The Progressive Nature of Addiction Specific to Cannabis/THC: Dependence, Abuse, and Addiction.©

by Antonia Teresa Amore Broccoli, MSW, LCSW

Clinical questions for your own personal use workbook or to write your story for the forthcoming Addiction Studies book. 

 Outline:

1. Early Stages of Use and Dependency: Recreational vs. Dependency

2. Middle Stages of Use and Dependency: Functionality and Self Medication

3. Addiction as a Psycho-Biological and Social Disease

4. Denial Characteristics of Addiction

5. Late Stage Addiction and Dependence: Loss of Control of Substance Use

6. Latest Stage of Addiction: Bottoming Out and Breaking Free of Denial

 7. Adverse Negative Consequences from Cannabis Use and Abuse.

A) Cognitive Function Effects

B) Psychological or Mental Effects

C) Physical Effects on Health

D) Social Effects 

E) Personal and Professional Effects

F)     Spiritual Effects

8) Detox and Post-Acute Withdrawal from Cannabis

A) Cognitive Function Effects

B) Psychological or Mental Effects

C) Physical Effects on Health

D) Social Effects 

E) Personal and Professional Effects

F) Spiritual Effects

9) Sobriety and Transformational Recovery

G) Emotional Sobriety

H) Relapse and Relapse Prevention

I) Long-term Sobriety

Personal Background Questions about yourself; please keep questions in mind if you are writing your recovery story

Background Questions about You: Please keep these questions in mind as you write your recovery story and how specific issues impacted your life, addiction and recovery. 
These questions can be answered directly if you prefer. Keep in mind if writing your story for the website or for the book; please write the various personal issues and experiences you experience regarding race, ethnicity, class, gender identity and sexual preferences. 

A. When did you first realize you were a girl and/or a boy . How was (as a child) being raised socially as a girl or boy was special and/or different. 

 B) Explore your gender identity.  Did you conform to the society and family expectations of your assigned and biological sex and gender? Explain if applicable.

 C) Did you know you felt different as a girl or boy child? If so, why? How? Please explain. 

D) What cultural and/or racial culture did you grow up with? Was it different from the dominant Anglo culture? Did you grow up in a diverse community or go to a school which was diverse in populations of various ethnic and racial backgrounds?  

E) When did you first become aware that not all races, ethnicities and cultures were created equal and or had the same weight in society? 

F ) Did you experience racial and ethnic trauma or discrimination as a child and young teenager/adult? 

 G)  What did you first dream about as a child or young adult, before you ever started using cannabis?  

The Progressive Nature of Addiction 

 Cannabis/Marijuana Dependence, Abuse, and Addiction

A.  Early Stage of Use and Dependency:  This stage is when you first began using cannabis, whether recreationally or otherwise.   (questions 1 - 4)

The above questions are some of the precipitating factors leading to cannabis use and cannabis  dependence. 

Feel free to utilize the four questions above and expand any other precipitating factors that impacted your childhood and adolescence and young adulthood. 

1. For example, do you feel you had specific underlying issues from your childhood or adolescence, or a family history of addiction or alcoholism which contributed to you having a vulnerability to cannabis dependence and addiction?

2. When did you first begin using cannabis? How old were you? What were the circumstances?

3. Did you feel peer pressure to do so? 

4. How did cannabis make you feel?

5. How often did you use it in the beginning? Was it recreational at first?

B) Middle Stage of Use and Dependency: 

This stage is when your cannabis use progressed from occasional or recreational use to dependency. (questions 5 - 33)

6) Did your use progress to regular and/or daily use? When did this happen? How old were you?

7) How did your use of cannabis develop chronologically over time from recreational use, to dependence, to active addiction?

8)  Tolerance: Tolerance is described as a period where ____________. 

Did you begin to use more and/or need more cannabis to get high and maintain your chronic use? If so, how and when?

 9)  How did this stage of the progression of your addiction affect your life?

10) Were you using cannabis to relieve emotional problems?

11) At this time, did your daily life become more difficult and did you feel you were becoming more socially isolated? 

12) There is an experience known as amotivational syndrome which can become part of the regular cannabis user’s experience of addiction. This term refers to a growing lack of interest in completing tasks, poor concentration, and a sense of apathy about one’s future. It can also include a decrease in the desire for social activities. As you became a regular user of cannabis, did you experience this effect? 

13) Did you tend to use cannabis in social situations to make you feel less inhibited and/or to relieve social anxiety?

14) Did you use cannabis for medicinal reasons (regularly/chronically) to relieve mental, psychological, and/or physical ailments?

15) As you were using cannabis more often, did you notice a decline in your cognitive function or thought processes over time?

16) Did you ever experience problems with staying focused or completing tasks for yourself, since using cannabis? 

17) Did you ever experience problems with staying focused or completing tasks in regard to others, since using cannabis?

18) Did you experience problems with short-term memory loss or did you sometimes overlook details since you began using cannabis?

19) Did you ever operate a vehicle or any other kind of machinery while using cannabis? If so, did you ever feel a sense of invincibility when doing so? 

20)  Since you began using cannabis, did you find you had difficulties maintaining boundaries or having sound reasoning? 

21)  As your use progressed, did you become more apathetic about life in general, especially in regard to your life’s purpose, and/or your career or educational goals?

22) If you were a parent: Did you have problems with being more permissive or alternatively, with being more rigid and controlling with your children since your cannabis use began? Did you feel you were the parent you wanted to be?

24) Were you ever irritable, discontent, and/or impatient or depressed when coming down from cannabis use? 

25) Did you ever experience the above feelings and decide to get high again? Did you notice that you wanted to get high sooner and more often?

26) Did you ever become anxious when your cannabis supply was nearly gone? Did you go to extreme lengths to be sure your supply didn’t run out?

26) Did you hide your cannabis stash in different places and later forget where? Did you hide it from a significant other or family members?

27) As your cannabis use increased, did you ever feel your life was becoming sluggish, as if time was slowed down or stopped completely? 

28) Did your cannabis use affect your ability to follow through on pursuing your dreams and aspirations?

29) Did you at times consider abandoning your dreams and aspirations or have feelings of complacency, telling yourself that spending more time getting high was okay?

30)  Did you ever experience any adverse consequences in your job or in school as a result of your cannabis use?

31) Did you ever feel an increase in your mood instability, or an overall decline in your mental health? 

32) Did your friends, family members, or co-workers ever confront you or become upset with you regarding your cannabis use?

33) When you were under the influence of cannabis, did you tend to feel more present or more distant with regular use? Please describe.

34) Were you aware that you had become dependent on using cannabis, or were you still unable to recognize it? 

C. Late Stage Addiction and Dependence: 

(This stage is when your cannabis use has been regular and habitual for a period of time. )

Full blown active addiction is referred to as Late Stage Addiction. It includes complete loss of control and/or an inability to moderate or regulate your cannabis use. It also includes everyday use; sometimes throughout the day and night and/or at the same times of the day.  For many women, their use progresses from every few hours every day, to round the clock use. (questions 34 - 40) 

35)  Did you ever try to reduce your use or moderate or control your use of cannabis? Were you ever successful in doing this? 

36) Did you make promises to yourself about reducing your use, and then find you were unable to keep them? If so, did this cause feelings of shame, self-criticism, or depression?

37) Did you ever reach a point where you knew you had lost control of your cannabis use? Did you find yourself using it despite your best intention not to use it? 

 38) Once at this point, did you ever have increased problems with impulse control, anger or rage?

Method of Use:

At this stage, some women change their type or method of cannabis use as an attempt to moderate or control their use. How did you use marijuana? For example, did you smoke a pipe, use joints, blunts, bongs or water pipes, try vaping, or eating edibles and tinctures? Please explain. 

39) At this point, how much cannabis did you use with each delivery method? How often? Did your use and/or method change over time as you progressed into later stage addiction? Please describe.

The Role of Denial: 

Denial is the number one characteristic of active and long-term addiction. Denial is the refusal to recognize that you have an addiction to a substance. 

 40)  By this stage, did you ever have serious thoughts of quitting? Were you able to imagine your life without using cannabis?  

41) Alternatively, did you feel you were in a period of denial? How did your denial contribute to your long-term chronic cannabis use? Please explain your period of denial. (questions A - D)

 A)   Did you rationalize and convince yourself and others that you were in control of your cannabis use? In what ways?

B)  At this time, did you believe that you were functional and still managing your life, your personal relationships, and career without any problems?

 C)  Did you decide that any problems you had were unrelated to your cannabis use?

D) As previously mentioned, addiction is a disease of denial. Overcoming one’s denial is a significant stage of recovery in the life of an addict. Can you describe that stage? How did you begin to confront and break through your denial? For example, were you able to confront specific delusions of functionality you held, fueled by your active cannabis use? How? Please explain this period and how your self-awareness changed. What factors led to this change? Was there one moment or breakthrough in particular? Or was it a series of moments which finally culminated in breaking your denial that you were an addict?

Adverse Effects of Long-term Addiction:

There are numerous unfavorable effects of long-term cannabis use. Some of these include adverse physical, psychological, and emotional effects such as tachycardia (rapid heartbeat), hypotension (low blood pressure), decreased cognitive function, short-term memory loss, dry mouth, impaired motor skills, reddened eyes, muscle relaxation, paranoia, anxiety and anxiety attacks, psychosis, and decreased gastrointestinal motility. Some research has indicated that marijuana use may also worsen pre-existing mental health conditions such as depression, ADHD, anxiety, bipolar and schizophrenia. Other research indicates an increased likelihood of developing mental health issues or symptoms as a result of chronic cannabis use. Acute high THC toxicity levels can even lead to psychosis over time. 

We define addiction as the drive to continue a behavior or an activity, or to use a particular substance despite seeing ongoing harmful life consequences resulting from that behavior or substance use. The following questions address specific adverse consequences that may have occurred in your life as a result of your chronic use and abuse of cannabis. (questions 41 - 53)      

42) Addiction and Cognitive Function: Chronic cannabis use affects women's ability to function, think, and make sound decisions. This is known as our cognitive function. If impaired, it can affect one’s life both personally and professionally. What cognitive deficits or problems did you face as a result of your marijuana addiction and dependency?

Long-term use of cannabis can also lead to a lack of motivation, inability to follow through on life tasks, emotional detachment, and abstinence. 

 43) Psychological or Mental Deterioration:  Mental deterioration can often manifest as our addiction progresses. Addiction can be viewed as a disease of the self. That is, we as women can use marijuana to numb out or dissociate from reality. In this way, we may become disconnected from ourselves and from our day to day reality, and experience mental decline. 

44) How was your emotional, psychological, and/or mental state affected by chronic cannabis use? Did you ever feel a decline in your mental sharpness?

45) Do you feel you experienced more frequent depression, anxiety, panic attacks, etc. as your addiction to cannabis progressed?

46) How did your cannabis addiction affect your physical health and well-being and your ability to stay active physically?

47) Cannabis Induced Psychosis: 

With long-term cannabis addiction, high levels of THC in your system can sometimes lead to induced psychosis, that is, a disconnection from reality. Did you ever become psychotic, or did you ever feel disconnected from reality, as a result of your cannabis use? 

48)  If so, did you recognize it and seek outside help for it?

49) Hyperemesis and Long-term Cannabis Use:

Hyperemesis is severe or prolonged nausea and vomiting. It can sometimes be associated with long-term cannabis/marijuana use. Did cannabis use ever affect your gastrointestinal tract? If so, did you experience hyperemesis? 

If hospitalized please expand on the medical events including how many encounters. 

50) Eating disorders can also be associated with long-term cannabis use. Did you develop an eating disorder as your chronic cannabis use progressed?

51) At this stage, how was your cannabis addiction affecting your life socially? That is, were your intimate relationships with your spouse/significant others, family and/or parenting or any other social interactions impacted?  How?

 52) At this point, was your career and your dreams or visions for the future being affected? This would include your aspirations and life goals regarding your professional life and also your personal life goals. Were any of these impacted by your ongoing use of cannabis? How?

 53)  Did you ever feel you were wasting your life away by being “wasted,” “stoned,” and “high” the majority of your time

54) Did you attempt to use cannabis as a pathway to spiritual enlightenment and/or a higher level of consciousness? Please explain. How did this change over time, with chronic use?

 D. The Latest Stage of Addiction: Bottoming Out: 

This stage is marked by the time you first experience bottoming out and you first begin to break through your denial. By bottoming out, we mean your addiction has become so total that every aspect of your life is now affected. It is all-consuming, and you finally realize you must seek help to get better. (questions 54 - 59)

 55)  While in the all-consuming grip of your addiction, what wasn't working in your life now?

56) What part of your life, if any, was still functioning?   

57) Can you describe what it was like when you finally hit your bottom, at the very end of the progression of this disease? 

Breaking Free of Denial:

As mentioned above, denial is the refusal to recognize that you have an addiction to a substance. Once you begin to recognize you have a serious problem with a substance, your denial is finally shattering. This period of your breakthrough can be a frightening or exhilarating moment or it can be a gradual dawning and awakening.

58) How were you able to break free of your own denial, especially regarding challenging the delusions of functionality you had previously held during your active cannabis addiction? 

59) Do you feel your denial about your addiction was finally shattered through a series of moments or awakenings which finally accumulated? Or was there one moment in particular which finally broke your denial? If there was one moment in particular that you remember as a pivotal moment of your awareness, what brought this moment about? Please explain.

60) What motivated you to seek recovery and finally get clean of cannabis?  

E. Long-term Recovery and Relapse Prevention 

This is the stage when you have entered recovery and are actively working every day to stay clean and sober. (questions 60 - 71)

 61)  How long have you been in recovery?

62) What treatment modalities did you use during your early, middle, and later stage of recovery? For example, did you see an addictions counselor, did you attend twelve step meetings, did you find a sponsor? Or something else?__________ Please describe your chosen methods of recovery.

 63)  Relapsing is a return to active addiction after a long or short period of abstinence. Do you ever have concerns about a possible relapse in your addiction? Please explain.

64) Can you identify your own personal emotional and physical triggers that could possibly cause you to relapse, or lose your sobriety? If so, what are they? 

65) Have you ever relapsed, that is, returned to active addiction after a long or short period of abstinence from cannabis? If so, how? What happened and why?

66)  How long did your relapse last? Please tell the story of your relapse, what contributed to it, and how you got back into recovery. 

67) Have you ever relapsed with a different substance other than cannabis, such as pain medications or alcohol? 

68)  After your relapse, if you experienced one, how long did it take you to get clean and sober again? Did you ask for help? Who helped you?

69) Since relapsing, do you feel you have now gained a better understanding of your own emotional and physical triggers that could lead to another relapse? If so, please explain. 

70) How do you address relapse prevention today? Do you have specific practices to prevent a future relapse?

71) Can you offer any learned wisdom for other women/people in the prevention of a relapse?

72) What advice can you share with other women/people struggling with chronic cannabis abuse who have a goal of long-term sobriety from this substance?

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