It started as a sleep aid.
Sleep evaded me for years. I remember family trips with my parents as a kid, poking at their shoulder at odd hours of the night, complaining that I had counted all the sheep and still couldn’t sleep. In high school, I took Nyquil for a lot longer than the recommended two weeks. I did the same with all the other over-the-counter sleep aids on the market. Of course, I never wanted to be dependent on anything. So in college, I was excited to discover something that worked and that I understood to not be addictive: cannabis. It was the ultimate loophole. I slept so soundly after a night of smoking weed with friends, I finally brought it into my solo sleep routine.
But what once was a welcome respite slowly transformed into an inconvenient habit. I’d pack my stash in with my toothbrush if I was staying over at my boyfriend’s place. I’d think of elaborate plan Bs for when I was traveling and couldn’t get my hands on any weed. Finally, I had to wonder, was my constant cannabis consumption prolonging (or even exacerbating) my ability to sleep? More importantly, was I even capable of quitting?
For years, we’ve relied on the tentative, seldom researched claim (or myth?) that cannabis is not addictive. But with the increasing accessibility of cannabis, new products marketed to pair with any activity any time of the day, and the emergence of Marijuana Anonymous groups in legal states, it’s hard to take that myth at face value. One neuroscientist has dedicated over 20 years of research to determine just how much truth lies behind the claim. We caught up with Dr. Danielle Piomelli, the head of UCI’s dynamic Center for the Study of Cannabis Research Institute to review his findings on just how addictive cannabis can be, if at all.
Addiction or dependence- what’s the difference?
Before he’d answer my question of whether cannabis is addictive, Piomelli made clear the difference between dependence and addiction. According to Piomelli, “addiction is when you lose cortical control,” meaning your prefrontal cortex is no longer in control of your decision making. It is a chronic brain disorder in which you experience a loss of voluntary control. It leads to habitual, dangerous, and harmful behavior no matter the vice (gambling, for instance).
Cannabis is not addictive in the medical definition, in which someone no longer has control of their frontal cortex. “I do not believe there is a real addiction with cannabis, in the sense that [it would never come down to] ‘I’m going to have my joint or I’m going to kill you.’” With addiction, “there is a craving–an intense desire to use the substance.” With cannabis, we are not necessarily physically pining for the drug. Studies show this is an important distinction between behavioral addiction and substance addiction.
Cannabis can, however, create a dependence. According to Piomelli, “Dependence is the state where the organism adapts to the continuous use of a particular substance, and the homeostasis of that organism then changes incorporating that particular substance.” While the distinction between addiction and dependence is important, “the fact that cannabis may not cause real addiction does not mean that the dependence it causes should be taken lightly.”
Dependence is a state where the organism adapts. So, “if you were to withdraw that substance after your body adapted to it, the organism would find itself in a strange position. Typically, that is followed by a variety of symptoms. For example, if you are taking a blood pressure medication and you stop–you’ll see a spike in blood pressure. This is true of most medications, from psychoactive to steroidal to anti-inflammatory drugs. This state of dependence is what happens with cannabis.”
This is why when you remove cannabis from the equation, you’ll experience symptoms that are similar to withdrawal. According to Piomelli, “the moment an individual experiences withdrawal, it’s uncomfortable. Withdrawal from cannabis is not as serious as withdrawal from other drugs like opiates, for example–but it’s still pretty nasty.” You can have irritability, loss of sleep, loss of appetite, mood dysphoria, to name a few. “All those symptoms last for a time, and they are a strong motivator to continue use.”
Piomelli started his research 20 years ago with the common assumption that cannabis was not habit-forming. “Back then, there was talk of psychological this or that, but the evidence was flimsy. Now, with the work of several laboratories across the country, there is strong evidence that intense cannabis use, particularly if one starts early in her or his life, causes a state of dependence that must be combated–must be fought. You cannot just stop one day and say, OK, fine. Today’s another day. No.
For those that only stick to the non-psychoactive components like CBD, there is little evidence to worry about. When I asked him if, in his research, he found that certain cannabinoids were more addictive than others, he replied, “only THC.” This is because THC is the only popular cannabinoid known to go straight to your brain (hence, why it’s psychoactive). Other cannabinoids (like CBD) interact with your endocannabinoid system and receptors elsewhere in the body.
What Piomelli is still unsure about is how many people actually run the risk of becoming dependent on cannabis. “We need much more data, but there is a number floating around–it’s 8%. Eight percent of frequent users become dependent.” When I asked how that compares to other substances that are addictive, he made clear the comparison is very flattering for cannabis. “Nicotine is around 40%, and cocaine is around the same. On a scale of 1 to 10 of dependence-forming, nicotine is likely at the top (we also have a lot more data on nicotine), while cannabis is somewhere at the bottom.”
Are some more vulnerable to cannabis dependence than others?
Cannabis is like any other substance–it feels good, so it’s habit-forming. But I was curious if, like other drugs, some are more vulnerable to “marijuana use disorder” than others.
I was curious to know what Piomelli thought made someone vulnerable to cannabis dependence. Was it the same group vulnerable to other drugs: those with a genetic predisposition to dependence or struggling with mental illness? He agreed that genetic and environmental factors could play a role, in addition to someone having a variant in the endocannabinoid system.
But according to Piomelli, the best way to avoid dependence is to have an established social support system. “My opinion (and it’s only that–an opinion), is that the vast majority of drug abuse cases can be explained by a lack of a tight social network–cannabis and alcohol in particular.”
As humans, we are social beings. Therefore, it’s pertinent to feel “social reward” often: the release of dopamine you get from just interacting with others. “Social species tend to have a social reward effect, so they flock together. That is an endocannabinoid mediated effect.” If you are lacking a social support system or “social reward,” cannabis hits the spot because the social reward feeling happens in the endocannabinoid system.
The social reward system that is so closely intertwined with our wellbeing interacts with and is connected to the endocannabinoid system. “Our social brain is based on neurochemicals that are mimicked with particular drugs. If our social brain is not accomplished, not satisfied–cannabis can fill that empty space.” So, when you are in need of social reward and not getting it elsewhere, cannabis helps replicate that feeling. When someone uses cannabis this purpose–to combat loneliness or replace the social reward system essential for humans–they are significantly more vulnerable to dependence.
Forming healthy habits with cannabis
Before we parted, I asked Piomelli what tips he had to avoid dependence.
“Always question your use. Be cognizant of your actions. Have some mindfulness and self-awareness, so you can see when things start to go awry. With awareness, you can make the decision to live with the habit or confront it. But I think that’s a very personal decision.”
For cannabis, cultivating dependence takes a long time of making the conscious choice to consume daily. However, Piomelli suggests spacing out your use, because there is no scientific consensus on exactly how long of prolonged use it takes to become dependent. “I used to tell my daughter, if you feel like you need to consume, that’s fine. But try not to do it two, three days in a row.” For anyone welcoming cannabis into their lives, spacing out their use isn’t a bad idea if you want to maintain a healthy relationship to (and you are not medically reliant on) the plant.
While cannabis dependence is a serious issue for Piomelli, he isn’t as concerned about people using it as he is about his ability to study it. Cannabis remains a Schedule 1 drug despite other cannabinoids being further down on the list (you can’t study a cannabinoid without cannabis). This makes it difficult to study the plant in the United States, and nearly impossible to study the products on the market today.
On the Senate floor, Elizabeth Warren and Cory Gardner have proposed a bipartisan bill called the States’ Act, which mandates that if cannabis is legal in the state of California, it is also legally recognized by the Federal Government. Piomelli says the bill would alleviate his most urgent concern about cannabis dependence: his access to research it.