Cannabis is a common substance of abuse during adolescence among school, college going students and street children in India. According to the World Health Organization (WHO), 147 million people or 2.5 percent of world population use Cannabis, making it the world’s most widely cultivated, trafficked and abused illicit substance. A recent study in India reveals that Cannabis holds 35% of the most common substance abusers nationwide. The mean onset age for Cannabis usage is 13.4 years and 13.6 years as per the survey conducted by The National Commission for protection of Child rights.
Cannabis is a drug that comes from Indian hemp plant, Cannabis sativa and Cannabis indica. The main active chemical in Cannabis is THC (delta-9 tetrahydrocannabinol). It is a depressant drug. Depressant drugs do not necessarily make us feel depressed. Rather, they slow down the activity of the central nervous system and the messages going between the brain and the body. When large doses of cannabis are taken, it may also produce hallucinogenic effects.
This drug is also known as grass, pot, hash, weed, reefer, dope, herb, mull, Buddha, ganja, joint, stick, buckets, cones, smoke and hooch .It is used for the psychoactive (mind and mood altering) effects of THC and other active ingredients. THC is the chemical in cannabis that makes one feel “high”. There are three main forms of psychoactive cannabis: Marijuana, Hashish and Hash oil.
Marijuana is the most common and least potent form of Cannabis. It is the dried leaves and flowers of the plant. Hashish or Hash is dried cannabis resin, usually in the form of a small block. The concentration of THC in hashish is higher than in marijuana producing stronger effects. Hash oil is a thick, oily liquid, golden brown to black in color, which is extracted from Cannabis. It is the strongest form of cannabis.
The different forms of cannabis are used in different ways. Marijuana is smoked in hand –rolled cigarettes, known colloquially as ‘joint’ or in pipe or Bongs. Hashish is usually added to tobacco and smoked or baked and eaten in foods such as hash cookies. Hash oil is usually spread on the tip or paper of a cigarette and then smoked.
Cannabis and Hash are also smoked using vaporizer. The THC in cannabis is absorbed into the blood stream through the walls of the lungs, if smoked or through the walls of the stomach and intestines if eaten. The bloodstream carries the THC to the brain, producing the “high” effects.
Cannabis has a greater impact on younger developing brains than older ones. The human brain begins to develop in the womb and is not fully formed until well into adulthood. Drugs influence the way our brains develop. Regular cannabis usage at an early age may have negative effects on brain development. It causes significant impact on teen’s brain development, memory, IQ and emotional regulation. If one gets addicted to Cannabis, he will feel compelled to continue to misuse this substance, sometimes in increasing amounts that will lead to detriment of his health and wellbeing.
The likelihood of initiating addictive behaviors is higher during adolescence than during any other developmental period. The differential developmental trajectories of brain regions involved in motivation and control processes may lead to adolescents increased risk taking in general, which may be exacerbated by the neural consequence of drug use. Neuroimaging studies suggest that increased risk taking behavior in adolescence is related to an imbalance between prefrontal cortical regions, associated with executive functions and sub cortical brain regions related to affect and motivation.
Why do adolescents take Cannabis?
Adolescence is a critical transition period during which fundamental changes prepare the adolescent for becoming an adult. This transition is associated with increase in reward and sensation seeking behavior, peer-directed social interactions and risk taking, with exploratory use of drugs like Cannabis.
1. To feel better: Some adolescents suffer from depression, social anxiety, physical pain and stress related disorders. Therefore, by using drugs like cannabis they attempt to lessen these feelings of distress.
2. To experiment: Adolescents consider the use of drugs like Cannabis for a thrilling experience.
3. To do better: Some adolescents consider use of Cannabis to enhance their performance academically and athletically.
4. To feel good: Cannabis interacts with the neurochemistry of the brain to produce feelings of pleasure. So to feel good adolescents depend on this drug.
5. To fit in: Many teens use Cannabis because others are doing it or they think others are doing it and they fear not being accepted in a social circle of drug using peers.
How do adolescents become addicted to Cannabis?
Adolescents often differ from children and adults in the ways they interact with and react to stimuli in their environment. Their social orientation shifts with marked elevations in the importance of and time spent interacting socially with peers. With the hormonal and physiological changes associated with puberty and the processes of sexual maturation along with romantic and socio-sexual interests.
Addiction occurs when repeated use of Cannabis changes a person’s function over time. The transition from voluntary to compulsive Cannabis use reflects changes in the brain's natural inhibition and reward centers that keep a person from exerting control over the impulse to use this drug even when there are negative consequences.
Some people are more vulnerable to this process than others, due to a range of possible risk factors. Stressful early life experiences such as being abused or suffering other forms of trauma are one important risk factor. Adolescents with a history of physical or sexual abuse are more likely to be diagnosed with Cannabis and other substance use disorders. Many other risk factors, including genetic vulnerability, parental exposure to Cannabis use, lack of parental supervision or monitoring and association with drug using peers play an important role.
Cannabis use in adolescents frequently overlaps with other mental health problems. A teen with addiction to Cannabis is more likely to have a mood, anxiety, learning, or behavior disorder too. Adolescents may begin taking this drug to deal with depression or anxiety, but on the other hand frequent drug usage may also cause or precipitate those disorders.
Signs and Symptoms of Cannabis Intoxication:
Like any other form of drug abuse, Cannabis misuse may reveal itself through variety of signs and symptoms affecting behavior, physical, mental and social wellness.
Physical signs & symptoms include:
• Excessive sleepiness
• Constant mucus filled cough
• Rapid heartbeat
• Increased hunger and appetite
• Poor co-ordination
• Impaired balance
• Dry mouth
• Fatigue and lethargy
• Blood shot eyes
• Slurred speech
• Psychomotor impairment
Behavioral symptoms include:
• Frequent, unexplained absence from school
• Distorted perceptions
• Difficulty in thinking and problem solving
• Ongoing problems with learning and memory
• Losing interest in activities or events that were previously significant
• Lack of attention to grooming and hygiene
• Declining performance at work or in school
• Lying or secrecy involving whereabouts or activities
• Trying but being incapable of stopping or reducing cannabis use
• Continuing to misuse cannabis even after experiencing negative repercussions due to prior misuse of the day.
• Withdrawing from friends and family
• Associating with new peers
Psychological symptoms of Cannabis addiction include:
• Problems concentrating or focusing
• Delayed responsiveness
• Poor judgment
• Dramatic mood swings
• Impaired ability to track the passage of time
Diagnosis of Cannabis intoxication
Regardless of age, acute cannabis intoxication is a clinical diagnosis. Urine drug screens can be helpful in confirming the diagnosis in young children because any positive result identifies acute exposure. It is less helpful in adolescents although testing is usually positive several hours after acute exposure and it can also be positive well after symptoms have resolved.
Standard urine drug screens that are available in most healthcare facilities consist of immunoassays that detect delta-9 tetrahydrocannabinol (THC) metabolites, primarily THC carboxylase. The lower limits of detection range from 20 to 100 mg/mL, depending upon the specific assay. Positive results have been reported up to 10 days after weekly use and up to 25 days for after daily use. Thus, cannabis testing does not provide any specific information on the timeline of exposure or correlate with severity of intoxication.
In adolescents and adults, inhaled doses of 2 to 3 mg of THC and ingested doses of 5 to 20mg THC impairs attention, concentration, short- term memory and executive functioning. More severe adverse effects may occur at doses >7.5mg/m2 THC, including nausea, postural hypotension, delirium, panic attacks, anxiety and myoclonic jerking .Psychosis has also been associated with use of higher potency cannabis products.
Withdrawal from Cannabis usage
The longer someone has taken cannabis, the more likely they are to develop withdrawal symptoms when they stop. The severity will vary from person to person. Someone with mild cannabis dependence may be able to stop on his or her own. However, chronic users with severe cannabis use disorder or cannabis addiction should usually need professional addiction treatment.
Adolescents may not feel that they need treatment and families may inadvertently enable individuals to continue pattern of problematic drug usage in a misguided attempt to protect them. It may feel socially unacceptable to seek treatment or it may feel normal for teens to be experimenting with drugs like cannabis. Increased understanding of the basics of addiction will empower teens to make informed choices in their lives.
The first step on the journey to recovery is to make them recognize that they have a problem with cannabis usage. Sometimes, though it is difficult. They feel that drugs help them fit in socially. Substance abuse can reduce inhibitions and self-confidence levels temporarily. They potentially numb or minimize difficult emotions for a short time and provide escape from reality.
Support services and continuing care are helpful for adolescents struggling with substance abuse. We should provide safe places to talk to others with similar circumstances build a positive network of people and help prevent relapse.
According to a recent study, children who start Cannabis use in the beginning of their teens are at a higher risk of having a drug abuse problem by the age of 28. The younger they started, the more likely the boys had a problem later as young men. The researchers also found that the earlier they used cannabis the earlier those boys were involved in gangs, got into fights, stole or vandalized property. Some teen’s steal money from their home in order to purchase Cannabis, so parents should be always aware of even minor changes in mannerisms in their child. Regular checking of school bags and rooms must be done so that they might feel they are always under surveillance.
Management of Cannabis abuse
Adolescent Cannabis abuse treatment should take into account specific gender, cultural, ethnic, psychological development and relations with family, friends and community. High school and college students may not have all the necessary cognitive tools to handle some of the daily stressors that may surround them and drugs can seem like the answer. Most among the teens and adult community states that high self-esteem was one of the main factors that kept individuals away from substance use and abuse. Hence, life skills, which includes not just enhancement of self-esteem, but also negotiation skills, decision-making etc. must be kept central to programme that focus on the youth.
It is important to implement these programmes by the end of primary school to prevent early onset of cannabis use. Since peer influence and delinquency were identified as early risk factors for earlier cannabis onset and abuse, targeting these risk factors in prevention programmes is very important. Parents, teachers and key community influencers must be included under the communication strategy to endure that there is uniformity and consistency in the messages being conveyed from all ends.
All the neurological wiring is laid down in adolescence for judgment, reason controlling impulses, empathy, compassion, flexibility and all those more mature brain functions that help people grow into responsible adults. When drugs are thrown to developing brain it hinders emotional development. That is one important reason why it takes children so long to recover from addiction, because they don’t have those skills built up, those underlying brain foundations that help them know how to build strong relationships and make reasonable, rational decisions.
Most treatment models for adolescents and young adults use behavioral therapy models and research-based methods that include both group and individual therapy sessions with groups of peers. Treatment for Cannabis abuse may be performed in either an outpatient or residential setting, depending on the specific needs of the individual. A teen with a strong support system at home that has been abusing this for a shorter period and is less dependent on it, may do well in outpatient treatment. Teaching both families and young people about substance abuse, addiction and the science behind these issues can help teenagers and young adults to make healthier life choices.