Marijuana and Psychosis: Which is the Chicken and Which is the Egg?

by Kristina Bullard, BSN, RN on May 24, 2013 · 9 comments

in substance abuse

Has anyone noticed the phenomena of teens discussing drug use as if it’s no big deal?

"Marijuana plants"From Facebook and Twitter feeds to t-shirts, glorifying drug use seems to be a growing trend. It’s astounding to hear what a casual topic it has become. From new ways to ingest alcohol to the latest fads in drugs, including bath salts, candy weed and molly, the trend seems to be changing by the minute. However, one drug seems to be a growing staple among teens and young adults: marijuana.

I find myself thinking, “If only they understood the affect it can have on their mental health.”

During my experience as a mental health nurse, I have seen a number of young adults who admit to the hospital with an extensive history of marijuana use. More times than not, they also present with psychotic symptoms. It got me thinking, “What comes first: the marijuana or the psychosis?” As I became more intrigued, I started to seek out my colleagues for their opinion, and as I did, it became clear that this version of “the chicken and the egg” is a hot topic in the mental health field.

What the research says

A literature review by D’Souza, Sewell and Ranganathan (2009) explores marijuana as a causal factor for psychotic disorders. All of the studies reviewed suggest that as marijuana use increases, the risk for psychotic disorders also increases.

Manrique-Garcia et al. (2012) conducted a study that concluded there is three times more risk for schizophrenia in those who use marijuana frequently.

However, many other studies have been inconclusive. Findings are mixed, making it difficult to determine the nature of the relationship between marijuana and psychosis.

Like many topics in mental health, there is obviously more to be desired in terms of research into drug use. When will research be able to describe the exact relationship between marijuana and psychosis? Although I cannot predict when, I know that the answer will greatly impact the mental health community.

What to do about it?

<Keep Off Grass sign>Regardless of the nature of the relationship, the public is in great need of education regarding this topic. Drug education and awareness programs are already a part of public school systems; yet, teens and young adults continue to use marijuana and other illicit substances. What are we missing?

I would argue that the mental health component may be the missing link. Educating our youth on the lasting effects that marijuana can have on one’s mental health, including IQ, suicide risk, psychosis and other substance addictions, may hit a nerve that has not yet been reached. Still, we all know that many teens may continue to have the mindset that “It won’t happen to me.”

As for me, I will continue to do what I can to impact change. This means educating not only my patients but family and friends. My hope is that the education I provide will touch someone in a way that the knowledge continues to spread.

I challenge you to think about what you can do to make a difference in the lives of our youth to help prevent them from becoming our future patients.

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{ 9 comments… read them below or add one }

Elvia K. Macias June 6, 2013 at 5:19 pm

While the research on marijuana and the mind has not yet connected all the dots, these new studies provide one more reason to caution young people against using marijuana—especially if they have a family member affected by schizophrenia or some other psychotic disorder.

Berry Wall June 5, 2013 at 5:32 pm

This article is actually very timely in that it is pointing out the obvious, not much is known about cannabis and what it can cause. Recently, there has been several studies on marijuana that address your concern “Is marijuana somehow causing psychosis.” Here is what the experts say: A study in Australia confirmed the link between marijuana and psychosis, but this isn’t at all a new development. Psychiatrist and psychologist have known or suspected the link for years. One leading psychiatrist was quoted on Sixty Minutes as saying she would prefer her kids were smoking heroin rather than pot, due to the large amount of cases of marijuana psychosis she has seen. Studies show that one in twenty marijuana smokers who start in their early teens will develop Schizophrenia, (the most serious and permanent form of psychosis) while one in fifty will develop it if they start smoking in adulthood. Both figures are higher than average. While mental illness is fairly common in the general population, and there are many causes such as genetic pre-disposition, it is almost certain that smoking marijuana will bring on mental illness faster, and sometimes be the cause of it. The chief of the schizophrenia treatment unit at the Veterans Administration said: In the absence of definitive evidence from randomized long-term placebo controlled trials, the strongest evidence of a connection between cannabis use and the development of a psychotic disorder comes from prospective, longitudinal cohort studies. In the past 15 years new evidence has emerged from 7 such studies that cumulatively provide strong support for an association between cannabis use as an adolescent or young adult and a greater risk for developing a psychotic disorder like schizophrenia. In conclusion, as an addictions counselor I would like to point out that many of the young people who will pick up the habit of smoking pot won’t know if they are predisposed to psychosis or schizophrenia. I would hope that common sense will prevail and they will leave this drug alone given the cumulative evidence that problems are hidden beneath the surface. Marijuana is often stepped on in the process of being sold and many chemicals beyond the 400 that are already there are added (something as simple as hair spray to make it weigh more). I applaud your willingness to talk to the young people about the dangers of marijuana especially in light of the numerous states that are hurrying to legalize it. The major point I want to make is that it really doesn’t matter if marijuana causes psychosis or not. There is plenty of evidence it brings it to the surface if there is a predisposition and with the addition of synthetic pot we are just seeing the beginning of the problem.

Kristina June 3, 2013 at 9:58 pm

Thank you for your feedback. I could certainly see how the research presented is not a thorough presentation of all of the research out there. For the sake of time and length, I did not discuss as much of the research that I have found. I have written many papers discussing this in school and opted to just highlight a couple studies I found interesting.
I arrived at the conclusion to educate our youth not only by the research I presented here but from a number of studies and my own clinical experience. In my opinion, if there is any positive correlation suggested, it is better to warn against the potential effects than not to. That being said, there is much more research needed to suggest any major changes to practice. This is why education is the best option for now in my opinion.

Thank so much for your feedback and I hope I was able to clear some things up.

Victor June 2, 2013 at 10:13 am

Hi, Kristina. Yes, I’ve witnessed the trend, in general, over the years in a lot of areas. I’m going to play devil’s advocate with you along the lines of anonymous’s comments.

I don’t like marijuana use and am wary of any addictive substance (I don’t intake caffeine for instance). However, I saw two sources of tension in the blos post.

First, your presentation of research may be biased. I was slightly confused. You presented two articles showing a positive correlation. Then you said other studies were inconclusive. You then said the results were mixed. Were they mixed between only inconclusive and studies suggesting a positive correlation? Or were there any studies suggesting a negative or non-existant correlation? This second question was what I was wondering when you used the term “mixed.” Mixed suggests that some show a correlation while others don’t but you didn’t mentioned any studies showing no correlation (or you didn’t say that there studies like that). You only mentioned studies suggesting a correlation and inconclusive studies. If there are studies suggesting no correlation, it would be good to add that to the post to be unbiased. Also if any of these were in the recent past, like any recent literature reviews, it would be good to name them explicitly, as well.

Second (the bigger tension), the first part of your post seemed to contradict the second part. You said the studies were mixed or inconclusive. So I was confused at how you arrived at the conclusion (in the second half of the blos post) that it was important to educate “our youth on the lasting effects that marijuana can have on one’s mental health, including IQ, suicide risk, psychosis and other substance addiction.” Do you see what I mean?

Anonymous May 28, 2013 at 1:58 pm

Lumping marijuana in with these other fad drugs is just ignorant. Sounds like your knowledge of the drug is hearsay. Already been proven that marijuana use does not strictly cause psychosis. Or there would be a good chunk of the population going crazy.

Not to say it can’t be triggered in individuals that are genetically susceptible to psychosis.

Richard A. May 28, 2013 at 1:32 pm

Thoughtful comments and concern. We are witness to this often with those we work with and must share the mental health link we see with our friends and family. We all have the opportunity to touch someone.

B. Henry May 28, 2013 at 8:27 am

Great post. I will be sharing this with my teen and twenty-something relatives. I definitely agree- the mental health risks associated with marijuana use should be a major part of the campaign to educate youth AND EVERYONE who thinks weed is “safe.”

Carol Coats, RN May 26, 2013 at 4:42 pm

Tina, I truly commend and thank you for your insightful article and the research you have done. Throughout my life it has become increasingly apparent that there could be a definite link between marijuana use and mental health issues. I try to use every opportunity possible to warn young people of this hazard. Your article reaffirms what I have been trying to say for many years, and encourages me further to continue the fight to try to keep young people from negatively impacting their lives by using what they think is such a “safe” drug.

Justin G. May 25, 2013 at 3:47 pm

Great article! As someone whose got a brother in college, another in highschool and a third in Jr. high, this totally makes me aware of how important it is for me, as an older brother, to let them in on marijuana’s “best kept secret”

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