Cannabis, adicción y abstinencia

A reader of this blog recently asked me for help abstaining from his frequent cannabis use. I responded with advice later summarized in my post "Practical Advice on How To Quit Cannabis." In exchange, I asked for a weekly report on his experience. What follows is quoted with permission from his emails and weekly diary:

Prologue

I would like to stop using for at least a couple months to see how my life would benefit, but I have a hard time stopping use entirely. I keep slipping back into my old habit. To overcome this obstacle, I feel like I need a little guidance, a timetable that is doable, as well as some outside accountability.

Week One of Abstinence

It’s now 7 days that I’ve not used and I’m not feeling like myself right now. My mind feels raw, exposed, and very vulnerable. I’ve been more emotional and even small tasks or problems were overwhelming. As soon as I had to think about complex problems, my mind spun out of control, and it’s been really hard to get it back under control. Needless to say, it’s impacted my work, and thinking is so hard right now I’m extremely slow and unsure about what I do. The same goes for social interactions with people with whom I have no established relationship of trust. Sleeping is as you predicted (i.e., insomnia). I really hope I’ve hit rock bottom… cause keeping up appearances is tough and sometimes impossible.

Interestingly enough, no urge to use at all.

Week Two

The second week of abstinence, I experienced pretty much the same symptoms, but to a lesser degree. The feeling of being unable to control my emotions and thoughts still persisted and I felt overwhelmed by simple tasks and even by (emotionally) mildly challenging situations, but it didn’t feel as dramatic as the first week The feelings of rawness of the mind also subsided but persisted to an uncomfortable degree. The most unsettling symptom was constantly feeling I couldn’t trust myself, for I wasn’t able to untangle which feeling was caused by the withdrawal and by my altered mind, and which would be present if I had never used.

Week Three

By the third week, I finally started feeling more myself again. I started being able to put perspective to my thoughts and emotions and was able to accept my situation without second-guessing everything. With this feeling of “coming back” to normality, I started seeing, experiencing, and most of all remembering the things that cause anxiety and stress in my life as actually factual things that were not caused by my use.

Still no urge to use.

The Next Three Weeks

The next three weeks were more or less the same, with me feeling more and more “stable,” no longer overwhelmed by sudden unexpected stressful situations, and able to have more control over my emotions. I still have trouble focusing on just a single task and sticking to plans or courses of action I set for myself in everyday life, but this feels more and more like the way I remember myself.

The big "but" is that now that I have completed the six weeks of withdrawal, I start thinking about using on a nice evening or on weekends.

I wonder what comes next.

Analysis and Comment

Cannabis can be subtly addictive for most people, and deeply addictive for some. Withdrawal from cannabis is far less severe than from alcohol, opiates, or stimulants, but it is still real. Some aspects of withdrawal stem from the reduced number of natural cannabinoid receptors caused by their excessive stimulation by THC. It takes up to 6 weeks for the brain to rebuild its normal number of receptors, with most receptors returning in the first couple of weeks. People experience a deficit of receptors in a variety of ways, with the most common symptoms being restlessness, anxiety/irritability, boredom/depressed mood, decreased appetite, and insomnia.

In the articulate diary above, withdrawal was described as a vague feeling of not being oneself, with less control over thoughts and feelings, and being less able to concentrate and deal with stress. After two weeks of receptor healing, these symptoms lessened. When the frontal lobes, which lose 20% of their receptors in regular cannabis users, come fully back on board, perspective on one’s emotions improves. After six weeks, the remaining symptom appears to be a re-emerging urge to use cannabis again, which can be explained by the long-term impact of THC’s release of excess dopamine in the reward center. This condition predisposes individuals to respond to cues associated with cannabis use (i.e., a warm evening, weekends, or stress and anxiety) to increase motivation to use cannabis. The reward center issues cravings for what has stimulated it in the past. The lack of urges to use cannabis early in this man’s withdrawal may have been affected by his use of N-acetylcysteine (NAC), a supplement that may suppress cannabis craving, though its efficacy in those not in a structured treatment program has yet to be proven.

While cannabis can be used safely by most adults, it can also be used addictively. Everyone must decide for themself where they lie on the continuum between safe and addictive use. The following post may help you determine where you lie along this continuum: "20 Questions to Tell if You're Using Cannabis Safely."