This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.
Cannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.
Results and conclusions
An appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.
A substantial number of young people in the community use a range of drugs which includes cannabis. Ramsay & Percy (1996) found that 4% of a group of 16- to 29-year-olds admitted using cannabis and other drugs in the past month, by contrast with 8% who had used only cannabis. Clinical observation suggests that cannabis users who also misuse other drugs or alcohol seem to experience more severe mental health problems than those who solely take cannabis, but there do not appear to be any substantial published studies on this issue. Polydrug use is a recognised concern in psychiatric populations: for example, Baigent et al (1995) found that 20% of their dual-diagnosis #patients misused more than one substance.
Given the heterogeneity of the population of cannabis users, it is not surprising that no single personality type or disorder is particular to users of that drug or, indeed, to users of any illicit drug (Allen & Frances, 1986). However, it is a matter of clinical observation that the use of cannabis by some individuals seems to be predisposed by traits such as social anxiety, anxiety or dysphoria. Such posited use as a form of self-medication to relieve unwanted affects or feelings was not corroborated in a study of cannabis-dependent individuals (Greene et al, 1993). There is good evidence for the comorbidity of drug misuse and some personality disorders. For example, Regier et al (1990) report that some form of substance abuse was identified in 83.6% of individuals with antisocial personality disorder (ASPD), with an odds ratio of 29.6. It should be appreciated that this very high rate arises because substance abuse is one of the major diagnostic criteria for ASPD; only 16% of individuals with ASPD did not have a history of substance abuse. The same study showed that the lifetime prevalence of ASPD in cannabis abuse or dependence was 14.7% with an odds ratio of 8.3. The interaction between ASPD and cannabis use is too complex to explore at length in this review, but it is probable that each disorder exacerbates the adverse effects of the other. See Dolan & Coid (1993) for a discussion of factors determining outcome in ASPD.
Implications for mental health care
How should mental health services respond to these findings? The key priorities are: (a) risk-management and care-planning have to be informed by a thorough substance-misuse assessment (Johns, 1997); (b) community and in-patient psychiatric services should develop policies on substance use which balance the treatment needs of individual patients with duties of care to other patients and to the general public; and (c) research is needed into treatment interventions for patients with mental illness and substance misuse problems.¹
Pot party: Hunts Point, Bronx. Courtesy of Chris Arnade.
The night they smoked marijuana was puppet theatre. Arms and fingers cast open-mouthed animals against the narrow room's wall. These arms bore marks of abscessed circles, greyed-out veins.
Three people stood in a line, each at a different level of fucked up. It was a party, with signs of candles enjoyed to their wax, but instead of pinned letters and balloons, dried vomit was affixed to the wall. Demurely, it was dried vomit.
The audience sat on a daybed for show, or sat there to co-exist. The room felt its six occupants.
Three different acts happened in unison:
Cowboy gets money from the government soon. A big check. He'll never be here anymore. He'll pay everyone back. Stage left, voice and hands low.
Sarah and Ramone see their kids soon. They'll buy all-new things. They'll regain custody, no problem. Down-stage, hands up.
Shelly gets her own place soon. She'll be able to be bored, stay in an apartment with a stable job. She'll have a boyfriend and go out to Applebee's. Stage right to all over the place.
Someone had stolen a gallon ziploc bag of marijuana. Three quarters full a couple of hours ago, now at a quarter and dropping.
Joints rolled and were smoked to their butts where the audience was, on the twin-sized mattress pressed flush to the only wall big enough to hold it. Two single windows held smoke captive so that the room became a cloud consuming faces.
There was laughter and ease of speech and talk of happy.
Mood disorders, bipolar, reality and depression lay beyond the room, in another nook, another place. A place where needles and crack pipes appeared fast and with no love.
That paraphernalia wasn't appropriate here. This was romantic comedy. This was a Saturday night.