As things always happen to do, another trend has been resurfacing for the past decade, and that trend, is marijuana use. Marijuana seems to be a fairly common drug used by young adolescents and adults alike that gets its hype for not being quite as “lethal” as some of the other drugs out there. While this may be true to some extent, marijuana use can have its consequences, including early-onset schizophrenia in teen users, psychosis, and physiological complications in the heart and digestive system.

What is Marijuana?

According to the NIDA, marijuana is a product extracted from the plant Cannabis sativa that can be smoked, inhaled, eaten, etc. (2021). There are two main types of Marijuana (arguably the most common forms that we hear about in the media): CBD and THC. Both of these chemical compounds are similar, in fact they have almost the same chemical structure, yet they have different effects when consumed by humans. CBD aka cannabidiol lacks the psychotic component—this means that it does not alter your mental state at normal dosages—and can be used to medicinally treat seizures, inflammation, chronic joint pain, IBS, migraines, and even mental disorders like anxiety and depression. On the other hand, THC aka tetrahydrocannabinol. THC does alter one’s mental state, causing the feeling of a “high.” THC alters your senses, mood, cognition and problem solving, impair your memory, and may even induce paranoid, hallucinations, and delusions if taken at high enough doses or used over a long period of time. Both CBD and THC act on endocannabinoid receptors in the brain to release dopamine, but the effects are very different (Holland, 2020).

How Does Marijuana Affect You?

For those addicted to marijuana, the most concerning aspect of the drug is the side effect of avolition, or the complete lack of motivation to do anything—this avolition can prevent you from wanting to bathe, dress, go to work, go to class, take out the trash, and take the necessary steps to managing your addiction (Pacheco-Colón, et al., R, 2018). In addition, early use of marijuana (teens and young adults) can induce schizophrenia, a chronic mental disorder characterized by hallucinations and/or delusions, disorganized speech, and avolition. Age, duration of use, and genetics play a large role in the development of schizophrenia from marijuana use, but the likelihood is much greater for those who use marijuana as teenagers (Pearson & Berry, 2019).

To Summarize:

First, remember that an addiction is a chronic relapsing disease where the structure and function of the brain have changed in response to the use of alcohol or a substance, including marijuana. Second, while marijuana may have some positive uses and may not be as deadly as alcohol or fentanyl, it can still be harmful to an individual who uses it without restraint. Marijuana can cause psychotic symptoms and even permanent brain damage, inducing schizophrenia in teens who use too early. Likewise, marijuana can lead to a lack of motivation, which can lead you to not want to do anything and make you complacent with occupations or circumstances that are less than ideal. Lastly, you need to harvest and maximize your potential, and overcoming your addiction to marijuana is a critical step towards doing so.

References

Torres, Felix M.D., MBA, DFAPA. (2022, August). What is schizophrenia? American Psychiatric Association. Retrieved January 28, 2022, from https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia#:~:text=Schizophrenia%20is%20a%20chronic%20brain,thinking%20and%20lack%20of%20motivation.

Holland, K. (2020, July 20). What’s the difference between CBD vs. THC? Healthline. Retrieved January 28, 2022, from https://www.healthline.com/health/cbd-vs-thc#at-a-glance

National Institute on Drug Abuse. (2021, June 7). Marijuana drugfacts. National Institute on Drug Abuse. Retrieved January 28, 2022, from https://www.drugabuse.gov/publications/drugfacts/marijuana

Pacheco-Colón, I., Limia, J. M., & Gonzalez, R. (2018). Nonacute effects of cannabis use on motivation and reward sensitivity in humans: A systematic review. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors, 32(5), 497–507. https://doi.org/10.1037/adb0000380

Pearson, N. T., & Berry, J. H. (2019). Cannabis and Psychosis Through the Lens of DSM-5. International journal of environmental research and public health, 16(21), 4149. https://doi.org/10.3390/ijerph16214149

What Did You Learn?

A new year is dawning! People around the globe are writing down their resolutions or goals for the year of 2022 in order to make it the best year yet. Goals to work out more, spend more time with family, do more, see more, and be more. These goals can see insurmountable at first, idealistic, which makes it both easier and harder to loose traction, especially over the length of the entire year. This isn’t a fault in the motivation or inspiration, but rather, the goal was too large.

Break It Down!

Goals for managing your addiction can see unachievable and difficult at first, so you need to break it down in achievable baby steps—as with anything. If you want to run a marathon by summertime, you can’t just start running 13 miles the first day of January! You need to break it down over a longer period of time. Maybe January first, you will run a mile and repeat this three days a week for the two few weeks until you increase it to two. By the time February rolls around, say you’re doing 3 miles! While you are not up to 13, you are a lot closer than what you started with and that is PROGRESS! Similarly, learning and managing your addiction is the same way. It takes a lot of time (more than 30 days!) and effort from both the individual and their support system in order to successful tackle one’s addiction. And even then, there are set backs—but minor setbacks (or relapses) should not get in the way of one’s PROGRESS. If you are running 3 miles and you stumble halfway through, it does not negate the 1.5 miles you have already ran. It just means you need to catch your breath and keep moving forward.

The term “relapse” implies a negative connotation that essential means one has reverted back to the original state or starting line—to individuals, it feels like we have failed or ruined all our progress. This can lead to the abstinence violation effect, where a person feels that they have completely ruined all their progress so they might as well go overboard. We see this a lot in the dieting world. Have you ever decided to abstain from chocolate or coffee or carbs? What happens when you cheat on your diet and eat chocolate? You may be inclined to just indulge in the entire Oreo package or chocolate ice cream tub instead of a single spoonful because you already broke your streak of abstinence. It is easy to feel this way. A minor setback or “relapse” can make you feel like a failure or incapable of getting back on track, but you can. If you do stumble, ask the important question: what did you learn? What did you learn from stumbling? Did something/someone/some situation trip you up? Did you learn a new strategy to help you get back on your feet? Focus on what is ahead of you rather than what is behind you. Dwelling on the negative feelings of guilt, remorse, and depression can further activate the “addiction loop” and keep you in the cycle of use. To prevent this, just keep moving forward and do your standard routine tasks (make your bed, do push ups, write in your journal, go to work, etc.) and ask: what did I learn?

End Goals Can Differentiate

The end goals of managing an addiction can look different from one another too. One’s goal may be to be completely abstinent from alcohol or a particular drug. Other’s may just want to decrease frequency of use or have the control to quit using once they have gotten started. While it is important to have a goal in mind, it is even more important to keep moving FORWARD. Also, goals can change. Maybe you start out believing that by the end of treatment, you never want to touch alcohol again, and over the course of learning about yourself, you find out that is not your ultimate goal. One size shoe does not fit all.

So What Should My New Year’s Resolution Be?

Set goals that are short, attainable and lead to a long-term, larger goal. If you fall down, keep moving forward and learn from your past mistakes and behavior. Relish in the progress that you have made so far on your path to becoming healthy. The path to stability is not linear!

References

Encyclopedia.com. (2022, January 3). .” encyclopedia of drugs, alcohol, and addictive behavior. . encyclopedia.com. 28 Dec. 2021 . Encyclopedia.com. Retrieved January 3, 2022, from https://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and-maps/abstinence-violation-effect-ave

Neural Circuits of Addiction

How does one learn how to play an instrument like the violin? How does one learn a new language or the lines of their favorite movie or song? How does one develop an addiction? The answer is in learning.

When you learn something, neurons in your brain fire and form new connections. These physical connections, or representations of you learning something, are called engrams. Engrams are not just a singular connection between two neurons, rather, it is a complex network of neurons that all fire collectively (Whitaker and Hope, 2018). For example, envision the American flag: red, white, and blue with stars and stripes. Maybe you also hear the national anthem or stories of Independence day. Or maybe you remember posting the colors and folding the flag during grade school. This singular image connected us to visual memories (the flag itself) but also auditory memories and possibly memories that we had forgotten about. This is the power of neural circuitry! Our brain links things together in order to strengthen our memories. And once these memories are stored in our long-term memory storehouse, it is permanent!

 

But how does this work exactly? And how does this relate to the formation of an addiction?

Well, there are many ways that we learn something. One major way is through conditioning, which involves the presence of stimuli and responses. Pavlov is the psychologist who founded the concept of classical conditioning when he discovered a dog would salivate in response to his dinner bell ringing—even when his dog food was not present (Mcleod, 1970). It was natural for the dog to salivate at his food, but unnatural (learned) for the dog to salivate to a bell without his food present. Another form of learning is called operant conditioning, and this is where we learn a behavior based on the rewards or punishments we receive—this is utilized in schools to promote certain behaviors in students (Cherry, 2020). Kids may learn that when they are quiet during class, they will receive a sticker for good behavior—this is called positive reinforcement because the kids received a reward to promote a certain behavior. Parents may become “trained” by their own kids, who scream or throw a temper tantrum in order to get candy. The kids scream so that their parents will give in to their demands in order to make them quiet down —this is called negative reinforcement because a negative stimulus (i.e., the screaming) was removed/stopped when the parents performed a certain behavior (gave the child candy). Addiction works this same way.

First, the person learns to associate a particular substance with a feeling of pleasure or relief. This is due to the release of dopamine in the nucleus acumbens or the reward center of your brain. Dopamine is a neurotransmitter involved in motivation, learned rewards, and movement (think Parkinson’s disease). When a dopamatergic neuron fires in response to a stimuli, dopamine is released into the synapse and lands on different types of dopamine receptors, which tell subsequent cells to propagate this signal. Dopamine receptor 1 is a specific type of dopamine receptor that is necessary for someone to feel the rewarding effects of drugs and for triggering conditioned responses. Conditioned stimuli or cues associated with the reward (acquiring the drug, environment, etc.) trigger dopamine cell firing and the activation of D1 receptors (Koob and Volkow, 2010). Continued activation of this pathway or neural loop strengthens these neuronal connections and allows for faster and more efficient firing in the future—this creates a stronger motivation to use the drug in the future.

Next, the person learns that by taking a particular substance, they alleviate feelings of stress or discomfort—whether this is stress built up at the end of a work week or a constant feeling of stress that they are feeling. And the substance or additive stimuli can include caffeine, Xanax, marijuana, alcohol, chocolate, gambling, sex, and many other things. This is essentially the application of negative reinforcement because the person is using a substance in order to remove or stop a feeling of discomfort. Withdrawal-induced use is the same because a person will continue to use their drug-of-choice in order to alleviate the awful physical symptoms of withdrawal.

This pattern of substance use strengthens this addiction circuit in the brain—addiction physically alters the structure of your brain!–and develops over the span of months and/or years, which is why it is difficult and time consuming to treat addictions. With time, medication that blocks or helps with cravings and compulsions to use (both caused by the firing of this neural circuit), and cognitive behavioral therapy, one can begin to rewire the brain and form stronger, healthier reward pathways in order to control or prevent substance use in the future.

 

References

Cherry, K. (2020, June 4). What is operant conditioning and how does it work? Verywell Mind. Retrieved December 20, 2021, from https://www.verywellmind.com/operant-conditioning-a2-2794863

Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 35(1), 217–238. https://doi.org/10.1038/npp.2009.110

Mcleod], [S. (1970, January 1). [classical conditioning: How it works with examples]. Simply Psychology. Retrieved December 20, 2021, from https://www.simplypsychology.org/classical-conditioning.html

Whitaker, L. R., & Hope, B. T. (2018). Chasing the addicted engram: Identifying functional alterations in fos-expressing neuronal ensembles that mediate drug-related learned behavior. Learning & Memory, 25(9), 455–460. https://doi.org/10.1101/lm.046698.117

 

Dear ATS Patients,

I know that you all are thinking about safety during the current coronavirus spread. I am writing today not to alarm you, but to put you more at ease in knowing the steps we are taking at ATS to keep you safe and healthy. The virus is likely to cause only mild symptoms in most of us, but it is crucial that we all do our part in preventing its spread.

CLEANING AT ATS
As always, the staff will be thoroughly washing hands before each patient but will also have hand sanitizer for additional use . We will be thorough in cleaning the rooms including furniture, doorknobs and between each patient by using disinfectants to reduce risk of exposure.

ILLNESS AT ATS

Staff will be checking themselves for fever or symptoms and will take time away from clinic as warranted.
We also have hand sanitizer available or you can use the bathroom sink to wash with warm water and soap for at least 20 seconds.
Please stay home if you have a dry cough, shortness of breath or have had a fever in the past 21 days.
If you become exposed to anyone who has a confirmed case of COVID-19, we humbly ask that you not come in, (and consider self-quarantine) for 21 days. While many are advising 14 days, there are cases of people spreading it up to 21 days.

LIFESTYLE AND SUPPLEMENTS TIPS TO BOOST IMMUNITY
Maintain healthy lifestyle habits. Sleep deprivation, stress, excess alcohol or caffeine all decrease immune function. Set yourself up for success with good self-care. Nourish your body with healthy whole foods and drink plenty of fluids.
Consider stocking up on healthful pantry items such as frozen veggies and berries, frozen meats, poultry and fish, bone broth, soup, nuts, seeds, canned beans, grains and teas in case you need to spend an extended time at home.

Thanks in advance for your understanding and patience as we navigate implementing best practices during this time. Please feel free to reach out with any questions or concerns.

RESPECTFULLY,
John P. Crum LCPC