The purpose of this study will be to examine psychiatric disorders that have been induced by overdependence on Cannabis. Cannabis Sativa is a herb originating from the Cannabaceae family that is recognised worldwide as a euphoric and hallucinogenic drug. The strong smelling herb is used for medicinal purposes, for making hemp fibres and for developing recreational drugs (hashish and marijuana). The different parts of Cannabis have been used for different purposes and functions with one of the most common uses being for recreational purposes.
Marijuana is basically derived from the dried flowers and leaves of the cannabis sativa plant which is usually ingested or smoked while hashish is a resinous extract obtained from the plant which is usually vaporized or smoked (Elsohy, 2007). Cannabis is one of the most famous recreational drugs in the world after caffeine, alcohol and tobacco where over 100 million people especially in the United States are consumers of the drug on an annual basis. The reason for this is attributed to the fact that Marijuana which is derived from the Cannabis herb allows the user to be in a state of relaxation thereby reducing any cases of anxiety, paranoia or stress. The tetrahydrocannabinol compound found in the leaves of the herb usually acts as the main stimulant once it is consumed by the user enabling them to experience a sense of peace and relaxation (Bolla et al, 2002).
The drug however presents tertiary and secondary psychoactive effects that might pose a threat to the individual taking the drugs some of which include an increased heart rate, hallucinations, loss of memory, increased anxiety levels, high energy levels and an increasing sense of hunger. If larger doses of the drug are taken through smoking, vaporization or oral ingestion, the effects might last longer for 24 hours where the consumer experiences both the secondary and tertiary psychoactive effects of the drug (Fusar-Poli et al, 2009). Marijuana is a very addictive drug which means that once it is consumed, it is very difficult to stop smoking or ingesting the drug because of the various effects that are presented by Cannabis.
Cannabis dependence is defined as a condition where an individual who continues to take Cannabis or Marijuana demonstrates cognitive, behavioural and physiological symptoms. Based on the DSM-IV criteria for diagnosing substance dependence on various drugs such as the one understudy (Michael et al, 2004), cannabis dependence is determined by the existence of three or the following criteria which might occur within a period of 12 months. Tolerance which is the first DSM-IV criteria explains Cannabis dependence to be the need that an individual has to consume large amounts of Cannabis Sativa so that they can achieve an increased level of intoxication that will lead to diminished thoughts, emotions or feelings on the part of the user (Michael et al, 2004). The second criteria based on the DSM-IV criterion for substance abuse is withdrawal which explains Cannabis dependence to be a manifestation of withdrawal symptoms such as increased restlessness, insomnia or poor sleeping habits, increased appetite as the drug brings about hunger, irritability, paranoia and anger. Other DSM-IV criteria that are used to explain dependence of marijuana is when an individual takes the substance in large amounts for a long period of time than was intended to relieve anxiety or stress, the individual experiences a persistent desire to reduce substance abuse but unsuccessfully fails to do so and/or they spend most of their time and resources trying to acquire the substance or drug which means that their social life and other recreational activities are abandoned because of the continued use of the drug (Wenger et al, 2003).
Based on the various studies that have been conducted on the dependence of cannabis, the drug has presented a less addictive potential when compared to hard drugs such as heroin, cocaine, tobacco or alcohol (Coffey et al, 2003). According to Michael et al (2004), Cannabis dependence has been cited as one of the clinical entities of substance abuse and dependence in the DSM-IV of mental disorders criteria. The coding criterion that is used by the DSM-IV is usually based on the international classification of diseases where the signs and symptoms of diseases are identified and described in the various versions of DSM-IV textbooks. Based on the DSM-IV criteria, cannabis dependence falls under the category of substance related disorders as the individuals who consume the drug experience the various side effects that lead to cannabis dependence (Michael et al, 2004). To further explain cannabis dependence, the extended use of marijuana or hashish is likely to produce various changes in the bodily processes of an individual which affect how cannabis is absorbed or metabolized by the individual. These changes which are referred to as pharmacokinetic changes usually force the user to increase their dosage of the drug so that they can be able to achieve a desirable effect which is known as a higher tolerance to marijuana or Cannabis Sativa (Joy et al, 1999).
Higher doses of cannabis further reinforce the metabolism rate of the individual thereby increasing the rate at which the drug is broken down and expelled from the body. This means that Cannabis sativa, marijuana and hashish act as a system of reinforcement to the metabolic functions of an individual’s digestive system as well as their small and large intestines (Wenger et al, 2003). According to Hall et al (2001), the risk factors of Cannabis dependence are usually determined by the number of doses an individual user takes in a day as well as the frequency of these doses.
Based on their research, the authors determined that one in every ten people who consumed cannabis were more than likely to become dependent on the drug at some point in their life. People who consumed the drug frequently (five times in a day) were more than likely to increase their risk of developing dependence on the drug. The risk factors that are considered to be the major contributors to cannabis dependence based on longitudinal studies conducted by Copeland et al (2004) include the frequent use of the drug especially at a young age where drug users who begin taking the drug during their teenage or adolescent years are at a greater risk of being cannabis dependent. Coffey et al (2000) conducted a study in Victoria, Australia where they examined 2032 high school students to determine the impact that young age had on cannabis dependence. The results of their study revealed that mid-school consumption of cannabis sativa was mostly associated with other factors such as frequent cigarette smoking, peer pressure from other students who are ingesting or smoking cannabis sativa and anti-social behaviour such as stealing, sexual promiscuity and violent tendencies. Coffey et al’s (2000) study also revealed that the regular use of marijuana or Cannabis Sativa among young people at an early age continued to persist even as the adolescents approached young adulthood. A follow up study conducted by Coffey et al (2003) of the high school students who had attained the ages of 20 to 21 years revealed that one in five the adolescent users of the drug demonstrated dependence to cannabis well into the early stages of adulthood. Other risk factors that have been related to an increased risk of cannabis dependence include psychological distress where individuals use the drug to relieve feelings of distress, anger or sadness, poor parenting where children raised by parents who are cannabis consumers are more than likely to develop cannabis dependence in their teenage and adult years and influence from peers where children with friends who smoke or ingest cannabis are more than likely to consume the drug and also become cannabis dependent at an older age.
Ehrenreich et al (1999) from their study of cannabis dependence from a young age have concluded that there exists strong evidence that children who are exposed to cannabis or marijuana at a young age are more than likely to become cannabis dependent when they are older.
A psychiatric disorder which is otherwise referred to as a mental illness/disorder is a psychological or behavioural pattern that is usually associated to emotional distress or mental disabilities which an individual goes through. Psychiatric disorders are not part of the normal development of an individual and they are therefore termed as abnormal manifestations of the mental health of the individual. Psychiatric disorders encompass very many mental health conditions which affect the behavioural, intellectual and cognitive abilities of an individual and some of these mental health conditions include anxiety disorders, personality disorders, sexual disorders, eating disorders, dissociative disorders and drug dependence disorders (Akiskal & Benazzi, 2006). Psychiatric disorders or mental illnesses usually affect the mental well being of an individual as well as their cognitive capacity further deteriorating their intellectual capabilities and functions (Insel & Wang, 2010). Mental disorders are caused by a variety of factors where most researchers have conceded that the disorders arise from genetic vulnerabilities or predispositions. Other studies have revealed that psychiatric disorders result from psychological, emotional, sexual and physical traumas during the formative years of a child.
These traumatic experiences usually come to manifest themselves as the child continues to develop intellectually as well as emotionally and if they are not managed properly they might lead to psychiatric disorders. Based on a significant number of studies, children who have been sexually abused contribute significantly to the percentage of causation factors that lead to mental or psychiatric disorders during their adulthood years (Kashner et al, 2003). Based on worldwide statistics, the number of people who suffer from psychiatric disorders have been estimated to be one in every three people in over 100 countries around the world (WHO, 2000). In the United States for example, the number of people who suffer from psychiatric disorders accounts for 46 percent of the total American population where one in every three Americans suffers from a mental illness at one point in their lives (Kessler et al, 2005).
The most common psychiatric disorders based on the World Mental Health Survey initiative include anxiety disorders, mood disorders, substance disorders and impulse control disorders which are common in all but a few countries in the world (Demyttenaere et al, 2004). Psychiatric disorders that are not suitably dealt with result in obsessive or compulsive behaviour, manic depression, paranoia, delusions or hallucinations or violent behaviour.
Cannabis Induced Psychiatric Disorders
There exists limited research on the clinical implications of cannabis induced psychiatric disorders despite the existence of medical evidence that cannabis or marijuana is linked to the genesis of paranoid schizophrenia in an individual (Arseneault et al, 2004). Based on various research studies (Hall & Degenhardt, 2004: Johns, 2001: Large et al 2011), the psychotic symptoms of continued or frequent marijuana consumption were usually short-lived and the cases of total remission were expected in patients who developed psychiatric disorders. These results were however based on case studies that lacked any follow-up information that could be used to further explain whether cannabis dependence elicited any psychiatric disorders in individuals (Arendt et al, 2005). A follow-up study conducted by Arendt et al (2005) revealed that the prognosis for cannabis-induced psychiatric disorders cannot be properly ascertained because such a condition is termed to be a rare occurrence by the American Psychiatric Association as well as the diagnostic and statistical manual (DSM-IV) of mental disorders. The study conducted by Arendt et al (2005) was the first to provide an accurate estimate of the rates of incidence that can be attributed to cannabis induced psychiatric disorders.
The results of the follow-up study were able to reveal that half of the 535 people who were under examination were treated for cannabis induced psychotic disorders with paranoid schizophrenia being the most dominant form of mental illness. The follow-up study also revealed that there were 77 percent of new psychotic episodes reported in majority of the population involved in the follow-up where male participants and people of a young age were associated with a more severe outcome of cannabis induced psychiatric disorders (Arendt et al, 2005). Most of the patients who were consumers or users of cannabis sativa recorded an increase the level of schizophrenic-spectrum disorders which occurred within a span of more than a year. Also for the majority of the patients placed under the follow-up study, cannabis-induced psychotic symptoms were seen to be the first step in the development of schizophrenic-spectrum disorders or other severe forms of paranoid schizophrenia. Arendt et al’s (2005) study is however inconsistent with the findings from previous studies such as those conducted by Talbott and Teague in 1969, Thacore and Shukla in 1976 and Carney et al in 1984 where their results revealed that people who were users of cannabis sativa demonstrated complete remission of the effects of the drug when the individuals abstained from using the drug completely. However, the patients examined by the researchers were not followed up after the cannabis induced psychotic condition remitted which means that their studies did not provide any long-term data that would be used to explain cannabis induced psychiatric disorders.
Many of the investigations reported that cannabis induced psychotic conditions usually subsided at a faster rate than the psychiatric disorders which were not induced by any substances all. Arendt et al’s study was able to dispute previous findings where they discovered that the development of paranoid schizophrenia was often delayed in the case of cannabis induced psychosis. They based this finding on a sample population of 47 percent of the people understudy who received a diagnosis a year after seeking treatment for cannabis induced psychotic conditions.
The researchers were able to conclude that cannabis induced psychotic disorders were of great prognostic concern and importance and doctors/psychiatrists needed to treat the disorders once they were diagnosed in patients (Arendt et al, 2008).
The discussion focused on cannabis dependence which is how an individual constantly consumes marijuana to achieve a feeling of relaxation or euphoria. The discussion also highlighted psychiatric disorders and identified the psychotic illnesses that arise as a result of continued cannabis consumption. Most of the research referred to in the study pinpointed the fact that cannabis induced psychotic disorders did not last for long and they were therefore of no concern to health practitioners and psychiatrists. Only one study was able to concur that psychiatric disorders which arose as a result of cannabis dependence were of a major concern to doctors.
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