it s just a natural plant. T/F Everyone Uses it??? Canadian Stats (2004)- 14% of Canadians age 15 and over reported using cannabis in the past year, nearly double the rate reported in 1994 (7.4%); however, almost 46% of these people had not used cannabis or had used it only once or twice in the three months preceding the survey. Alberta Stats- In 2004, 15.5% of Albertans (14% of Canadians) reported using cannabis during the year prior to the survey. Just over half of Albertans and Canadians were lifetime abstainers from cannabis (51.3% and 55.5% respectively), having never used the substance. About one-third of the population (33.2% of Albertans and 30.3% of Canadians) were former cannabis users, having used cannabis at some point during their lifetime, but not during the year prior to the survey. Alberta Teen Stats- Percentage of past-year Cannabis use in Alberta (grade 7-12) in 2005 was 26.7%. Canadian Rates eh? 3 million The number of Canadians who used marijuana in 2002, according to Statistics Canada. The Canadian Medical Association estimates that about 1.5 million Canadians smoke marijuana recreationally. 10 per cent The proportion of Canadian users of marijuana in 2002 who used it every day. 10 million The number of Canadians who reported having used marijuana at least once in their lives. 4.5 million The number of Canadians who used marijuana in 2004 (about 14 per cent of the population), according to Statistics Canada. Males were more likely than females to use pot, and about 70 per cent of those aged 18 to 24 said they use marijuana. The Canadian Medical Association estimates that about 1.5 million Canadians smoke marijuana recreationally. 3

4 What Are the Risks? Physical Health Risks Respiratory Reactions with other drugs (alcohol) Cancer causing substances (similar to tobacco) Co-ordination and balance Safety Concerns Impaired Judgment (decision making, driving, operating machinery) Psychological Health Cognitive Effects (impairs learning and memory) Mental Health (increased risk to trigger psychotic episode, frequent use risk factor for later depression and anxiety) Problematic Use (dependency, withdrawal) Legal Risks De-criminalization vs. Legalization Convictions can result in life long barriers around employment and travel. Adolescent Brain Development Teen brains still under construction Adolescence is a period of profound brain maturation We thought brain development was complete by adolescence We now know maturation is not complete until about age 24 Construction Ahead Wave of over production during late childhood - neurons increase their number of connections in preparation for adulthood Connections start to be pruned off around the age of 11 for girls and 12 ½ for boys When the pruning is complete the brain is faster and more efficient BUT during the pruning process, the brain is not functioning at full capacity 4

5 Pruning starts at the back of the brain and moves to the front Judgment Amygdala Emotion Prefrontal Cortex Motivation Notice that judgment is the last to develop Nucleus Accumbens Cerebellum Physical coordination Age 24. Judgment Emotion Motivation Physical coordination, sensory processing Ahh Balance, Finally! What this process means for adolescent behavior. Physical activities benefit from earlier back of brain development Complex, judgment-demanding thinking is compromised by later front of brain development Preference for physical activity Poor planning and judgment More risky, impulsive behaviour Minimal consideration of negative consequences 5

6 Drug Use and the Growing Brain When brain is most vulnerable is also when youth most likely to use alcohol and other drugs Drug use may have impact on pruning process A brain under development is more vulnerable to drug dependence Adolescent Drug Use Experimentation starts early (Gr. 6 & 7) (immature nucleus acumens) Many youth experiment, but most will not develop a problem Number of youth using substances increases with age/grade level Some youth are more at risk of developing a long term problem with substances (Adverse Child Experience Study). Vulnerabilities can be connected to childhood experiences The earlier the behaviour starts, and the more often it is repeated, the greater the likelihood of harmful involvement Age and Drug Use Age 12 Age 14 Age 16 Age 18 Tobacco Cannabis Alcohol 6

7 What is Mental Health? The World Health Organization defines mental health as: A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. What is Mental Illness/Disorder? Mental illnesses or disorders are characterized by alterations in thinking, mood or behaviour (or some combination thereof) associated with significant distress and impaired functioning over an extended period of time. Mental illnesses can occur together (ex. Depression and Anxiety) People can have co-occurring or concurrent disorders which generally describes a situation in which a person experiences a psychiatric disorder and either a substance use disorder and/or a gambling disorder. (CAMH.) Mental Illness... what comes to mind? People often think of schizophrenia, borderline personality disorder, OCD, multiple personality. We also need to keep in mind other types of disorders such as depression, anxiety, ADHD, impulsivity and the accompanying degrees of interruption in normal functioning. There is a reluctance to diagnose youth with personality disorders until age 18, instead they are assessed as having tendencies toward a particular illness. 7

8 Optimal Mental Health Continuum Optimal Mental Health Less than Optimal Mental Health Positive Health Determinants are evident and the individual is well adjusted and is coping and adapting well. The individual has: Basic needs met Safety and security Opportunities for work and play Meaningful attachments and relationship with families or others Opportunities to pursue goals and create a positive future Knowledge and decision making skills Positive self esteem Controlled mental disorder Absence of factors above and presence of factors including: Serious mental disorders Violence, abuse and neglect Poverty Addictions Harsh social conditions Discriminatory attitudes Crisis Trauma Youth and Mental Health The onset of most mental disorders occurs during adolescence and young adulthood. 1 in 7 children in Canada will experience mental health problems serious enough to impair their development and functioning. Problems deserve attention when they are severe, persistent, and impact on daily activities. Mental Health and Youth Who Misuse Substances Psychiatric conditions most often reported among substance abusing youth: Conduct disorder Mood and anxiety disorders Attention deficit/adhd Multiple diagnosis is common in this group. 8

9 AADAC Youth Services Many youth who access services struggle with mental health concerns: ADD/ADHD Post Traumatic Stress Disorder Depression Anxiety Conduct Disorder/Oppositional Defiant Disorder Psychosis/Bipolar Disorder Eating Disorder What Causes Mental Health Problems? Genetics/heredity Individual factors/personality Environment Family factors Social experience Economic All these factors interact and influence each other. These are the same factors that impact substance use. ACE STUDY The Adverse Childhood Experience Study is one of the largest investigations conducted on the links between childhood maltreatment and later-life health and well being. Recurrent physical abuse Recurrent emotional abuse Contact sexual abuse An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized, or suicidal Mother is treated violently One or no parents Emotional or physical neglect 9

10 ACE Study cont d Exposure to one category is equal to one point. Ace scores translate into health and behavioural outcomes. For each ACE the risk for the early initiation of substance abuse increased two to four times Subjects with five or more ACE s had seven to ten times greater risk for substance abuse than those with none. With an ACE score of 4, a person is 460?% more likely to be suffering from depression Substance abuse and mental health the relationship Often occur together Relationship between the two is sometimes difficult to determine (which came first) Both typically begin in adolescence Alcohol/drugs/mental disorder together produce a wider range of symptoms and functioning difficulties, require more resources to treat, and are more difficult to treat than either one alone. The Relationship Between Cannabis and Psychological Harm There are four main views on the nature of the association between cannabis and later mental disorders: 1.That the link may be due to sociodemographic, economic or genetic factors common to both cannabis use and the disorder. 2. The self-medication hypothesis suggests that patients with mental health problems may be using cannabis and other drugs as a form of self-treatment for their condition. 3. That cannabis directly causes new cases of the mental disorder. 4. Finally, the vulnerability hypothesis proposes that the use of cannabis can increase the risk of mental health problems for some at-risk people (Hall et al. 2001). 10

11 Vulnerability Hypothesis Most people who experience psychosis after cannabis use have a vulnerability to developing a mental health disorder or actually have such a disorder. Cannabis use by these vulnerable individuals may trigger an episode of their illness. In addition people who have a family history of mental illness (and this may not be known by many people) may experience negative mental effects, including episodes of psychosis if cannabis is used regularly. Is Cannabis Use A Contributory Cause of Psychosis? A review of six longitudinal studies in five countries. Over the past few decades, there has been growing evidence for an association between regular cannabis use and psychotic symptoms and disorders, both in the general population and among incident cases of schizophrenia and other psychosis. Degenhardt, Hall; Canadian J of Psychiatry, Vol 51, No 9, August 2006 Cannabis and Psychosis Danish study (British Journal of Psychiatry): almost half of patients treated for a cannabisrelated disorder go on to develop a schizophrenic illness. People who had used the drug developed schizophrenia earlier than those with the illness who had not smoked marijuana. An American study using sophisticated imaging techniques found similar abnormalities in the brains of adolescents with schizophrenia, and those who use cannabis daily, but no such abnormalities in healthy teenagers. 11

12 Implications All youth with mental health problems should be screened for alcohol/drug use. All youth seeking help for substance use should be screened for mental health issues. Prevention initiatives with children and youth can help protect against both substance abuse and mental health concerns. Target prevention efforts to youth who fit the vulnerability profile (e.g., ADHD, family history of mental illness etc.) Prevention Risk and Protective Factors All adolescents experience risk and protective factors in their lives Risk Factors make it more likely individuals will experience poor overall adjustment or negative outcomes, such as mental health or substance use problems Protective factors reduce the potentially negative effects of risk factors 12

13 Adolescent Protective Factors Individual Self esteem Self reliance Social skills Can experience range of emotions. School Connection Good performance Community Participation in and availability of pro-social activities Norms of non-use Family Close relationships Support/monitoring High expectations Participate in decisions Coping skills Preventing Adolescent Concurrent Disorders Focus on Social determinants of health Secure attachment and good parenting Social support and friendship Meaningful role for individual Preventing early trauma Teaching psycho social strategies for dealing with stress and anxiety Ensure community is educated and aware of signs and symptoms this supports early detection/intervention. Stigma of mental health/addictions is addressed Assessment 13

14 Assessment Is the starting point for identifying client needs, developing treatment and support plan Comprehensive assessment by addictions counsellor includes: personal history, behavioural component, psychosocial functioning, evaluation of supports/motivation for change. Psychiatric diagnosis requires assessment by physician or mental health professional Assessment Chronology of symptoms onset: Were the mental health issues present prior to the use of substances? Relationship between symptoms: Do the mental health symptoms worsen or improve with substance use? Do the symptoms dissipate with abstinence? Mental Health and Youth Who Misuse Substances Externalizing disorders (conduct/ oppositional defiant disorders, ADHD) more common in males who misuse substances. Internalizing disorders (anxiety, depression, PTSD) and mixed disorders (externalizing and internalizing) more common in females who misuse substances. 14

15 Challenges cont d Externalizing disorders less likely to successfully engage in, participate in, or complete treatment programs. Concurrent disorders may increase risk for relapse among certain youth clients E.g., Cannabis dependent adolescents who were diagnosed with depression were more likely to relapse during treatment, and to relapse more frequently than those not diagnosed with depression. Challenges in Youth Concurrent Disorders More challenging to treat concurrent disorders than either condition alone Variety of biological, psychological and social components Adolescents with concurrent disorders begin using substances at an earlier age, present with more severe substance abuse problems, and present with greater treatment needs in a greater variety of life areas. Engagement Challenges Youth with concurrent disorders often come to addictions treatment while experiencing chaos and negativity in their life. Prior contact with numerous agencies (also leads to attendance issues) Come because someone else says they should Deny need for help with addictions Deny presence of mental health concerns (stigma, lack of awareness). 15

16 Treatment Treatment Approaches Both substance abuse and concurrent disorders share common approaches in treatment Range of interventions Stages of Change Model/Motivational Interviewing/Solution Focused Therapy Cognitive Behavioural Therapy Strength based, client/family centred Individual, family and group therapy Family involvement increases effectiveness. Treatment Outcome Researchers have concluded that youth with concurrent disorders have a higher rate of post-treatment substance use relapse than those without mental health problems. Youth with concurrent disorders are more likely to move in and out of treatment over a period of months or years. 16

17 Issues in Treatment Longer time needed for engagement/development of trust Pace of treatment is slower, over a longer period of time, with frequent setbacks Must address stigma of/preconceptions about mental health Self medication seen as solution Cognitive ability, attention span, thought processes (ex. Hard to work in groups re: focus, attention seeking and relationship issues) Stages of Change Stage 1 Precontemplation: No need for change, Problem? What problem? Stage 2 Contemplation: OK there s a problem, but I m still not changing anything. May still blame others. Stage 3 Preparation: Making a plan What do I do now? Stage 4 Action: Behavior change Here I go Stage 5 Maintenance: Building new patterns and avoiding relapse Moving forward Good Intentions That Tend to Backfire Long explanations Trying to give insights Trying to get adolescent to understand Convincing them that you know better Trying to change them Wanting them not to resist 17

18 Some Things that Work Better Phrases that encourage conversation: Wow! I can see this is really important to you. You raise a good point. I never thought of it that way before. I m not sure I understand could you tell me more about that? That s an interesting viewpoint. I can see why you would be upset. Acknowledgement and validation do not equal agreement. Summary Adolescent brains are different from adult brains. Relationship building is the key, adolescents need to hear themselves talk more than the adult. Kids today need a darn good listening to. Importance of experiential education. Tell me and I will forget, Show me and I may remember, Involve me and I will understand. Chinese Proverb Conversations that encourage change are characterized by curiosity. References Alberta Alcohol and Drug Abuse Commission. (2006) Building Capacity: A Framework for serving Albertans Affected by Addiction and Mental Health Issues: Summary Report. Edmonton, Alberta Copeland J, Gerber S, Dillon, P. (2006). Cannabis: Answers to your questions. Australia; Australian National Council on Drugs Degenhardt, L & Hall, W. (2006). Is Cannabis Use a Contributory Cause of Psychosis? Canadian Journal of Psychiatry, Vol 51, No 9. Fergusson D M, Horwood L J & Swain-Campbell N R (2002) Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction, 97: Hall W, Degenhardt L, Lynskey M (2001) The health and psychological effects of cannabis use. Canberra: National Drug Strategy. Hall, W. (2006). Cannabis use and the mental health of young people. Australian and New Zealand of Psychiatry; 40: Hunt N, Lenton S, Wilton J (2008). Cannabis and Mental Health: Responses to the emerging evidence, report eight. Multiple Authors. (2007) Canadian Addiction Survey; Substance Use by Canadian Youth. Her majesty the Queen in right of Canada. Tjepkema, M.(2004). Use of Cannabis and other Illicit Drugs. Health Reports-statistics Canada catalogue, Vol.15, No.4. 18

19 References Cont 1a.htm XPE/pdf/ pdf Sharon Cirankewitch and Alison Penney AHS-AADAC Youth Services Calgary, AB (403) Community Education Service To register for notification or an upcoming education session go to: For general CES enquiries Call: Funding generously provided by Encana Corporation and the Alberta Children s Hospital Foundation 19