Health

Wake and Bake

A psychotherapist details the rise of marijuana-induced psychosis among his clients

Illustration by Vesna Asanovic

Illustration by Vesna Asanovic

“Peter” was a seventeen-year-old skateboarder from an affluent family. He had spent most of the last two years waking and baking. If he was conscious, there was a good chance Peter had just hit a bong or smoked a joint.

He was like so many of the clients I worked with as an addictions counsellor: good kid, okay grades, loved playing with his younger siblings. And then things changed. After a few months of experimenting with marijuana, Peter began lying and manipulating his parents to get money to support his habit. When they finally cut him off from the parent bank, Peter began stealing directly from their wallets. He started skipping classes and getting failing grades. As his moods became increasingly erratic, he lost the ability to maintain eye contact. When in withdrawal, he had severe anger outbursts that frequently ended with a hole punched through the wall.

And then things got weird. His mother noticed that he would watch TV when it wasn’t even on. He developed conspiracy theories about CSIS, the CIA, and the Illuminati. Having recently returned from a Florida vacation where his parents had detoxed him while watching his every move, Peter was totally sober when he asked me to stop violating his mind with my psychic brain probes. I laughed when he said this, assuming it was a joke. His response: “No, no—I am being serious. Can you teach me how to do it? Can I get chicks to fuck me if I read their minds? Can I control them?”

Peter was my introduction to marijuana-induced psychosis—a schizophrenia-like condition that afflicts a small but growing minority of the adolescents and young adults who become dependent on pot. As Canada moves toward legalizing marijuana, my fear is that such cases as Peter’s are being ignored in the conversation about pot legislation. Pot psychosis is only one of the many detrimental life-limiting effects that can result from pot addiction. Yet when I mention the words “marijuana” and “addiction” together, I’m often met with a disbelieving eye roll. Unfortunately, the idea that marijuana is a harmless substance has been accepted as fact by much of our society. And so those of us who raise concerns about its risks are often stigmatized as alarmists.

Those reeling from their pot addictions often see this collective state of denial as a damning judgment of them. I now work as a Toronto-based psychotherapist who specializes in concurrent disorders—mental health conditions that are intermeshed with addiction. One of the most important ways I can help clients move on from their substance abuse is severing the link between shame and addiction. Thankfully, society’s attitudes have begun to change. Increasingly, we see addiction as a medical condition that needs to be treated, rather than a symptom of criminality or moral failure. But in the case of marijuana addiction, this compassionate attitude gets discarded because of a blind belief in the benign nature of marijuana. Our message to people such as Peter is clear: There’s no problem with pot. So the problem must be with you.

Many are shocked when I tell them that pot is the substance I deal most with in my practice—more so than heroin, cocaine, or even alcohol. Most have little understanding that the pot consumed today is completely different from the weed smoked twenty or even ten years ago. The tetrahydrocannabinol (THC) potency of many strains of pot has exploded in that time. THC is the main psychoactive agent in marijuana, and it’s what produces the drug’s euphoric effects, gives users the feeling of being high. Throughout the 1980s, most of the pot you could buy on the street had a THC content of around 3 percent. Marijuana was then generally grown in arable fields, and the top, leafy portion of the plant was harvested for distribution. In the 1990s, production started switching to indoor grow ops that used sophisticated hydroponic technology to cultivate strains that maximized THC potency. New harvesting methods targeted the middle of the plant, where THC content is higher. It is no longer uncommon to find strains with a potency of more than 30 percent.

More recently, competitive market forces have unleashed the technological innovation of cannabis-oil extraction. Commonly known as “BHO” (butane hash oil), “dab,” or “shatter,” cannabis oil is a sticky, wax-like substance that has a THC potency of between 70 and 80 percent. It can be inhaled through a vaporizer, or by using simpler methods, such as “dabbing,” which involves heating the pot extract on a knife or nail.

Even some pot supporters have become concerned about the impact of cannabis-oil extraction. As one columnist on leafy.com, a marijuana-advocacy forum and pot-culture online magazine, recently wrote: “One of the most unsettling facts about dabs is that thanks to the super-concentrated power of BHO, for the first time it seems possible to ‘overdose’ on cannabis. While still not lethal, taking more than your personal limit of dabs can lead to uncomfortable highs and, in some cases, passing out. After all of the chanting that ‘you can’t overdose on marijuana,’ concentrates could be undermining advocates’ message of safety.”

In a number of jurisdictions where cannabis has been decriminalized or legalized, there are growing movements to limit the THC potency of recreational pot. The Netherlands was the first to propose a limit of 15 percent THC potency in 2011, as the country saw an increase in pot psychosis and people seeking help for marijuana addiction. One of the criticisms of this change to the nation’s liberal drug legislation is that the 15 percent cap is arbitrary—and the challenges involved in accurately testing THC levels would make enforcement nearly impossible. Nevertheless, politicians and advocacy groups in Colorado started petitioning for similar THC limits after research showed that legalization could be resulting in an increase in the THC levels of pot sold in that state.

We really have no clue what consuming THC at levels in even the mid-to-high twenty-something percent range will do to a human being over the long term. What we do know is that the younger you are when you start smoking pot, the more likely you are to become addicted to it; the more you smoke it, the more likely it is to have debilitating affects on mental health and brain development; and the stronger the THC content, the more profound the damage will be.

When researchers ask people why they smoke pot, among the most frequent responses is that the drug relaxes or calms them. This tranquilizing effect is the result of a phenomenon pot researchers call “emotional dampening”—a diminishing of emotional arousal or distress—which lowers the intensity of emotional activity in the brain. For some, however, continual emotional dampening becomes necessary for daily functioning as they switch from healthier forms of emotional coping to pot smoking. Woody Harrelson, for one—an actor famous for his pot advocacy—recently disclosed that he had stopped smoking pot because his chronic usage had kept him from being “emotionally available.”

Those who come to the drug with compromised coping abilities, especially in regard to anxiety, often develop an urgent need to smoke pot all day long, so as not to feel as if they are about to go crazy or have a nervous breakdown. This psychological dependency becomes an emotional ball and chain. I once had an executive seek out my services because he’d found himself smuggling pot through airport security when flying into the United States for business trips and family vacations. It took putting himself and his family in jeopardy for him to realize he was fully addicted to pot.

In my experience, the emotional-dampening effect that chronic pot smokers experience makes it impossible to treat underlying mental health disorders while they are actively using. The core of treatment for those suffering with concurrent disorders is to allow them to safely feel emotion and effectively regulate the intensity of their feelings. Pot’s emotional-dampening effect reduces a person’s ability to manage their emotions, while at the same time making the prospect of experiencing uninhibited emotion terrifying.

Adolescents and young adults are two and a half times more likely to smoke pot than adults are. This is problematic, because there is growing consensus that, over time, THC exposure can alter the development of the cortex region in the brains of people younger than twenty-five. Such changes can result in the long-term inhibition of executive functioning, leading to deficits in attention, memory, verbal learning, and impulse control. (There is conflicting evidence as to whether these deficits are permanent, or could be mitigated if the user gives up pot.)

Just as significant as these neurological effects are the cascading psychological effects experienced by a young person who becomes addicted to weed. As the drug becomes their preoccupation, these youth can find themselves alienated from their peers, family, and teachers. They create narratives of themselves as misfits and screw-ups, a process often supported by other psychologically damaging experiences, such as abuse, bullying, or family dysfunction. Whether they end up in my office at the age of fifteen, twenty-five, or thirty-five, these users have seen their lives diminished. It should be noted that a recent UNICEF study found that Canada has the highest rate of youth cannabis consumption in the developed world.

I am not concerned by teenagers who occasionally smoke joints at parties, or take bong hits on weekend nights out. Sporadic pot use is not nearly as risky as unprotected sex, aggressive driving, binge drinking, or experimenting with harder drugs. But I am concerned for the nearly 20 percent of kids who experiment with pot and then eventually get hooked on it and start smoking it daily. I once had a sixteen-year-old client who refused to quit pot, but agreed to try to reduce his use from forty bong hits a day to twenty or thirty.

It’s situations such as Peter’s—the ones involving full-blown psychotic episodes—that really scare me. At a number of youth psychiatric wards in Toronto-area hospitals, the staff know me by name. “Hey, Felix, got another one for us?” is a greeting I often get from psychiatrists and nurses. We sometimes use dark humour as a means to cope with the surreal nature of the delusions. This patient was talking to the Martians in the curtains; that one was sure there was a conspiracy to keep him off Wi-Fi. No humour can be found in other cases. I had one twenty-one-year-old client, with no prior history of violence or aggression, who mistook his mother for a demon and attacked her with a knife. While I was writing this, a seventeen-year-old client of mine was forcibly confined to an intensive psychiatric unit reserved for the most serious cases.

If we can get these patients into the hospital in time, and they find a way to break their dependence on marijuana, it is possible for them to return to a normal life. But there are some kids, such as Peter, who just won’t listen. After spending two months in the psych ward, he came out seeming like his old self again. His parents thought it was a miracle that they had their good-tempered and caring son back. And then he started smoking weed again, and quickly landed up back in the hospital. After his third admission, he was diagnosed as being permanently schizophrenic.

The debate around pot legalization is largely irrelevant to the work I do with my clients. The history of civilization teaches us that an addict will always find their fix, whether it is legal or not. (Personally, I am pro-legalization, as drug-prohibition laws have so clearly failed.) What disappoints me about the Liberal government’s approach to legalization is the tenor of the discussion surrounding it. I was appalled in late March when the Liberals paid homage to pothead culture, announcing that they intended to table marijuana legalization before April 20, or 4/20: a date that is commemorated annually (for obscure historical reasons) in most major cities in North America, having become a sort of pothead Christmas, complete with ad hoc parades. It’s a nod and a wink to the infantile side of Canadian youth culture, and helps feed the caricature of Trudeau as the high-school teacher who tries too hard to be as cool as his students.

For so many in Canada, marijuana is “just pot.” Those of us who deal with marijuana’s consequences know better. And one would think that our federal government would, too.

Felix Vikhman is a Toronto-based registered psychotherapist in private practice. In recovery from addiction himself, he has been sober since January 2006.

Vesna Asanovic is an illustrator living and working in Toronto. She graduated from OCADU in 2012 with a BDes in illustration. Her clients include Nylon, Illustrated Impact, and Bay Street Bull.

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