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Substance use and mental health

Substance use, with its vague boundary between its subsets of abuse and addiction, is one of the most misunderstood areas of mental health. 

It’s easily misunderstood, because there are many different common substances people use that are biochemically addictive, such as nicotine, alcohol and some pharmaceuticals. And there are addictions to unusually high abnormal amounts of normal brain chemicals triggered by modern behaviors. These are ones that mimic behaviors designed by Nature to encourage early mankind to protect and perpetuate the species.

Both kinds of addictions—to external substances and to neurotransmitters in the brain—are an addiction to a chemical. They both have mental health side effects—subtle and not so subtle—that can affect the user, abuser or addict in different ways from drug to drug and person to person. No matter which drug we examine, use can more easily become abuse, and abuse addiction, than most folks think. Often people don’t realize their mental and emotional processes are being biochemically held hostage. Whether it’s an outer chemical like alcohol or an inner chemical like our brains’ reward chemical, abuse or addiction has serious consequences for ones emotional, psychological, social and physical wellbeing.

A common denominator of all abuse and addiction is that the victim is engaged in paradoxical thinking. In other words, while she tries to figure out what is going wrong with her relationship, career, emotional and/or physical health, she tries to do it with a brain affected by a psychoactive addictive substance. Very often she cannot see that smoking cannabis, spending five hours on FaceBook daily, or drinking a couple glasses of wine every other evening is the primary source of her misery. In some cases, it’s the culprit instigating the mental illness for which she is now taking meds.

Mental illness, particularly bipolar disorder, insomnia, depression, anxiety, or even a psychotic break, may be a side effect of a substance, but psychiatrists and other med providers sequestered in their allopathic pharmaceutical world notoriously miss this connection. Patients show up at counseling, often pointing their fingers at all sorts of perfectly logical reasons for suffering not able to see the face of their abuse or addiction in the mirror.

Say what?

Just talking about alcoholism can be confusing, because it is not “an addiction” if a person “binge drinks,” but binge drinkers are “alcoholics.” Getting screaming drunk routinely, but occasionally, is not a biological addiction, it’s a psychological dependency. For it to be an addiction, one must have the addictive substance to not go into a biochemical withdrawal. With binge drinking, alcohol hasn’t taken over a chemical process in the brain because it’s not used often enough for that to occur. However, binge drinking is a dysfunctional coping strategy and it is abuse—a serious psycho-emotional disorder for which professional help is needed, if only for the binge drinker to NOT kill herself or someone else accidentally while blasted or black-out drunk.

A little known fact is when a person consumes alcohol on a weekly but not daily basis, she can be addicted without realizing it. Alcohol stays in the body for four days, so a drinker can maintain low-grade addiction by imbibing only a couple beers or glasses of wine on every fourth day. In other words, if a person drinks four glasses of wine a week, one on Tuesday and three on Friday, it is possible she is mildly addicted to alcohol. Not horribly addicted, but biochemically the body may feel it needs the alcohol a couple times a week to maintain a maintenance level to not go into withdrawal, even if society does not label the drinker as an alcoholic.

And the drinker will be affected by it. Consistent weekly drinking can affect mental health not only because alcohol is a depressant that can aggravate or stimulate depression, but because experiencing mild withdrawal every few days creates anxiety. A person drinks (or takes a benzodiazepine that is taken up into the alcohol receptors in her brain) to quell anxiety not realizing it was actually low-grade withdrawal that caused her to feel anxious in the first place. It was not necessarily her husband’s difficult behavior, job stress or the threat of global warming.

Researchers Ed Diener and Martin Seligman screened over 200 undergraduates for “levels of happiness” and compared the top ten percent (extremely happy) with the middle and bottom ten. They discovered extremely happy students experienced no greater number of objectively positive life events than the other two. They found people don’t need happy things to happen to be happy if they are able to focus on good stuff, instead of only the bad. That’s hard to do that if a person is using a depressant a few times a week like beer or using a drug like cannabis that causes anxiety or paranoia. Users believe their unhappiness is because of external things that happen in their lives.

Of course, I am not saying they may not have serious issues. Some are absolutely terrible problems, but I am suggesting when a person looks at past or current events through a chemically depressed or agitated brain, challenging issues cannot help but be magnified.

Another common illusion is that alcohol, cannabis or even Oxycontin is a good choice to mitigate pain. Many people drink or smoke because “I have a bad back,” or a “sore neck” and welcome the pain mitigation effects of these drugs regardless of obvious side effects. However, there is much evidence that supports the hypothesis that the pain many are experiencing is the memory of chronic pain exacerbated by a nervous system rattled by low-grade chronic withdrawal and spring back effect. A spring-back effect is when the symptom returns at a higher level than before using the substance. A common occurrence that works kind of like a Jack in the Box.

For people who use addictive substances daily, even in relatively small amounts, chronic morning withdrawal causes various symptoms, one of which is to jangle the nervous system. While alcohol stays in the system for four days and cannabis at least thirty, withdrawal begins almost immediately. If a patient has chronic pain, the last thing I believe she needs is jangled nerves. The pain she perceives is not solely caused by the injury, but from withdrawal which inflates the memory of pain in a neural pathway through which original pain signals traveled to the brain. Then, she gives the addiction what it craves causing pain to go away, not because it is mitigating actual physiological pain or even its evil twin remembered pain, but because it is mitigating withdrawal.

I have seen this numerous times in my practice. After a patient has been substance free for around six months, she finds she does not experience pain at all. Upon giving up Oxycodone or cannabis, pain may go away on its own after a little while because the addiction and its withdrawal are gone, the nervous system has healed and the brain receives signals that everything is OK. In fact, in my personal experience as a healer, I have never seen it not go away.

Other maladies fade also. Alcohol consumption contributes to insomnia, hypertension, cardio myopathy, atrial fibrillation and ventricular tachycardia among other disorders. Cannabis, nicotine and alcohol are well documented to trigger depression and anxiety. Imagine the mental and physical problems that may occur when someone mixes the three together in a daily regimen! For some people with challenging childhoods or recent traumas, the resulting depression is deep enough to explain suicidal behaviors.

The most misunderstood drug on the market may be cannabis

I’m so glad it’s legal now in Washington State! Its illegality was a black hole of societal and scientific ignorance. Its biochemical effects on the brain cause a delusion that makes a user believe it’s benign when it is not. Marketers are out in force touting its benefits. Granted, there may be several, but they ignore its serious side effects and detriments particularly to mental health. Many people have heard one joint is equivalent to chain smoking five cigarettes in terms of carcinogenic effects, but most people do not know long-term cannabis use has been proven to lower IQ by as much as eight points in twenty years.

What else can we prove about cannabis use? If we are talking side effects, not much. As of 2019, there’s only one institution at the University of Mississippi where it can be cultivated for scientific use because of the plant’s status as a Schedule 1 controlled substance under federal law. This means not much research is happening. Research that has happened has occurred in other countries and a few research clinics where the feds turn a blind eye, because the drug has become legal in 34 states over the last few years.

Because of the way science proceeds, researchers must focus on one aspect at a time necessarily ignoring other effects or components. Currently, most researchers are looking for positive effects to help the drug to become legal or are paid by big corporations to get research results to help sell it. In plain English, they look for what they want to see. It will be decades before we have a full picture of the effects of cannabis, because documented use is just beginning. We are peaking under the hat at what is medically useful and what is downright dangerous.

A hundred years ago, alcohol was used as an anesthetic for surgery. Seeking neurological benefits, Dr. Sigmund Freud experimented with cocaine so heavily his palate disintegrated. In Grandma’s childhood, national ads touted “four out of five doctors recommend Camel cigarettes for increased lung capacity.” A lot of people suffered before the truth came out about harmful side effects of these drugs. By 2019, the FDA has only approved Epidiolex synthesized from CBD for rare severe forms of epilepsy. People who suffer from this disease are so ill, they have nothing to lose. Wonderfully, they are able to get their lives back and rightfully disregard side effects. But short of being diagnosed with major seizure disorder or end-of-life cancer pain, I ask myself if my mother raised me to be a guinea pig when it comes to cannabis and products synthesized from it.

Most folks have not heard that cannabis is highly addictive. Urban myth and burgeoning big business suggest it is not. However, cannabis not only triggers endogenous opioid (endorphin) addiction, it is also strongly habit forming. So when a person tries to quit, she not only has to go through an emotionally-painful withdrawal which has been documented to result in a psychotic break called “cannabis psychosis” in some persons, but she has to struggle to change a behavioral habit as well, e.g. “I smoke weed everyday when I get home from work to relax.” This habit formation is quite significant and is the same with any addictive substance or behavior.

Primary versus secondary addiction

Cannabis addiction is distinct from alcohol, nicotine or heroin addiction in that it is “secondarily” not “primarily” biochemically addictive. This “primary versus secondary” addiction distinction is the source of the erroneous belief of it not being addictive at all. THC which causes the intoxication is not an addictive substance, whereas with alcohol the intoxicating substance is the addictive substance—it becomes part of the biochemical process in your brain and liver, hence alcohol’s status as a primary addictive agent.

To make a long, complicated scientific explanation shorter, cannabis induces secondary addiction by triggering an endorphin in the brain to which the user becomes addicted, i.e. the reward chemical. The addiction is NOT less problematic except that withdrawal won’t kill you, unless you commit suicide from unhappiness. The reward chemical is an opioid designed by nature to reward us when we enact behaviors that enhance the species’s chances for survival, such as warring, hunting, gathering, having sex or eating food.

This internal opioid is an endorphin. Scientists coined the word “endorphin” by contracting two words “endogenous” and “morphine” into one word, i.e. inner morphine. Like other drugs, endorphins feel good, but too much of a good thing has poor results. Cannabis triggers so much of the reward chemical that normal amounts no longer feel motivating. A user feels unrewarded enacting behaviors that used to reward him, so motivation for positive or productive behavior sags. He continues the behavior of smoking cannabis, because his brain says it’s a good thing—it triggers the reward chemical and its job is to tell us what we are doing is good! Sadly, those internal fake reward messages makes it one of the hardest addictive substances to quit. It’s almost impossible to hear the truth when a spouse or therapist suggests a user stop using something his brain is whispering is beneficial for species survival!

Exogenous (outer) opioids are the well-publicized highly-addictive drugs like heroin, opium or Oxycontin. But an opioid is an opioid, so while the inner opioid that cannabis triggers can be useful in mitigating pain, inducing sleep or reducing seizures like exogenous opioids, it is addictive and has similar side effects. Since most cannabis users have become addicted to their internal endorphin, it feels normal. Getting a hit of the reward chemical is an experience we normally have many times a day. It doesn’t feel like, say, a heroin high, it feels like “me feeling good naturally,” so cannabis users do not realize they have become endogenous opioid addicts. It creates cravings because the endorphin stimulates the I-want-it chemical dopamine, another neurotransmitter.

A rose by any other name…

There are four neurotransmitters responsible for our happiness: Dopamine, Serotonin, Oxytocin, and Endorphins. Many situations can trigger these neurotransmitters, but there are ways you can cause them to flow at abnormally high levels without realizing that is what you are doing. Too much of a good thing, such as sex, gambling, social media, shopping or cannabis, can create a functional addiction earmarked by increasing tolerance, reducing neurotransmitters natural effectiveness, creating craving for the triggering behavior and symptoms of withdrawal when the behavior is stopped suddenly. As Shakespeare famously wrote, “a rose by any other name would smell as sweet,”—an excessive need for substances in your brain is still a chemical addiction.

In 2013, I attended a seminar produced by INRseminars International to comply with my mental health counselors’ license requirements for continuing education units (CEUs). Author of The Hungry Brain, Dr. Laura Pawlak, RD, an expert on the effects of food and other substances on brain chemistry, explained secondary cannabis addiction in response to a question from the audience. Even though I knew cannabis was inimical for my satisfaction with life from my experience of it, I was as surprised as anyone by her explanation of it triggering endorphins to the point of addiction. But in thinking back over my experiences in my personal life and in my practice, a giant nickel dropped. Scientifically substantiated by Dr. Pawlak, everything I’d seen, experienced and learned suddenly integrated–it all made perfect sense. 

I knew first hand, that the inner opioid addict loses interest in things she used to do like bring her wife roses or take their son to baseball, because cannabis gives larger amounts than normal of the reward chemical without having to do anything other than hit on a delivery system of choice. That’s why users become less contactable, less motivated and less productive when using cannabis: it interferes with motivation process by providing the illusion they are doing something for which they deserve to be rewarded. They feel like they’re doing a lot, when actually, as cannabis-free folks around them see, cannabis users do less and less. They are also drifting farther and farther away, because they are not being internally rewarded for social interaction like they used to be. They become increasingly alienated from friends and family.

This is also the reason most people who use cannabis regularly become dissatisfied with life in general. I sadly listen to complaints about “my lousy job” or “my creepy neighbors” or “my stupid husband” from cannabis users. They are not receiving a big enough dose of the reward chemical to feel joy about many areas of life, because cannabis has taken over the reward process. Like other addictive drugs, tolerance is created. So unless a user continually increases her dosage over time, increasing dissatisfaction inevitably arises because the natural reward system becomes less and less able to operate.

The cannabis user has made the internal process of satisfaction dependent on a drug, thereby losing natural motivation to change based on a normal endorphin-driven reward for behaviors. When a human being feels dissatisfied, she needs the motivation to change or she stays dissatisfied. Consequently, many cannabis users and other endogenous opioid addicts feel stuck, because they have lost the motivation to change. Their joy in life lessens. After all, it feels like they’re already doing so much and they are so wonderful! Their reward chemical swamped brain tells them so.

As implied above, cannabis use seems to decrease the effectiveness of counseling. After all, the primary purpose of counseling is to encourage and support change and a cannabis user has little or no motivation to do so. Another reason I rarely see patients who choose to continue using while doing psychotherapy is because, in my experience, it interferes substantially with the energetic connection between two people—something all opioids are famous for doing. Try as I might, it is almost impossible to help someone who is not energetically capable of connecting, nor can be naturally motivated to change.

It would be a lack of integrity on my part to take someone’s hard-earned money promising to help effect a change I scientifically know I most likely cannot unless she is willing to titrate to cessation during the therapeutic process. We just can’t know how much of her unhappiness or mental disorder is directly related to cannabis use unless she tries to go without at least while in therapy.

The saddest side effect produced by all opioids is this lack of connection which results in a sense of alienation and utter aloneness. Tracey Mitchell, the author of the memoir “The Big Fix: Hope After Heroin,” says “Being on opioids makes you feel disconnected not only from children, but all people. I just felt disconnected from them, as if the opioids had built a wall between me and them.”

Cannabis triggers endogenous opioids (which triggers other neurotransmitters). They have the same effect as exogenous ones, but at a lessor level because they aren’t as potent. But the result is similar. Sadly, the feeling a user has of being disconnected from others often is not noticed by him, because a user is using a brain effected by the drug. But, it’s noticed by others. While a heroin addict may rip off his granny’s savings, a cannabis addict simply hears his wife in the distance saying “you seem so distant…”

It’s a triple whammy! An effect of opioid addiction on the prefrontal cortex lessens caring about others AND the effect of lessening the effectiveness of the reward chemical eliminates the motivation to change AND there is little biochemical reward for beneficial social interaction. This makes cannabis extremely hard to even consider quitting! Why bother? I may be miserable but I am the way I am. Everyone just doesn’t understand me…

Last but not necessarily least

I’d like to stress that besides cannabis, there are modern behaviors that trigger neurotransmitters at higher levels than humans were designed to receive naturally. These behaviors include pornography, gambling, social media, shopping, gaming, and others. These modern behaviors mimic ancient behaviors designed by nature to help homo sapiens sapiens survive and thrive. Sex feels good so we’ll make babies, but porn is hyper explicit and tremendously rewarding biochemically. A guy can have a two dozen vicarious sexual encounters a night! After a while, a porn addict cannot “get it up” over the real deal. A flesh and blood woman just isn’t thrilling enough to stimulate erection or the reward chemical and other neurotransmitters he’s been mainlining through porn.

Social media is rewarding, because as social animals we are more likely to survive in a group that can protect an individual from saber tooth tiger attacks. It allows a person to have hundreds of social connections in an hour, again, overstimulating our reward chemical and making real social connecting relatively unrewarding. Gambling is like hunting. Shopping is like gathering. Gaming is like warring.

Some of us can find ourselves in a real pickle by hyper stimulating neurotransmitters in the brain unwittingly becoming endogenous opioid or other neurotransmitter addicts, particularly people who wish to be distracted from uncomfortable feelings. Ignorance is not bliss when it comes to substance use—the drugs on the street, at the pharmacy or in our brains—as the uncomfortable feelings we are trying to avoid become much worse due to side effects and addiction. And, please, do not kid yourself, inner addiction can lead some folks to try street drugs to help manage the intolerable unhappiness they feel. They forget that heroin, pharmaceutical opioids and alcohol can put you in prison or kill you, sometimes quickly, through addiction, overdose and withdrawal…

The End

Sources for this article beyond my personal and professional experience

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November 1st, 2016 | Permalink

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