Disclaimer: This post discusses topics related to drug use and addiction. I encourage you to recognize and respect your limitations in consuming sensitive content.

Hallucinogens are drugs that alter your perception of reality by changing the way the nerve cells in your brain communicate with each other. Examples include LSD, psilocybin, MDMA, and marijuana. Side note: The class of drugs that marijuana fits into is debated. Its effects can vary widely from person to person as it can depress, excite and impair the central nervous system, and certain strains can produce different effects.

The media fuels the debate over the acceptance of marijuana, highlighting its medicinal and therapeutic effects on one hand and emphasizing its harmful effects, to the individual as well as to society, on the other. With the growing legalization of marijuana, its health and wellness claims, and its ever-present controversy, I hope to present you with a different perspective altogether. This is the story of a man who was in recovery from heroin use yet still faced criticism for marijuana use to treat his anxiety. This is a story of self-determination, embracing ambiguity, and being brutally honest with oneself.

Marijuana and the Brain

THC is the main psychoactive compound in marijuana. When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. Marijuana stimulates regions of the brain that contain the highest number of THC-receptors. This “high” can cause altered senses (e.g., seeing brighter colors), changes in mood, altered sense of time, and difficulty in thinking and problem-solving. Side note: Marijuana in high doses has the capacity to induce psychosis (i.e., hallucinations and delusions) especially in those who are genetically vulnerable.

Marijuana is often used for its calming effects on one’s anxiety. I worked with a thirty-six-year-old Black man, whom I’ll refer to as “T,” who faced stigma for his marijuana use. Despite his steadfast conviction in smoking marijuana to treat his anxiety, he challenged himself to reflect on the roots of his mental health issues and was surprised by the outcome.

“I smoke because it helps me feel less anxious. Is that a crime?”

Medicinal THC & CBD

With the abundance of misinformation on marijuana in our society today, it’s imperative to understand it at a fundamental level. Currently, the two main cannabinoids (i.e., compounds unique to marijuana) that are of medical interest are THC and CBD. THC can increase appetite, reduce nausea, and may also decrease pain, inflammation, and muscle control problems. Unlike THC, CBD is a cannabinoid that doesn’t make people “high.” It may be useful in reducing pain and inflammation, managing epileptic seizures, and possibly even treating mental illness and addiction. Research continues to explore the possible uses of THC, CBD, and other cannabinoids for medical treatment. 

After achieving sobriety from opioids, T continued to smoke marijuana as it helped him “relax” and “wind down” at the end of each day while also calming his anxiety. He didn’t see anything wrong with smoking marijuana as it didn’t get in the way of his job, relationships, or financial stability the way that heroin had.

However, others didn’t see it that way…

Marijuana Use as Harm Reduction

In the field of addiction treatment there are two models:

1. Abstinence model: maintain complete abstinence from all substances (a model common to AA and other twelve-step groups)
2. Harm reduction model: reduce harmful consequences of substance use without the need for complete sobriety (e.g., provision of clean needles to reduce the spread of infection and disease)

As T was in recovery from heroin use, he argued that smoking marijuana was harm reduction and helped prevent relapses with heroin and other drugs with high overdose potential. “Why does it matter if I smoke after work?,” “It helps me relax and I’m not hurting anyone,” “It’s going to be legal soon, anyway.” These are some things T would say to me, and I understood his frustration. He had worked so hard to maintain sobriety from heroin and begin rebuilding his life, and was weary of facing criticism for his life decisions.

Stigma of Harm Reduction

The harm-reduction model is often looked down upon. Another example of harm reduction for people in recovery is the continuance of cigarette smoking. While nicotine is a drug (and the most addictive one, at that), many continue to smoke cigarettes long after their sobriety from other substances. Cigarette smoking “takes the edge off,” as some may say, and flies under the radar as it’s legalized. As the legalization of marijuana slowly spreads in the United States, it’s interesting to think that one’s treatment and perceived stigma may vary greatly based on their state of residence. Having worked in Massachusetts, and now working Texas, it’s been fascinating seeing how the political climate affects stigma in behavioral health care treatments, and how this in turn affects one’s quality of life.

Marijuana as Treatment for Anxiety

As mentioned earlier, T struggled with anxiety. He recounted its crippling effects during his childhood, and his necessity to manage it as he got older. “I wouldn’t leave the house some days when it got bad. People don’t realize that when you have anxiety, you feel stuck in a loop inside your head,” he sighed.

He shared that smoking marijuana was tremendously more effective for alleviating his anxiety than any medications he’d been previously prescribed. “I still feel like myself — and it’s natural,” he said to me with a shrug. Now, you may be wondering why he didn’t just get a prescription for medical marijuana. Trust me, he tried. He met with more than one provider who unfortunately turned him away as “medication-seeking,” an all too common experience for those with a history of drug dependence despite their current sobriety.

Weaning off of Marijuana

While T held fast to his beliefs surrounding marijuana use, he couldn’t deny the adverse health effects we discussed of smoking in general. He also acknowledged that it had been years since he experienced his anxiety without the aid of marijuana. This set the groundwork for his acceptance of my challenge: give up marijuana for one week.

The results of this experiment surprised him. He found that it was extremely difficult to stop smoking as he’d come to rely on it for relaxation, and it had become part of his daily routine. Side note: To those who say that marijuana is not addictive — don’t believe them! It is absolutely possible to become dependent on marijuana as it is with any other substance. Most shockingly, he found that his anxiety felt much worse without marijuana that week — worse than he’d ever experienced it.

We talked about his experience of going through each day either without smoking at all or smoking minimally (it can be challenging to stop any habit cold-turkey). He concluded that his anxiety felt worse because he’d gone so long without acknowledging how to cope with it on his own. Smoking marijuana had become a comfortable crutch for him that he’d inadvertently become dependent on to feel “normal.” After this week, he became more open to discussing his triggers for anxiety as well as alternate coping skills. For example, we found that his anxiety worsened while he was at work, and manifested in his body in the form of back and neck muscle tension.

We slowly began to unfurl his experience of anxiety into one that was more clear and manageable. Don’t get me wrong, my work with him ended while he still smoked marijuana. However, he became more self-aware of how he coped with negative emotions, and felt more empowered to address the roots of his anxiety opposed to solely alleviating the symptoms.

Pause Judgment — Begin Listening

Whether we like it or not, it’s human nature to judge others and engage in self-comparison. These subtle, yet critical, moments of differentiation help us make sense of the world and our place in it. However, as we become more aware of the experience of others seemingly “different” from ourselves, we have a moral obligation to challenge our tendency to judge, and foster our capacity to empathize.

With T, you wouldn’t know his battle unless he opened up to you about it. While his marijuana use was looked down upon by treatment providers and others in the recovery community, his individual experience was never actually considered. Society and the media do an excellent job in demonizing people who engage in “unsavory” behaviors like drug use, homelessness, and sex work. T’s story reminds us that everyone is fighting their own battle — one that we know nothing about. When faced with the decision to either judge or listen, I hope you listen.

How Do You Cope?

However you cope with your negative emotions, it’s important to be mindful of whether your coping skills are healthy in both the short- and long-term. Whether you use drugs, alcohol, food, sex, overspending, self-harm — or something else entirely to help cope — it may be helpful to consider how these behaviors affect your mental health. With T, he found that while smoking marijuana was an easy way for him to manage his anxiety, relax, and maintain sobriety from heroin, it inhibited his ability to more deeply address his anxiety and form lasting coping skills without the aid of a substance.

“What helps me feel better?”

“How do my coping skills serve my mental and physical health?”

“Am I open to trying something that could be healthier for me?”

These are questions we must periodically ask ourselves.