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Cannabis and young peoples mental health: a guide for those working with young people
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This leaflet summarises what is known about the links between regular cannabis use and mental health problems/disorders in children and young people and is designed for those working with that age group.1 The information and advice given here is based on the most relevant and up-to-date research and has been considered by a range of experts in the field.
the researchers, for a variety of reasons, have not yet either identified or accounted for in their results. There is now general agreement that cannabis use, particularly if regular or heavy,2 (NB: see endnote for definitions of these terms) is associated with a number of mental health problems/mental disorders. However, the evidence for the strength of this association varies across different types of mental health problems/mental disorders. With certain types of problems, there may not be universal agreement about the nature of the link, but the fact that the experts do not agree fully on the interpretation of the research (there are differences of opinion about the role of confounding factors, for example) is not a reason to be unconcerned about the use of cannabis by young people.
1. Please note, different factors may affect adults. Those seeking information about adult cannabis use and mental health problems should consult other sources. For instance, see the leaflet Cannabis and your mental health. www.csip.org.uk/mentalhealthandcannabis 2. The amount or dose of cannabis used depends on several factors, including frequency, duration, method of use and potency of cannabis. The terms regular and heavy are often used, yet there is no consistent approach in the way these terms are defined by different researchers. This variation leads to difficulties when comparing or aggregating the findings across studies. However, those studies that have looked at the relationship between dose and clinical outcome have almost invariably found significant differences between occasional use of cannabis (which researchers variously define as anything from sporadic up to once a week) and regular use (which researchers again variously define as once a week or more). Likewise, the term heavy could refer to more than one joint at a time or differences of tetrahydrocannabinol absorption depending on whether the joint has been shared or not. It should be borne in mind that, unlike alcohol, there is no recommended sensible dose of the psychoactive ingredient present in cannabis tetrahydrocannabinol (THC) at which harm is considered unlikely to occur.
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This suggests a potential for greater problems for those starting younger.
describe herbal cannabis usually grown from selected seeds by intensive methods which results on average in two or three times as much THC (tetrahydrocannabinol, the main psychoactive agent in cannabis) as traditional cannabis (see footnote 2). Although there is some anecdotal evidence that skunk may be contributing to recent increases in hospital admissions for acute drug-induced psychosis, a link specifically between skunk (as opposed to other forms of cannabis) and schizophrenia remains speculative. Even if scientists disagree about the level of risk associated with regular cannabis use in young people, there is consensus that using cannabis regularly when young increases the risk of developing a psychosis. It should be noted, however, that because the prevalence of psychosis is low, only a relatively small percentage of young people is at risk of developing psychosis, whether or not they use cannabis.
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one study has shown that cannabis use in young girls increases the risk of depression and anxiety. Another study found that weekly cannabis users between the ages of 14 and 21 were almost twice as likely to suffer from depression as non-users. Suicidal ideation and suicide attempts were 7 and 13 times higher respectively for 14-15 year old cannabis users than 14-15 year old non-users (but that these rates dropped significantly with age). Another study found that those who used cannabis heavily were four times as likely to develop depressive symptoms than those who did not. In contrast to these studies, a recent survey of 12-16 year olds found cannabis use was linked more strongly with aggression and delinquency, rather than depressive or anxiety problems. As with psychosis, without further more powerful studies there remains the possibility that the association between cannabis use and poor mental health consequences is not causal and depends on other factors and mechanisms as yet unaccounted for. Given the strengthening of the evidence for an association, and a consensus that regular cannabis use exacerbates pre-existing mental health problems, it seems prudent to caution strongly against the use of cannabis, especially by those who already have mental health or behavioural problems. There are also often less direct, but long-lasting and profound mental health consequences of heavy cannabis use, such as missing a lot of school, a lessening of motivation to achieve and a withdrawal into a small circle of like-minded friends, thereby reducing the exploration of other worlds which is such an important part of adolescence. Furthermore, cannabis use (even after its reclassification to a Class C drug) remains illegal and carries with it the risk of criminalisation. Under-18s face arrest if caught with cannabis. The criminal and social consequences that can arise from young people being identified as cannabis users may indirectly have a negative impact on their mental health.
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and, where this proves difficult, to watch closely for its negative effects, including the onset of psychosis or the possible relapse of problems that were otherwise improving. For the vast majority of young people, many of whom are at risk at different times and in different ways of developing both mental health problems or of using cannabis, the evidence on the impact of cannabis use is still emerging. Given what we know thus far, this should lead to a very cautious approach to those people who engage in cannabis use at a young age or who are becoming regular and/or heavy users. Finally, it is important to stress that the dangers of tobacco, usually smoked with cannabis, are well evidenced. Young people need to be reminded of these in this context.
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GLOSSARY
Amotivational syndrome This refers to a pattern of symptoms, including apathy, social withdrawal and impairment of memory, concentration and judgement which has been described in long-term cannabis users. Cognitive impairment This term refers to a reduction in the ability to use higher-level mental faculties, such as concentration, idea-formulation, problem-solving, reasoning, memory and motivation. Mental health problems/mental disorders Mental health problems refer to a broad range of emotional and behavioural difficulties, covering stress, anxiety, depression etc. These vary in the level of distress they cause and the extent to which they interfere with everyday living. It is estimated that around 20% of children and young people have a mild-to-moderate mental health problem. Often these problems can be contained with help and support within the family, school or community before they become overwhelming. The term mental disorders refers to conditions that are diagnosable and may require treatment. They are usually more severe and distressing than isolated mental health problems, often resulting in significant interference with everyday life for weeks, months and even years. Just over 10% of children and young people between the ages of 5 and 15 have a mental disorder. Psychoactive medication This refers to a wide range of prescribed medications that have effects on the brain and on thinking and feeling, some of which are used in the treatment of mental health problems and disorders. They include anti-psychotic drugs. Most drugs of abuse, such as cannabis, also have substantial psychoactive effects. Psychosis This is a general description for an acute or chronic abnormal state of mind that can be characterized by a number of psychotic symptoms and signs, such as rigidly-held false beliefs (delusions), sensing things that are not really there (hallucinations), disorganised thinking patterns and behaviour, and in which the individual appears to have lost contact with reality in some way. There are many possible causes of psychosis, including genetically determined conditions, prescribed and illicit drugs, severe infections and, in some
predisposed young people, excessive psychological stress. As well as the acute or short-lived psychoses, certain clinically recognised mental disorders particularly schizophrenia and bipolar (or manic-depressive) disorder - are characterised by severe and persistent symptoms, hence these are also known as psychotic disorders. However, many research studies use the term psychotic disorder more imprecisely to refer only to disorders with schizophrenia-like features. In this text we have used the term explicitly and in its widest sense. Psychotic symptoms These are the specific abnormalities of mood, thought and experience, such as hallucinations or delusional beliefs that may occur in isolation (for example as an acute effect of cannabis or other drug use) or with other psychotic symptoms and signs in a range of different psychotic and non-psychotic disorders in young people. An individual may be very troubled by one particular symptom (e.g. paranoia whilst using cannabis or cocaine) but may otherwise maintain quite good contact with reality generally. Schizophrenia This refers to a specific type of psychosis which is particularly important because of its severity or its persistence in many of those affected (with a generally accepted lifetime prevalence of 1%). Schizophrenia usually begins in early adulthood and commonly requires lifelong treatment. Although it is understood that genetic predisposition plays an important role, environmental factors have also been shown to influence both the onset and severity of its course. Much of the research that has looked at early cannabis use and risk for later development of psychosis has measured either risk of psychotic symptoms, risk of schizophrenia-like states or risk of developing schizophrenia itself, which has made reaching confident conclusions more difficult. Tetrahydrocannabinol (THC) This is the main psychoactive ingredient in cannabis.
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BIBLIOGRAPHY
Advisory Council on the Misuse of Drugs (ACMD) (2006). Further consideration of the classification of cannabis under the Misuse of Drugs Act 1971. London: Home Office. See: http://www.drugs.gov.uk/ publication-search/acmd/cannabis-reclass-2005 Arendt, M., Rosenberg, R., Foldager, L., et al. (2005). Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. British Journal of Psychiatry, 187, pp. 510515. Arseneault, L., Cannon, M., Poulton, R., et al. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal, 325, pp. 1212-1213. Arseneault, L., Cannon, M., Witton, J., et al. (2004). Causal association between cannabis and psychosis: examination of the evidence. British Journal of Psychiatry, 184, pp. 110-117. Bovasso, G. B. (2001). Cannabis abuse as a risk factor for depressive symptoms. American Journal of Psychiatry, 158 (12), pp. 2033-2037. Fergusson, D. M., Horwood, L. J. & Swain-Campbell, N. (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction, 97 (9), pp. 1123-1135. Fergusson, D. M., Horwood, L. J. & Ridder, E. M. (2005). Tests of causal linkages between cannabis use and psychotic symptoms. Addiction, 100 (3), pp. 354-366. Henquet, C., Krabbendam, L., Spauwen, J., et al. (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal, 330 (7481), pp. 11-14. Jenkins, R. (2006). Cannabis and young people: reviewing the evidence. London: Jessica Kingsley. Macleod, J., Oakes, R., Copello, A., et al. (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. The Lancet, 363 (9421), pp. 1579-1588. Monshouwer, K., Van Dorsselaer, S., Verdurmen, J., et al. (2006). Cannabis use and mental health in secondary school children: Findings from a Dutch survey. British Journal of Psychiatry, 188 (2), pp. 148-153. Negrete, J. C., Knapp, W. P., Douglas, D. E., et al. (1986). Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychological medicine, 16 (3), pp. 515-520. Patton, G. C., Coffey, C., Carlin, J. B., et al. (2002). Cannabis use and mental health in young people: cohort study. British Medical Journal, 325, pp. 1195-1198. Schneider, M. & Koch, M. (2003). Chronic pubertal, but not adult chronic cannabinoid treatment impairs sensorimotor gating, recognition memory and the performance in a progressive ratio task in adult rats. Neuropsychopharmacology, 28 (10), pp. 1760-1769. YoungMinds (2006). A work in progress: the adolescent and young adult brain: a briefing paper. London: YoungMinds. See: http://www.youngminds.org.uk/sos/SOS_YM_AdolescentBrain.pdf
Websites
www.drugs.gov.uk
Visit the government drugs strategy website for more information on the latest research, the reclassification of cannabis and information for professionals and others interested in this area. Website contains resources that professionals can download or order for users.
www.knowcannabis.org.uk
This website can help young people assess their cannabis use, its impact on their life and how to make changes and cut down if they want to.
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Useful organisations
Addaction
Tel: 020 7251 5860 (Mon-Fri 9am-5pm) Email: info@addaction.org.uk Website: www.addaction.org.uk Provides a range of drug and alcohol services for adults and young people.
Rethink
Rethink general enquiries: 0845 456 0455 Email: advice@rethink.org or info@rethink.org Website: www.rethink.org Website includes information and discussion boards about cannabis and mental health. Rethink provides services for people with severe mental illness and their families and carers.
DrugScope
Call 0870 774 3682 for further information on drugs and their effects Email: info@drugscope.org.uk Website: www.drugscope.org.uk Provides a full range of information and other resources on drug issues.
Youth Access
Signposting Service: 020 8772 9900 (Mon-Fri 9am-1pm and 2-5pm) Email: admin@youthaccess.org.uk Website: www.youthaccess.org.uk (directory of services now available online) A national membership organisation for youth information, advice and counselling agencies. Provides information on youth agencies to children aged 11-25, their carers and professionals who work with them, but does not provide direct advice.
FRANK
Freephone: 0800 77 66 00 (24-hour service. If you call from a landline the call is free and wont show up on your phone bill. Also provides language interpreting service for non-English speakers.) Textphone: 0800 917 8765 (24 hours) Email: frank@talktofrank.com Website: www.talktofrank.com Friendly, confidential advice about drugs.
Mind
MindInfoLine: 0845 766 0163 (Mon-Fri 9.15am-5.15pm. Also provides a language translation service.) Textphone: 0845 766 0163 (if you are using BT Textdirect, add the prefix 18001) Email: info@mind.org.uk Website: www.mind.org.uk Offers information about mental health.
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YoungMinds PO BOX 52735 LONDON EC1P 1YY Parents Information Service: 0800 018 2138
(Monday and Friday 10am-1pm,Tuesday and Thursday 1-4pm, Wednesday 1-4pm and 6-8pm) Office telephone: 020 7336 8445 YoungMinds Order Line: 0870 870 1721 Fax: 020 7336 8446 Email: enquiries@youngminds.org.uk Website: www.youngminds.org.uk YoungMinds is the leading charity committed to improving the mental health of all children and young people. YoungMinds Parents Information Service is a free confidential telephone service providing information, advice and details of other national/local services to any adult with concerns about the mental health of a child or young person.
This leaflet can be downloaded from: www.youngminds.org.uk/cannabis To obtain up to five further copies of this leaflet (ref L15), please call the YoungMinds Parents Information Service on 0800 018 2138. Alternatively, bulk copies can be purchased by calling the YoungMinds Order Line on 0870 870 1721.
This leaflet was produced by YoungMinds. YoungMinds 2006. This publication was up to date at the time of going to print. YoungMinds Parents Information Service is supported by the Department for Education and Skills. Freephone supplied by Verizon Business. YoungMinds wishes to thank those people who commented on drafts of this publication. YoungMinds is a registered charity no. 1016968.