Barbara E. Kaplan, MHDL

Counseling for Individuals, Couples, Partners, Marriages, Families




  • According to a Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health of people 12 years and older in the civilian population (excluding those people institutionalized) of the United States, there were.
    • in 2014, about 1 in 10 people who used an illicit drug in the past 30 days.  Most of the illicit drug use was marijuana (22.2 million people).
    • about 21.5 million people in 2014 who had a substance use disorder in the past year of which 7.1 million with an illicit use disorder.  Of the 7.1 million with an illicit use disorder, 4.2 million had a marijuana use disorder (1.6% of the people).  In 2014, approximately 3.3 percent of adults had both a substance use disorder and another mental health disorder (excluding developmental disorders) in the past year.
  • According to the World Health Organization (as specified in its publication titled The health and social effects of nonmedical cannabis use), about 181.8 million people  (ages 15-64 years old) in the world used cannabis for non medical use in 2013, making it the "most commonly used psychoactive substance under international control. … There is an increasing demand for treatment for cannabis-use disorders and associated health conditions in high- and middle-income countries."
  • According to the University of Michigan study Monitoring the Future, in 2015, 1 in 17 students in the 12th grade used marijuana daily.  70.7% of 12th graders have a personal disapproval of regular use of this drug and there is a decrease in approval of trying marijuana since 2007 or 2008.  What is alarming is that since 2005, there is a substantial decrease in perception of smoking marijuana regularly as a great risk.  Only 32% of 12th graders see smoking marijuana regularly as a great risk which is a substantial decrease from 2005.  In other words, a majority of 12th graders do not perceive a great risk from regular marijuana use.   This is of concern because this study shows over the decades that when the perception of risk of harm is low, the use of the drug is high and vice versa.   Annual marijuana use (at least 1 time in the past 12 months) was 34.9% for 12th graders in 2015.
  • In 2010, marijuana was involved in 461,028.00 emergency room visits nationwide.
  • According to Traffic Safety Administration of the US Department of Transportation, marijuana "is the most frequently detected drug (other than alcohol) in crash-involved drivers as well as the general driving population … There is evidence that marijuana use impairs psychomotor skills, divided attention, lane tracking, and cognitive functions  … ."

About Marijuana

The most commonly used illicit drug in the United States is cannabis, commonly known as marijuana which is derived from the dried leaves, stems, flowers and seeds of the hemp plant, Cannabis sativa.  The mind-altering chemical in this plant is delta-9-tetrahydocannibinol (THC) which changes brain activity.  According to the National institute on Drug Abuse (NIDA), extracts:

with high amounts of THC can also be made from the cannabis plant.  … Smoking THC-rich resins extracted from the marijuana plant is on the rise.  Users call this practice dabbing.   People are using various forms of these extracts, such as:

  • hash oil or honey oil—a gooey liquid
  • wax or budder—a soft solid with a texture like lip balm
  • shatter—a hard, amber-colored solid

These extracts can deliver extremely large amounts of THC to users, and their use has sent some people to the emergency room.  Another danger is in preparing these extracts, which usually involves butane (lighter fluid).   A number of people who have used butane to make extracts at home have caused fires and explosions and have been seriously burned.

As specified above, THC is the mind-altering chemical in marijuana which changes brain activity.  It is the main chemical to produce intoxicating effects desired by recreational users.   According to the American Society of Addiction Medicine (ASAM):

Marijuana contains more than 500 other chemicals, including more than 100 compounds chemically related to THC, called cannabinoids. … The human body produces cannabinoids that are similar to those found in the marijuana plant.  The areas of the brain that influence pleasure, memory, thinking, concentration, movement, coordination and sensory and time perception are affected by these endogenous cannabinoids.  THC is able to take advantage of this similarity and attach to cannabinoid receptors on neurons in these brain areas, activating them and thus disrupting various mental and physical functions. ... Acting through the cannabinoid receptors, THC also activates the brain’s reward system, which includes parts of the brain that respond to healthy pleasurable behaviors like sex and eating. THC is similar to other drugs of abuse in that it stimulates neurons in the reward system to release the signaling chemical dopamine at levels higher than typically observed in response to natural stimuli. This flood of dopamine contributes to the pleasurable effects that recreational marijuana users seek.

As a result of chronic THC use, the cannabinoid receptors in the brain involved in memory and cognition are reduced!

Some common names for marijuana are mary jane, reefer, weed, dope, pot, ganja, boom grass, skunk, gangster, kif, MJ, chronic, herb, green, dagga and bhang.

Methods Of Consumption

In smoking marijuana, the drug quickly goes from the lungs into the bloodstream.  From there, it is carried to the brain and other organs throughout the body.  With oral consumption (eating or drinking it), the effects are usually experiences more slowly - after 30 minutes to 1 hour.

Typically, marijuana is hand-rolled into a cigarette (referred to as a joint) with or without tobacco.  However, it can be placed into a hollowed-out cigar, also with or without tobacco and known as a blunt.  Another method of use is vaporizing to avoid inhaling smoke.  In addition, marijuana can be brewed such as a tea or baked into food (e.g., brownies).  The resins can also be eaten in cooked foods or smoked.  Marijuana can be chewed or taken directly in capsules (which can also be added to food or beverage).  Tincture is another method of use which is applying liquid under the tongue or on the skin.  According to Wikipedia:

the “Tincture of cannabis, sometimes known as green dragon, is an alcoholic extract of cannabis.  Cannabis tinctures are used in the production of specific extracts, like Nabiximols. … tincture is typically made by soaking the dried flowers of the female hemp plant (marijuana) in ethanol and evaporating the solvent.   The tetrahydrocannabinol (THC) and other cannabinoids dissolve into the alcohol.  Some preparations also extract some of the water-based plant products such as chlorophyll, resulting in a dark green or brown liquid.  Baking or drying the cannabis to decarboxylate prior to the alcohol bath increases the amount of THC in the resulting preparation. …”

The potency of marijuana has increased greatly over the years.  According an ASAM publication (The health and social effects of nonmedical cannabis use):

The breeding of different strains has yielded plants and resins with dramatic increases in THC content over the past decade, from around 3% to 12–16% or higher (% of THC weight per dry weight of cannabis) with differences in different countries (Radwan et al., 2008; Niesink et al., 2015; Swift, et al., 2013; Zamengo, et al., 2014; Bruci, et al., 2012)

In the USA the THC content of cannabis increased from less than 2% in 1980 to 4.5% in 1997 and 8.5% in 2006 (ElSohly et al., 2000; ONDCP, 2007) to 8.8% in 2008 (Mehmedic et al., 2010).  The increase in cannabis potency in the USA was mainly due to the increased potency of imported rather than domestically-produced cannabis (Mehmedic et al., 2010). In 2015, according to a number of USA laboratories, some retail cannabis seized by the US Drug Enforcement Administration (DEA) was found to contain 20% THC or more.

Contrary to what a number of people think, most American do not use marijuana and have never even tried it.

Contrary to what a number of people think, marijuana is not a harmless drug.  There may be altered senses, change in mood, impaired memory and learning, impaired body movement, difficulty with thinking and problem-solving.  And it affects brain development.  According to the ASAM, “The long-term effects of marijuana use include altered brain development and cognitive impairment, including impaired neural connectivity in specific brain regions associated with memory, learning and impulse control, decreased activity in prefrontal regions and reduced volumes in the hippocampus.  Use during adolescence can exacerbate these effects and cognitive impairments.”

According to NIH:  "When  marijuana users begin using as teenagers, the drug may reduce thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.  Marijuana’s effects on these abilities may last a long time or even be permanent.” 

Marijuana users may experience the following physical and mental effects:

  • breathing  problems
  • more frequent lung illness
  • higher risk of lung infections, daily cough and phlegm.
  • increased heart rate for up to 3 hours after smoking which may increase the chance of heart attack.  Office of National Drug Control Policy (ONDCP) reports that one study found that "marijuana users have a nearly five-fold increase in the risk of heart attack in the first hour after smoking this drug."
  • stroke
  • orthostatic hypotension (head rush or dizziness on standing up)
  • temporary hallucinations
  • temporary paranoia
  • worsening of symptoms in patients with schizophrenia.  Also chronic use can raise the risk of this disorder in people who are vulnerable.
  • sleep problems
  • increased risk of bronchitis
  • impaired learning, memory and coordination
  • impaired impulse control
  • distorted perception
  • impaired body movement
  • difficulty in problem-solving
  • altered brain development
  • intoxication which may include anxiety, sensation of slowed time, impaired judgment, social withdrawal, impaired motor coordination, tachycardia, conjunctival injection
  • In a pregnancy, using marijuana may result in harm to the brain of the fetus

According to NIH, when with heavy use are compared to nonusers of marijuana, the former report poorer physical and mental health, more relationship problems and lower life satisfaction.  Users of this drug also report less career and academic success.

Contrary to what a number of people think, marijuana users can become addicted to the drug.   Research clearly supports this conclusion.

Contrary to what some people think, there can be withdrawal symptoms from marijuana use: restlessness, sleep difficulty such as disturbing dreams or insomnia, irritability, aggression, anger, anxiety, depressed mood, abdominal pain, shakiness or tremors, headache, chills, fever, decreased appetite or weight loss.

Medical Marijuana

ASAM "reports that the use of legalized medical marijuana is unsafe as the “marijuana being distributed is not standardized or quality-controlled; the dosage forms do not provide a known, reproducible dose; and data on efficacy and adverse effects are not being collected in a reliable manner.”

According to the United States Food and Drug Administration (FDA), the FDA “has not approved marijuana as a safe and effective drug for any indication. … The FDA’s drug approval process requires that clinical trials be designed and conducted in a way that provide the agency with the necessary scientific data upon which the FDA can make its approval decisions.  Without this review, the FDA cannot determine whether a drug product is safe and effective.  It also cannot ensure that a drug product meets appropriate quality standards. For certain drugs that have not been approved by the FDA, such as marijuana, the lack of FDA approval and oversight means that the purity and potency of the drug may vary considerably.”  The FDA, however, “supports research into the medical use of marijuana.” It “supports researchers who conduct adequate and well-controlled clinical trials which may lead to the development of safe and effective marijuana products to treat medical conditions.”

Over half of the states in the United States and Washington, D.C. have legalized marijuana for medical purposes.  However, this state legalization is in sharp contrast to federal law.  The Office of National Drug Control Policy reports that:  “Congress has determined that marijuana is a dangerous drug and that the illegal distribution and sale of marijuana is a serious crime.”

Even though there is legalization of medical marijuana in a number of states and Washington, DC, this does not necessarily mean that medical marijuana is safe!  (Please consider the possible harmful effects of marijuana use (e.g., impaired learning and memory) as specified above.   Further study is warranted.  As specified above, the FDA needs scientific data through clinical trials.

According to the Mayo Clinic (website), medical marijuana may be used in a number of forms:

  • Oil
  • Pill
  • Vaporized liquid
  • Nose spray
  • Dried leaves and buds
  • Plant …

Some medical marijuana is formulated to provide symptom relief without the intoxicating, mood-altering effects associated with recreational use of marijuana.

According to the National Institute on Drug Abuse, the "US Food and Drug Administration has not recognized or approved the marijuana plant as medicine.  However, scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form.”  According to the Mayo Clinic (http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855?pg=2), these drugs “have some of the same benefits as medical marijuana … [but] are made from synthetic forms of certain ingredients in marijuana.  They can be legally prescribed.”  The two medications are dronabinol and nabilone.  They are used for the treatment of nausea from chemotherapy and in increasing appetite in patients with AIDS who have extreme weight loss.

Something to Consider in Making a Decision to Seek Professional Assistance

People may wonder when to seek help for marijuana use.  Although not an exhaustive list, the following may be considered in making a decision to seek professional assistance:

  • marijuana use as a way to cope with stress
  • marijuana use is causing anxiety and or depression or making it/them worse
  • repeatedly unable to stop or decrease marijuana use when desired
  • driving a vehicle while impaired from marijuana
  • giving up or reducing participation in pursuits that were enjoyable because there is a preference to use marijuana instead or due to recovering from the negative effects of its use
  • marijuana use is repeatedly causing arguments with another person or making the arguments or a relationship worse
  • receiving complaints or concerns from others about one's marijuana use
  • repeated cravings for marijuana
  • repeatedly can't wait to get off from work to use marijuana
  • marijuana use interferes in caring for family, meeting household or school obligations
  • absences from work or repeatedly going into work late due to marijuana use
  • repeatedly spending a lot of time in marijuana use or recovering from the negative effects of its use
  • stealing or prostituting self to obtain money for marijuana use
  • the same amount/quality of marijuana consumed for some time has less of an effect than it use to have
  • withdrawal symptoms are causing impairment in functioning or are very bothersome
  • morning marijuana use
  • if you think you have a problem with marijuana use
  • repeatedly using more marijuana than on mind to use


According to a new study conducted by the National Institute of Alcohol Abuse and Alcoholism), marijuana use disorder "goes largely untreated.”

The good news is that Marijuana Use Disorder is a treatable disorder   Of the different types of treatment, common behavioral therapies found to be effective are Cognitive Behavioral Therapy, Motivational Enhanced Therapy and Contingency Management Therapy.   Motivational Enhanced Therapy views motivation as crucial to change.  It tends to be used to assist the client in developing internal motivation for change, to overcome the ambivalence to participate in therapy/stop marijuana use.  It is a brief non-judgmental, and non-confrontational therapy, usually consisting of an assessment session followed by an additional 2 - 4 sessions.  It is a therapy that focuses to resolve ambivalence rather than focusing on recovery.  Therefore, it may serve as pretreatment, used to transition to a specific treatment focused on recovery.   Contingency Management, also referred to as Motivational Incentive, is utilized in community treatment programs and shown to be effective when used in them.   It uses rewards for patients who abstain from marijuana and other drugs.  Cognitive Behavioral Therapy (CBT) may be utilized in inpatient and outpatient treatment with individuals and groups.  It assists clients in acquiring skills in an effort to achieve long-term abstinence.  Cognitive Behavioral Therapy recognizes that one’s feelings and behavior are largely influenced by one’s thought(s).  It consists of identifying, testing and correcting unhealthy thinking to change the view of self and the world in an effort to decrease psychological disturbance, unwanted/problematic/self-destructive behaviors and improve functioning.  There is a focus on acquiring skills.  These learned skills may be applied during and following counseling to aid in obtaining and maintaining abstinence from marijuana use and throughout life to apply to other issues or problems such as relationship difficulties, stress, anxiety, depression, anger.  According to the National Institute of Drug Abuse research a  "central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.”

For information about Cognitive Behavioral Therapy, please click on the following link:

Because people who use marijuana may also use other drugs, it is important that treatment include any other substance use disorders and use of other substances.  It is also not unusual for people with marijuana use disorders to have other psychiatric disorders such as anxiety or mood disorders.   Therefore, it warrants that treatment identifies, assesses and treats both.  Tailoring treatment to the individual and not a one-for-all treatment approach is important.

Currently, there is no medication that is approved by the Food and Drug Administration for the specific treatment of marijuana use disorders.

Treatment may be supplemented by participation in support groups.  However, the effectiveness of 12-step support groups modeled after Alcoholics Anonymous is difficult for researchers to determine due to the anonymity of its participants.  Please be aware that this 12-step group is not confidential!

For additional information about counseling regarding marijuana issues or counseling in general, please call 704 333-1510.

This article is solely for information purposes.   It is not advice.   It is not intended for minors, and minors are instructed to leave the site.   It is not intended and it does not constitute professional or clinical advice.  The user of this page should not take any steps, or refrain from taking any steps, based on the information in this page, but should instead consult a qualified mental health professional.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association, 2013

This article was written some time between January 1, 2016 and January 22, 2019.