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This assignment evaluates the relationship between cannabis use and mental health disorder related to it in Australia. Recent national data reflects that cannabis use was at its peak in 1998 when over 60% of people aged 20-29 were reported having used cannabis.
Since then various studies have found co relation between cannabis use causing no mental health issues and cannabis use causing schizophrenia and psychosis. Recent studies have found that cannabis is recognized in Australia as the third most prevalent drug of dependence following alcohol and tobacco. About 10% of people who try cannabis will develop dependence at some point in their life. Studies have found relationship between weekly frequency of cannabis use and mental illness such particularly psychosis, schizophrenia, anxiety and depression (www.mhca.org.au).
Cannabis is a plant contains a psychoactive molecule that produces a high associated with this drug. The psychoactive product contains dried flowers and leaves of plants selected to produce high levels of tetrahydrocannabinol (www.dictionary.com). There is a significant and growing research on the relationship between mental illness and cannabis use in Australia. The evidence supports the association between mental illness and regular cannabis use. The evidence states that regular cannabis use from young age will increases the risk of mental illness since there is genetic vulnerability to psychosis being which can be triggered by cannabis use. Evidence shows that cannabis use facilitates schizophrenia in people who have family history of mental illnesses. The average first use of cannabis users is now 14.9 years. This is of a very important concern in Australia as this is the age at which there are psychological changes in brain. Psychosis is an abnormal condition of the mind in generic psychiatric term for a mental state is often described as a loss of contact with the reality. This disorder can disable the normal functioning of the brain. This malfunction in brain causes people with elevated risk of death by suicide. Thus it is important to analyse the evidence carefully in order to make conclusions and recommendations (Hall et al, 2004).
Relationship between Mental Illness and Cannabis.
Certain pockets of Australian population consume cannabis in form of heating or ignition combined with inhalation of smoke or oral consumption of the plant itself mixed into a food medium. The other way that individuals consume cannabis is by vaporization, which causes the active ingredients to evaporate into gas without burning the plant material. This is generally done by boiling the ingredients of cannabis plant. Once these vapours are inhaled, it produces various short term and long term effects. The short term effects range from sleepiness, difficulty keeping track of time, impaired or reduced short term memory. In my general practice I have observed that the patients consuming high amount of cannabis find it hard to communicate and focus. They are generally slower to react and have increased heart rate, heart palpitations and show signs of psychological dependence on cannabis drug consumption. Their reasons for addiction generally range from recreational purposes and sometimes to escape their present hardships in life (Personal Communication, Clinical Placement, 2010).
Evidence shown by scientific research shows that potential harm of cannabis use is generally and especially in vulnerable groups such as Aboriginal, young people, people belonging to poor socio economic background. The habit starts from peer pressure and gradually becomes an addiction. Rates of cannabis use by people with mental illness such as anxiety and depression also show heavy use of cannabis use.(Castle, 2004)
The self medication hypothesis states that people experiencing signs of mental health disorder consume cannabis in order to alleviate or increase symptoms. There have been longitudinal studies to determine whether the mental illness is related to cannabis use. The hypothesis covers two scenarios –that cannabis initiates mental disorder that were previously lying inactive and that cannabis causes mental health illness who would not otherwise develop them. Thus research has been conducted on biological mechanisms such as effects of cannabis on brain chemistry and its effects on people without genetic predisposition to mental illness. Other social effects are taken into consideration when researching on cannabis users exposed to factors such as poor mental health, substance using peers, school dropout, unemployment and crime. It is a difficult to justify the effects of cannabis on an individual if many variables co exist both for the cannabis user and people with other social vulnerabilities including family difficulties. Thus it is possible that there is a common genetic factor that predisposes individuals to cannabis use and mental illness (Patton et al, 2002).
According to D’Souza et al (2004) there is little dispute that cannabis can produce short term recurrences of pre existing psychotic symptoms. However there is no evidence relating to the fact that cannabis actually causes schizophrenia or other psychotic illness in long term (Johns, 2001). Research also shows that cannabis can also amplify a pre existing thought in an individual. These thoughts tend to overwhelm the individual causing severe reactions by individuals including suicide and self harm in extreme cases. In order for ascertain the research Hill (1965) states that following criteria must be met: Strength, consistency, specificity, temporality, biological gradient, coherence and plausibility. Every case needs to support each criteria to make the hypothesis stronger.
Relationship between Cannabis consumption and Psychosis
A recent study conducted by Hldes et al (2006) states that there is a two way relationship between psychosis and cannabis which states that regular use of cannabis is associated with higher risk of psychotic relapse. Many longitudinal studies have found that the mental illness particularly psychosis leads to increased use of cannabis.
Research conducted by Hall et al (2004) states that most common symptoms related to the individuals with psychosis smoking cannabis were sudden confusion which were generally related to delusions and hallucinations. Their emotional state became unstable and showed signs of paranoid symptoms. These findings have been supported by individuals suggesting that they took large doses of cannabis product. Most of these people had no family history of psychosis. Their symptoms were gone once the individuals stopped their cannabis intake. These symptoms were seen back within days once the individuals started cannabis consumption again. Thus this evidence supports the hypothesis that the regular use of cannabis increases chances of psychosis in an individual.
On the other hand the other hypothesis can be argued that cannabis intake does not support psychosis. There have been number of studies conducted that have compared people with people who have mental illness post cannabis use and who have developed mental illness prior to cannabis consumption. There is always a little variation in the results. According to Mental health council of Australia, there have been number of researches that have been conducted investigating the cannabis use among individuals with psychotic disorders and found that they were not significantly different from the general population. A range of motive can be grouped into following four categories: coping with unpleasant affect (to relieve emotional distress), enhancement (to have fun), social interaction (to affiliate with others), confirming (to fit in) (www.mhca.org.au)
The evidence obtained shows that the first two tend to be heavy cannabis consumers and the later two are just recreational. The first two consume cannabis to relieve themselves from emotional distress, psychotic symptoms and medication side effects which lead them to consume heavy amounts of cannabis in order to feel that state of mind and emotion. People with psychosis initially use substance to change their emotional state and facilitate social contact. They then develop dependence on this substance stating,” If I don’t smoke then I will not be able to cope.” These individuals then have belief that cannabis is the only way out thus worsening their psyche and this will lead to worsening cannabis dependence (Spence in Castle and Murray, 2004)
Various cases and individual analysis state that there is a strong connection between cannabis consumption and psychosis. The hypothesis states individuals consuming cannabis have developed symptoms of psychosis and these individuals have normalised once they stopped consuming cannabis. Thus, there is some evidence that suggest that cannabis consumption will impact the psyche of an individual but these findings are inconclusive at this stage as it fails to take into consideration other variables such as socioeconomic background, mental state, lack of family and community support.
Relationship between Cannabis Consumption and Schizophrenia
Schizophrenia is a mental illness caused by disintegration of thinking process and disorientated emotional response. It usually consists of hallucinations, paranoid, disorganized speech and thinking process with social and occupational dysfunction, withdrawal from reality, social apathy (www.dictionary.com)
According to research by Mental Health Council of Australia relationship between Schizophrenia and cannabis use is growing though by no means comprehensive. Schizophrenia affects one percent of the Australian population. Smaller but substantial bodies of research exist such as depression and anxiety. In some cases, Schizophrenic patients had previous symptoms of psychotic illness (Hall et al, 2004).
In research conducted on 100 young people consuming high amount of cannabis, 49% male with an average age of 19.3 years were identified at ultra high risk of psychosis. Schizophrenia was the symptom with presence of other acute psychotic symptoms. This research is very difficult due to the fact that there are many variables that co exist both cannabis users with mental health illness and non cannabis users with mental health difficulties have similar behavioural problem. Most of them have substance abuse history, unemployment and life time on benefits past. It can be possible that these are the common genetic factors in both cannabis users with mental health issues and non cannabis users with mental health issues (www.mhca.org.au).
Longitudinal studies show that continuous cannabis consumption in people with schizophrenia is associated with worse mental health outcome in terms of more severe symptoms and thus there is a greater chance of relapse and more psychosocial issues. Thus frequent cannabis use is associated with a higher risk of psychotic relapse and a more increased risk of cannabis relapse (Hides et al, 2006). Studies conducted by Arsenault et al, (2004) cite cross national surveys from USA, Netherlands and USA found rates of cannabis consumption among people with Schizophrenia was double than those of general population. Thus following conclusions were derived from these findings:
Evidence of self medication of cannabis because of pre existing Schizophrenia due to the mental health issues caused by schizophrenia related to negative symptoms may be a factor in continuous Cannabis consumption. There have been consistent longitudinal studies stating that cannabis precipitates schizophrenia and many other psychosis related symptoms in people who are vulnerable because of their family background. The rate of schizophrenia has remained stable or decreased with increases in cannabis use over the past few decades. Overall longitudinal studies conducted by Nemesis study from Holland and New Zealand have made these findings that conclude that cannabis can be considered a casual factor in schizophrenia. Research has found that alleged increases in cannabis use over past two decades have not affected increase in rate of schizophrenia. However vast number of people who consume cannabis have not developed schizophrenia and vast number of people who have schizophrenia have not got schizophrenia because of their cannabis consumption (Degenhardt et al, 2004).
Cannabis consumption may affect small percentage of population that is vulnerable socially and mentally. The pattern of cannabis use leading to clinically significant impairment or distress has manifested by a need for increased amounts of the substance to achieve intoxication or desired effect. That effect is then reduced by continuous use of the same amount of substance. Individuals then consume larger amount of substance to achieve that similar feeling and these persistent efforts start to affect the psyche of the individuals. Schizophrenia is more prevalent in individuals with poor socio economic background and history of substance abuse. Cannabis causes changes in neurotransmitter systems that make depressed mood more likely but greater evidence supports that this problem is due to individual behaviour pattern. Evidence from both hypotheses is limited and there needs to be well designed longitudinal studies including studies that examine cannabis use on older Australians to further narrow the relation between cannabis use and schizophrenia (Degenhardt et al, 2004).
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