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Tuesday, December 17, 2013

Why is Marijuana a gateway drug?

I used to discuss with people about whether or not marijuana is a gateway drug for heroin, cocaine or other drugs but not anymore. I have absolutely no doubt that marijuana is a "gateway drug" for heroine and cocaine. My certainty comes from hearing the stories directly from so many teens and young adults, over the last ten-plus years, in the Lincoln Way school district, near Chicago, Illinois. 

 The term "gateway drug" should be changed to "replacement drug," 
because that is the real function of using stronger drugs
after developing a tolerance to marijuana. 

 There are two problems with drug education. The first is that we teach kids that drugs are "bad." We don't teach them that drugs "feel good," so many kids will assume that because parents say drugs are bad then they must feel bad, too. However, as these kids grow into their teenage years, some of their childhood friends tell them that drugs "feel good." 

The logic of a teen is that "if it feels good then it must not be bad." 
We need to teach children and teens: 
what feels good can be sometimes be bad, very bad, 
and what feels bad can sometimes be good, even very good. 

The transition to more dangerous drugs can be a slow process.
There are other costs to society from marijuana use:, the loss of water supply in some areas, the destruction of wildlife related to chemical use, and the carcinogenic nature of the pesticides used in growing marijuana; many of these carcinogens remain in the soil and water supply. Just because some people want marijuana to be legal shouldn't mean that so many others have to pay the cost of it's production. Pot-smokers should pay for the full cost of this destructive forms of entertainment.

UPDATE: Marijuana appears to cause anatomical changes in brain of teenagers who use it just once a week or more.

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We need to give them examples of these facts. Aside from McDonald's food, drugs are the best example of something that feels good but is actually bad. Surgery or taking medicine is an example of something that feels bad that is actually very good. Kids need to be taught that people use drugs because drugs "feel good." They need to be taught that some things that feel good are actually very bad. They need to be taught about the Spell-binding effect of drugs. The second problem is that we teach kids to say "no" to drugs. The problem is that kids never have to say no to drugs; they have to say "no" to their friends, and when it comes to saying "no" to their friends, many teens just don't know how. The best way to teach children this is to have them practice doing it in a classroom setting, in front of their peers.

Parents who use marijuana have children 
who will be more likely to use heroin. 

There are all sorts of scenarios that can be created where kids can role-play saying no and dealing with the social consequences of rejecting their peer's request that they use a drug. Kids never have to say "no" to drugs. Drugs don't talk. Kids have to learn to say no to their friends, they have to learn how to reject their friends; they have to learn how to deal with the social consequences of saying "no" to their friends who will ask them, even tell them, to do drugs. All illegal drugs and even prescription drugs like Prozac, Abilify, and Lexapro have a spell-binding effect on the user. 

The spell-binding effect is when the person using the drugs becomes unaware of the negative effect of the drugs. This effect can be seen with prescription and non-prescription drugs that have a psychoactive effect. For example, some users of Lexapro may lack awareness of weight gain or be oblivious to the marital consequences of the loss of sex drive. Users of meth are notorious for their lack of awareness of their personal appearance, sometimes appearing gaunt and grotesque. Marijuana users often look pale, skinny, and lack motivation to shower, wear make-up or comb their hair. This loss of self-awareness is a reflection of the brain damage directly caused by the drug and sometimes made worse by poor sleep, poor hygiene, lack of exercise and poor nutrition. 

Here's a typical story of how marijuana is a gateway drug: 

     John (fictional client for this example story) was 14 when he first tried marijuana. His friend, Mike told him that he had used marijuana for about year. Mike's older sister, Tracy, smokes it everyday, sometimes several times a day, before school, after school, and sometimes at night. Mike and Tracy's parents apparently don't know that Tracy smokes it in their home. They think she takes long showers and baths to cope with her stress, but she actually sits in the bathroom taking hits from a joint while the fan is running; she sprays air freshener, perfume, and sometimes lights incense to hide the odor of marijuana. 
     Mike told John that Tracy told him that marijuana is not addictive and that it makes her feel relaxed. John has been feeling very anxious for almost a year, and he feels like he "can't take it anymore." He doesn't know why he feels so anxious, but his parents tell him that he'll grow out of it. John also has bad acne which makes him feel very bad about himself. He thinks that girls won't like him, he acts reserved and awkward as a result, which only reinforces his negative ideas about himself. John feels like he has to be careful around his friends so he doesn't lose any, like he has the underhand when it comes to social standing. So, John doesn't feel like he can so no to Mike. Mike is John's best friend even though they're not that close, but John can't stand the thought of not having any friends again. Mike has lots of friends and is outgoing. John looks up to him. In reality, Mike isn't that great. He's a nice guy, but like John, they don't have much direction for the life, no big picture of how high school performance will tie into their future, later. 
     John tries marijuana. He feels relaxed just as he expected to feel. He feels good. He's not sure how his parents feel about marijuana, so, he doesn't feel guilty or ashamed about it. He doesn't think his dad will ever find out anyway, because his mom would never tell his dad because they don't get along, and he only sees his dad a couple weekends a month. Since John liked marijuana, he starts smoking it more often. He actually quits his after- school club so that he could go over to Mike's house instead and smoke marijuana with Mike and sometimes with Mike's sister, Tracy. Because marijuana is addictive, John feels more motivation to use it. Mike and Tracy make marijuana available to John whenever he wants. Sometimes they ask him to pay for it. Sometimes John saves his lunch money to give to Mike and Tracy. He occasionally steals money from his mom's purse. 
     A couple years pass, and by this time, John and Mike have been smoking marijuana every day for at least 6 months. They "worship the weed," as some teens like to profess. Mike and John have been selling marijuana for Tracy to get free weed. As time passes, Mike and John start getting "bored" with marijuana. Their level of tolerance to marijuana is very high, so to speak, so it takes a lot more marijuana to feel good. Because they have such a high tolerance, they often feel edgy or anxious without enough of it in their system. So, they end up smoking it more often, not to get high, but to avoid feeling the withdrawal anxiety. 
     In the meantime, John told his mom that he can't concentrate anymore, "maybe I have ADD." John's mom takes him to their pediatrician who immediately diagnosis him with ADHD and prescribes Adderall. John tries the Addreall, but it makes him feel very anxious and panicky. He goes to Mike's house and drinks alcohol and smokes pot to help him calm down. He sells the Adderall for $25 a pill to other kids at school (some kids snort the Adderall because it has the exact same effect as snorting Cocaine) and uses the money to buy more weed. John doesn't like feeling anxious at all. Over the last couple years, he has become very averse to any feelings of anxiety. 
     Since the marijuana isn't working for him anymore no matter how much he smokes, he "needs" something else. He tells Mike and Tracy about how he feels. Tracy tells him about Xanax, that he should take that with or without marijuana. John starts using Xanax, and within a few weeks, he has developed an addiction to it. He thinks that 1 mg of Xanax isn't much, but that's about the equivalent of 20 mg of Valium. John's tolerance to Xanax increases as well, and it's expensive and difficult to find. One week, John can't find any Xanax and after a few days, he starts have extremely bad panic attacks. He tells Tracy who calls up her "friend" Lisa. A half-hour later, Lisa brings over a pill for John; she calls it "Oxy" which is the prescription form of heroin, Oxycontin. She says, "You can swallow it or smoke it, but if you smoke it, you'll feel better right away." John smokes it. He feels "great" right away and then a while later, he's asleep on the floor. Not too many hours later, John asks Lisa for another pill. Lisa tells him that it's $20 a pill and that he owes him $20 for the first one. John steals more money from his mom's dresser. He buys several pills. 
     Within a few months, John is using Oxycontin and heroin on a daily basis. He tells his mom that the Adderall isn't working and that he feels very anxious. He stays home from school for a week before she calls his father to tell him about John's "anxiety" and missing school. His assignments pile-up. During the day, John drives to the city of Chicago to buy heroin. He started injecting it a week ago.

At this point, the prognosis for John is very poor. It is possible that he could recover from his addictions and lead a fairly normal life, however, it is more likely that he will continue using heroin until he dies. He may self-medicate with marijuana and other drugs, but he will likely return to using heroin or Oxycontin, having ups and downs for one or two years before a fatal overdose. Attempts at rehab are often followed by overdoses since the tolerance lowers but the brain attempts to satiate itself with too much of the drug during relapse. 

 I have known many teens who have developed Schizophrenia, Schizoaffectivity, and Bipolar disorder after moderate and heavy use; some teens who are very sensitive to marijuana may develop psychosis after just a few times. Many of these teens will end up suffering from psychosis or mania for years, a decade, or their lifetime. More common is for teens and young adults to develop panic disorder or other anxiety disorders. Emergency room visits for marijuana related anxiety and psychosis have significantly increased aside efforts by some millionaires and billionaires to legalize marijuana. The social and economic cost for marijuana addiction is very significant. Teens will lose years of social and academic progress; family relationships will be strained, and in some cases, the financial burden is substantial. Many wealthy Americans have been funding efforts to promote legalization of marijuana, claiming that it should be someone's personal choice to use or not and that it only harms the user; this is not true. 

If States and the federal government choose to legalize marijuana, they need to develop more effective drug prevention programs and drug treatment programs for parents, kids, teens and young adults. Current drug treatment programs, although costly, are not very effective, overall. Tax revenues from marijuana sales will not off-set the cost of increased rates of abuse and addiction. This doesn't include the issue of potential increases in auto accidents and work-related accidents or a decline in productivity due to the memory loss and attention problems caused by marijuana. 

Marijuana is a gateway drug for several reasons: 
1. it is addictive, meaning that you will build a tolerance to the drug. 
2. there is a point which marijuana will no longer have an effect regardless of how much is used and some people will use other drugs to "get high" as a replacement to marijuana. 
3. it is additive, meaning that you will have withdrawal symptoms. 
4. withdrawal symptoms can be intolerable for some people and they will use other addictive drugs to cope with the withdrawal. 

There are many risk factors for drug use: 
1. low self-esteem 
2. depression 
3. anxiety 
4. for teens, if their parents use drugs 
5. for teens, if their parents use prescription drugs like benzodiazepines, opiate-based pain kills, and ADHD medications. 
6. teens who are unassertive 
7. victim of trauma 
8. for teens, parents who use corporal punishment 
9. for teens, if they feel like their parents don't care about them 10. a tense or tumultuous home environment 
11. poor identity development, a "lost child" 
12. having friends who use drugs 
13. lack of effective education about risks of drug use 

Playing sports will not prevent your teen from using drugs. A healthy parent-child attachment may help prevent a child from using drugs. It is important for parents to understand that the parent-child relationship has to be mutually satisfying; just because a parent "feels like" they have a good relationship with their child doesn't mean that the child feels like they do. Corporal punishment is highly correlated with anti-social behaviors, from behaviors that make-up the diagnosis of ADHD, to truancy, drug use, vandalism, theft, and violence. Prevention is the best drug treatment. Focusing on self-esteem, assertiveness and drug-free mood management (including not using prescription anti-depressants) should be part of the plan. 

Mental Health Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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