PSY 3011 Week 8 – Assignment: Develop a Comprehensive Analysis of One Abused Substance

PSY 3011 Week 8 – Assignment: Develop a Comprehensive Analysis of One Abused Substance

PSY 3011 Week 8 – Assignment: Develop a Comprehensive Analysis of One Abused Substance

Marijuana Abuse

            Substance use and abuse is a crucial public health concern in most of the modern societies globally. The rate of substance abuse and use has been rising significantly in most countries over the past decades, including the United States. The abused substances vary to include alcohol, tobacco, cocaine, and marijuana among others. Substance abuse has adverse health effects such as dependence and decline in the productivity among the affected populations. Nurses play a crucial role in the promotion of health and wellbeing of individuals that abuse drugs and their communities. They implement treatment, preventive, and rehabilitative services with the aim of reducing the overall burden of substance abuse on the community and country. Therefore, the purpose of this essay is to explore marijuana abuse. The essay examines topics that include society’s reaction to marijuana abusers and those dependent on it, its psychopharmacological properties, differences in use, impact on families, evidence-based treatment options, and ethical principles in the treatment of the affected.

How the Society has Reacted to Those who Abuse or Become Dependent on Marijuana

            Marijuana abuse and dependence is a social problem. The society has mixed views towards those abuse or become dependent on marijuana. However, most of the society members have a negative attitude toward substance use, abuse, and addiction. Accordingly, studies have shown that most of the Americans are highly likely to have a negative attitude towards people suffering substance use disorders as compared to patients with mental health disorders. The society’s negative attitude stems from the view that addiction is more of a moral failure than a medical condition. Almost all societies do not support the use and abuse of substances such as marijuana. It is part of the cultural values, beliefs, and practices that individuals should be educated about the negative effects of marijuana on health. Governments invest their resources in public health programs to create awareness about the ills of marijuana and other substances abuse in communities. As a result, such publicity and influence of culture make most societies to develop a negative attitude towards marijuana, marijuana abusers, and those who depend on it.

            The society’s negative attitude towards marijuana, marijuana abusers and dependents can also be seen from the data on the stigma they experience in their communities. According to a research by Buttazzoni et al., (2020), the stigmatization that marijuana abusers and dependents undergo develop from the influence of society’s view of the problem, culture, and religion. Stigma worsens the health status of marijuana abusers and addicts, as it predisposes them to loneliness, social isolation, anxiety, stress, low utilization of healthcare services, and abuse of other substances (Abbas et al., 2021).

            Despite the above negative view towards marijuana abusers and dependents, some societies have a positive view towards them. This is largely seen in societies where marijuana has been accepted for use because of its medicinal purposes. Marijuana is largely recognized for its medicinal purposes such as for managing chemotherapy-induced nausea and vomiting. Marijuana has also proven effective as an appetite stimulant in patients with HIV/AIDS. The additional health benefits of cannabis include symptom relief in sleep and pain disturbances among those diagnosed with multiple sclerosis, symptom management in glaucoma and Tourette’s syndrome, and inflammatory disorders (Page et al., 2020).

The society’ positive view towards marijuana abuse and dependence can also be seen from the involvement of religious institutions in addressing the problem. Over the recent past, researchers have focused their attention on the role that religious institutions play in preventing and addressing the issue of substance abuse in societies (Caplan, 2019). Results from studies have shown that religion has a preventive effect on initiation of marijuana use. It also exposes abusers and the vulnerable populations to specific moral directives and religious doctrines, which are based on sacred texts and religious traditions. The exposure is crucial in challenging abusers and dependents’ view towards marijuana, hence, healthy lifestyle and behavioral change (Grim & Grim, 2019). Therefore, the involvement of religious institutions in addressing the problem demonstrates society’s positive view towards substance use and abuse.

Psychopharmacological Properties of Marijuana

            Marijuana is a substance that has more than 60 cannabinoids and 400 compounds. The pharmacology of marijuana is largely comprised of delta9-tetrahydrocannabinol (THC), which is its primary psychoactive compound. The human brain has exogenous and endogenous cannabinoid systems and receptors. Cannabinoid 1 receptors (CB1) are located in the central nervous system, brain, and some tissues. The CB2 receptors are primarily located in the peripheral organs and cells involved in the immune system. Exogenous cannabinoids comprise the synthetic and THC. They produce their effects via CB! Receptors in the spinal cord, brain, and their distributions to the peripheries. Synthetic cannabinoids and THC act as agonists of CB2 receptors to influence the immune system and peripheral tissues. At the cellular levels both CB1 and CB2 receptors stimulate MAPK activity by inhibiting adenyl cyclase (Amin & Ali, 2019; Maselli & Camilleri, 2021). CB1 and CB2 pathways regulate the physiological processes needed for long-term neuronal function changes and synaptic plasticity.

            Statistics show that about 50% of THC is inhaled as smoke, with most of it absorbed in the lungs. It enters the blood stream after its absorption and transported to the brain. Its bioavailability following ingestion is less with blood concentration being 25-30% of the smoked THC. The onset effect of THC is 0.5-2 hours. It has prolonged action because of its slow absorption in the gut. Marijuana compound, THC, has rapid distribution rate to other body tissues. Its distribution rate is highly dependent on the tissue blood flow. THC accumulation in fatty tissues is high because of its high solubility in lipids. The fatty tissues slowly release the stored THC to other tissues such as the brain, which accounts for the long-lasting effect of marijuana on the body. THC has a long period of half-life tissue elimination (7 days) because of its sequestration in body fats. It is estimated that it can take up to 30 days for a single THC dose to be eliminated from the fats. Repeated doses of marijuana results in significant body accumulation, which can extend to the brain to produce devastating effects (Amin & Ali, 2019). Accordingly, there is differential THC distribution in the brain, which affect limbic, motor, sensory, and neocortical functioning, due to the elevated THC concentration.

            The liver metabolizes cannabinoids. The metabolism results in 11-hydroxy-THC, a metabolite, which is highly potent than THC. The high potency of the metabolite contributes to the psychoactive effects associated with marijuana. The renal system partly excretes some of the marijuana metabolites. The remaining metabolites are reabsorbed back to the gut, which prolong the actions and side effects seen in patients the abuse and are dependent on marijuana (Mlost et al., 2020). Consequently, the presence of active THC metabolites and THC sequestration in fats explain the elevated degree of cannabinoid-induced intoxication and poor urine and plasma concentration of THC. Marijuana has been shown to affect almost all the body systems. Its ability to affect many body systems is attributed to multiple properties it has such as that of hallucinogens, opiates, alcohol, and tranquilizers. Its associated effects include being an analgesic, sedative, and psychedelic (Maselli & Camilleri, 2021). Marijuana also has low acute toxicity since it has no direct association with deaths in patients that abuse it.

Differences in Abuse in Terms of Gender and Ethnicity

            Evidence shows the existence of considerable disparities in the use of cannabis among men and women in the United States. According to the National Institute on Drug Abuse, men are highly likely to use almost all the types of illegal drugs as compared to women. Men are also highly likely to visit or be taken to the emergency department due to illicit drug overdose than women. The risk of men also dying from illicit drug overdose is higher than women. In all the age groups, men also have the highest rate of illicit drug dependence and alcohol as compared to women. The risk of developing substance use disorder is equal for both men and women. However, women have a high susceptibility rate to illicit drug craving and relapse as compared to men (National Institute on Drug Abuse, 2023). These observations by the National Institute on Drug Abuse are generalizable to all illicit drugs, which include cannabis.

            The effects of marijuana also differ among men and women. While few women use marijuana than men, women are more likely than men to suffer from impaired spatial memory.         Male teenagers that smoke marijuana tend to have poor family problems and relationships as compared to female teenagers that smoke marijuana. The risk of brain structural abnormalities is also high in teenage girls who use marijuana regular as compared to boys. For both genders, the use of marijuana increases the risk of developing at least a mental health disorder such anxiety or depression. The rates of mental health disorders such as antisocial personality disorder is high among men who are addicted to marijuana while women addicted to it have high rates of anxiety disorders and panic attack (National Institute on Drug Abuse, 2023). While men have a highly severe marijuana use disorders than women, they take a longer period to develop the disorder as compared to women.

            Marijuana use affects all races and ethnicities in America. However, evidence shows the existence of racial and ethnic disparities in the rates of marijuana use, abuse, and dependence in the United States. The differences extend to treatment, prevention and initiation of marijuana and marijuana use disorder. According to Montgomery et al., (2022), the prevalence of cannabis use and use disorder among adults has been rising in all races and ethnicities since 2007. However, African Americans/Black adolescents and adults demonstrated the highest rate as compared to other ethnicities. There are also considerable disparities in the emergency department visits prevalence because of cannabis use and its disorder. The data analyzed by the authors showed that Asian Americans have the lost rate of marijuana use when compared to the national average. The high rate of marijuana use was seen among Hispanics, White, and Native Hawaiian/Pacific Islanders. The highest rate was reported among American Indian/Alaska Natives and African American/Blacks. Despite having the highest rate of cannabis use, American Indian/Alaska reported the most decrease in prevalence in 2018 (Montgomery et al., 2022).

            There also exists disparities in the availability of evidence on marijuana use and dependence among individuals from different ethnic and racial backgrounds in the United States. Most of the studies on cannabis use and abuse in America has largely focused on African Americans/Blacks. Small number of studies have been conducted among Native Hawaiians/Pacific Islanders. The disparities in evidence affect the implementation of population-centered interventions adopted to address the problem of marijuana use, abuse, and dependence in the United States (Lee et al., 2021).

Impact on Family

            Marijuana use and dependence have considerable effects on families. Individuals that use and dependent on marijuana suffer from short and long-term effects associated with THC. In the short-term, the THC cross the blood brain barrier when smoked to affect numerous physiological functioning. The THC acts on brain receptors to activate the different parts of the brain, which makes people feel high. The accompanying symptoms in the short-term include altered senses, altered perception of time, mood changes, impaired movements, difficulty in problem-solving and thinking and impaired memory (Murillo-Rodriguez et al., 2020). Patients may also develop psychosis, hallucinations, and delusions, which affect their normal functioning in their societies.

            Marijuana abuse and dependence also has considerable long-term effects that affect family dynamics. The use of marijuana repeatedly over time cause structural changes in brain functioning, which has significant health implications. Studies consistently agree that chronic use of marijuana results in altered brain development. The drug affects the normal processes such as learning, thinking, and memory. The THC also affects the creation and maintenance of the normal neural networks that the brain requires for undertaking its functions (Feingold et al., 2022). The consequences include declines in mental abilities such as decision-making and high-order functions, which lower individual’s and family’s quality of life.

            Marijuana use and abuse increase the healthcare costs that families and individuals incur in the society. Issues such as comorbidities associated with marijuana use, abuse, and dependence increase healthcare spending. Marijuana use and addiction is associated with other mental health problems such as anxiety and depression, which demand frequent hospital care, hence, increased care costs for patients and their families. Marijuana addiction is also expensive for patients and families. Accordingly, patients must spend the finances they have to maintain their optimum functioning (Costain & Laprairie, 2019). The dependence act as a source of financial strain in families as they struggle to manage marijuana withdrawal symptoms, meet their healthcare needs, and access marijuana to maintain functioning.

            Marijuana use also increase its generational use in a family. According to the National Institute on Drug Abuse, children born to families where parents abuse marijuana are likely to be the victims of the drug. Children’s risk and attitude towards marijuana and other substances depends largely on the pattern of use by their parents over time (Murillo-Rodriguez et al., 2020). Children who witness their parents’ abusing marijuana at their early ages to early adulthood have the highest risk of using and abusing marijuana due to the influence of parental roles in their lives.

            Marijuana use, abuse and dependence also disrupts family life. Health problems due to marijuana abuse and dependence affect the normal health, wellbeing, and life in a family. Marijana abusers and dependents lose their productivity in their social and occupational roles. This may threaten the survival of families of these individuals. The risk of premature mortalities due to other comorbidities such as major depression also alter the normal family dynamics. The coexistence of cannabis use disorder and other substance use disorders is also high. For example, patients diagnosed with cannabis use disorder may be victims of other substance use disorders such as the use of heroine and cocaine. These comorbidities predispose patients to other diseases such as HIV/AIDs, which are acquired by sharing the injectables for drug use. Smoking marijuana also increases the risk of respiratory problems such as asthma and chronic obstructive pulmonary disease (Kondo et al., 2019). These diseases act as a source of considerable burden, which affect the normal family life and dynamics.

Evidence-Based Treatment Options

            The Food and Drug Administration has not approved any medication for use in treating marijuana abuse and dependence. However, several medication choices exist for treating the cravings due to cannabis used disorder, withdrawal symptoms, and comorbid psychiatric conditions. Several medications have been recommended for treating cravings that patients with marijuana abuse disorder and dependence experience. One of them is naltrexone, which is largely used in opioid and alcohol use disorder. The prescription of naltrexone 50 mg can help overcome the cravings that patients have for cannabis and other stimulants such as cocaine. Bupropion and topiramate are the other drugs that have anti-craving properties. Bupropion has demonstrated effectiveness in smoking cessation and its effects also extend to cannabis cravings (Kondo et al., 2019; Maselli & Camilleri, 2021). The other drugs that have been examined for cannabis cravings include dronabinol and N-acetylcysteine.

            The other pharmacological approach in treating patients with marijuana abuse disorder and dependence is by focusing on cannabis withdrawal symptoms. Patients may develop acute withdrawal symptoms in cases where they do not get the required dose of cannabis for their daily use. In such cases, practitioners can prescribe patients different classes of medications such as selective serotonin reuptake inhibitors, alpha 2 agonists, gabapentin, hydroxyzine, and serotonin and norepinephrine reuptake inhibitors. Medications to induce sleep are also important since patient can experience several months of insomnia (Bryson C. Lochte et al., 2022). Medications such as mood stabilizers are also considered because of their subjective benefits in continuous cannabis abstinence among marijuana abusers and dependents.

            The other evidence-based focus in the treatment of marijuana abuse and dependence is by focusing on psychiatric comorbid disorders. Patients with cannabis use disorder often develop mental health problems such as anxiety and depression, as comorbid conditions. A focus should be on treating them simultaneously to achieve successful cessation of cannabis use. The most common psychiatric comorbidities that these patients develop include generalized anxiety disorder, post-traumatic stress disorder, and major depression. Currently, there is limited evidence on the efficacy of medications use in treating patients with cannabis use disorder and comorbid psychiatric conditions. As a result, the use of intensive psychosocial interventions is considered the mainstream approach in these patients (Williams & Hill, 2019). Medications are only considered when the patient has not responded to behavioral and psychosocial interventions for cannabis use disorder.

            One of the psychosocial interventions for marijuana abuse and dependence is cognitive behavioral therapy. Cognitive behavioral therapy is a psychotherapeutic intervention that aims at transforming the thoughts and feelings of the patients diagnosed with cannabis use disorder. The intervention entails a therapist working with patients to identify their problematic thoughts, feelings, and behaviors that contribute to marijuana use and substituting them with realistic behaviors. The aim of the treatment is to promote self-efficacy and control in stopping marijuana use (National Institute on Drug Abuse, 2023). The other treatment is contingency management. Contingency management entails frequent monitoring of the patient to ensure they achieve the target goals and behaviors in the treatment of the disorder. Motivational enhancement therapy may also be considered where the therapist works with patients to motivate behavioral change (Winters et al., 2020). The therapist helps patients utilize their resources for achieving the desired change.

Ethical Principles in the Treatment of Those Who Develop Substance Use Disorder

            Ethical principles guide the treatment of patients that develop cannabis use disorder. One of the principles is the promotion of patients’ autonomy. Psychiatric mental health practitioners must ensure that the right of patients to autonomous care is protected. This is achieved by seeking informed consent before the initiation of any treatments (Butts & Rich, 2019). The practitioners also involve patients in making decisions about their health needs, hence, shared decision-making and patient-centeredness.

            The other ethical principle is the promotion of data integrity. Practitioners should ensure the protection of confidentiality and privacy of their patients’ data. They should seek informed consent from the patients before sharing their protected health information with other parties. The information should also be protected from any unauthorized access (Hemmington & Vicary, 2023). Practitioners must ensure that they adhere the regulations set by policies such as the Health Insurance Portability and Accountability Act (HIPAA) that safeguards data privacy and confidentiality.

            Practitioners also promote safety and quality in the treatment of cannabis use disorder by ensuring beneficence and non-maleficence. They uphold these ethical principles by ensuring that the adopted decisions in the treatment process do not subject patients to any harm. The decisions made are in the best interests of the patients. Practitioners prioritize the patients’ needs, values, and preferences to optimize care outcomes such as safety, quality, and efficiency (Burkhardt & Nathaniel, 2019). They also utilize evidence-based interventions to minimize any intended harm to patients diagnosed with the disorder.

Conclusion

            In summary, the selected substance being abused for analysis in this paper is marijuana. The society has mixed views toward people who abuse and are marijuana dependent. Marijuana has unique psychopharmacological properties that increases its potential or abuse and addiction in the population. The use and abuse of marijuana vary based on gender, race, and ethnicity. Marijuana abuse has negative effects on families. Pharmacological and non-pharmacological interventions are effective in marijuana abuse and dependence. However, the FDA has not approved any medication for use in its treatment. Mental health practitioners must ensure that ethical principles are followed when treating patients that develop cannabis abuse disorder.

PSY 3011 Week 8 – Assignment: Develop a Comprehensive Analysis of One Abused Substance References

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