Is cannabis addictive?

Ask this woman.

My dad will never stop smoking pot. Sometimes I wonder about the man he might have been, and the lives we all might have had, if he’d never started.

As I keep saying: the evils of prohibition do not disprove the evils of substance abuse. In the case of cannabis, it’s probable that we could get rid of the former without greatly increasing the latter. But it’s not automatic. And denying that cannabis abuse is a real problem doesn’t help.

Note how the mythology of “addiction” cultivated by the “drug-prevention” effort and the drug-treatment industry interferes with understanding. Most drug abuse is very unlike the horrible picture painted in the linked story: it’s relatively transient. And most people who use “addictive” drugs don’t get addicted to them; substance abuse happens to only a minority of users, and only a minority of abusers actually have the “chronic, relapsing disorder” touted as typical. Bad habits around drug-taking are like other bad habits: they lie along a spectrum, and not everyone who uses a drug that turns out to be habit-forming in others encounters a problem.

But if you have the problem, or your brother, or your son, or your mother, it’s a serious problem. And the risk can’t just be wished away. If you support making cannabis available from profit-seeking commercial vendors, heavily marketed, and cheap – which is the path Washington and Colorado are walking down right now – then the predictable result of your preferred policy will be more people with very bad cannabis habits. And there could be fewer such people if cannabis were kept expensive, if marketing were kept to a minimum, and if users were offered modest helps to their self-command, such as user-set periodic purchase quotas, or if we keep the commercial motive out of the business altogether with state stores or by limiting vendor licenses to consumer-owned co-ops and not-for-profit businesses with boards concerned with limiting drug abuse rather than maximizing revenue.

Of course you’re free to oppose all of that. But if you do so, you ought at least to acknowlege the inevitable human cost.

h/t Andrew Sullivan

Update Comments closed due to persistent trolling, using multipe IPAs. I may start to follow Keith’s lead. Alterantively, we could go to some sort of registered-commenter system. Sorry, folks, but I suppose if you have a picnic you have to expect some cockroaches.

Comments

  1. Ed Whitney says

    Pres. Obama suggested over the weekend that smoking marijuana is a vice, not unlike smoking tobacco, a habit which he, to his regret, had had most of his adult life.

    Mark, did you think he was about right in saying that cannabis is like other common vices? We discourage vices, we constrain their marketing, and (since there is still plenty of time to manage this), we can prohibit its being advertised. The Pres. sounded as if he were saying something pretty reasonable in his statement the other day.

    And, how do you explain the fact that the two teams in the Super Bowl are from the only two states to legalize cannabis? Coincidence???

    • Mark Kleiman says

      No coincidence. Both teams got thoroughly wrecked before their playoff games, and the resulting increase in the creativity of their play-calling accounted for their victories. Or, alternatively, George Soros bribed the referees because he hopes to become rich(er) by trading cannabis futures post-legalization.

      Yes, I think “vice” is the right category. But we don’t in fact discourage the use of alcohol nearly as much as we ought to, and I don’t want to see cannabis (which, the President correctly said, is less dangerous but not benign) going down the same path.

      As to whether the Constitution allows a ban on advertising for a legal commodity, you and I and (I suspect) James Madison are on one side of that question, but the majority of the Supreme Court is on the other.

      • Anonymous says

        Should the FEDERALgovernment really be in the business of deterringevery vice? Even relativelymild ones like pot?

        • politicalfootball says

          I have a high-functioning friend – and I mean, high-functioning in every phase of his life – who is a daily pot smoker, has been for decades, and who entirely seriously argues that pot is a performance-enhancing drug.

          I draw no conclusion from this whatsoever. I offer this anecdote only in the spirit of marveling at human variety.

      • airdrummer says

        perhaps now is the time to prevent legalization from leading to commercialization: ban advertising and restrict sales for ALL psychoactive products, not just pot…both sides give, both sides get; isn’t that how the political process is supposed to work?

  2. prognostication says

    I read that article in the Atlantic when it was posted, and although I take your point, I also think some of the Atlantic commenters are right to point out that this is a person who has some huge problems, and that a good percentage of the behavior described seems difficult to attribute to cannabis consumption. Some of it, of course, probably is tied to his addiction. But I’m not sure how much of the picture is addiction and how much of the picture is problems that would be present without drug abuse, and the distinction is largely glossed over within the piece.

  3. Dead Or In Jail says

    I strongly suspect that the answer to the question “Is Cannabis Addictive?” is the same as if you replaced it with Alcohol: For some people, yes, it’s addictive.

    In other words the rhetorical strategy of equating the vaguely exotic marijuana with the more familiar alcohol really is a half-way decent paradigm for thinking about controlling problem use in general.

    Undoubtedly, getting taxes and regulation right is a big part of harm reduction.

    But I’m wondering about the potential role of stigma in minimizing future harms. More specifically, should stigma be diminished (in order to make sure people who get in trouble are willing to seek help) or should it be heightened (as a disincentive to overindulgence)?

    I know that we cannot control the culture anymore than we can dictate how high or low this spring’s hemlines (or how tight teens’ jeans) will be; but can we put a thumb on the scale?

    Some people fall into self-destructive habits and it’s a terrible thing for them and the people who care about them. I actually also have a hunch — not based on anything more than anecdata — that cannabis can serve as a substitute for alcoholics trying to dry out. I know that that sounds like “happy horseshit.” But permanently stoned people can be plenty sad in their own right.

    • Anonymous says

      I think we have to decide how bad of a vice marijuana really is.

      Because really, you can come up with horror stories for any risky behavior. Steve Irwin’s family must have been devastated.

      It sucks when your relatives take unwise risks and suffer bad fortune as a result. But it’s also unfair to single out one set of risk takers just because they are a disfavored group.

      • Dead Or In Jail says

        I think we have to decide how bad of a vice marijuana really is.

        But this is easier said than done, right? First of all, marijuana comes a dazzling variety of forms. If you think about the highest CBD/lowest THC oils compared to the most THC-heavy concentrates, the difference in degree approaches a difference in kind. Second, is the variation in different users’ behavior and physiology. If you’re using pot the first thing in the morning, you’re probably going to have trouble; similarly, if some people can’t stop themselves from becoming drunks or obese, it’s not clear that that says something about alcohol or food rather than saying something about that person.

        No matter what, I reckon, all social policy is experimental.

        • Anonymous says

          Yeah, it is.

          But what I would suggest makes the issue more difficult is that we really don’t treat most personal risk taking as an opportunity to make razors-edge cost-benefit analyses as to whether the government should give the person permission to take the risk.

          Outside of the context of things that throw huge risks onto strangers (such as driving), we really only do this with some unpopular forms of intoxicating drugs. Which is unfair to recreational drug users and not particularly respectful of their freedom, and suggests that our public policy is dictated by moral prudery / Puritanism rather than a principle that we are committed to stopping people from engaging in risky behavior.

          The strength of marijuana is a regulatory issue. I could totally see a legalization regime that imposes restrictions on the potency of the drug. But at some point we have to treat marijuana (and narcotics more generally) the way we treat other forms of risk-taking. To do anything else really does strike me as just pure hatred for the DFH’s.

          • Julien Offray says

            “we really don’t treat most personal risk taking as an opportunity to make razors-edge cost-benefit analyses as to whether the government should give the person permission to take the risk…
            we really only do this with some unpopular forms of intoxicating drugs. Which is unfair to recreational drug users and not particularly respectful of their freedom, and suggests that our public policy is dictated by moral prudery / Puritanism.”

            That’s a POV, but not the only PO. There are many who’re irritated by government interference that’s not based at all on prudery: soft drink size and trans fat bans and similar ‘nanny state’ issues..

            Personally, I’m bothered by the loss of cheap useful products like plastic bags and incandescent light bulbs.

            That’s at least two non-prudery examples.

  4. Anonymous says

    I usually comment under my own name, but am going to be anonymous for this, for reasons that will be obvious.

    The rhetoric and the popular perception of the issues surrounding drugs and addiction have been hopelessly confused, compromised, and ideologically tainted for a long, long time. I have a tendency to addiction in general: I smoked cigarettes for 30 years but have been tobacco-free for the last 13. When I was in college, my second year was spent stoned on pot for almost all of my waking hours. It pretty well drove the last few nails into the coffin of my already iffy academic career, but I eventually returned to academic pursuits and earned an M.A. in history. I spent several years using heroin and other opioids pretty regularly, periodically to the point of having trouble making the rent. I’ve been a steady drinker for all of my adult life. I’ve never missed a day of work because of alcohol, nor because of heroin, nor because of pot. They’ve screwed me up to some extent now and then, but have never ruined my life. I’d probably still use heroin occasionally if it weren’t so dangerous to procure.

    A friend of mine who is quite intelligent, and has a college degree, when I told him years ago of my history of heroin use, expressed surprise that I wasn’t hopelessly addicted, as it was his understanding that if you use heroin once, you’re totally addicted for the rest of your life without the possibility of redemption. I don’t think his understanding of the nature of heroin use specifically and of addiction more generally is uncommon, even among the well-educated.

    How can there be a useful public discourse on this subject when the popular perception of the issues involved is so woefully uninformed and so completely skewed by the prohibitionist culture? Someone like me isn’t even supposed to exist, according to the ruling ideology. I’ve been a major druggie, and yet I’ve got a very well-paying job, a beautiful condo apartment in one of the nicest parts of the city I live in, and am liked and admired by many estimable people–and I’m totally open to the prospect of using illicit drugs in the future if it’s convenient, not too risky, and I’m in the mood. And I should add that I had no rich parents smoothing my way or paying to make my problems go away.

    I have no idea how common or uncommon my story might be, but would really like to find out. Alas, in our society as it exists today, I will probably never know.

    • Mark Kleiman says

      Thanks! Your story is commoner than you think. It doesn’t seem to me an entirely happy story, but you’re right that the dominant ideology doesn’t allow for its possibility. Once we learn to recognize that most drug users are fine, a big minority is a little messed up, and a smaller minority are a whole lot messed up, that most of the ones who are messed up will get better on their own, with more or less damage as a result, and that some won’t, we can begin to talk seriously about how to minimize the damage from bad drug use patterns.

      • Anonymous says

        No, it’s not an entirely happy story, but the unhappiest parts of it are all the wrong parts, according to the prevailing narrative. My very heavy cannabis use when I was 18 to 20 years old had a far more deleterious effect on my cognitive abilities and my life’s trajectory than did my heroin use when I was 20 to 30 or so. I remain convinced that my frequent memory lapses (which have plagued me for decades) stem from marijuana use, while heroin and other narcotics have had no long-term negative consequences that I can discern. It’s likely that the worst consequence of either drug would be prison, but I’m white and from a middle-class background, so it never came to that for me. There is a lesson in all of that, but you’re far likelier to see it than I am.

  5. O. B. Server says

    re: “If you support making cannabis available from profit-seeking commercial vendors, heavily marketed, and cheap – which is the path Washington and Colorado are walking down right now – then the predictable result of your preferred policy will be more people with very bad cannabis habits.”

    Sure – so let’s throw those pot- “addicts” into prison (even though studies tell us this cannabis “addiction” is not as strong a coffee “addiction). Or at least, after we SWAT-team their homes and divvy up the seizure-loot, let’s force treat them, against their will. To prevent addiction, you see. If not that, we should at least (in our superior wisdom) make them pay dearly for this shameful cannabis habit. You know: to “help” them stop, with perpetually-increasing taxes. That’s how government helps: taxing (or killing if they flee or otherwise resist the voluntary taxation).

    No, but seriously: we should ask ourselves about this (or any policy) – what will line our pockets best? Which policy will give our political faction the most advantage? (I mean: looking to the future – the next election.) Then think of some way to dress that up with some altruistic -sounding motive (suggestion: the children).

    What we cannot allow ourselves to utter – let alone contemplate – is this useless idea of letting the marketplace (via supply and demand) set the price of pot as we do with other things. How can we do good for the people if we just leave them alone?

    Marijuana is a wicked “evil” scary substance of abuse – we all know that of course. The question is: how can we grow government power using pot as excuse, without overtly seeming to do so?

    • Mark Kleiman says

      I’m going to leave this rant up as evidence of the astounding mendacity of the extreme pro-legalization forces. Notice that the post called, not for continued prohibition, but for a tightly regulated market. But the comment talks about putting users in prison.

      This will also serve as a warning to O.B. Server and others. Ranting on this site is no longer allowed. The next such comment will result in a site ban for the poster. If you have something serious to say and can say it calmly and respectfully, you’re welcome. If not, there are lots of other places where your rant can be happy with others of its kind.

      • NCG says

        Look, I don’t know if you two have a history so I don’t want to be in the middle.

        But from where I sit, that wasn’t a particularly bad rant, and maybe isn’t a rant at all. (Maybe if it were aimed specifically at Mark it would be, but it didn’t seem so to me.) This person is just describing a mindset, and I don’t think we could realistically deny its existence, not with the PIC we’ve got.

        I too have an instinctively negative reaction when people talk about making things expensive because “we” don’t approve of them when used in certain ways by certain people, probably because of what I’m seeing in the “public health” realm around “obesity” issues. It’s turning into a bunch of bureaucrats trying to tell poor people what they can eat. Literally. And I have a biiiiiig problem with it. First, the rules are often wrong. Second, they treat people with disrespect.

        So, I hope I don’t get banned too. Btw, if anyone cares, I don’t read posts where there’s no discussion allowed afterward.

        • wibari says

          there are plenty of ways in which public policy noodges people, via the retail price of a product, to either do or not do certain activities.

          sometimes, this can be accomplished by a person who, in good faith, is thoughtfully considering the pros and cons on likely buyers/users in the hopes of achieving the best societal outcome (see, mark kleiman). unfortunately, this approach tends to be scorned by the libertarian set.

          other times, the noodging is the result of lobbying efforts of powerful private sector business interests (see government subsidies to makers of corn-based junk foods) in order to make more money. this approach, though equally reliant on the use of government power, is somehow seen as an exercise of the pure “free market.”

          • NCG says

            I forget the definition of nudge, exactly. IIRC, it was more complicated than it sounds.

            In my current state of mind, the only nudging I accept foodwise is that of making those *few* things we know that are unambiguously healthful — ie, fresh fruits and veggies — cheaper and easier to find.

            It only mollifies a little bit if someone has a good motivation for banning low fat chocolate milk in our local schools. Point is, they were *wrong* to do that. If they wanted to freak out about something, ask the mfr to tone down the sugar. But getting rid of it entirely? Stupid.

            And I don’t need a bajillionaire to tell me how much salt to eat. Just put the info on the menu or board or whatever, and let people decide.

        • Mark Kleiman says

          No, it’s not “particularly bad.” Just averagely bad for a pro-pot fanatic. It’s rude, false, and off topic, and contains no actual insight, fact, or analysis, just emotion. The prevalence of ill-informed and reason-proof commentary on RBC drug posts has driven out what could have been a high-level discussion; several of the world’s leading experts on drug policy are regular readers, but they’re not interested in mud-wrestling. I will delete not only obivous rants, but any comment that doesn’t – in my judgment – contribute to the conversation. If you have something substantive to say, say it. If you want to whine about how mean prohibition is, please do so elsewhere.

          Keith Humphreys decided he lacked the patience to play hall monitor. and closed his posts to comments. Any comments on my posts criticizing him will be zapped.

          In short: Take it outside, people! This is not a kindergarten.

      • Barry says

        Mark, what the commenter might be working from is your statement ‘Of course you’re free to oppose all of that. But if you do so, you ought at least to acknowlege the inevitable human cost. ‘.

        Frankly, I see most opponents of legalization refuse to face the massive human cost of prohibition.

        • Mark Kleiman says

          Of course they do. That’s why I criticize them. My point is that many legalizers are equally stubborn and fact-proof.

  6. says

    Just speaking anecdotally, I’ve had several good friends who were heavy marijuana users and managed to stay gainfully employed — most of the time — but were almost impossible to be around thanks to their mood swings when they weren’t using. Half an hour and a smoke after work (or during a dinner break), and all was better again.

    If that’s not addictive behavior, what is?

    • Freeman says

      Just speaking anecdotally, I’ve had several good friends who were heavy coffee drinkers and managed to stay gainfully employed — most of the time — but were almost impossible to be around thanks to their mood swings when they weren’t using. Half an hour and a couple of cups after waking, and all was better again. For a while. As long as the coffee keeps flowing. I’ve known lots of people who regularly drink coffee after dinner and several who have difficulty sleeping without a strong cup before bedtime.

      Addictive behavior? Perhaps. People get addicted to all manner of things, banned, heavily regulated, or otherwise. Some people think so little of their fellow citizen and so much of themselves that they reckon it’s their duty to manage everybody’s lives but their own, and end up getting addicted to that. Those are the ones I have the most difficulty being around.

  7. Rob in CT says

    ARRRG. Massive comment eaten.

    Short, short version: I really think addictive personality is a real thing, and I say this based on personal experience. It’s not yes/no. It’s a spectrum. Some of us are prone to overdoing things (not just substances!), and some of those who are prone are *really* prone. Then add in various other factors and you get a variety of outcomes (the tendency can be reinforced or counteracted by, say, employment/lack of employment, relationships, and so on).

  8. says

    Thank you for this thoughtful perspective. I find this topic one that engenders such illogical and confused thinking, testament aplenty that humans don’t like cognitive complexity but only simple black/white answers.

    As an expert in ADHD, I see the devastating effects of “self-medicating” with pot. You start with a neurocognitive disorder already associated with amotivation and other Executive Function Deficits; then you exacerbate motivation and working memory deficits–and add an addiction!

    It certainly doesn’t help that many Rx prescribers are reckless with those ADHD patients who are actually taking medication and not solely relying on marijuana. The MDs often neglect to address the comorbidities present in at least 75% of adult ADHD patients, including anxiety, depression, bi-polar disorder, and substance abuse. Some compound the problems by failing to recognize when certain stimulants (most notably, Adderall) exacerbate baseline anxiety to the point of making marijuana a necessity in these patients’ lives. When, all the while, better treatment could have obviated this course of events.

    But it’s not just ADHD that is causing this rush and dependence on marijuana. It is all the chronic conditions, including the aches and pains that elude our medical expertise.

    A failed medical system — meaning physicians poorly trained to understand and treat chronic conditions — provides a huge impetus for this rush to get stoned.

    In this 21st Century, when we need to be paying more attention than ever, it is depressing to think of how many Americans are not only addicted but checked out.

    Gina Pera

  9. HW says

    I have questions about the lead quote in this article;

    “My dad will never stop smoking pot. Sometimes I wonder about the man he might have been, and the lives we all might have had, if he’d never started. ”

    Isn’t it possible some other ‘thing’ might have held him back? Some internal tendency that might have kept him from being “the man he might have been”? It seems it’s easy — thought admittedly painful — to suggest that it’s always an outside force that is causing the problem. It’s emotionally convenient to blame marijuana (or whatever else) instead of possibly admitting, “Marijuana didn’t ruin my dad, he would have been distant and unmotivated no matter what”. Not that that’s necessarily the case, but I wonder.

  10. EST says

    Thank god for drug dealers that made pot available to such a horrible dad as was mentioned in the article. Can you imagine what her life would have been like if her dad had chosen a more socially acceptable intoxicant? How do we measure the human cost of choosing alcohol over pot?

    Just as we should think about the relative harms of different drugs, we should think about their relative availability. If advertising promotes the use of a product, and we can’t ban alcohol advertising, then I think marijuana advertising is important to promote a safer choice. I understand that some believe it’s possible that marijuana use causes alcohol use to increase, but I think the burden of proof should fall upon them to show that is the case before we limit advertising, or create quotas, or whatever consumption control measure that is greater than what exists for alcohol. Because, for now, we at least know that marijuana is the safer intoxicant.

  11. Ed Whitney says

    You may enjoy a book titled “Cannabis Chassidis” by Yoseph Leib ibn Mardachya. It deals with the Torah of marijuana. An interesting read, with lessons about moderation in the use of everything.

  12. Ed Whitney says

    There is a study (Varner MW, Silver RM et al, Obstet Gynecol 2014;123:113–25) in the Jan. 1 issue of Obstetrics and Gynecology reporting that cannabis u se in pregnancy is associated with an increased risk of stillbirth (odds ratio of 2.34 with 985% confidence intervals from 1.16 to 3.27). There was some confounding arising from tobacco use, which is also very common among cannabis users, but the authors, unfortunately, did not report separate odds ratios for THC adjusted and not adjusted for tobacco. They used umbilical cord levels to measure THC and also cotinine, the major metabolite of nicotine and a strong marker of tobacco use. They think that increasing cannabis use may increase the relevance of their findings.

    This looks like something to think about and get more data on, especially concerning just how great an independent risk factor cannabis represents for stillbirth. You want to see whether cannabis remains associated with stillbirth when all other drug use is accounted for, so this, as yet, is no basis for jumping to conclusions about its threat to an otherwise healthy pregnancy.

  13. me says

    How timely.

    My daughter has just been diagnosed as psychotic. There is no question her pot addiction is fueling the psychosis, and may very well be a proximal cause. And this is just a heartbreaking time for her mother and I as we struggle to get her to accept the treatment she so desperately needs.

    The literature is fairly consistent. The incidence of psychotic signs and symptoms may be as high as 20% in marijuana users. Psychosis is, indeed, pot’s most significant side-effect.

    The widespread use of marijuana is going to come with a widespread “epidemic” of psychosis. You can bank on it.

    • Mark Kleiman says

      Very, very sorry to hear about your daughter. Here’s hoping she gets better soon.

      Now, as to the policy argument:

      The prevalence of isolated psychotic episodes in the general population is moderately high. A single psychotic episode is not the same as a diagnosis of psychosis. We’ve run the social experiment, and the massive increase in heavy cannabis use for the birth cohorts around 1961, compared to earlier and later cohorts, was not associated with a measurable increase in the rate of psychosis in those cohorts. Of course you can’t prove a negative, and I’d be surprised if there weren’t some cases of psychosis where cannabis was a contributory cause. As you note, cannabis can worsen psychotic symptoms in those already ill, and that’s a legitimate source of worry. And of course even a single case of psychosis is horrible for the person affected and those around him or her.

      But I do not regard the risk of an upsurge in psychosis as among the strong arguments against cannabis legalization. It’s also fair to note that incarceration can also precipitate psychotic breaks, sometimes leading to suicide. So it’s not as if the current policy has no mental-health costs.

      It’s always a matter of balancing harms and risks. I think the dangers of cannabis are sufficient to justify tight controls, but not to justify full prohibition.

  14. Julien Offray says

    I’m guessing some folks won’t like what I’m going to say, but then again I’ve not liked many preceding comments. So here are the four things that I always come back to when this topic comes up…

    1. When legalization advocates talk about the supposedly relatively minor nature of adverse health effects, I think about how different modern cigarettes are from the tobacco of 200 years ago. I think about the difference between modern marijuana and marijuana 50 years ago. I worry that future marijuana will be more addictive and be packaged with unsafe additives to heighten the users enjoyment. If it’s legalized and becomes big business, I’d be very surprised if that could be avoided via regulation.
    2. You can agree that there can be legitimate medical use and that the way the justice system deals with it are problems, but that doesn’t mean legalization is necessarily a good idea. I’m relatively open to the idea of treating small scale possession
    much the way we treat speeding. I’m fine with medical use when it’s taken seriously. In other words the Rx isn’t a sham and you use real pharmacies. I don’t see why more than that is necessary from a pragmatic perspective – and the ideological/libertarian case for legalization has zero appeal to me.
    3. The biggest long term policy concern for both parties is reducing the cost of healthcare- but more narrowly of reducing the level of government spending on healthcare. There’s a lot of discussion about what incentives would get people to eat healthier and exercise more. This seems like a stupid time to start significantly increasing the number of smokers. (Maybe marijuana is less harmful than tobacco smoke, but all smoking is bad for your health.)
    4. The argument based on freedom seems self-indulgent to me. Preventing people from making harmful choices is a perfectly legitimate activity for government when there’s significant harm. It’s mostly just an argument about what ‘significant’ means. (No one wants heroin legalized. Hardly anyone wants prostitution legalized, and most don’t want to make gambling more available.) The argument that marijuana isn’t ‘significant’ is that it no worse than alcohol and tobacco.

    Alcohol use predates humanity. It can’t be eliminated. We’re trying to eliminate tobacco and having some success. Alcohol and tobacco are the two greatest scourges to public health. Saying marijuana wouldn’t be worse, so it should be legal, is an irrational point of view. I like saying that if you’ve broken two ribs, then you can’t object to a third.

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