“However, there was a relatively small change in the brain that is difficult to interpret,” says Hermann. If a human’s brain weighs between 1200 and 1400 grams, then in this study there is a change that takes place in the cubic millimeter range. “It’s difficult to interpret.” Still, he says, the results fit well with the existing theory that cannabis affects the ECS and are consistent with findings from animal experiments.
Cannabis as a gateway drug?
According to the Gateway model, use of cannabis sooner or later leads to harder drugs. “In fact, studies show that a large proportion of people who use heroin have used cannabis first in their life history,” says psychologist Eva Hoch. However, only a very small proportion of people who use cannabis regularly later also use harder psychotropic substances. So, is cannabis a gateway drug or not?
If so, the pharmacological action of the intoxicant could increase a young person’s propensity to use other illicit drugs. Supporting this model is that juvenile rats given high doses of Δ9-tetrahydrocannabinol (THC) are more likely to self-administer heroin and cocaine than animals not given THC.
However, there are also alternative explanations for the gateway model. The first is availability: people who use cannabis have more opportunities to get other drugs. Eva Hoch knows this from the stories of her patients: »When I go to my dealer, he has other things with him than cannabis.« The offer increases the temptation to also consume cocaine, ecstasy or other drugs, says Hoch. According to the second thesis, people who use cannabis early are more willing to take risks than others. Either genetic or environmental. Or both.
“Whether one or the other theory is correct doesn’t play a decisive role in practice,” says the psychologist. Psychotropic substances have different risks and can be addictive. Young people should be better informed and credibly informed about this. What is needed are more prevention programs, says Hoch.
What the changes in the brain could mean is shown by another longitudinal study, the authors of which followed the more than 1,000 participants for almost 40 years. At the age of 13, participants were given intelligence tests. These tests were repeated at age 38, some after patterns of sustained cannabis use had become established. “Those who only started using cannabis in adulthood only showed poorer IQ performance as long as they also used it,” says Hermann. A certain deficit persisted even after abstinence among participants who had started in adolescence.
“Apart from its long-term design, what’s good about this study is that the researchers included the subjects’ school education in the analysis,” says Hermann. It was thus possible to rule out that differences in education play a role in development. At the same time, the study showed that the age at the start is not the only decisive factor. How long someone smokes weed and how intensely is also relevant.
Exemplary is the story above of the young man who developed a cannabis use disorder. As head of the Institute for Therapy Research in Munich, Eva Hoch regularly treats people like him. With the help of a behavior therapy-oriented withdrawal program, those affected should learn in ten sessions to take fewer drugs or to stop completely. The three core elements of therapy are motivational support, behavioral therapy and problem-solving training.
“When it comes to the motives, my clients are faced with the question: Why am I consuming?” says Hoch. Many want to sleep better, be more relaxed, think more creatively. »On the other hand there is the question: What do I want in my life? Could there be reasons to change my consumption? For example, to have less stress with the parents or less trouble with the police. Many would like to graduate from school or get a driver’s license,” says Eva Hoch. Together with those affected, she develops alternative strategies to relax or find satisfaction in life. »We also set goals together. How much consumption is realistic? Is it enough to reduce, so only smoke weed on some days? Or does it have to be a stop?” says Hoch. A dependent brain is very difficult to control. The simplest thing is to stop smoking, eating or inhaling cannabis at all.
At the beginning it is challenging for some clients to take part in the therapy. Some might not be able to concentrate so well because they have smoked pot intensively for a long period of time. The others are ambivalent about their motivation. But that changes over time. »It is particularly nice to see how young people change over the course of treatment. They are then much more alert, more efficient and much more interested, often there are new perspectives and goals for the future,« says Hoch.