Cannabis-in the form of marijuana, hashish (a dark, blackish resinous material

that exudes from the leaves of the Indian hemp), or other cannabinoids- is considered the

most commonly used and readily available illegal substance in the world. Cannabinoids

are substances that come from the cannabis plant, Cannabis Saliva. The plant is usually

dried and chopped or shredded and smoked, however an alternative method of using

marijuana involves adding it to foods and ingesting it orally. All parts of the plant are

composed of psychoactive substances, with delta-9-tetrahydrocannabinol (THC), the

drug’s main ingredient, making up the highest percentage. This substance by itself is

hardly ever available in a pure form. These cannabinoids exhibit diverse effects on the

brain, prominent among which are actions among the CB1 and CB2 cannabinoid

receptors that are found throughout the nervous system. These brain alterations provide

both pleasant effects, which is one reason why marijuana has been used to help medical

conditions, and destructive and maladaptive behaviors. These maladaptive and

detrimental behaviors provide the basis for most Cannabis-Induced Disorders.

With the psychoactive effects of cannabis, related disorders persistently develop

reflecting the problematic use of the drug in varying degrees. Cannabis intoxication

marks the direct maladaptive psychological and behavior changes of acute cannabis use,

developing during or shortly after usage. Intoxication usually starts with a “high” feeling

followed by euphoria, inappropriate laughter, and feelings of grandiosity. Other

symptoms include sedation, lethargy, impaired judgment and short-term memory,

difficulty carrying out complex mental processes, impaired motor performance, distorted

sensory perceptions, and the feeling that time is passing unusually slowly. Sometimes

severe anxiety, feelings of depression, or social withdrawal may occur. Along with these
symptoms, common signs of cannabis intoxication include reddening of the membranes

around the eyes, increased appetite, dry mouth, and increased heart rate. Cannabis

intoxication can also be associated with depressive symptoms and hypomania.

Intoxication develops within minutes if the cannabis is smoked, but may take a

few hours to develop if ingested orally, with the effects lasting three to four hours (this

may be somewhat longer if the substance is ingested orally). “The severity of the

behavioral and physiological changes depends on the dose, method of administration, and

individual characteristics of the person using the substance, such as rate of absorption,

tolerance, and sensitivity to the effects of the substance (American Psychiatric

Association, 2000).” A majority of cannabinoids, including THC, are fat soluble,

resulting in the effects of cannabis or hashish to sometimes continue or reoccur for 12-24

hours due to the slow release of psychoactive substances from enterohapatic circulation

or fatty tissue.

Following intoxication, Cannabis Abuse, and more severe stages of dependence,

also prove to be problematic. The central features of Cannabis Dependence are

compulsive use, tolerance of its effects, and withdrawal symptoms. Continual use may

interfere with family, school, work, and may cause legal problems. Heavy users also

display a greater impairment in mental functioning, suggesting this is most likely due to

an alteration of brain activity directly produced by the marijuana use. These changes in

the brain are similar to those seen with long-term use of other addictive substances.

Regular cannabis smokers show many of the same respiratory symptoms as tobacco

smokers as well. These include daily cough, chronic bronchitis, phlegm, and more

frequent chest colds. Cannabis users diagnosed with dependence are also believed to
continue using in order to avoid unpleasant withdrawal symptoms, which include

irritability, stomach pain, aggression, and anxiety. Cannabis Abuse is characterized by

less frequent use, and subsequently, less severe problems. “However, as with Cannabis

Dependence, Cannabis Abuse can interfere with performance at school or work, cause

legal problems, and interfere with motor activities such as driving or operating machinery

(Gale, 2003).” When there are increasing levels of tolerance, or when physical or

psychological problems are linked with cannabis in the context of compulsive use, a

diagnosis of Cannabis Dependence, rather than Cannabis Abuse, should be considered.

Also, the distinction between recreational use of cannabis and Cannabis Dependence or

Abuse can be hard to make because social, behavioral, or psychological problems may be

difficult to link to the drug.

After an individual has abused cannabis or reached a state of dependence, some

may also experience additional, less common cannabis induced disorders. Cannabis-

Induced Psychotic Disorder is rare, however it is seen when the behavior exhibited by

cannabis is distinct form other forms of psychosis. Usually, an individual affected by this

started using marijuana in their teen years, which causes a permanent disturbance to

neutral activity. People affected by Cannabis-Induced Psychotic Disorder also seem to

develop a schizophrenic tendency in their behavior. Moreover, many individuals that at

one time suffered from Cannabis-Induced Psychotic Disorder experience a number of

subsequent psychotic episodes and about half are diagnosed at some time within the next

three years or more with a schizophrenia-spectrum disorder. The pattern of symptoms do

not fall easily into the usual criteria for psychosis. Many times drug taking is often

denied because these individuals may not even consider cannabis as an illegal or serious
drug and so do not mention it. With this psychosis, gradual deterioration in social ability

and contact with others usually follows. Often, a depressive component usually comes

into play. Sometimes paranoid delusions and hallucinations may be present and marked

by psychotic episodes (“hemp insanity”), which may be quite severe, sometimes resulting

in hospital admission. When these episodes occur, individuals may be more specifically

diagnosed with Cannabis Induced Psychotic Disorder, With Delusions, of Cannabis

Induced Psychotic Disorder, With Hallucinations. Consequently, psychotic disorder may

be correlated with a preexisting personality disorder. Cannabis-Induced Anxiety

Disorder is a common diagnosis for acute cannabis intoxication which in many persons

induces short-lived anxiety states, sometimes provoked by paranoid thoughts. Sometimes

panic attacks may be induced, based on harmful and disorganized fears. Inexperienced

cannabis users are more likely to experience these panic attacks then regular users,

however.

“When taken in high doses, cannabinoids have psychoactive effects that can be

similar to those of hallucinogens (e.g., lysergic acid diethylamide [LSD]), and individuals

who use cannabinoids can experience adverse mental effects that resemble hallucinogen-

induced “bad trips” (American Psychiatric Association, 2000).” These range

from mild to moderate levels of anxiety to severe anxiety reactions resembling panic

attacks. There may also by paranoid ideation ranging from suspiciousness to delusions

and hallucinations. Depersonalization and is also a common symptom that has been

reported.

Cannabis-Induced Disorders may be marked by symptoms that are similar to

primary mental disorders. Excessive abuse of cannabis can yield symptoms that are
similar to dysthymic disorder. Also, adverse reactions to cannabis are sometimes hard to

differentiate from the symptoms of panic disorder, major depressive disorder, delusional

disorder, bipolar disorder, or schizophrenia, making cannabis-induced disorders hard to

diagnose. However, diagnosis of cannabis Intoxication is easier to make because of

clinically observable signs, like reddened eyes, dry mouth, increase in appetite, and

increase in heart rate. The presence of impaired motor coordination, anxiety, judgment,

and social withdrawal are also used to make the diagnosis. Psychologically, continued

use of marijuana has been linked “ amotivational syndrome.” Amotivational syndrome

has been associated with long-term heavy use and has been characterized by a person’s

reluctance to persist in a task, at work, school, or in any setting that requires long

attention. These individuals are described as becoming apathetic, lethargic, and usually

gaining weight and appearing slothful. Urine tests are also used to identify metabolites of

cannabinoids, and an examination of the nasopharynx and bronchial lining may show

clinical changes due to cannabis use as well.

“Treatment options for individuals with cannabis-related disorders are identified

to those available for people with alcohol and other substance abuse disorders (Gale,

2003).” Treatment approaches use both in-patient hospitalization, drug and alcohol

rehabilitation facilities, and a number of outpatient programs. Programs like Narcotics

Anonymous and other twelve-step programs are also treatment options. “For heavy users

suffering from withdrawal symptoms, treatment with anti-anxiety and/or antidepressant

medication may assist to the treatment process (Gale, 2003).”