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NEWS: The Age - 14/12/2006 'Where there's smoke ... there's mental illness'

hoptis

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Where there's smoke ... there's mental illness
Sarah Smiles, Canberra
December 14, 2006

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AVERAGE first-time dope smokers are now only 14.9 years old, warns a report on the dangers of cannabis to mental health — especially among young people.

Released by the Mental Health Council of Australia, the report highlights a growing body of research linking cannabis use with increased risks of mental illnesses such as schizophrenia and psychosis.

"You increase that risk further if you have a family history of mental illness," said the council's chief executive John Mendoza.

"You increase the risk again a notch further if you begin using at a young age, when brain development is at crucial stages."

Launching the report yesterday, former Australian Federal Police commissioner Mick Palmer said states and territories with relaxed cannabis laws should consider re-thinking them in light of the report.

He said tougher law enforcement must be coupled with awareness programs that inform the community of the drug's dangers.

"We are not going to deal with this issue simply though a law-and-order response," said Mr Palmer. "We've got to find more effective ways of … getting rid of the perception that cannabis is harmless and that there's no danger associated with its use."

He said throughout his career he had failed to see criminalisation alone curb cannabis use.

The report calls for the federal and state governments to launch national and schools-based awareness campaigns to warn of the dangers of the drug.

"Just as we made tobacco unfashionable, we would be keen to make cannabis unfashionable," said Rob Knowles, the council's chair.

Federal Opposition spokeswoman for health Nicola Roxon said the report "provides a framework for governments to better address the issue, and for the community to gain a greater understanding about the risks of cannabis use".

Greens Party leader Bob Brown said he rejected Mr Palmer's assertion that jurisdictions with relaxed cannabis laws should rethink their legislation. He said awareness programs about the drug's dangers should be advocated instead.

"In the past a huge amount of police time was spent catching people who were using small amounts of cannabis, rather than catching the big drug dealers and people causing real harm," he said. "There's lots of evidence to show that locking people up is counterproductive."

The report found that cannabis use aggravates existing mental illnesses and is associated with "adverse outcomes" such as failure at school and not finding a job.

The Age
 
Teens at most risk from dope
December 14, 2006

Tackling misconceptions about cannabis use is the key to reducing the harm it causes, writes Ruth Pollard.

WHEN tetrahydrocannabinol, the active ingredient in cannabis, collides with the growing brain of a teenager the results are dangerously unpredictable.

Some use cannabis socially for a time then dump it as they take on the responsibilities of adulthood, suffering no serious effects.

But for a significant number of others, psychosis, schizophrenia and other mental illnesses develop and a vicious cycle of self-medication and worsening symptoms is amplified by torrid teenage emotions.

In 1920, when Australia first outlawed cannabis, there was little evidence of its use here.

Now it is the country's most widely used illicit drug: at its peak in 1998, 60 per cent of 20- to 29-year-olds reported having used cannabis.

Once viewed as a bit of harmless fun, it is now recognised as the third most prevalent drug of dependence after alcohol and tobacco. About 10 per cent of people who try cannabis become dependent - this is 3 per cent of Australia's population, or 700,000 people.

Those most vulnerable are the young and those who use regularly. With the age when people first try the drug dropping from 30 to below 16, many young brains are at risk of harm from cannabis.

The key question for those in the field is not whether cannabis is associated with mental illness, but how to reduce the harm it causes.

The Mental Health Council of Australia says most of the effort must be directed at teenagers, many of whom do not associate their cannabis use with the negative feelings they are experiencing.

"Years ago I loved it [cannabis] but now I just think back to my symptoms and how bad it was and the problems it caused my life, and I just really think it's not worth it," says one young man who has recovered from psychosis.

Delays in seeking help are a big problem, with many people waiting until their 30s to try to find treatment.

"It is clear we need much more sophisticated interventions than currently used," a council report, Where There's Smoke, notes.

Yet experts also say it would be wrong to demonise the drug, or run a scare campaign that attempted to raise the level of fear about its side effects - after all, 90 per cent of users experience few or no long-term problems.

Indeed, most have stopped using the drug by their late 20s, as employment and family responsibilities kick in, the report, released yesterday, says. Since the peak of use in 1998, there has been a decline in the numbers of people aged 14-19 and 20-29 taking cannabis.

Yet, disturbingly, there has been a corresponding, albeit smaller, increase in the use of ecstasy and methamphetamine over the past six years, says the chief executive officer of the Mental Health Council of Australia, John Mendoza.

Investing money, and lots of it, is the first step for state and federal governments, he says.

The creation of centres of excellence around Australia to deal with cannabis interactions, as well as alcohol and other drug use, and provide an outreach service for young people, was vital and expensive - it would cost $300 million a year.

Beyond that, an additional $100 million a year is needed to deal with adults with problematic cannabis use, Mendoza says.

Then there is the issue of treatment.

"We have got a group of young adults who smoke and smoke regularly, and we have virtually nothing in the kitbag in terms of treatment programs for dependence," Mendoza says.

School-, university- and TAFE-based drug education is another area that needs significant investment to send consistent, strong prevention messages similar to those warning against smoking or drink-driving, he says.

"This is the period where people will experiment with illicit substances and the period when they will most likely experience their first episode of mental illness or psychosis; it is also when, if we intervene, we get the best results.

"It is coinciding with a time when brain development is undergoing fairly critical changes. It is a period where all sorts of things go a bit awry for individuals … Throw in some chemical additives and things can go horribly wrong."

But Mendoza warns against punitive approaches.

"Experience from here and abroad is that if you ban those students who use cannabis and alienate them, it makes it more difficult to reach them with prevention messages.

"You will drive the drug use underground or drive students away from being able to access help."

Ten years ago the link between cannabis and psychosis was not clear. There is now a significant and growing body of evidence of the relationship between the two.

There is evidence of a genetic vulnerability to psychosis being, in effect, triggered by cannabis use, the council report says.

Cannabis use is also known to precipitate schizophrenia in people who have a family history of the illness. The incidence of psychotic symptoms is two to three times greater among those who have used the drug yet, in this case, cannabis has not been proven as a major causal factor.

While there is no clear causal link between cannabis use and depression, there is a link between early cannabis use and later depression, the report notes.

Patrick McGorry is a professor of youth mental health at the University of Melbourne and the executive director of the ORYGEN Youth Health, a mental health service that also provides education, advocacy and health promotion activities.

"We see a lot of young people with a lot of cannabis-related problems, and we see the subgroup who have really got into trouble," McGorry says.

"It is so freely available that I do not think there is any possibility of restricting the availability like you might with heroin."

Yet as the harm associated with cannabis use becomes better recognised, governments and services are at risk of losing credibility with those who smoke it if they try to demonise the drug, he warns.

The reason: most people who use cannabis do not get into trouble. "You cannot cry 'reefer madness', but it is important to say that it is harmful for a subgroup of people - it is a real balancing act."

In one program that McGorry runs, half of the young people with psychotic illnesses have had some exposure to cannabis and a quarter have significant current use that complicates their illness.

"Moderate to heavy use exacerbates their illness, impedes their recovery and increases their relapse rate," he says.

A lack of proven treatments also clouds the issue. There are no medications to treat cannabis addiction, and questions about the effectiveness of psychological interventions, such as cognitive behavioural therapies, alone.

McGorry conducted a trial involving the provision of basic education, support and information about the dangers of cannabis use and compared it to the provision of cognitive behavioural therapies.

The two arms of the trial had the same results, and showed that simple interventions such as education do work for some people.

"We need new treatments to treat the addiction … and we need a lot more investment in research into cannabis use."

It was also vital to realign drug and alcohol services with mental health services so families and clients did not constantly bounce from one service to the other, or, worse still, fall through the cracks.

The executive director of the Black Dog Institute, Professor Gordon Parker, says there is little doubt he is seeing more and more young people with psychotic conditions where cannabis is involved.

More and more were ending up in acute psychiatric beds. "The in-patient services are now disproportionately weighted to those who have drug-induced psychosis, squeezing out other people with mental illness who used to occupy those beds," Parker says.

"It is not a very efficient use of the health dollar if you merely hold somebody for a few days or a week, and then they go back out and start taking the drugs again - the return on that investment is minimal."

Instead, Parker says, it is important to intervene early in the development of a psychotic illness, and to ensure it is properly diagnosed and treated and that follow-up support is provided.

"Adolescents are unlikely to identify drugs even if drugs are the culprit … they will present with anxiety and depression but they will not link these feelings with cannabis."

Intervention at this stage can mean the difference between a low-level mood disorder and a teenager moving on to a more serious mental illness such as psychosis and, in many cases, harder drugs, he says.

The news in NSW is not all bad. The Government has opened four specialist cannabis clinics - in Paramatta, Sylvania, the Central Coast and Orange - and the early results from two of those centres is promising.

People who attend the clinics have reported an average reduction in use of more than 50 per cent, and 58 per cent were either abstinent or rare users, says David McGrath, the director of mental health and drug and alcohol programs at NSW Health.

"We are looking at rolling the model out on a broader basis … [because] people who use cannabis didn't necessarily see themselves in the same demographic as people who use heroin or had problematic alcohol consumption."

Sydney Morning Herald
 
"We need new treatments to treat the addiction … and we need a lot more investment in research into cannabis use
Adolescents are unlikely to identify drugs even if drugs are the culprit … they will present with anxiety and depression but they will not link these feelings with cannabis"
if it were legal we wouldn't have to deal with the bull shit we are now, recreational cannabis use poses no harm to adolescence and if it were legal it be an easy milestone to cross thus causing less additions to this at a young age
 
Read the full report here

Excerpt from Forward of above report:

The information provided in this report is of the highest quality and the recommendations are generally reasonable and practical, especially in the context of recent and overdue reform and investment in mental health by Australian governments. Some challenging issues remain however and I will only mention two. Firstly, cannabis is an illicit drug, yet despite this, availability, arguably the main driver of levels of morbidity from drugs and alcohol, is almost universal. Secondly, the major harm in terms of mental health flowing from cannabis, as emphasised in the report, occurs in a minority of those who try or continue to use the drug. Combined with the extreme difficulty in limiting availability, this implies that the major focus should be on the prevention of progress from initial or occasional to harmful use. Of particular concern are those with a vulnerability to psychosis, and those with an established or revealed mental illness, again especially psychoses, such as schizophrenia. The most harm in these vulnerable subgroups comes from heavy use and from combined poly drug abuse. These facts tend to support more emphasis on targeted rather than universal approaches, though both have their place as recommended in the report. The problem we still face with both approaches is the relative lack of effective, evidence-based interventions either at the population, targeted or clinical levels. This is particularly obvious in clinical services, where interventions which will reliably reduce moderate to heavy cannabis use are simply not available. In preventive terms, focusing on attitudes in younger people prior to use may help, but we cannot yet be confident of this. All this means that we need to invest in the creation of better intervention strategies at all levels, from the community to the clinic, and be much more committed to clinical trial and health services research in this area. Better integration of mental health and drug treatment services is a crucial goal and this is a long overdue piece of health services research that we should tackle nationally.

(emphasis mine)
 
"In the past a huge amount of police time was spent catching people who were using small amounts of cannabis, rather than catching the big drug dealers and people causing real harm," he said. "There's lots of evidence to show that locking people up is counterproductive."
I like this.
 
I recommend people read the actual report rather than relying on the crappy media misreporting that goes on whenever something like this is released. I found the report to be mostly quite balanced, and fairly pragmatic.

It tells the same story that's been known for a while now. The vast majority of people who smoke pot have virtually no negative consequences. A minority of people with a predisposition to psychotic illnesses could have those illnesses either brought on or made worse by heavy cannabis use.
 
Smoke signals a health warning
By Sue Dunlevy
December 22, 2006 12:00

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IMAGINE watching your cannabis-smoking son stab himself three times in the stomach right in front of you – and later having to deal with his suicide.

Imagine watching your beautiful daughter become a schizophrenic after using drugs and having to take over the job of caring for her baby.

Imagine realising you had a mental health problem and were seeking help, only to be turned away because the mental health service classified your problem as drug-related.

For years the parents of cannabis users have seen a link between their child's use of cannabis and mental illness.

Now evidence is emerging that they are right.

A major report into the links between cannabis use and mental illness, which was released last week, should cause a serious rethink about the reputation of cannabis as a safe, non-addictive and harmless illicit drug.

And it demands an urgent overhaul of school-based drug education programs, with new evidence showing that cannabis use is starting much earlier in high school, at a time when young brains are undergoing massive changes.

The third most-used drug in this country after alcohol and cigarettes, it is often claimed that cannabis is less harmful to your health.

However, a review of major health studies by the Mental Health Council of Australia has debunked this view, finding that cannabis can increase the risk of mental illness in a small number of people and is addictive.

The study concludes that cannabis use can bring on schizophrenia in people who have a family history of mental illness.

And people who use cannabis have a two to three times greater incidence of psychotic symptoms.

Mentally ill people suffer relapses and worsened condition when they use cannabis.

One in seven cannabis users experience strange and unpleasant experiences, such as hearing voices, or becoming convinced that someone is going to harm them.

And one in 10 cannabis users becomes addicted to the drug. In Australia that is 700,000 people!

One in every three Australians will try cannabis over their lifetime and, although its use is declining due to the rise of ecstasy and ice, teenagers are trying it at a younger age.

The average age of those who have their first experience of the drug is now just 14.9 years.

The Mental Health Council's report says this means a major school-based drug education program is behind the times.

Under the program, children are discussing cannabis use in Year 9, while many of them start using the drug in Year 8.

In light of the evidence of the damage cannabis is causing, the Mental Health Council is calling for funding for more programs to help those who have a drug problem, as well as a mental illness.

Too often young people are turned away from mental health centres because they are told they have a drug problem, the report found.

The Federal Government has been pushing the states to get tough on cannabis, demanding earlier this year that they introduce new nationally consistent laws on the trafficking and use of cannabis.

Parliamentary Secretary for Health Christopher Pyne wants the law to treat cannabis in the same way as heroin.

However, state and territory laws currently deal with cannabis offences by imposing fines and diverting users into treatment programs.

A cannabis hotline has been set up as part of mental health reforms to provide information on the risks of smoking cannabis.

And $21 million has been earmarked over the next four years for a public awareness campaign to alert people to the link between illicit drugs and mental illness.

However, the Mental Health Council's report calls for a much more comprehensive approach to tackling the mental health problems that are linked to cannabis.

It wants a thorough evaluation of the effect of existing school-based drug education programs and public awareness programs.

Evidence to date suggests that these school-based programs prevent only between 3 and 20 per cent of those who were planning to try cannabis from doing so.

Teachers are given insufficient support to deliver the programs – and they often modify the programs they are given to suit their own values, or because they feel uncomfortable with advocating a harm minimisation approach to their students.

The effects of these programs fade over time and more needs to be done to refresh the messages at key points throughout adolescence, the report says.

The report is keen not to overstate the risks of cannabis – for the vast majority of people who try it, there will be no long-term effects.

But no one knows if they have a predisposition for mental illness that is likely to be triggered by cannabis use.

Reading the tragic stories in this report of cannabis users whose mental illness was triggered or made worse by this drug is a sobering exercise.

This report should be compulsory reading for every parent and every 13-year-old considering whether to experiment with drugs.

Daily Telegraph
 
So true Flexistentialist.

It's interesting that I read the report as confirming what I already knew about cannabis. It doesn't present a stronger argument for some kind of causal link between cannabis and mental illness, like the title of the news articles tends to read. The issue that is hard to deal with is that some people are prone to mental illness, and when they use cannabis (especially heavily and starting early), this is very likely not to help them.

I was lucky in that for some reason I escaped being around any illicit drugs at school. Trying pot for the first time when you're 20 years old is pretty unusual. But by this age, I knew anxiety and paranoia; and I knew cannabis was not a drug that suited me. I don't think I would have had the same insights if I'd tried it when I was 13.

So the dilemma for parents and other adults who are concerned about young people using it and it triggering mental illness, is that it's almost impossible to tell someone not to use it because it may have a low chance of causing mental illness. Cars kill people now and again but we don't tell kids not to get their drivers license. It would be better for younger people (and everyone really) to be more aware of the signs - to be more aware of when they might be looking down the tunnel of mental instability and get support as soon as little triggers begin. Not an easy task though!
 
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