May 16, 2017
Some are turning to cannabis as an addiction recovery tool.
Josh was 22 when he first tried cocaine.
“It was in a social setting. Being young, a bit naive and a tad curious, I took the plunge thinking it wouldn’t mean anything,” Josh, who asked to be identified by first name only, told Extract. “I sniffed furiously and boy, I felt great.”
Shortly after, Josh mixed cocaine with alcohol. He said it felt like a “warm hug”, and he liked it – a lot. He quickly became addicted to the combination.
Josh abused cocaine and alcohol for the next seven years of his life. He was caught in a powerful cycle that he did not think he could break. It took a toll on his ability to function, communicate and find joy in life.
“I had severe suicidal ideation happening upstairs,” he said. “When you’re pushed that far down the path of addiction, to where death looks better or more appealing than your favorite drug, then that’s a red flag.”
Seven months ago, with the birth of his first child, Josh knew it was time to stop using cocaine and alcohol. And he did. This June, it will be six months since he’s touched either substance.
“I decided to stop using ultimately because I decided I want to live,” Josh said. “I also want to grow, spiritually and emotionally, but I didn’t know that at the time. I love my girlfriend and I want the best for us – me, her and our 7-month-old son.”
Josh is in recovery now, but he’s not clean and sober – not technically. He uses cannabis as a replacement for cocaine and alcohol dependency.
It’s an unconventional recovery narrative, but Josh isn’t the only one using cannabis to kick vices. As drug abuse and overdose rates surge across North America, cannabis-inclusive substance abuse treatment is becoming an increasingly viable option in the world of drug and alcohol recovery.
According to the National Survey on Drug Use and Health, an estimated 21.5 million Americans ages 12 and older struggled with a substance abuse disorder in 2014. Nearly 80 percent of those individuals specifically battled alcohol use disorder.
Joe Schrank, a clinical social worker and program director at the Los Angeles rehab facility High Sobriety, says cannabis can be successfully used as a replacement for lethal, addictive substances.
“From my perspective as a social worker who’s steeped in the world of addiction, the value of cannabis is that you can’t die,” Schrank told Extract. “If we can use it to help people not get HIV, not get Hep B, not inject crazy stuff that they don’t even know they’re getting, not overdose and die, why wouldn’t we do that?”
Schrank, a recovering alcoholic with 20 years of sobriety under his belt, founded High Sobriety because he saw abstinence-only treatment programs weren’t working for everyone. High Sobriety offers a “cannabis-inclusive approach” that utilizes cannabis as a medication to assist patients with addiction recovery.
Although he doesn’t personally use cannabis as a tool for maintaining sobriety, Schrank says he sees many patients benefit from cannabis-replacement treatment.
“When someone has been using for a prolonged period of time, moving into total abstinence within 30 days may not be a realistic undertaking, it may not even be the best strategy,” the High Sobriety website explains.
High Sobriety’s cannabis replacement protocol operates in full compliance with California law, according to the facility’s website. Doctors determine how cannabis should be used and supervise each patient’s treatment plan.
Shrank and other advocates of cannabis replacement for drug and alcohol addiction say marijuana can help individuals during the initial detox process by easing discomfort, insomnia and flu-like symptoms of withdrawal and can reduce or eliminate the need for other medication to manage symptoms. After the detox period, cannabis-replacement advocates say it can help individuals maintain their abstinence from substances like alcohol, cocaine and heroin.
There is very little scientific evidence that proves marijuana works as an effective treatment for drug addiction. There is, however, research indicating cannabis can help chronic pain patients reduce opioid painkiller use and abuse.
A study published in The Journal of Pain in June 2016 found cannabis use was associated with 64 percent lower opioid use in chronic pain patients. The study also found cannabis use was associated with better quality of life, fewer medication side effects and fewer medicines used by chronic pain patients.
Another study published October 2014 in the Journal of the American Medical Association found states with medical cannabis access saw fewer opioid-related overdose deaths each year.
The research falls short of determining that cannabis can effectively help people kick drug habits, but many former addicts and a growing number of treatment professionals say they’ve seen it work. And given the country’s staggering rates of drug-related overdose deaths and limited substance-abuse treatment options, cannabis-replacement advocates say this recovery option deserves serious consideration.
According to the Centers for Disease Control and Prevention (CDC), the number of drug-overdose deaths in the U.S. nearly tripled from 1999 to 2014. More than 47,000 people died in the U.S. due to drug overdose in 2014, and more than 60 percent of those involved an opioid. By 2015, drug overdose was the leading cause of accidental death in the U.S., with more than 52,000 lethal overdoses across the country that year.
Schrank, who says he has successfully treated a number of opioid-addicted patients using a cannabis-replacement protocol, suspects much of the controversy surrounding this form of recovery treatment boils down to the morality culture of drug use in America.
“If someone’s injecting heroin and they’re able to replace that and maintain with cannabis use, that, to me, is a massive victory,” Schrank said. “And people will say, ‘Oh, well, he’s not drug-free.’ But maybe he doesn’t need to be drug-free. Maybe that’s okay.”
One of these drugs is not like the others.
One of the main points skeptics and opponents of cannabis-replacement therapy often make is that cannabis, like heroin, cocaine or alcohol, is addictive and substituting one drug addiction for another drug addiction doesn’t constitute healthy recovery.
According to the National Institute on Drug Abuse, an estimated 30 percent of people who use marijuana may have “some degree of marijuana use disorder,” which “takes the form of addiction in severe cases.”
Marijuana Anonymous (MA), a 12-step program designed for people seeking to overcome marijuana addiction, notes that marijuana addiction is a “progressive illness” that often leads users to become addicted to other drugs, including alcohol.
The controversial theory that marijuana use leads to harder drug use and abuse – often referred to as the “gateway theory” – has been hotly debated for years. While this theory may ring true for some, the majority of people who try marijuana do not develop marijuana use disorder and do not go on to abuse other drugs, according to findings published in 2015 in the American Journal of Drug and Alcohol Abuse.
But Marijuana Anonymous contends marijuana addicts often don’t acknowledge that they have a problem.
“It is the nature of addiction that addicts don’t believe they are ill,” the MA website states. “Marijuana addicts, in particular, tend to believe that they must be ‘OK’ since there are much worse drugs, and other people whose lives are much worse off as a result of their using. That is denial.”
Still, there’s no denying that marijuana is among the safest of all psychoactive substances.
Some data points to consider:
- More than 15,000 people died from prescription opioid-related overdose in the U.S. in 2015, according to the Centers for Disease Control and Prevention (CDC).
- Nearly 13,000 people died from heroin-related overdose in the U.S. in 2015, according to the CDC.
- More than 8,000 people died from benzodiazepine-related overdose (with and without opioids) in the U.S. in 2015, according to the National Institutes of Health (NIH). (Benzodiazepines, such as the brand-name drugs Xanax and Valium, are a class of tranquilizers.)
- Nearly 7,000 people died from cocaine-related overdose (with and without opioids) in 2015 in the U.S., according to the NIH.
- An estimated 22,000 people die from alcoholic liver disease and alcohol-related liver cirrhosis each year in the U.S., according to the CDC.
- There has never been a recorded death attributed to marijuana.
Beyond the relatively high safety profile of cannabis, users often describe the drug as a mentally and emotionally uplifting substance.
“Cannabis does not lower or reduce my vibrational frequency or positive, creative mind to that of a caged animal like cocaine and alcohol do,” Josh told Extract. “I get new ideas under the influence of cannabis. Cocaine will keep you trapped in a tunnel vision.”
Josh says cannabis helps quell his cravings for alcohol and cocaine and helps him maintain a positive frame of mind. But he doesn’t attribute his recovery to cannabis alone.
“It took some hard work and inner strength to go and repair broken bonds and relationships with family,” he said.
Josh also completed a three-week outpatient treatment program after getting clean and has attended some Cocaine Anonymous (CA) meetings. The treatment program and CA meetings helped him open up and talk about the issues underlying his addiction and reinforced his path to recovery, he said.
Harm reduction and SMART Recovery
In terms of community treatment options and group support meetings for drug and alcohol recovery, 12-step programs and SMART Recovery are the two main options available today. Twelve-step programs like Alcoholics Anonymous (AA) largely dominate this landscape.
The spirituality-based, 12-step framework is helpful for many people seeking to achieve and maintain sobriety from drugs and alcohol. But for many others, 12-step programs simply aren’t effective. Schrank says the pseudo-religious and abstinence-only aspects of 12-step programs are particularly difficult for some to swallow.
In his 2014 book, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry”, retired Harvard Medical School psychiatry professor Dr. Lance Dodes estimated about five million people attend Alcoholics Anonymous meetings every year, and only a sliver are successful in recovery.
“Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent,” Dodes told The Atlantic in a March 2014 interview. “About one of every 15 people who enter these programs is able to become and stay sober.”
Although the AA website does not explicitly state that people must be completely sober to attend meetings, one of the program’s central tenets is that alcoholism can only be “arrested through total abstinence from alcohol in any form.”
Perceived shortcomings in the 12-step framework led a group of psychologists to develop an alternative, science-based substance abuse recovery program about 20 years ago. They called it Self Management and Recovery Training, or SMART Recovery.
Dr. Tom Horvath, a San Diego psychologist who helped develop the SMART Recovery program and served as the organization’s president for 20 years, says the alternative recovery program speaks to a segment of people that doesn’t respond well to the confines and beliefs of of the 12-step program.
“In 12-step, the ‘solution’ lies outside of you – in a higher power, in a group, with a sponsor – and that works fine for some folks,” Horvath told Extract. “With SMART approaches, the solution is inside you, but it’s in need of development.”
SMART Recovery, which bills itself as “the leading self-empowering addiction recovery support group,” offers a four-point program for addiction recovery. Much like 12-step programs, SMART Recovery offers free group support meetings. Unlike 12-step, SMART Recovery prioritizes harm reduction and self empowerment rather than abstinence and powerlessness over drugs and alcohol.
“There is openness to a wide range of options including cannabis substitution or cannabis use as an alternative,” Horvath said. “So it fits within that self-empowering framework, or you could think of it as a harm reduction framework.”
Horvath, owner and founder of Practical Recovery, a drug rehab and alcohol treatment center in San Diego, does not offer cannabis-replacement treatment himself. But he thinks facilities like High Society fill a necessary hole in the treatment landscape, and he sometimes refers patients to Schrank’s treatment center.
“These patients had serious substance abuse problems, and it’s the idea of one small step at a time,” Horvath explained. “For these people, it didn’t seem feasible to me that they would give up everything, which is what you usually do in a rehab. So this is a halfway measure that is non-lethal, and if they’re willing to do it, it’s a major improvement.”
Horvath admits that one of the most useful aspects of 12-step programs is that they exist all over the world, and there are always meetings for people to attend. SMART Recovery, while growing, can’t yet match the widespread availability that AA and related 12-step programs provide.
For its part, the AA General Service Staff says the organization “is neither for or against” cannabis-replacement programs or non-12 step programs like SMART Recovery.
“AA has no opinion on whether people should or shouldn’t drink, and does not weigh in on any outside issue,” a representative for the organization told Extract in an email statement. “Our sole purpose is to stay sober and help the still suffering alcoholic achieve sobriety.”