That’s a question many people are asking now that dagga is legal for private use in South Africa. There were a lot of funny memes doing the rounds on social media when the news broke in September 2018 but the bigger debate is, “is South Africa courting the devil”?
Marijuana, weed, cannabis, dope, dagga… whatever you call it, tends to be used as a social drug and it’s seen as a ‘soft drug’. Supposedly, it’s harmless and not addictive, and certainly less harmful than hardtack alcohol and less addictive than cigarettes.
Or is it a gateway drug that leads to harder and more destructive drug addiction?
The Gateway drug theory claims that so-called ‘soft drugs’ like weed set naïve users on a path to experimenting with other drugs such as cocaine, meth, heroin and opiates. Most people who develop an addiction to these drugs say they started off smoking weed.
Weed provides a safe ‘high’ experience which lures users into a false sense of security when it comes to trying other drugs. If they hadn’t started with a soft drug like weed, the thinking is they may not have progressed onto harder drugs.
This is based on the notion people who use illegal substances progress along a linear path from “socially acceptable and legal substances” like alcohol and nicotine; to soft drugs like weed; and then onto harder illicit drugs like cocaine and heroin.
What’s the reason for this?
Firstly, experimenting with weed increases the taste and perceived pleasure for other drugs. And secondly, there’s an increased likelihood you’ll be exposed to harder drugs if you hang out with people that have a free association with drugs in general.
The science people say that weed isn’t any more or less of a gateway drug than alcohol and nicotine is when it comes to kickstarting a drug-taking habit. If you have a genetic predisposition (the addiction gene) to drug use, the springboard could be booze, cigarettes or dope. In fact, regular cigarettes are far more addictive than weed.
It’s impossible to say that someone who experiments with weed is likely to go on and experiment with harder drugs, mainly because the vast majority don’t get addicted. The latest research stats show that between 10 to 30% of regular users will develop a dependency on weed, while only 9% develop a serious addiction.
A study by The Center on Addiction and Substance Abuse at Columbia found that children who used marijuana, alcohol and tobacco were 266 times more likely to use cocaine than children who used none of the gateway drugs.
The same was true for adults. Adults who used marijuana, alcohol and tobacco were 323 times more likely to use cocaine than adults who used none of the gateway drugs. Adults who used all three were 104 times more likely to use cocaine than adults who used only one gateway drug.
The fact is marijuana has been around since ancient times. The earliest recorded use as a drug was 2 737 BC in China. It made its entry to the New World in 1545 when the Spanish brought it and produced it as a commercial crop to make hemp fibers.
Marijuana is not necessarily the problem; the habit is. In other words, smoking weed can lead to a drug-taking habit. This is where a person enjoys the experience, feels withdrawal symptoms when not taking the drug and seeks out the drug to relieve the cravings; repeat!
It’s known as ‘marijuana use disorder’ and it becomes addiction if you cannot stop using weed even when it starts having a negative effect on your life. Marijuana dependence occurs when your brain adapts to large amounts of the drug.
Marijuana often makes you irritable and moody, affects your sleep pattern and decreases your appetite. About 1 in 10 frequent marijuana users experience anxiety, hostility, insomnia and depression after the intoxicating effects of weed wear off.
If and when you try to quit, you’ll battle with mild to strong cravings, restlessness and different forms of physical discomfort. This is proof weed is not completely harmless and is addictive in the same way people become addicted to the habit of smoking cigarettes as well as the actual nicotine.
The big problem with weed today is its potency. It’s been steadily increasing over the past few decades. In other words, the weed you smoke in 2019 is a lot stronger than the weed your folks smoked 20 years ago. And the scariest problem with smoking weed in South Africa is it’s not always pure and clean. In other words, there’s a good chance it’s laced with something like Tic or Mandrax.
The verdict is still out whether weed is a gateway drug or not. One side says it’s a scare tactic and the other side says it is a gateway drug.
What we know for sure is; if you have a genetic predisposition to drug use, the springboard could be booze, cigarettes or dagga. If you develop an addiction, you can’t say for sure whether weed was the main culprit or whether there were other factors at play. If you have the addiction gene, something will ignite it.
If you or a family member need help with drug or alcohol addiction, all you need to do is call us. You’re not on your own.
White River Manor works closely with medical practitioners such as psychologists and psychiatrists who have years of experience in dealing with alcohol and drug addiction as well as a team of highly experienced counsellors who understand the intervention process and are strong counsellors.Giles Fourie
Dual diagnosis is so common that most alcohol and drug recovery centres expect to find it in a patient. It’s where a patient is diagnosed with a mental illness and a co-occurring addiction. This ranges from alcohol and drug addiction to an addiction to sex, gaming and stealing.
Studies show that at least 50% of people living with a mental illness have a substance abuse problem. Similarly, more than half of the people battling with alcohol and drug addiction have a common mental health disorder.
The fact that there’s a link between addiction and mental illness is fairly obvious. If you’re feeling out of sorts emotionally, you’re likely to reach for alcohol and drugs to cope. Likewise, if you’re regularly abusing alcohol and drugs, you’ll likely develop symptoms of a mental disorder.
In the medical world, it’s called a co-occurring disorder or comorbidity when a person has more than one mental disorder.
A simple analogy to help you understand a dual diagnosis is comparing it to the science of fire. It takes more than one element to ignite a fire. Similarly, it takes more than one element to ignite an alcohol and drug addiction.
The fire triangle
For a fire to ignite, it needs fuel, heat and oxygen. They say that when all three elements are present and combine in the right mixture, a fire is actually an event rather than a thing.
You can prevent a fire or put it out by removing ANY ONE of the three elements in the fire triangle. For example, you can remove oxygen by throwing a wet blanket over the fire and remove heat by dousing it with water. And a fire will naturally die out when it runs out of fuel (wood, paper, grass etc.).
If you don’t COMPLETELY remove that element, the fire will reignite. You think you’ve put the fire out but the woodpile is silently smoldering (heat). All it takes is for the wind (oxygen) to pick up and the fire reignites.
The Addiction Triangle
Let’s call a dual diagnosis the Addiction Triangle.
The three sides of your Addiction Triangle are alcohol and drugs, negative thought patterns and a mental disorder.
When all three elements are present and combine in the right mixture, a fire of pain and destruction will ignite. You can remove any one of the three elements to extinguish the fire of destruction but it’s only temporary if you don’t COMPLETELY remove it.
You can stop using alcohol and drugs and you can learn self-help tools to deal with feelings and situations that trigger a relapse. However, if you don’t deal with your mental illness; you’re highly likely to relapse if you turn to alcohol and drugs to cope with anxiety and depression.
This is why an integrated treatment plan is critical for a patient with a dual diagnosis. All three elements of the Addiction Triangle must be treated for successful recovery from alcohol and drugs.
Substance abuse and a mental health disorder needs to be treated simultaneously. If you’re staying at a recovery treatment centre that doesn’t offer an integrated approach, the chances of you relapsing are high.
Co-occurring mental disorders that go hand-in-hand with addictions include:
The integrated approach usually involves:
Detox is the first stage in the recovery process and the most grueling. The detox process purges your body of harmful chemicals and restores it to a clean slate.
During detox, a patient stops using what they’re addicted to immediately. You experience painful and very uncomfortable withdrawal symptoms which include seizures, hallucinations and cravings.
Withdrawal symptoms such as seizures and a sudden drop in alcohol levels can lead to sudden death. It’s critical that you have proper medical supervision when you detox. This is very important for alcohol and opioid detoxification.
Your medical team will keep you safe and comfortable using the right medication and therapy to see you through the detox process.
Behaviour therapy (cognitive behavioral therapy and psychotherapy)
Behaviour therapy helps people uncover and address the negative thoughts, false beliefs and insecurities that lead to substance abuse. In the process, patients are provided with self-help tools to deal with situations that trigger cravings and self-destructive behaviour.
When an addict understands why they feel or act in a certain way and understand how these feelings or situations trigger substance abuse, they’re more likely to succeed in their recovery.
Depending on the diagnosis, this could include:
A person living with a mental illness is more likely to abuse alcohol and drugs mainly because they mask symptoms such as of depression, anxiety, self-loathing and low self-esteem. Using alcohol and drugs over a period of time will make a mental illness worse and the medical treatment less effective.
A bigger problem is alcohol and drug abuse can trigger a mental illness. If you have a predisposition to a psychotic illness such as bipolar disorder or schizophrenia; alcohol and drugs may trigger your first episode which then becomes a lifelong illness.
The common mental health disorders linked to alcohol and drug addiction include:
Alcohol and drugs are a form of self-medication for people living with depression but it usually makes the problem worse. Feelings of self-loathing after alcohol and drug binges can drive a person deeper and deeper into depression.
People who suffer from generalised anxiety disorder (GAD) may use alcohol and drugs to cope with their anxiety. They’re more likely to abuse benzodiazepines which are prescribed for anxiety and highly addictive.
OCD (Obsessive Compulsive Disorder)
People living with OCD often suffer from high levels of anxiety and low self-esteem which leads to depression. They may use alcohol and drugs to cope with their feelings that arise from irrational obsessions and compulsions.
ADHD (Attention-deficit Hyperactive Disorder)
People, in particular school-going children, are prescribed a stimulant to treat their ADHD which can be habit-forming. When coupled with anxiety and low self-esteem, it can lead to destructive behaviour patterns and substance abuse.
People struggling with anorexia or bulimia often use drugs to suppress their appetite. Cocaine is a common drug used by models forced to keep their weight down to the bare minimum as it takes your appetite away completely.
PTSD (Post-Traumatic Stress Disorder)
The brain of a person struggling with PTSD produces less endorphins which often leads to depression. Someone who’s experienced a traumatic or violent event and has not dealt with it in therapy may turn to alcohol and drugs to cope with their anxiety and stress.
Alcohol and drugs provide temporary relief from the emotional, manic rollercoaster that people with bipolar travel in life. The statistics are that about half of people with bipolar disorder struggle with addiction.
BPD (Borderline Personality Disorder)
Research shows there’s a strong link between BPD and addiction. A person living with BPD is more likely to use alcohol and drugs to cope with their symptoms.
Schizophrenia is characterised by bouts of severe hallucinations and delusional thinking. A person with schizophrenia may use alcohol and drugs to cope with their symptoms and this can make things much worse.
The most difficult thing about a dual diagnosis is separating the addiction from the disorder. This is because many of the symptoms overlap. It all depends on the type of substance abused and the severity of the mental health disorder.
Overlapping symptoms include:
Dual diagnosis is used to describe a person living with an addiction and a mental health disorder. More than half of people with a chronic mental illness will also have a substance use or abuse disorder.
Comorbidity is used when a person has two or more mental health disorders. They may occur at the same time or one comes after the other.
If an addiction and mental illness co-occurs in a patient, they need an integrated dual disorder treatment programme delivered by a multidisciplinary team.
The more severe the mental illness, the more likely the person will be to use and abuse alcohol and drugs. People living with a mental illness commonly use alcohol, marijuana and/or cocaine to cope with their symptoms.
Males aged 18 to 44 years old living with a mental illness are at greatest risk of developing an alcohol or drug addiction.
Teenagers and young adults with serious behavioural problems are 7 times more likely to eventually use and abuse substances.
Dual diagnosis should ideally be made by a multi-disciplinary team at an alcohol and drug recovery centre and needs to be treated using an integrated dual disorder treatment programme.
White River Manor works closely with professionals with years of experience in dual diagnosis. Our multidisciplinary team includes a psychiatrists, cognitive behaviour specialist, counsellors, nursing sisters and a nutritionist. The aim is to ensure you or your loved one receive a tailor-made recovery programme that’s holistic and comprehensive.