Chronic with the Chronic?

By Kim Duffy

What happens in the brain of a marijuana smoker isn’t all that mellow.
by Kim Hancey Duffy
duffy_drugs.jpgRich Glade has been a practicing psychotherapist since 1968, and has spent a lot of time with drug issues. He is also a Buddhist meditation teacher in the Tibetan tradition. From both meditative/Buddhist and psychotherapeutic perspectives, he sees a lot of similarity with regard to marijuana-because pot affects attention, memory and recall. The following is an interview with Glade on how popular views of marijuana as a harmless drug don't jibe with the recent brain research, or with the people he sees in his practice.

What have you learned about marijuana that goes against the popular opinion that it opens up one's perceptions, that it's not harmful, and that it's not as bad as alcohol so should be legalized?

Let me see if I can give you a quick and overly general differentiation of function in terms of the cerebral cortex of the brain. The frontal lobe has executive function with three important phases: reality testing, using intention to integrate values into the current reality, and refining that integration in a way appropriate to the situation.

Is this the portion of the brain where people's morals are held, and where events are assigned salience?

Yes, in the present moment. Now when people smoke marijuana their dominant brain activity switches to the posterior part of the brain which is principally a perception processor and analyzer. It tends to rely on templates.

You're saying that the executive functions in the frontal areas of the cortex go offline in someone who is high, and instead they're using the posterior part of the brain?

Sure. And children do that. A child can't necessarily do reality testing, but they can learn to recognize a situation and apply a rule to it. They don't necessarily know how to find the value that's actually underneath the rule, and adjust their responses to the current reality.

So if there's any ambivalence they become flummoxed?

Yes. And what happens is that if you're relying on templates, you become more rigid. You think: There's a right way to do it; I've labeled the situation X, and X requires Y. It's an indicator that the nuanced functioning associated with mature frontal and prefrontal lobe functioning is not available to that person.

Even when the chronic user isn't high, their prefrontal cortex isn't functioning normally?

Yes, they can perform things in a very routine way with a high degree of skill. Template-based behavior is the most useful behavior in certain contexts, if we want someone to repeat something over and over. But in any situation where you need to rely on memory and past information, current reality and current information, and you need to make value choices and situationally appropriate assessments-you're going to have a huge amount of difficulty because marijuana significantly impairs memory and cognition and interferes with the kind of attention that's necessary to the current reality. In the chronic user, those functions may have essentially gone offline.

By "chronic user" do you mean people addicted to pot, for whom quitting would be difficult?

Anyone who has used pot for longer than 15 years is, in most cases, going to have a pretty difficult time stopping that use.

What kind of weekly use are you talking about?

People who smoke four to five times a week or more. With people who regularly smoke on weekends, what happens over time is a significant alteration in the function of the frontal areas of the cortex which affects your ability to pay attention and execute a whole series of executive functions, including emotional regulation. It affects your ability to test reality.

If they quit smoking pot would this function return?

It can and frequently does if the person engages in activities within which they resume utilizing executive function. It is a matter of strengthening neural pathways through dendritic growth. Dendritic growth is the result of using a pathway frequently.

Is that what you do?

Yes. Example: I had a client who had been diagnosed as having strong psychotic tendencies. He was hospitalized and put on medications. In his intake materials, for whatever reason, there was no evidence of anyone asking him about drug use. This man had used pot daily from the time he was 15. What actually happened was that he had marijuana psychosis. This is where a person begins to have a certain amount of paranoia and anxiety, except when they're high. Part of that comes from this inability to discriminate what is real. They have the combination of impaired memory function, impaired ability to pay proper attention and assess the immediate environment -and if they have any kind of paranoid tendencies they will be amplified. When he quit smoking marijuana and went into a treatment program, his wife became afraid of him. He'd been a mellow, easy-going guy who never got angry, but suddenly he was putting his fist through the wall. They ended up in divorce. He actually became quite functional when we got him through this period.

The withdrawal period?

It's longer than that because you have to relearn emotional processing. Another example was a man who was quite functional in the community, held a good job, and performed reasonably complicated duties. He was given a simple neurocognitive task to maintain attention and intentionality, but became very frustrated with a task that a 10- or 12-year-old would have no problem performing. What's going on here is if you bypass difficult emotions and difficult situations by getting mellow and high, your brain circuitry gets formed differently. And what we know about the brain and its neuroplasticity, whatever circuits we're using is where the dendrite growth occurs. If you frequently get high, you stop using those circuits. Then when you want to use them they aren't there, and have to be rebuilt. So with a person like this, my interest is to teach them how to stabilize their attention, stay present, learn to describe the reality they're in, and see the nuance and details. Secondly, to begin to have some intentionality. Teach them to have a point of focus and maintain it over a period of time.

Does this happen at a particular phase of life, like middle age?

Yes. What I typically see is the chronic marijuana user who is having a crisis, and it's as though reality is saying to them: Wake up! Friends or family are telling them they smoke too much pot. Or they realize it's possible their son's meth problem is related to dad going out into the garage and smoking a pipe every evening. When their crisis becomes unavoidable, the issue of marijuana use becomes serious.

Is this a baby boomer issue?

Yes, as near as I can tell. I'll give you another example. A woman came to see me after her teenage children became aware that she smoked pot almost every day, and she panicked about what impact that might have on them. Through her work with us, she got off pot and did quite a bit of attention training. That was two years ago. Recently she came back and said she needed better parenting skills. She recognized that she started smoking pot as a teenager to avoid things that were too difficult, too complicated. Her husband had long since quit smoking pot and wasn't bothered that his had wife continued-until they started talking about the potential effect on their teenagers. She did a lot of work rebuilding her marriage but when she became sober, she realized she and her husband lived parallel lives. She had simply disengaged. He went on doing what he wanted to do and, though he didn't have an affair, she realized how much time he spent with friends at work. His social world was not with her. She was home, high, and listening to music.

Wouldn't it be the same if she were home nursing a cocktail?

I used to think that smoking pot heightened one's suggestibility and loosened inhibitions. But what happens with marijuana is that our ability to pay attention is altered, though not in the same way as with alcohol. With marijuana, the ability to do certain cognitive tasks is reduced. Physical abilities are not as impaired unless they're using high doses. But this gives them an illusion because they don't feel drunk. They're mobile, they feel okay. However, in a situation where they may need to make a split-second decision or evaluate a number of things, they may not have the ability.

So the chronic user loses the ability?

Yes. The areas that they avoid using, through marijuana intoxication, end up losing functionality.

Which is true with any drug.

Yes. But in particular, with marijuana, they may be trying to smooth over their relationship with reality. To not have to deal with things that are difficult. I have a client who went through a depression in his early 20s and didn't like the side effects of the drugs they put him on. He found that he felt better if he smoked pot. After a period of time he started to feel depressed. So he'd developed two kinds of depression: on-pot depression, and off-pot depression.

Is that because he had provided his body with dopamine for long enough that it stopped producing natural dopamine? Then when he quit smoking (and providing the dopamine), his body had no source of either natural or pot-induced dopamine, so he was left with no sense of joy or pleasure in his life?

Right. With a lot of substance abuse, but particularly with marijuana self-medication, patients see it as a less serious drug with some salutary effects. The notion is that: "I work hard all day and just need to chill out. I don't want to get drunk, so I'll smoke a joint."

And when people smoke pot, they're typically in their own head.

They become disengaged.

How do you turn this around-with meditation and cognitive restructuring?

I do neurofeedback which has been around since the 1980s and has a very good clinical record. Along with that, I do attention training using biofeedback, plus cognitive behavior therapy.

Where does the meditation come in?

Meditation becomes important for those who want a replacement for smoking pot.

So-we've talked about what smoking does to the individual's brain. What about the effect of having a pot smoker in the family? We hear about the physical dangers of secondhand smoke-what are the psychological effects of it? When parents are chronic pot smokers, how does it affect their kids?

I think it has a profound effect on children. I don't have research on this, but from my own clinically informed experience, kids do much better with parents who are fully present and available. You know, a lot of people don't think they're addicted. They think, "Well, I only smoke two to three times a week, and if I can't get any good stuff for a couple of weeks it isn't a big deal. It's not like so-and-so who has to have three drinks before dinner. I don't have that kind of compulsion, so I'm not addicted." But then they try to stop and find they're easily frustrated and vulnerable to becoming enraged. In some situations, if they can admit it, they don't know what to do anymore.

So, they come to you.

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This concludes the interview with Rich Glade on the effects of marijuana on the brain, and also completes an 11-piece series on addiction for CATALYST. Twelve would have been too expected, and addiction teaches you the unexpected. So just add to this series the addiction we didn't discuss, the one that's affecting you or your loved ones. Do some digging and see what you can find out about it. We are surrounded by people with food or nicotine addictions which are slowly killing them. And though it's not as easy to spy a person with a gambling, shopping, sex, exercise, or work addiction, for some people these compulsions constrict their everyday life.

Response to this series has been rewarding.  Therapists have requested copies. Articles are passed around in Al-Anon gatherings, and used as talking points in agency meetings. Salt Lake County Division of Youth Services is publishing the series in book form.

I thoroughly enjoyed having the license of time to quiz these experts without having to submit it to my insurance company for payment. I was able to coerce a policeman to be candid in my living room, and to ask the hard questions of a beautiful young woman who saved her own life. All of these people are experts; some got a little more scraped up getting their knowledge.

One thing became quite clear: They all want to help. There are people out there who will accept a phone call from a stranger in need at any hour.  People who meet every day to help family members of addicts. People who will rearrange their schedules for someone who is ready to go into treatment. Treatment works.  Not for 100% of people, and not on your timeframe. But therapies exist to help addicts heal. u

Kim Hancey Duffy is a freelance writer in Salt Lake City, and is also a member of Salt Lake City Mayor's Coalition on Alcohol, Tobacco and Other Drugs:

This article was originally published on February 1, 2008.