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Is ignorance bliss?

Addictive substance use and mental health

(Warning: If you wish to remain ignorant about the effects of addictive substances on your bodymind, do not read this article.)

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

One reason for misunderstanding is there are many different substances people use that are biochemically affecting their brain and emotions. Many are 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 due to 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 addictive substance use

is that the user is engaged in “paradoxical thinking.”

In other words, while someone tries to figure out what is going wrong with a relationship, career, emotional or physical health, she thinks with a brain affected by a psychoactive substance. Too often, a person cannot see that using cannabis or drinking a couple glasses of wine every evening is the primary source of his misery. Sometimes, it even has caused the mental illness for which a doctor is prescribing meds! It is hard to learn to regulate emotion if a substance is masking emotion or sending messages to keep using the drug.

Mental illness, particularly bipolar disorder, insomnia, depression, anxiety, or even psychosis, may be a side effect of an addictive substance, but medical providers sequestered in the allopathic pharmaceutical world often miss this connection and make an incorrect mental health diagnosis. 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 in the mirror.


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–a response to stress. 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. Science has shown 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. A significant percentage of prisoners are in prison for things they did while drunk.

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 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.

Many drinkers do not know most people don’t drink as much as they do. Thirty percent do not drink at all and another thirty drink on occasion. They may go a month without a drink. Thirty percent drink once or twice a week and only ten percent of the population drinks daily. The heavy drinkers are prone to say, “Everyone I know drinks.” Their alcoholic brain wants to see proof that what they are doing is normal. Normal is what “most people do.” Drinking every day is not normal. Over time, it destroys health and shortens lives.

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 cannabis oil, challenging or traumatizing issues only 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 imbibe 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 instability. (If a person 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. A “holiday heart attack” occurs after having too much to drink, a person mistakenly thinks she is having a heart attack and goes to the ER. ER docs don’t ask “how much did you drink last night,” they just send her home.) Cannabis can stimulate boredom, grumpiness and agitation. Nicotine can stimulate suicidal thoughts. Imagine the mental and physical problems that may occur when someone mixes three together in a daily regimen! For some people with challenging traumas, the resulting depression can be fatal.

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 from which we are just beginning to emerge. 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 detrimental side effects 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 smarts to lose!

What else can we scientifically prove about cannabis use? If we are talking side effects, not much. As of 2021, there’s only one research lab 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. Though it may soon be moved to Schedule 3, this still means not enough research is happening. Research that has happened occurred in other countries and a few labs where the feds turn a blind eye because the drug has become legal in over 34 states during the last few years.

Because of the way science proceeds, researchers necessarily focus on one aspect at a time ignoring other effects or components. Currently, most researchers are looking for positive effects to help the drug become legal or are paid by big corporations to get research results that help it to sell. In plain English, they look for what they want to see. It will be a decade or two before we have a better 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 2021, 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 injurious 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 do not know 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 a 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, but it can trigger a psychotic break in some people, particularly with today’s extra strong products.

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 rewarding and, therefore, motivating. A user feels unrewarded enacting behaviors that used to reward him, so motivation for positive or productive behavior sags. He continues using, 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—a craving 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 personally knew  cannabis was inimical to satisfaction with my 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 enjoy doing, such as bringing a spouse roses or taking 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 as time goes on. 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. They do not realize the main reason they are getting a divorce or losing friends is their use of cannabis.

This is also the reason many people who use cannabis regularly become dissatisfied with life in general. I sadly listen to complaints about “my lousy job” or “my creepy 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 healthy 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. Joy in life fades. Their reward chemical-swamped brain tells them they are wonderful and everyone else just doesn’t recognize how wonderful they are. I call it “narcissistic personality disorder in a bong.” It feels like they’re doing so much, because they are high on the reward chemical! It must be someone else’s fault they are so unhappy.

Even CBD oil stripped of THC is proving to be problematic. Medical News Today reported in 2020, “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

You may have figured out by now, 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 change. 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 AND cannot be naturally motivated to change as easily as someone with a substance-free mind. Further, we can’t know how much of their unhappiness or mental disorder is directly related to cannabis use unless they become cannabis free during the course of therapy.

Repeatedly, patients who used cannabis have left counseling saying they feel unheard or unseen or say that therapy doesn’t work for them. Sadly, because of the cannabis affect on their brain, they simply cannot connect and blame counseling instead of the drug. Successful therapy is not so much about the quality of the content as it’s about the quality of the connection to the therapist and to oneself.

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 effects as exogenous ones at a lessor level because they aren’t as potent, but the resulting inability to connect can be 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 granny’s savings without remorse, a cannabis user may simply hear a spouse saying “you seem so distant” or a friend asking if they are tired or bored.

It’s a quadruple whammy! One 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 AND the reward chemical addiction tells users they are the center of the universe and everyone else is wrong. This makes quitting cannabis extremely hard to even consider. A user feels, “why bother? Nobody cares about me. Cannabis the only thing that makes me feel good.”

THC, the active ingredient, concentrates in the ventral tegmental and the nucleus accumbens and also effects the hippocampus, the caudate nucleus and the cerebellum. The effect on the hippocampus probably explains why it causes problems with memory and its effects on the cerebellum 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 are 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 at our local psych crisis center in Sedro. She said that approximately 60% of those being admitted with mental health problems are experiencing psychosis due to cannabis. The diagnosis is “unspecified psychosis,” because the DSM5 does not have a “cannabis psychosis” designation yet, but it is clear to staff at the crisis center that the psychotic agent is cannabis.


Another common addiction is to benzodiazepines, or “benzos,” some of the most commonly prescribed medications in the world despite the significant risk, particularly to former alcohol addicts. While at university, one of my professors tole me, they are directly taken up into the alcohol receptors in the brain, so you might as well use a shot of gin to relax. They are initially helpful in the treatment of many mental illnesses and sleep disorders which is why they are so commonly prescribed.

Benzodiazipines, anxiolytics (anti-anxiety meds) like Alprazolam or Lorazepam, are perhaps the most addictive and dangerous legal class of drugs on the market next to the oxys. They all interact with the neurotransmitter gamma-aminobutyric acid-A (GABA-A) in a unique way causing unique mental and physical effects. They slow down the activity of the nervous system which is good during a panic attack, but the manner in which these drugs impact brain chemistry can QUICKLY cause dependence and addiction and, over time, can induce severe emotional dysregulation and agitation resulting in bipolar disorder.

Benzos are some of the most commonly abused drugs in the US today, but during the early seventies, Congress was going to make them illegal due to their highly addictive nature. Not surprisingly, pharmaceutical companies fought back and won. Today, they constitute a multibillion dollar industry. Recent studies have found that between 11% and 15% of American adults take benzos via prescription in any given year. Because most are legally prescribed, many users don’t understand how dangerous they are. As tolerance increases, patients just take greater and greater doses without worrying about the consequences, thinking that is the natural course of a prescription. When they begin to show signs of addiction, many will deny they have a problem. It is common to hear defenses such as, “I don’t have a problem, I have a prescription.”

However, benzodiazepine addiction is very real and powerful and at a certain point the medication may no longer work at all to its desired effect. Since benzos work by altering the chemistry of the brain, when they are no longer present in sufficient amounts or are no longer producing the desired effect, the brain is no longer able to function normally and withdrawal symptoms begin to appear. These symptoms include mood swings, nausea, weight loss, headaches, muscle pain, hallucinations, and more. I’ve seen longtime users diagnosed as bipolar or borderline when in fact, they are benzo addicts. Slow titration detox results in a full recovery, but in my experience, takes about two years—the amount of time it takes for the body to replace every cell in the brain.

Research shows benzo use may be implicated in increased chance of Alzheimer’s even in small amounts. Studies have shown, around 32% of people who use these drugs, including those who only take one tablet every four months, end up with Alzheimers. Within a week of daily use, a person may be on their way to full blown addiction. In my practice, I have seen patients who were prescribed these drugs devolve into bipolar disorder, i.e. their emotions go wildly out of control. Benzos have a profound spring back effect. While in the moment using one may reduce anxiety, a few days later it’s back even more pronounced. Things spiral out of control over time, but the connection to the offender, the benzo, is not recognized by the medical industry. Unwitting folks end up on a cocktail of antidepressants, anxiolytics and anti psychotics which, while good for Wall Street, is not good for the patient.

Behavioral addictions

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 human beings were designed to experience naturally. These behaviors include viewing 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 lots of babies, but porn is hyper explicit and therefore hyper 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 along with his member.

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 predator attacks. Social media allow people to have hundreds of social connections in an hour, again, overstimulating the reward chemical for social behavior making actual social connection 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 use of street drugs, from the pharmaceuticals or behaviorally triggered brain chemicals. The uncomfortable feelings we are trying to avoid become worse due to side effects and chronic withdrawal. Inner opioid addiction or legal pharmaceuticals lead some folks to try street drugs to help manage the intolerable unhappiness they feel. A counseling office is the place where one may learn and practice the behaviors that trigger happiness-inducing brain chemicals at normal, healthy levels and help us navigate through the various difficulties that burden all lives. 

The End

updated April 23, 2021


“Benzodiazepines,” The Rehab Spot,, April 2021

RECREATIONAL MARIJUANA: Facts, Fables, & Concerns” Workshop for healthcare professionals, presented by Dr. Eric Bornstein, Institute for Natural Resources, 2354 Stanwell Dr. Concord, CA 94520. Copyright 2020.

Note: INR has a number of seminars for medical professionals about cannabis addiction and side effects. It is a non-profit scientific organization dedicated to research and education in the fields of science and medicine.

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