Nicotine Alcohol Marijuana

We have known for some time that continued use of Nicotine in patients recovering from alcohol dependence significantly affects risk of relapse but a recent study in The Journal of Addictive Medicine empasized how great the effect is. The information came from a study that was actually looking at another issue and that is the effect of use of acamprosate (Campral) in alcoholism. Acamprosate is designed to reduce alcohol cravings and the evidence so far is unclear about how much it really helps. This study of 601 patients over a six month period in those alcoholics who smoked showed about 14% of good response rate vs. 7% for placebo.

For alcoholic smokers there were several factors that predicted a poor outcome regarding alcohol relapse rates over the six month period. Those factors were smoking while sick in bed, difficulty refraining from smoking in public areas and smoking more than 20 cigarettes per day. The ionteresting thing is that for those who had any of these factors the relapse rate was the same as those who continued to smoke marijuana in this early recovery period. Those of us in the field of addiction are well aware of the phenomenon of cross tolerance in which the use of one drug increase the possibilty of abuse of any other drug. What is suprising here is that the cross tolerance effects of nicotine are the same as marijuana. We would not consider any alcoholic who smoked marijuana to truly be in recovery and this evidence suggests that the same is true for nicotine. I want to repeat this. The cross tolerence effects increasing alcohol relapse rates are the same whether one is smoking tobacco or marijuana! To me that is striking.

Thought for the day

If you smoke in early alcohol recovery it doesn't matter whether it is tobacco or marijuana that you smoke.

Michael Phelps, Marijuana, Drug Use and Ambivalence

A reader asked me to comment on Michael Phelps and wanted to know what I thought about him being caught smoking marijuana. At first I was reluctant to do so. So many people have already weighed in on this issue. But the reader pressed me, saying he really wanted my opinion on this matter so I thought I would share a few thoughts.

The most striking thing to me about his marijuana smoking has been the mixed public reaction which has ranged from excoriating him to an attitude of leniency. I believe that this ambivalence reflects America's ambivalence about marijuana itself. Is marijuana addictive? Is it a "harmeless" drug or a gateway drug to more serious drug abuse? Should it be legalized? Should marijuana be allowed for medical purposes? As a society we have not yet come to terms with marijuana and how and if it should be used.

I believe that all discussion about marijuana should be taken in the broader context that the two most commonly used, dangerous and destructive drugs are both legal, alcohol and nicotine. The harm caused by these drugs far outweighs all the harm created by all other drugs combined. I think we forget this in the often passionate debate over marijuana.

So what is the truth? What do we need to know in order to have more informed opinions on marijuana? In no particular order I will indicate some of the facts that are clear. Marijuana is an addictive drug. While most people who use try marijuana or use occassionaly do not become addicted there is a group of people who are highly addicted and whose lives are torn apart by marijuana use. At Cottonwood I see patients whose use of marijuana has been casual despite their addictions to other drugs and I also see patients who are addicted to marijuana alone and have been unable to function effectively in life due to this addiction. While most people who use marijuana do not go on to other drug abuse there are hardly any other drug users who have not used tobacco and marijuana first. Tobacco though is the main "gateway" drug. Marijuana is no longer the main drug of abuse among teens after tobacco and alcohol. Prescription pain pill use has overtaken marijuana use among youth and is increasing while marijuana use has been decreasing. The marijuana used to today is much more potent and has much higher content of THC (the active drug) than the marijuana used in the 1960' and 70's. Chronic marijuana use can lead to psychosis in a subset of people who may be more genetically prone to developing a psychotic disorder. Marijuana is currently calssified by the Federal Drug Enforcement Agency as a schedule I drug, a drug that has no medicinal use. We know however that it does have medicinal use and can be particularly effective for the nausea often induced by chemotherapeutic treatments for cancer. Medical use of marijuana has been legalized in several states including our own Arizona but the Federal government restrictions overide state law.

So I don't have the answer to the question of marijuana use but I do think we should base our opinions upon the knowledge we have rather than just uninformed opinions.
As for Michael Phelps? My thought for the day is

"Let him who is without sin cast the first stone".

Jesus of Nazareth