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Wednesday, November 28, 2012

Skunk Cannabis: a therapist's opinion

Cannabis- a therapist's opinion

Sarah Graham is a Priory trained addictions counsellor and director of Sarah Graham Solutions (www.sarahgrahamsolutions.com).

She is a leading authority on drugs use by teenagers and regularly appears in the media as an expert commentator for Frank

(www.talktofrank.com)

This is her personal and professional view of the drug and how to treat cannabis abuse and dependency:

Cannabis (AKA Skunk, weed, green, ganja, grass, chronic, chro, blunts, blow, puff, zero, sinsemilla, sensi, dope, smoke, shit, draw, spliff, black, hash, herb, marijuana, pot, black, Moroccan, Afghan, homegrown)

Of all the mind-altering drugs that people use cannabis is the one that causes the most controversy and about which there is enormous cultural denial.

My appearances on TV talking about cannabis (seewww.youtube.com/sarahgdirects) often bring me considerable hate mail from people who think that cannabis is "just a bit of spliff".

It is believed in popular culture that you "can't become addicted to cannabis" and is often described as a "soft drug", because its use wasn't thought to lead to physical dependency; in the way that heroin and alcohol use does.

Professionals working with young people are having to rewrite the rule book about cannabis use- as skunk takes over the lion's share of the cannabis market here in the UK.

Those of us working with young people are seeing physical symptoms of withdrawal- from the stronger "skunk" strains of cannabis. Along with extremely entrenched psychological dependencies that are very difficult to break.

In some cases we are seeing quite severe reactions- from both the taking of the drug and when the client starts to reduce cannabis use and become abstinent.

These symptoms may include hallucinations, loss of coordination, shaking, sweating, nausea, mood swings, panic attacks, memory loss, cognitive function problems, sleep disturbance, angry outbursts, uncontrollable giggling, ravings for the drug, binge-eating, or loss of appetite, diarrhoea, self-harming, reduced fertility and psychotic illnesses including schizophrenia.

You probably know this from your own experience- but it may help to have it confirmed in black-and-white by an addictions expert.

People can become addicted to cannabis (F12.2 Cannabinoid Dependence Syndrome, to use the term referred to in the World Health Organisation classification volume ICD-10).

I work with people addicted to all drugs- including the "hard ones".

And the treatment process of cannabis addiction is often one of the most challenging- for the individual and the therapist.

Ironically, it can take longer to successfully treat a young cannabis dependent person than a young person addicted to "harder drugs".

Why? Because of what it does to their brains and the length of time it remains in the system after totally stopping smoking and "getting abstinent" (4-6 weeks).

With a heroin or alcohol addiction, once the physical dependency has been medically managed (2-4 days detox) the person stands a good chance of being relatively clear-headed and able to process information; and engage in treatment.

Counselling skunk smoking teenagers, it is often painful to witness just how difficult it is for the young person to retain information and how damaged they can be by the thing they crave.

And how strenuously they will defend it against all the mounting evidence they and their loved ones are experiencing.

Sadly, even if they are very motivated and really want to make changes the effects of the drug are very counter-therapeutic.

Getting to an appointment on time- especially in the morning- can be very difficult. Cannabis use saps motivation and energy and the low mood, panic attacks and paranoia it can induce, makes it very difficult to get up and "do the work" necessary to get well.

In my company- Sarah Graham Solutions- we prioritise working with cannabis dependent teens because we've seen enough serious cases to understand just how damaging cannabis use can be; and what a time-bomb skunk use by teens may be for individuals and society.

The drug has "evolved" through man-made interventions and it may be years before the medical science can "prove" what many experts like me believe to be the case.

I think that skunk use is a key factor in gangs and the upsurge in the violent crime that accompanies them.

Some of the teens I have worked with have become extremely violent and behaved in ways they are very remorseful about; and can attribute this to their use of skunk cannabis- or its lack of availability; and definitely not the way they were raised.

Others have turned inwards and spent months and years living in a solitary, internal head-place, that feels lonely and quietly desperate.

Teenagers who smoke cannabis regularly- or who binge smoke heavily- seem particularly at risk of developing a dependency and the very latest neuroscience suggest they are seriously risking permanent brain damage; because their brains are still growing and can't repair once the damage has been done.

This addiction can be very powerful- the psychological grip it can have over an individual can seem almost impossible to break.

I hear often that an individual has tried to stop many times and "failed" this has led to ever-decreasing self-worth. Loss of educational aspirations and a sense that life is going nowhere.

The good news is- it is possible to stop smoking and for a person to turn things around. We've worked with many people who have managed to stop smoking and gone on to have healthy, happy, successful lives.

Even the best addictions counsellors are not miracle workers though and anyone who offers a quick-fix should be avoided.

Cannabis treatment that gets the best results often needs to be long-term and using a holistic model (it can take 3 months to a year of regular support for a young person to feel secure in their recovery).

Teens are often part of a cannabis using peer-group and the pressure to conform can be tough to resist. The USA has many residential rehabs for teens and sadly we don't (although I'm trying to find funding to set one up).

Watch Teen Rehab? Yes! Yes! YES!

As a trained counsellor and auricular acupuncturist and person in recovery, I know what works; and what doesn't. I have fostered close ties with Talking About Cannabis because I understand how vital good family support is- to achieve successful results (and preserve everyone's sanity).

There are some other very good projects available to do this therapeutic work (contact Frank to ask what's in your area) but don't be put off if your GP or local service doesn't know much about cannabis or minimizes the seriousness of its use).

We have a long way to go to bring all professionals up-to-speed and when we start to see the scale of the problem (and the potential cost of treatment) you can understand why this subject is such a political hot potato.

It's sad but true that a lot of the treatment agenda is driven by crime stats. Heroin and crack addicts can create one-person crime waves- so getting them into treatment is a political priority.

Cannabis and its impact on mental health may cost society a great deal too- but up until recently it hasn't been something that could harness voters.

This may change as more is discovered about the links between skunk and violence- especially knife crime.

Cannabis' place in society has long been contentious. It's been a symbol of counter-cultural rebellion and many politicians formed their opinions at college and haven't reassessed the facts.

Cannabis has even been seen by some parents as a safer alternative to alcohol.

I smoked cannabis for many years- from 14 until I came "into recovery" *10 years ago; and at one time wanted a cannabis leaf tattooed on my wrist (thankfully I was too young).

Having smoked traditional cannabis- grass and hash- and skunk in Amsterdam and Mexico, I can tell you first-hand, that cannabis has changed.

The THC/CBD ratio change in skunk has fundamentally altered the way the drug feels and its impact on the brain.

We need to bring everyone up to speed. And quickly.

I would say, in summary- that skunk is a very powerful, neuro-toxic substance- that it should be respected by everyone and is best avoided completely by teenagers.

Until we know more about the long-term effects I would definitely say "Err on the side of caution".

If you or your family member is using it and you are worried ask for help now.

Don't leave it until a serious, potentially irreversible, mental illness has taken hold.

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Sarah Graham Solutions has clinics in Surrey and on Harley Street.

She will try and answer all questions sent to her via her website.

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This article was just published by Talking About Cannabis

PS It has now been endorsed by one of the leading charities for family support-Drugfam

*my clean time birthday is 12.12.01

Tuesday, April 12, 2011

Teen Rehab? Yes! yes! yes!

Wednesday, October 6, 2010

Letter to My Body* (part 1)

Wednesday, May 19, 2010

The Line - All about addiction | A Big Picture film by the Wellcome Trust

Wednesday, March 31, 2010

Mephedrone Proves Case for teen rehab

Keme Nzerem's film about mephedrone for Channel 4 News (click on that link) proves the case for why we desperately need a teen rehab in the UK.

The thing that breaks my heart in that film is the mum knowing what hell awaits her daughter when she finally comes down; and how much violence she will face.

These kids need removing from their community and putting into a detox with other teens.

Sadly there is nowhere like that they can go now.

Our next action meeting to reopen a Middlegate inspired rehab in the UK is on April 16th- the same day that meph will be classified (or so it's looking)

The campaign is going well- but even if someone gave us a million pounds today (come on, roll up..) its' going to take months or maybe a year to 18 months to get a new rehab off the ground. All the CRB checks, staff recruitment, etc take time.

What I'm hearing from young people and parents affected by a teen who is using meow meow confirms what Keme's film is saying about the scale of the problem we have with this substance.

One young client I work with tells me that his whole peer group is using meph. Every single person he knows. He is desperately trying to stop but it is very difficult when everywhere you go people are holding and offering you a line. It's so cheap and freely available.

The addict in me has been in its cage for over 8 years now but even with years of recovery and everything I know and have seen re drugs and addiction- I've felt the cage being shaken a little by the sight of the piles of white powder.

So cheap and freely available- it's every addicts' dream.

Mephedrone has brought that scene from Scarface (a pile of powder, face down in it) into the reach of suburban Surrey; and every community across the land.

Imagine how tough it is to resist this stuff when everywhere you go people have a stash.

If you can't imagine this? Think about something you really enjoy- sex for example.

Now imagine that everywhere you go there are very sexy people- your ideal fantasy of attractive- throwing themselves at you. And you have to keep resisting. Resist. Come on Big Boy. Resist..Want some? Resist...Look at this! ...Resist...Get the picture?

The way mephedrone slipped under the radar has been quite incredible.

That whole "plant food" smokescreen was very clever.

Even I was taken in and felt quite sorry for people being so desperate to get high they were experimenting with Baby Bio's friends (that sounds wrong).

It's NOT A F***KING PLANT FOOD people. If you take it- feed your plants a gram and see what happens. That's your brain, that it!

And it was deliberately undersold- as poor man's cocaine/ecstasy- again another smoke screen for how strong it actually is.

The marketing has been extraordinary too.

My Facebook and Myspace page were both targeted by this plant food's importers (which is totally sick- blood on your hands guys..oh you've got that already from the nose bleeds?)

Now, I've sat on the fence a bit re classification over the years. And my work with Frank has given me a good excuse to stay out of the debate.

But mephedrone has been a case study in what would happen if drugs are legalised.

Especially in how young people view the world and what drivers and potential inhibitors effect use in mass populations:

a) they really do believe that if something is legal that it must be safe (so trusting of the State),

b) low price and free availability have combined with rapid tolerance process to create heavy, out of control use- very rapidly. "Good" kids have turned "bad" in a matter of months. All the usual stuff- stealing from parents, violence, sexual exploitation and abuse. Adults are seeking treatment at Priory Roehampton less than a year after starting using mephedrone (average adult using cocaine seeks help after 6/7 years)

c) people are avoiding Drs and health professionals because they don't want their symptoms to be picked up and have their use challenged- teens with holes in their nose refuse to seek help as it may mean being forced to stop.

d) Legal drugs still create a Black Market. Yes they do Transform (so stick that in your pipe and smoke it). Mephedrone has created a new type of teen dealer. Entrepreneurial kids and those seeking to be popular are buying as much as they can to deal to friends. Why deal something you can buy legally on the internet? People run out- they use more than plannned (surprise surprise). They run out of money and need a dealer to tick them. This process has taught young people a lot about how to be a "proper grown-up dealer". Great! And it is setting up a dangerous scenario as friends start falling apart and the guilt gets apportioned. Trauma that is going to take years to heal.

The next few months of stockpiling and selling will be interesting and yes many of those addicted will turn to crime as the price goes up. They may also turn to other drugs. Today, I have warned the ACPO Meth and Presursors Working Group (that I sit on) that we may see a sudden spike in crystal meth* production and use. Cocaine can't come down in price much more and the quality being so poor in the UK is part of why meow meow took off so much.

* see this chemistry of mephedrone film. Crystal and meth are closely related

e) Does mephedrone kill? People have been tweeting lots of denial at me- "it's not the meph wot done it", etc. It's the other drugs they combined it with, y'honor. But hello, poly drug use is the norm for most younger users. And the come down from meow is so "sh**" that people are becoming habitual users and using downer drugs such as alcohol and methadone (such a similar word but poles apart) to soften the crash. And younger users are smoking a bag of skunk to avoid the pain- which can lead to horrible hallucinations. And god* knows what in terms of psychosis and paranoia. But despite that, the drive to do it all again soon kicks in.

*even Prof Nutt doesn't. No scientist will have the sacred "evidence base" for years.

Does it matter whether it was the combo of drugs that led to death? If mephedrone is the common factor? The bullet in the gun that goes off every now and then in this mad game of Russian Roulette that so many people are playing.

Even our brightest young people are mad for it. (Is this a Chinese conspiracy to bring down the West? Come on Daily Mail- there's a story for you).

Here's a very worrying excerpt from The Cambridge Tab-

‘Fiendish’Mephedrone is highly addictive, and a number of students we spoke to described their experience with the drug as “fiendish.”A female student from Robinson said she and many friends had become highly dependent on the drug. “I can barely get up for anything without having a little snort, and I definitely can’t go clubbing without it,” she told us.“I haven’t experienced any physical problems, but I get so depressed when I’m not on meph. It’s dark.”Other students who take mephedrone habitually were less concerned. “I do take it almost every day,” said a student studying medicine, “But it’s not really a problem – it’s not that different to people who drink every day.”

Sorry to burst your bubble- would-be Dr (when I was President at Goldsmiths the Drs colleges were always the worst for piss-ups..which troubled me even back then).

But it IS different to alcohol. It is much more psychologically addictive because of the strong desire to redose as the dopamine level starts to drop.

The brain cannot replenish dopamine very quickly and every time you use you are burning up your very limited store; so will feel a bit lower afterwards.

And suicidal within how long? watch this space....

I urge coroners to test all young people dying in the UK for cathinones and record the presence of mephedrone centrally; and look for patterns with accidental overdose and suicide. Also check bodies for evidence of self harming.

We need to develop new drug testing kits urgently for rehabs and drugs programmes. I know of at least one case of a death in rehab I believe may have been caused by methedrone; but the young man passed a drugs test, after a home visit. Went to bed and never woke up. He's just one sad stat that may be being missed because of the failure to collect data effectively.

Worryingly, young people seem less able to cope with the Come Down than adults and report to me that they commonly go through a few hours of "not caring if they live or die".

One 12 year old was found in a park by friends- running a knife blade up and down his arms, saying repeatedly, "Shall I kill myself?"

So all in all. I'm getting off the fence.

On BBC Radio 4 Today I called for a new Q for quarantine classification.

yes, we have some legal drugs and these are the ones that we have the biggest health and social problems with. Why add to that list?

If we are serious about tackling alcohol misuse price per alcohol unit seems a good point of leverage. Let's not get into all the politics around cider production etc. A hornet's nest. Let's reduce it down to basics.

The Mephedrone experience has proved the case for classification to me and "the sooner it is made illegal the better". As a 17 year old said to me last week.

The internet and a list of over 400 new drugs waiting to come to market mean that we have to scrap the current Jurassic ACMD system.

Let's focus on psychoactive use. If people start using something new to get off on it- people can become addicted to all mind/mood altering substances- we could place it in quarantine for 12 months and have a special team assess the evidence.

Change is upon us.

We are in a new era.

Up against some totally unscrupulous, very clever people- who don't give a damn if they sell drugs that harm or kill adults; or children.

We may not be able to keep drugs off the streets- but we can try.

We can set firm boundaries and show we mean to enforce them.

And we can offer proper treatment to those people who are addicted.

Right now, I'm living in this weird Alice in Wonderland world- where I'm having meetings with Conservative ministers and Lords (James Brokenshire MP came to see me on Harley Street last Friday) and they are agreeing with everything I say about addiction and recovery.

And the Labour party retains faith in the NTA- which completely failed the UK's young people by refusing to step in and divert some of their millions to Saving Middlegate (shame on them).