Cannabis Rehab & Addiction Treatment

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Cannabis Rehab & Addiction Treatment

Cannabis may not be considered the most harmful of illicit drugs when compared with heroin or cocaine as any physical and psychological consequences do appear to be less severe than other drugs.

However, cannabis is reported as the most frequently consumed psychoactive substance throughout the world.

It is noticeable that there have been a greater number of people taking the drug in recent years and this is reflected in the higher number of patients presenting at medical centres and drug rehab services with cannabis addiction.

Because many people use cannabis to help them relax, they do, over time become psychologically reliant on the drug to help them cope with the day-to-day struggles they experience.

This makes it very hard for many people to give up the drug and to successfully consolidate any periods of abstinence they may exhibit when they attempt to stop taking cannabis. (5,11)

Cannabis – Psychoactive Ingredient

THC is the main psychoactive ingredient in cannabis and the degree to which a person becomes intoxicated due to cannabis use depends on the proportion of THC present in the drug, which can vary drastically depending on how the dose was chemically constructed. (5,11)

Signs that Someone is Addicted to Cannabis

In order to make an accurate diagnosis of cannabis use disorder (cannabis addiction) it is important to establish if the following factors apply to a patient over a one-year period:

• Some people may tend to rely on cannabis to cope with the daily anxiety and stress they experience.
• An individual’s cannabis use steadily increases and so does the dose strength they consume.
• They have talked about giving up cannabis and may have attempted to stop taking the drug but have been unsuccessful in their attempts.
• Their preoccupation with cannabis has negatively affected their physical and mental health.
• They experience strong cravings to take cannabis.
• Their preoccupation with cannabis has limited their ability to carry out daily responsibilities and function effectively. For example, they may be unable to hold down a job or work hard on a college course.
• They have given up activities they once found pleasurable because of their cannabis use.
• Their cannabis use has negatively impacted their personal and social relationships.
• They continue to take cannabis even though it may lead to negative consequences, for example, they may drive a car while still under the influence of cannabis.
• Their tolerance of cannabis has increased.
• They experience withdrawal symptoms when they go 6-24 hours (depending on the severity of their dependence) without consuming cannabis.

Consequences of Heavy Cannabis Use

Even though cannabis use is considered to be the least harmful of psychoactive recreational drugs it can still cause a significant decline in a heavy user’s physical and mental health and affect many areas of their life. (4,14)

The consequences include:

• Cannabis use can lead to a decline in mental health and many users experience a low mood or go through bouts of depression.
• Many people use cannabis to self-medicate, and people with anxiety, low mood and trauma-based conditions tend to use cannabis to provide them with some relief from the distressing symptoms of their condition. (1,11)
• Research has shown that cannabis leads to poorer cognitive functioning, with memory, concentration, and alertness particularly affected. Cannabis also leads to poor decision-making. (5)
• Many studies have indicated a link between cannabis use and psychosis in young people, particularly at risk.
• Psychological research has found that many cannabis users display Increased anger and aggression, possibly because of the increase in paranoid thoughts that can occur.
• A drop in their motivation and focus and the presence of “Amotivational syndrome”. Prolonged cannabis use does affect several aspects of people’s personalities and behaviour and this can be evident by a decline in their enthusiasm for activities, personal goals and causes they were once passionate about. This could be down to their inability to concentrate and focus on activities due to a deterioration in their cognitive abilities. (4,14)
• Individuals using cannabis will find that their personal and social relationships will suffer as they become preoccupied with cannabis and disregard previous activities they once found appealing. The change in their outward behaviour (paranoia and aggression) may cause people in their social circle to avoid them. (4,14)

Cannabis Withdrawal Symptoms

Cannabis users who have developed a physical dependence on the drug will experience the following symptoms if, after a period of sustained use they stop taking the drug:

• Irritability, anger and aggression.
• Nervousness or increased anxiety.
• Difficulty sleeping, may experience insomnia or have disturbing dreams.
• Decreased appetite or weight loss.
• Restlessness.
• Depressed state / low mood.
• Abdominal pain.
• Shakiness/tremors.
• Sweating, fever, chills.
• Headaches.

Withdrawal symptoms can appear at any stage from 6 hours to 2 days depending on the severity of the patient’s addiction.

Treatment for Cannabis Use Disorder (addiction)

Treatment programmes for clients admitted to rehab with cannabis dependence contain several elements which will take a holistic approach to care for patients as they follow their goal of achieving abstinence from cannabis use.

These elements are:

• Assessment and development of individual treatment plans.
• Detox treatment.
• Group therapy.
• Individual psychological therapies.
• Dual diagnosis treatment.
• Relapse prevention.
• Analysis of lifestyle and personal development,
• An aftercare plan

Detoxification Stage

The first stage in rehabilitation for any drug addiction is to tackle the patient’s physical dependence on cannabis.

This is achieved by supporting the patient through the drug detox stage where the aim is to facilitate the removal of the harmful chemical elements from their body which play a key role in stimulating withdrawal symptoms.

The main withdrawal symptoms that patients tend to struggle with are anxiety, stress, low mood and insomnia.

This is because all drug withdrawal symptoms tend to be opposite to the main effects of the drug being taken.

So, if patients take cannabis to relax and to feel calm, then when they stop taking the drug they will experience irritability, anxiety and be unable to sleep.

The intensity and type of withdrawal symptoms can differ between patients depending on:

• Individual biological characteristics.
• The pattern of their drug use (dose, frequency, duration).
• If they were dependent on other substances as well.
• The severity of their addiction (mild, moderate or severe).
• Other mental health conditions are present.
• The chemical design/potency of the cannabis form they took.

Is any Form of Medication Used to Facilitate Cannabis Detox

Unlike heroin or alcohol, there is no medication (substitute drug) available to facilitate the detox process so the main focus of the treatment team overseeing the detox treatment will be to help clients deal with severe and uncomfortable withdrawal symptoms. (8,15)

Some of the challenging withdrawal symptoms patients may experience during detox can be alleviated with medication prescribed by the physicians and/or nurses that are part of the rehab team, including:

• Sleep problems/insomnia – Benzodiazepines.
• Nausea and vomiting – Metoclopramide, also known as Maxolan.
• Headaches and muscle pain – Paracetamol and Ibuprofen.
• Anxiety/low mood – Antidepressant medication. (8,15)

Monitoring Client’s Mental Health

There is a strong association between cannabis use and low mood and depressive disorders.

Patients going through detox are vulnerable to suffering a significant deterioration in their mental health during the first 2-3 days of treatment and will therefore be monitored closely by psychiatric and mental health practitioners.

Patients in rehab diagnosed with severe cannabis use disorder are more vulnerable to a crash in their psychological mood which may result in suicidal thoughts and so needs to be monitored closely. (9)

Psychological Therapies

Rehab providers recognise the strong emotional reliance that people develop on cannabis which is why it can be such a difficult substance to give up fully.

Our psychological therapy programme utilises several interventions to help patients come to terms with the underlying causes of their cannabis use that also teaches them important skills which will make them more resilient in the future.

Some of the effective psychological interventions include:

1. Attending support group meetings

Just as people with alcohol addiction are advised to attend Alcoholics Anonymous (AA) patients who are admitted to rehab for cannabis addiction will be encouraged to attend Marijuana Anonymous or Narcotics Anonymous meetings.

These peer support group meetings follow the same structure as AA meetings and offer patients the opportunity to talk about their feelings relating to their excessive cannabis use in the presence of peers who have experienced similar challenges.

The idea of fellowship and mutual support helps to promote a strong bond between members who offer each other encouragement and motivation.

There are always several members present who have been in recovery for several years and will be able to pass their wisdom and guidance on to new members of the group.

2. Cognitive Behavioural Therapy (CBT)

Our thoughts play a hugely significant role in our mental life and can affect our mood and emotional state and determine our behaviour. Negative and irrational automatic thoughts have long been at the heart of substance use as patients struggle to find less destructive thinking styles to cope with feeling stressed, tense, angry and sad. (7)

CBT helps patients spot any negative thought patterns they may possess and help to correct them.

CBT will also challenge existing thoughts patients to possess about their cannabis use and help them explore other options they may have instead of taking cannabis. (7)

This may include encouraging them to use other techniques to reduce their stress levels such as exercise and relaxation techniques so they can adopt these instead of habitually taking cannabis to self-soothe.

3. Dialectical Behavioural Therapy

Many people who use and become dependent on cannabis have revealed that strong emotions such as fear, anger and sadness act as a trigger for their drug use.

DBT is a form of therapy that teaches patients psychological techniques to cope with strong emotions and to be able to tolerate them instead of being overwhelmed by them. (12)

4. Motivational Interviewing (MI)

MI is a technique used by therapists during their time with clients in recovery. Any addiction is tough to overcome and many people give up, or their motivation levels drop and they become disheartened.

If a patient is showing signs of disengaging with treatment then participating in MI sessions with a therapist will enable them to identify any mental barriers that are obstructing their progress.

The therapist will build a trusting relationship with the patient to help them find the motivation they need to continue fully involving themselves in their treatment plan. (6)

5. Group therapy

Group therapy helps patients talk about their feelings and challenges in the company of other patients who have been through similar experiences in sessions facilitated by a qualified therapist.

It also helps patients build better social relationships and to understand and reflect upon the communication patterns they tend to use when interacting with others.

This can be very useful in helping them improve their social and communication skills.

They may for example realise that they can be too judgemental, lack empathy and are unable to see other people’s perspectives. The feedback they receive from the therapist and other group members allows them to grow as a person.

6. Contingency Management (CM)

Contingency management is a strategy employed by rehab centres to help patients stop their cannabis use.

CM uses a behavioural psychology approach and offers patients rewards for making significant progress in their attempt to give up cannabis.

The rewards can be financial or in the form of material goods such as phones and Ipads, depending on the progress they have made.

If patients can show signs of progress (via a drug test) then they will be rewarded, if they are unable to make progress then rewards will be held back until they show abstinence from cannabis use. (13)

Dual Diagnosis Patients

Substance misuse treatment centres recognise the prevalence of other mental health conditions in patients diagnosed with cannabis addiction. Patients with another mental health condition co-existing alongside their addiction are referred to as dual-diagnosis patients.

Treatment providers have developed several separate treatment plans to account for the range of other mental health conditions people with cannabis addiction may have.

These include depression, anxiety, schizophrenia and post-traumatic stress disorder, all of which combine differently with cannabis addiction and affect people in a variety of ways meaning each dual diagnosis patient will be given their individual care plan.

Relapse Prevention for Cannabis Addiction

To ensure clients with cannabis use disorder do not slip back into drug use after leaving treatment they will engage in relapse prevention training during their time in rehab so they learn the necessary psychological coping skills to deal with challenging situations, including:

• High-risk situations that may trigger their cannabis use, can include being in a location they strongly associated with cannabis use in the past.
• Being in the company of a group of people who apply strong social pressure and influence to smoke cannabis. (3)
• Experiencing strong emotional and/or physical states can generate a need to take cannabis to alleviate psychological distress. Many people report that feeling angry, hungry, lonely and tired can place them in a vulnerable position emotionally making them more vulnerable to taking cannabis.

Relapse prevention combines several psychological approaches

Therapists conducting relapse prevention workshops base their sessions on principles of cognitive behavioural therapy, dialectical behavioural therapy and assertiveness training to help clients identify their own personal high-risk situations and practice the necessary strategies to remain abstinent when these challenging situations arise. (3)

Aftercare Plan for Cannabis Use Disorder Patients

Addiction specialists also organise an aftercare plan for patients to implement after they have left their treatment programme.

Aftercare plans for patients help them build a new life away from cannabis use and the contents of the plans tend to include a range of activities and goals for the patients to contemplate as they seek to eliminate unhealthy and toxic elements from their life and replace them with more fulfilling engaging activities that can help them grow.

Aftercare plans usually include:

• Continuing commitment to narcotics anonymous meetings.
• Reflecting on the kind of life they would like to have.
• Attending regular counselling/therapy sessions.
• Building and maintaining positive relationships / eliminating toxic people from their lives. This is in line with the “belonging” domain from Maslow’s hierarchy of needs.
• Identifying beliefs/values that have personal significance and practising them regularly.
• Adopting a healthy lifestyle, with exercise, diet and sleep being a priority.
• Engaging in several social and community activities.
• Setting personal and professional goals.

Where does Cannabis Rehab Take Place?

Clients have the option of receiving cannabis rehab treatment on an outpatient basis where they can go through a supervised detox regime and engage with psychological therapies to tackle the root causes of their excessive cannabis use.

Outpatient programmes are easier and cheaper to access and there is funding available to help patients who do not have their own finances to cover the cost of treatment.

Patients also have the option to enter a residential (also known as an inpatient) programme for a period of 1-2 months, although most patients follow a 28-day programme.

Whilst following the programme, all of the patient’s time in rehab is accounted for as they follow their treatment plan.

The treatment plan is devised after carefully reviewing the patient’s current level of cannabis dependence and their medical, social and personal history.

All patients on a residential programme sleep and eat on the premises and there is a range of challenging therapeutic and personal development activities for them to engage in each day.

The Benefits of Residential Rehab for Cannabis Use Disorder

There are several benefits to entering a drug rehab programme, including:

• Privately funded clients can enter rehab swiftly within days with no delays.
• All patients receive a fully personalised treatment plan which will be appropriate to their individual needs.
• Residential rehab codes of practice ensure patients will be shown complete discretion at all times during their stay. All of their treatment details and personal information will remain confidential and their privacy can be guaranteed.
• Qualified medical and psychiatric professionals with vast experience in treating substance use disorders will guide you through the detox phase, with your health and safety as their primary concern.
• Staying in residential premises means you will receive around-the-clock care to support you if you experience panic, anxiety or moments of personal crisis.
• You can focus on your recovery without any distractions from your usual environment causing you emotional distress, this will also ensure that you will not be tempted back into cannabis use by any negative influences.
• Patients in residential care will receive expert, proven psychological interventions to aid their recovery, delivered by highly skilled therapists.
• Patients will receive highly nutritious meals and will be able to focus on resting and recovering during their stay.

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References

(1) Champney-Smith, J. (2003) Dual Diagnosis in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(2) Crits-Christoph, P. et al (2009) The Alliance in Motivational Enhancement Therapy and Counseling as Usual for Substance Use Problems. Journal of Consulting Clinical Psychology. 77(6) pp1125-1135 available@The Alliance in Motivational Enhancement Therapy and Counseling as Usual for Substance Use Problems – PMC (nih.gov)

(3) Herie, A.M., Watkin-Merek, L. (2014) Relapse Prevention. in Herie, A.M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.

(4) Hughes, L. (2010) Cannabis Use and Psychosis. In Phillips, P., Mckeown, O. Sandford, T. Dual Diagnosis: Practice in Context. Wiley-Blackwell. Chichester.

(5) Kahan, M. (2014) Physical Effects of Alcohol and Other Drugs. In Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.

(6) Miller, W. & Rollnick, S. (1991) Motivational Interviewing: Preparing to Change Addictive Behaviour. Guilford Press. New York.

(7) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York.

(8) National Health Service (2022) Metoclopramide: anti-sickness medicine used to treat nausea and vomiting. available@ Metoclopramide: anti-sickness medicine used to treat nausea and vomiting – NHS (www.nhs.uk)

(9) National Institute on Drug abuse (2022) Available treatments for marijuana use disorders, available@Available Treatments for Marijuana Use Disorders | National Institute on Drug Abuse (NIDA) (nih.gov)

(10) National Institute on Alcohol Use and Alcoholism (1999) Motivational Enhancement Therapy. available@Project MATCH Volume 2: Motivational Enhancement Therapy Manual (nih.gov)

(11) National Institute on Drug Abuse (2022) What are marijuana’s effects? available@What are marijuana’s effects? | National Institute on Drug Abuse (NIDA) (nih.gov)

(12) Northamptonshire Healthcare NHS Foundation Trust (2021) Dialectical Behavioural Therapy available@ download.cfm (nhft.nhs.uk)

(13) Petry, N. (2011) Contingency Management: What it is and why psychiatrists should want to use it The Psychiatrist. May 35 (5) p161-163,

(14) Solowij, N. (1998) Cannabis and Cognitive Functioning. Cambridge University Press. Cambridge.

(15) Wernstein, A., Gorelick, D. (2011) Pharmacological Treatment of Cannabis dependence. Current Pharmaceutical Design. 17(14). available@Pharmacological Treatment of Cannabis Dependence – PMC (nih.gov)