Notes
Outline
Cannabis Substitution: Harm Reduction Treatment
for Alcoholism and Drug Dependence
Tod Mikuriya & Jerry Mandel
California Cannabis
Research Medical Group
1168 Sterling Avenue
Berkeley, CA 94708-1757
Introduction
The Compassionate Use Act of 1996 exempts patients and caregivers from state laws prohibiting possession and cultivation of marijuana
“…shall not apply to a patient or to a patient’s primary caregiver who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.”
Case #1 Patient D.A.
Since then, 104 cases after the 1996 California Compassionate Use Act
Sought recommendation and approval for eligibility under
Age of Patients Cover A Wide Range:
The 104 "drug replacement" patients are fairly evenly dispersed throughout the adult age range, with a median age of about 40..
Marijuana in the U.S. is no longer just a young person's drug. The young generation which, en masse, had discovered marijuana in the 1960's, are themselves about to enter their sixties. The broad age distribution of patients enabled the viewing of cannabis substitution over the course of a life-time. The author was long ago impressed by these histories, and routinely asks patients if their parents were alcoholics.
Drug Problems Start Early:
Many patients traced the cause of their own alcoholism back to their childhood.
Half of the sample had at least one alcoholic parent
Alcoholism, a chronic relapsing disease.
Tamert and Mendelssohn summarize the psychophysiologic process:
“The anxiety reduction model often utilized to explain initiation and perpetuation of episodic drinking was found inadequate to explain motivation for alcohol use by the alcoholic. Euphoria and elation were manifest only during the initial phases of intoxication. Prolonged drinking was characterized by progressive depression, guilt, and psychic pain. These unpleasant affects, however, were poorly recalled by the alcoholics following cessation of drinking.
Alcoholism- chronic and relapsing
Compulsive and constricted behavior patterns, which were present during sobriety, changed markedly during intoxication, with increased verbalization, varied expression of feelings, increased interaction, and frequent behavioral regression. During inebriation, psychic defenses appeared weakened with significant reduction of repression and reaction formation.” (Tamert and Mendelsohn  1969)
Harm reduction substitution
Alcoholism and alcohol abuse
Detox with high oral dose
Agitation and DT’s controlled
Inhale supplementary
Maintenance with lower dose
Control residual craving
Vaporization preferred
Minimize contact with other alcohol users to minimize relapse trigger behavior
Free from poisoning the recovery begins
Freedom from toxicity afforded by cannabis compared with alcohol is the simple physiologic reality. The problematic biphasic chronic alcohol inebriation-withdrawal cycle ceases with cannabis substitution. Sleep and appetite are restored, ability to focus and concentrate is helped, energy and activity levels are improved, pain and muscle spasms are relieved. Family and workplace relationships are restored as long term goals replace crises and apologies. Sobriety through cannabis substitution for some is not unrealistic. In providing a substitute for alcoholism and other drug habits, cannabis restores normal physiologic functioning of CNS, GI, hepatic, orthopedic, and endocrine systems.
Mood and affect modulator
Controls emotional overreactivity and mobilizes affect.
Improves attention and mental acuity by decreasing distraction.
Restores sleep without “hangover” or fogginess.
Psychosocial “easer”
Restoration of  perceptual awareness has a calming and comforting effect.
Controls emotional reactivity and enhances attention and focus.
Permits socialization and empathetic competence.
Integrates, facilitates connection among cognitive, emotional, and physiologic systems.
Psychosocial
Exemption from marijuana law prosecution removes stressors.
Fear of loss of freedom, job, housing, custody, health services, compensation, and harmful contact with police, court, probation, social workers, & etc.
Dealienation with improved self esteem, socialization, and health services access.
Findings from the initial case confirmed.