What is addiction? The American Society of Addiction Medicine (ASAM) utilized more than 70 experts over four years to answer this question, and a public policy statement published in 2011 provided the consensus definition: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”
Prohibitionists condemn cannabis as addictive, but does consuming the plant regularly lead to a chronic disease of the brain reward system that physically alters dopaminergic pathways and motivates a pathological pursuit of substance reward? Moreover, is the disease primary, and do cannabis addicts experience punishing cravings that demand relief? These symptoms can emerge in a small number of cannabis consumers, but it can also happen playing Candy Crush. This is why a deeper grasp of addiction and dependence is necessary to understand the widely different definitions of addiction. To put it another way, Time magazine encapsulated the problem in 2010 with the following headline: “Is Marijuana Addictive? It Depends How You Define Addiction.”
Physical Dependence on Cannabis
Whether physical or psychological, addiction is a primary disease epitomized by cravings and compulsion, while physical dependence is a condition in which the body starts to rely on an external source of chemicals to avoid withdrawal symptoms. Physical dependence is usually the precursor to physical addiction, but the two terms are not interchangeable, and the progression from dependence to addiction only occurs with certain substances. Opiate and benzodiazepine drugs produce notoriously severe dependence that can lead to physical addiction, but many dependence-producing substances do not involve a credible risk of physical addiction. Examples include antidepressants, caffeine, blood pressure medication and, yes, cannabis.
Excessive, long-term cannabis consumption can lead to dependence, and stopping use will likely produce withdrawal symptoms. For heavier drugs, the symptoms can include hallucinations, increased blood pressure and seizures, but common cannabis symptoms include insomnia, irritability and decreased appetite. Most people agree that these symptoms are not on par with each other, and even the U.S. government agrees. The generally anti-cannabis National Institute on Drug Abuse (NIDA) describes the plant as producing a “mild withdrawal syndrome” that lasts two weeks or less, and several clinical studies back this up. Addiction Science and Clinical Practice in 2007 noted that “the marijuana withdrawal syndrome does not appear to include major medical or psychiatric consequences,” while Psychology Today in 2013 wrote, “Marijuana is different from a lot of other drugs of abuse in that although there usually are some subtle physiological signs of withdrawal when a chronic user stops smoking—mildly elevated pulse, irritability, and so on—these physical effects are generally fairly mild, and they are dramatically less obvious or powerful than those seen when a habitual user of alcohol, opiates (either heroin or any of the opioid pain pills), or benzodiazepines (such as Xanax or Klonopin) abruptly ceases use.”
Cannabis can result in a physical dependence—which differs from physical addiction—and involves mild withdrawal symptoms that differ significantly from those associated with alcohol, opiates and sedatives. As noted in a 2007 study published in Addiction Science & Clinical Practice, “Many people in treatment for other drugs all say their cannabis use doesn’t matter.” In fact, many studies found that cannabis can actually serve as a “replacement drug” that helps recovering addicts refrain from more serious addictive substances.
Physical Addiction to Cannabis
During a live CNN interview in 2010, former U.S. Surgeon General Joycelyn Elders stated, “Marijuana is not addictive, not physically addictive anyway.” Her point was that different types and degrees of addiction exist, and the physical addiction associated with heroin, crack and painkillers is not consistent with what cannabis abusers experience. As noted by Psychology Today in 2012, “The vast majority of those who use marijuana do so occasionally and exhibit no addictive symptoms—no increased tolerance, no cravings and no withdrawal.” Hence, cannabis is the most commonly consumed prohibited drug in the country—by a very wide margin—but most every other abused substance dominates it in terms of addiction rates.
So what exactly is physical addiction? Heavy drug use can lead to a physical dependence as brain circuitry adapts, natural neurotransmitter production drops and neural receptors shrink and/or desensitize, and dependence turns into physical addiction when the body can no longer function without the substance. For example, a drug like morphine floods the mesolimbic system with dopamine—the neurotransmitter that produces pleasure—and prompts a decrease in the production of natural chemicals (e.g., endorphins) and blunts their impact when they bind to receptors. As a result, the body needs regular substance intake to adjust for the change, and the amount escalates the longer the substance is abused. This process happens with most drugs of abuse, but it does not appear to occur with cannabis.
Physical addiction also involves more immediate health risks. For example, a person who takes benzodiazepine sedatives (e.g., Valium, Xanax, Klonopin) can develop a physical addiction in mere months, and abrupt cessation of use can result in fatal seizures. Similarly, opiate and alcohol withdrawal can involve severe symptoms like the shakes, nausea, vomiting, hallucinations and physical pain. Cannabis involves no such risks. Likewise, cannabis compounds bind to receptors that are comparatively sparse in the medulla, the part of the brainstem that manages the respiratory and cardiovascular systems. Opiates, sedatives and alcohol—but not cannabis—can significantly impact the medulla, and overloading the medulla can result in potentially fatal respiratory depressions (i.e., an overdose).
Simply put, cannabis affects the body differently than physically addictive substances like heroin, morphine, cocaine, crack, alcohol and prescription stimulants, opioids and sedatives, and suggesting that cannabis involves this type of addiction is blatantly misleading.
Psychological Addiction to Cannabis
Michelin gourmet and Michelina’s Budget Gourmet both describe themselves with the same high-end gastronomic term, but the restaurant-rating group would certainly protest the notion that gourmet is equivalent in both contexts. An equally valid protest can be made when people equate cannabis addiction with substances that are physically addictive.
The risk associated with cannabis is psychological, and the primary driver for such addictions is other risk factors like genetic predisposition, co-occurring mental health disorders, neurocognitive dysfunction and sociodemographic and environmental issues. These same risk factors apply to process addictions like gambling, sex, gaming, eating, the Internet, shopping and other non-substance behaviors. Forget the ignorant stigmatization—process addictions are very real disorders, and addicts experience similar dopamine cravings that drive the compulsive behavior regardless of the consequences. Like process abuses, psychological cannabis addiction is rare, and it does not warrant criminal prohibition any more than overspending or overeating does.
Highlighting the rarity of psychological addiction, a medical doctor published a study in The Journal of Cannabis in Clinical Practice in 2007 that noted the following: “In my practice, 496/524 (94.6 percent) of randomly selected chronic users, asked if they had ever been completely abstinent for two weeks or longer, answered that they had, many for months or years. They had a variety of cogent reasons—being drug tested for a job application, probation, or the simple desire to see if they could get along without cannabis. None expressed the intensity of deprivation usually voiced by abstaining cigarette or morphine addicts.”
Though psychological addiction is rare, it is important to stress how serious the disorder can be. Physical addiction might involve more painful symptoms at the start of withdrawal, but psychological symptoms are often long-lasting and quite punishing. The withdrawal symptoms are commonly related to concurrent disorders like anxiety, bipolar or depression, and the symptoms of both can mutually exacerbate each other. As with process addictions, it is important for individuals with psychological cannabis addiction to seek professional help through a rehabilitation program. Seriously, don’t fuck around with this.