Does cannabis dependence exist?

Does cannabis dependence exist?

By Dr Fernando Caudevilla

It’s a known fact since ancient times that certain psychoactive drugs can generate dependence. But throughout history this has been considered one amongst multiple characteristics and not the inevitable consequence of their use, nor even a problem.

In classic Greek texts opium is a holy substance, very useful in medicine, and there are no references to people enslaved by its use or social problems derived from its consumption. Medical texts warn about the risk of its effects being too strong on people not used to it, and explain that the person has to get used to the drug slowly. According to Theophrastus “some drugs are toxic due to lack of familiarity, and it might be more accurate to say that familiarity takes their venom away, because they stop intoxicating when our constitution has accepted them and prevails over them”. In brief, the Greeks saw the pharmacologic tolerance (the reduction of a substance’s effect in time if the dose is not augmented) more as an adaptive advantage than a problem or a drawback.

Even an addictive, neurotoxic and hepatotoxic drug like alcohol had its own divinity for ancient Greeks (Dionysus) and also for Romans (Bacchus). In the Ancient World alcohol was considered primarily as a medicine, just like opium. In the late X century the Arab alchemists distilled alcohol with an alembic for the first time. What followed was the creation of drinks of high alcohol concentration, more toxic and with a bigger dependency potential. However the procedure was only generalized during the XVI century in Europe. Throughout the XVIII and XIX centuries alcoholism was already a public health problem of the first magnitude. This situation was the origin of certain lobbying groups during the first third of the XX century, which, coming from moral postures, tried out the total ban of alcohol in different countries (Russia, Finland, Iceland, Norway and USA) with disastrous results.

The equation drug=drug addiction is a relatively recent social phenomenon in human History. The surge of intravenous heroin use during the last third of the XX century in Western countries did strengthen this idea, which is nowadays deeply rooted in the collective subconscious. The heroin phenomenon, in its complexity and characteristics, has contributed to the association amongst society of illegal drugs as bad substances which mainly generate addiction.
The question of whether cannabis can or not generate dependency is one of the most controversial aspects concerning this substance. We should bear in mind that it’s the most widely consumed illegal drug in the world across all segments of the population. It seems important to ascertain whether addiction is one of the risks associated with its use. But this question does not have an easy answer and there are many aspects to be considered. Also, as we already know, it’s difficult to keep a rational approach when debating illegal drugs because too frequently the moral perspective gets in the way.

The first thing we should define in detail is exactly what we understand as an addiction. A well known sentence in healthcare world says: “someone who drinks excessively is a person that drinks more than their doctor”. The joke teaches us an interesting lesson. It points out that when somebody judges the practices of another person he does so from his own point of view and so tends to consider as normal attitudes that are similar to their own and “abnormal” those that are different. If we take into account that, as a general rule, healthcare professionals show greater tolerance for alcohol than cannabis, it’s probable that they will consider pathological any kind of recreational use of the substance. On the other hand, words like “dependence”, “addiction”, “being hooked”… are so overused and are so recurrent in everyday language that they lose part of their original meaning. Originally dependence appears as one characteristic of some psychoactive substances. But in recent times, supposedly, a great deal of conduct and behaviors (from eating chocolate to using mobile phones, shopping, playing videogames, chewing gum or cybersex) are considered cause of dependence.

However the “substance dependency” is a clear medical diagnosis that’s only accurate under very specific standards. The DSM-IV (the mental disorder classification most commonly used) defines substance dependence as “a pattern of maladaptive behavior of substance consumption that leads to clinically significant deterioration or discomfort”. That means the way the person uses the substance has to cause a certain level of unrest and objective negative consequences. These consequences are also listed in different standards. To ensure it is an addiction, three or more of the following circumstances must appear within the year.

•pharmacologic tolerance (need to increase the dose to get the same effect)
•abstinence syndrome: a number of signs and symptoms that appear when consumption suddenly stops. Every substance has its own
•consumption in larger quantity or frequency than desired
•persistent wish or ineffective efforts to stop or control the use of the drug
•investing more time in activities related to obtaining or consuming the drug, or to recuperate after its use
•reduction of time dedicated to social activities or work due to use of substance
•use of the substance in spite of physical or psychological problems caused or worsened by the substance use

In the next article we will analyze to what extent we can apply these standards to the most frequent cannabis consumption patterns, to determine whether cannabis can generate addiction and what is the magnitude or frequency of this problem.


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