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Is ignorance bliss?

Substance use and mental health

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

One reason it’s easily misunderstood is because there are many different substances people use that are biochemically affecting their brain and emotions. Many are obviously primarily addictive even at low levels, such as nicotine, alcohol, caffeine and some pharmaceuticals. And there are addictions to normal brain chemicals triggered at abnormally high levels by cannabis and some modern behaviors. These are behaviors that mimic ones 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 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 realize.

Often people simply don’t know 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, chronic use, let alone abuse or addiction, has consequences and effect on a person’s emotional, psychological, social and physical wellbeing. 

The primary common denominator of all use is that the user is engaged in paradoxical thinking. In other words, while a substance user 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 substance. Different people are affected to different degrees, but too often a person cannot see that using CBD oil, spending many hours on FaceBook daily, or drinking a couple glasses of wine every other evening is the primary source of misery. In some cases, it is the sole culprit instigating the mental illness for which a doctor is prescribing meds. It is difficult for a person to learn to regulate emotion if a biochemical agent is doing it for her.

Mental illness, particularly bipolar disorder, insomnia, depression, anxiety, or even psychosis, may be a side effect of a substance, but medical providers sequestered in the allopathic pharmaceutical world too often miss this connection. Patients show up at counseling pointing a finger at all sorts of good reasons for suffering, but are not able to see the unhappy face of chronic use, abuse or addiction to a substance in the mirror.

Alcohol

Just talking about “alcoholism” can be confusing, because it is not “an addiction” if a person “binge drinks,” but binge drinkers are “alcoholics.” Getting extremely drunk occasionally is not a biological addiction, it’s a psychological dependency. For it to be 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 emotional coping strategy and it is abuse—a psycho-emotional disorder for which professional help is needed.

Too often, the binge drinker accidentally injures himself or someone else while drunk. It is not uncommon for a binge drinker to completely black out, but keep on walking, talking and driving. I had a relative who did not know and could not remember what she was doing while drunk, but could hide the fact she was entirely unconscious so well police officers and social workers would assume she was sober in that moment. The scientific reason is alcohol can disable the prefrontal cortex, the part that decides, organizes and judges our actions, the part of our brain that makes us moral human beings, but the rest of the brain keeps working.

Another surprise fact is when a person consumes alcohol a couple times weekly, they 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 someone drinks four glasses of wine a week, say, one on Tuesday and three on Friday, they may be mildly addicted to alcohol depending on the genetic ability of their liver to process alcohol. Not horribly addicted obviously, 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. 

Consistent weekly drinking can affect mental health not only because alcohol is a depressant, i.e. stimulates depression, but because experiencing a mild withdrawal every few days feels like anxiety. A person drinks (or takes a benzodiazepine that is taken up into the alcohol receptors in their brain) to quell anxiety not realizing it was actually low-grade withdrawal that caused them to feel anxious in the first place. It was not only their spouse’s difficult behavior, financial 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 often believe their unhappiness is because of external things that happen in their lives. Heaven knows, I am not saying they may not have serious issues beyond substance use. Some people have absolutely terrible problems and have experienced some terrifically trauma-inducing things, but I am suggesting when a person looks at past or current events through a brain chemically-depressed by alcohol or agitated by CBD oil, challenging or traumatizing issues cannot help but become 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 kind of like a jack in the box.

For people who use potentially-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 they need is jangled nerves. The pain 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, giving the addiction what it craves causes the pain to go away, not because it is mitigating actual physiological pain, or 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 or perhaps only a little. 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 can send and receive signals that everything is OK. 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, anxiety and hemodynamic stability. (If a patient has stable hemodynamics, it means that the force at which the heart pumps blood is stable. Maintaining stable blood flow in the heart and vessels is important in supporting normal organ functions including the heart’s.) CBDs can stimulate irritation and agitation. Imagine the mental and physical problems that may occur when someone mixes the three together in a daily regimen! For some people with challenging traumas, the resulting depression may be deep enough to trigger suicidal behavior.

The most misunderstood drug on the market may be cannabis

I’m so glad it’s legal now in Washington State! Its illegality maintained a black hole of societal and scientific ignorance we are just beginning to dig out of. Its biochemical effects on the brain cause a delusion that makes a user believe it’s benign when it certainly is not. Marketers are out in force touting its benefits. Granted, there are 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. That’s a lot of IQ to lose!

What else can we prove about cannabis use? If we are talking side effects, not much. As of 2020, 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 enough 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 that help to 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 2020, 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 excessive neurotransmitters and causes 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 users, but they have to struggle to change a behavioral habit as well, e.g. “I smoke cannabis everyday when I get home from work to relax.” Habituation is quite significant and is the same with any addictive substance or behavior. One psycho-emotional drawback, I have seen repeatedly in my office, is the perceived necessity of lying to significant others or employers to cover up cannabis abuse which causes a loss of personal integrity damaging to self esteem and relationship.

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 chemical in the brain to which the user becomes addicted, i.e. the reward chemical. 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. The addiction is NOT less problematic except that withdrawal won’t kill you (unless you commit suicide from unhappiness), but it can trigger a psychotic break in some people. 

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 and cocaine trigger 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, 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 very difficult to hear a spouse or therapist suggest a user stop using something the 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 familiar side effects. Since most cannabis users have become addicted to their internal endorphin, it seems normal. Getting a hit of the reward chemical is an experience we normally have many times a day. It doesn’t feel like 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 natural substances in your brain is still a chemical addiction.

In 2013, I attended a seminar produced by the Institute for Natural Resources. 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 personally cannabis was inimical to my satisfaction with life from experience, I was as surprised by her explanation that it can trigger endorphins to the point of addiction. In thinking back over my and my patient’s lives, a giant nickel dropped. Scientifically substantiated by Dr. Pawlak, everything I’d seen, experienced and learned suddenly made perfect sense.

I had experienced first hand that the inner opioid addict loses interest in things they used to do, such as bring their spouse 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: 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 also drift farther and farther away, because they are not being internally rewarded for social interaction as 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 mean neighbors” from cannabis users. They are not receiving a big enough dose of the reward chemical to feel joy to balance their perceptions, because cannabis has taken over the reward process. Like other addictive drugs, tolerance is created. So unless a user continually increases dosage over time. Increasing dissatisfaction inevitably arises because the reward system becomes less and less able to operate naturally.

The cannabis user has made the internal process of satisfaction dependent on a drug, thereby losing 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! It must be someone else’s fault they are so unhappy. Their reward chemical swamped brain tells them so.

Even CBD oil stripped of THC is proving to be problematic. Medical News Today reports “Some side effects of CBD are noticeable, including:

Other side effects can happen without people being aware of the cause, such as:

Under the influence

As implied above, cannabis use decreases the effectiveness of counseling. After all, the primary purpose of counseling is to encourage and support change, but a cannabis user has little biochemical ability to do so. While I do see patients who choose to continue using while doing psychotherapy, in my experience, it interferes substantially with the energetic connection between two people–something other opioids are famous for doing. It is difficult to help a patient who is not as energetically capable of connecting or cannot be naturally motivated to change as easily as someone with a substance-free mind. We can’t know how much of their unhappiness or mental disorder is directly related to cannabis use unless they go without, at least during the course of therapy.

Repeatedly, patients who use cannabis have left counseling, saying they feel unheard or unseen or say that the content of my style of therapy doesn’t work for them. I’d never say I can’t make mistakes, but sadly, because of the cannabis affecting a patient’s brain, they simply cannot connect. Successful therapy is not so much about the quality of the content as it’s about the quality of the connection.

This lack of connection 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 have the same effect as exogenous ones at a lessor level because they aren’t as potent, but the resulting inability to connect is similar. Sometimes, the feeling a user has of being disconnected from others is not noticed by him, because a user is using a brain effected by the drug. But, it’s certainly noticed by others. While a heroin addict may rip off his granny’s savings without remorse, a cannabis user staring at a screen may simply hear a spouse saying “you seem so distant” or his therapist noting “you’re tough to help.”

It’s a triple whammy! An effect of opioids on the prefrontal cortex is lessened 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 quitting cannabis extremely hard to even consider. A user feels, “why bother? Nobody cares about me. It’s the only thing that helps.”

 THC, the active ingredient, concentrates in the ventral tegmental and the nucleus accumbens and also effects the hippocampus, the caudate nucleus and the cerebellum. Its effects on the hippocampus probably explains why it causes problems with memory and its effects on the cerbellum explains the balance and coordination problems experienced. Please don’t drive a car or climb a ladder while using cannabis!

THC effects neurotransmitters, too. It is taken up by the anadamide pathway causing a feeling of bliss and relaxation, but when it wears off normal anadamide production has been decreased causing a lack of joy and relaxation. Same problem occurs with dopamine that normally causes euphoria and with GABA interneurons which is an inner antidepressant. People think cannabis causes bliss, relaxation and joy and it does, but only while they are using. As they come down, it causes dysphoria and boredom.

For some, particularly teens, withdrawal can trigger cannabis psychosis. In spring of 2020, I spoke with a mental health worker in our local psych crisis center. She said that approximately 60% of those being admitted are experiencing psychosis due to cannabis. The diagnosis is “unspecified psychosis,” because the DSM5 does not have a “cannabis psychosis” designation, but it is clear to staff at the crisis center that the provocative agent is cannabis.

Last, but not least

It’s important to understand that besides cannabis and cocaine, 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, sports and probably 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 viewer can have two dozen vicarious sexual encounters a night! After a while, a porn addict cannot get excited over the real deal. A flesh and blood partner just isn’t thrilling enough to stimulate the reward chemical and other neurotransmitters he’s been mainlining through porn. His ability to have an erection shrinks.

Social media is rewarding because as social animals, like orangutans, we are more likely to survive in a group that can protect an individual from tiger attacks. Social media allows a person to have hundreds of social connections in an hour, again, overstimulating our reward chemical for social behavior and making real social connecting relatively unrewarding.

Gambling is like hunting. Shopping is like gathering. Gaming and sports are like warring. Some of us can find ourselves in a real pickle by hyper stimulating neurotransmitters in the brain unwittingly becoming endogenous opioid and other neurotransmitter addicts, particularly people who wish to be distracted from uncomfortable feelings they did not learn to regulate as children.

Ignorance is not bliss when it comes to substance use of the drugs on the street, at the pharmacy or in our brains. The uncomfortable feelings we are trying to avoid become worse due to side effects and chronic withdrawal. And, inner opioid addiction can lead some folks to try street drugs to help manage the intolerable unhappiness they feel. Counseling is the place where we can learn the healthy behaviors that help us navigate through the difficulties that burden all lives and trigger happiness-inducing brain chemicals at healthy levels.

The End

Sources

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November 1st, 2016 | Permalink

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