In going back through the patient histories, 85% started their drug use with pot and the other 15% started with alcohol. Marijuana is usually their first experience with a chemical high, and many move on to various other drugs searching for a stronger or better euphoria. If I don't ask specifically, "Are you smoking pot?", most will not mention it because they take it for granted, as they have usually been smoking since age 10, 11, or 16. They haven't looked at it as the problem, but rather as a given in their life. It's easier to see cocaine or alcohol as problems because behavior is disinhibited and dramatically out of control, involving car wrecks and fights. Marijuana is not so dramatic and in fact it causes people to sit on the couch, watch TV, and eat. How can that be a problem?

Well, marijuana is a problem - a big problem - for the patient and society, yet denial in our society and in the individual patient is huge. In our culture today many people say things like, "It's not addictive"; "It's natural and so it's okay"; "It just mellows me out"; and "I can keep smoking pot, I just need to quit the dangerous stuff."

It's so common for patients to continue to stick with marijuana use after treatment for addiction, that clinicians have coined the term "marijuana maintenance program" for this misguided recovery plan.

Besides working in an inpatient chemical dependency program, I am a psychiatric consultant for an adolescent residential treatment center. 98% of these patients start with marijuana (usually called "weed" these days), and end up in the program because while on probation for truancy, possession, or petty theft, they repeatedly test positive for marijuana on their probation officers' drug screens. They can't quit smoking even when monitored. These adolescents and the previously mentioned adult patients do not think they are addicted even though they smoke daily - sometimes for years. None believe they will become addicted to marijuana or get out of control with other substances.

Marijuana has an inaccurate reputation that it is not addictive because there is not a significant physical withdrawal syndrome when it is stopped. When alcohol is stopped abruptly, visual hallucinations, tremors, seizures, or DTs will occur. Stopping opiates abruptly causes an intensely uncomfortable flu-like syndrome. To avoid these withdrawal problems we give a cross tolerant drug and taper the patient gradually off of that detoxification medicine. Marijuana has a built-in taper when stopped abruptly. Because THC (the active ingredient in pot) is stored in the fat cells and because fat cells have such poor blood circulation, THC is slowly released from the body over a few weeks. This becomes a natural, undramatic withdrawal and explains why marijuana cessation does not cause a lot of physical discomfort. But just because no withdrawal syndrome occurs doesn't mean it is not addictive. Addiction is compulsive use and obsession with the drug. I have seen many patients who smoke every day, even though problems and losses pile up; they don't get high like they used to; and even though they get anxious and paranoid when they smoke – they still use. This is addiction.

Some people distinguish between "psychological" and "physical" addiction. Addiction is both psychological and physical. Marijuana is addictive, but, because of the built-in taper with this drug, people have a hard time believing it. Just like other addictive substances, not everyone becomes addicted. Denial is particularly strong with marijuana users, and society's attitude strengthens this denial.

The harm marijuana causes is passive rather than dramatic, and comes from what this drug takes away. All of the experts agree it causes the amotivational syndrome and decreases memory. Recently, I attended a family group session involving 15-20 likeable and hard-working parents of pot smoking teenagers. All of the parents said they were against their teenager smoking marijuana, but half of the parents were pretty soft on the issue. These parents had the attitude "teenagers will be teenagers," "everybody does it," "it's not addictive," and "look at me, I smoked through school and it didn't hurt me." One said, "I smoked all through college, it was the best 8 years of my life." Isn't college supposed to be 4 years? All of these parents are also encouraging their kids to make good grades, work hard in school, aim toward college, and enter a good profession. Passively condoning marijuana use works in the exactly opposite direction.

Many of these parents smoked pot 20 or 30 years ago when the marijuana was about 1/5th as strong as today's "weed." The product has been "new and improved." Kids also tend to start smoking earlier in their lives. It's not unusual for children to start in middle school or the early teens. Just as any salesman has new and improved products; dealers also have access to a variety of other products. Where pot is bought many dealers also have stronger and different drugs like Xanax "bars", "oxy", cocaine, etc. If a person really likes the vanilla ice cream, it's not long before cookies and cream ice cream, sorbet, or sundaes are tried. Some people pooh- pooh the term "gateway drug," but once a person likes getting high, it is natural to move on to "the better stuff."

A percentage of drug and alcohol users (about 15-20%) will go on to true addiction. The majority won't become addicts or alcoholics, but the harmful effects of marijuana affect all who use. The 15 year old who is smoking has lower motivation, becomes more withdrawn, and doesn't concentrate or remember as well. This interferes with achievement and with development. The brain isn't fully developed until age 24 or 25. This drug that profoundly affects the brain and neurotransmitters especially causes big problems in the developing brain. Richard Hawley says in his book, The Purposes of Pleasure, that "not only does marijuana change the personality, but what's worse it changes the thing that makes personality— the brain." Marijuana use in the teenage brain may cause irreversible changes and losses.

When a young person learns he or she can get high by just ingesting a substance, they tend to not learn the valuable things natural highs (non-chemically induced) teach us. Natural highs teach us mastery, problem solving, stress management, and make us healthier and happier human animals. Self- esteem is increased with these pleasures and coping skills. Highs from marijuana and other drugs teach us nothing, and decrease self-esteem along the way. Emotional and psychological growth is short-circuited by marijuana and other drug use. In the short run the chemical highs seem like a great deal, but in the long run they are terrible deals. Marijuana is one of the most dangerous of drugs because it has such a benign reputation, and yet takes away so much from our young people. It "dumbs down" our youth and our society, and the myth that marijuana is "not a big deal" is just that – a myth. In America we will either have to greatly lower our expectations of future generations, or take off the blinders and admit that marijuana is a very dangerous drug.

About the Author

Dr. William Loving has been practicing psychiatry for more than 30 years. He is certified by the American Board of Psychiatry and Neurology as well as the American Society of Addiction Medicine. Dr. Loving is Medical Director at Texas Star Recovery, an inpatient and outpatient program for people with chemical dependency problems, including those with psychiatric problems (often referred to as dual diagnosis patients.) Dr. Loving is also Regional Medical Director for the Phoenix Academy which has adult and adolescent drug and alcohol programs in Texas and several other states. In Austin we have the Phoenix House which is an adolescent program.