MARIJUANA AND MENTAL HEALTH !

The Impact of Marijuana Use on Mental Health: A Review

Elizabeth Carrier

University of North Georgia

MARIJUANA AND MENTAL HEALTH !2

Abstract

In a rapidly shifting legal climate, this paper summarizes some of the major research

conducted on how marijuana use may impact an individuals mental health. Although numerous

studies have been conducted to determine marijuanas impact on the mental health, there is still

disunity over whether the benefits of legalizing marijuana outweigh the risks. This paper focuses

on longitudinal studies which have attempted to determine the possible impacts that marijuana

use might have on several factors involved with mental health such as anxiety, depression, and

the development of psychosis. Through the summary of several studies this paper analyzes the

research, methods, conclusions and possible limitations of some of the most prevalent research

on marijuana that exists in todays field of psychiatry.

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The Impact of Marijuana Use on Mental Health: A Review

As of November 8, 2016 twenty-eight states have legalized marijuana for medical use,

and seven have legalized if for recreational use. It was reported in 2014 by the National Institute

of Drug Abuse that almost 52% of young adults ages 18-25 had used marijuana in their lifetime.

(Grunberg, Cordova, Bidwell, & Ito 2015, p. 590). The opinions of United States citizens are

rapidly shifting in favor of decriminalizing marijuana, and making it widely available for

medicinal and recreational use. Unfortunately, this shift has been set into motion without new

evidence for the wide spread benefits associated with marijuana use. In contrast, there has been

evidence which has linked the use of marijuana to the development of psychosis and psychotic

disorders (Griffith-Lendering et al., 2013, p. 737). Studies polling adolescents show that there is

an immense amount of confusion surrounding the long term side effects of marijuana use

(Roditis & Halpern-Felsher, 2015, p. 182). By examining several longitudinal studies and

reviews, this analysis will attempt to summarize what peer reviewed literature has found both the

positive and negative effects of marijuana on mental health to be.

There are several speculations as to the possible mental health benefits of marijuana. A

study titled Can Marijuana Make It Better? Prospective Effects of Marijuana and Temperament

on Risk for Anxiety and Depression examined individuals who experience moderate levels of

anxiety and depression and how marijuana use related to their symptoms. (Grunberg, Cordova,

Bidwell, & Ito 2015, p. 591). Their hypothesis was that marijuana use would help in the relief of

symptoms of anxiety and depression, and result in lower levels of depression in individuals who

were frequent users (Grunberg, Cordova, Bidwell, & Ito 2015, p. 591).
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To conduct their experiment, they found three-hundred students willing to participate in

their study and had them complete the Temperament and Character Inventory. The

Temperament and Character Inventory was used to measure traits such as Harm-Avoidance,

Novelty Seeking, and Reward Dependence to see if certain personality traits impacted their risk

for anxiety and depression (Grunberg, Cordova, Bidwell, & Ito 2015, p. 592). Then, over the

course of three years they gave the subjects brief self-report examinations to determine the

frequency in which they used marijuana, and to determine if they had experienced any changes

in their experiences of anxiety and depression.

The results of this study found that marijuana use was correlated with decreased amounts

of anxiety and depression in individuals with significant Harm-Avoidance characteristics, but for

all other individuals more frequent marijuana use was correlated with increased levels.

(Grunberg, Cordova, Bidwell, & Ito 2015, p. 599). This study shed some light on the

applicability of marijuana to reduce symptoms of anxiety and depression, however it should be

noted that subjects in the study were solely studies college students, which in theory could have

affected the results of this experiment. In addition, it is important to understand that the results of

this experiment were correlational, meaning that none of the results can empirically prove the

relationship between marijuana in the relief or stimulus of depression and anxiety (Grunberg,

Cordova, Bidwell, & Ito 2015, p. 600).

Although most studies point to the possible negative outcomes of frequent marijuana use

one study that was examined during this analysis showed no significant relationship between

marijuana use and the development of mental health problems. This longitudinal study entitled

Chronic adolescent marijuana use as a risk factor for physical and mental health problems in
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young adult men. aimed to dissipate the confusion surrounding the effect that marijuana has on

mental and physical health.

The study was conducted over the course of twenty two years. It sampled from a pool of

both black and white teenagers and used over seventeen periodic assessments to determine the

physical and mental health of the participants, and to track the frequency in which they used

marijuana. The study began when the participants were fourteen years old and ended with a final

survey when the participants were thirty-six years old (Betchtold, Simpson, White, & Pardini,

2015, p. 555). It attempted to separate the results of the experiment from possible confounds by

excluding individuals who had preexisting physical and mental health problems, and individuals

with substance abuse problems before the study began (Betchtold, Simpson, White, & Pardini,

2015, p. 554).

This study found that marijuana use beginning at an early age was not significantly

associated with an increased risk for developing either anxiety or depressive disorders. This

study also failed to find a significant difference between the development of psychotic disorders

in users and nonusers of marijuana (Betchtold, Simpson, White, & Pardini, 2015, p. 558). The

lack of a difference between users and non-users in regards to the development of psychotic

disorders in this study goes against what the vast majority of research has found regarding

marijuana and mental health. The elimination of individuals with pre-existing mental disorders

from this study may suggest that marijuana does not hold a causal relationship with psychosis,

but rather aggravates pre-existing conditions, making psychotic disorders more likely to develop

(Betchtold, Simpson, White, & Pardini, 2015, p. 558).

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Another question that has been presented through the course of the marijuana legalization

politics is whether frequent use of marijuana can lower a persons IQ. Two twin studies

conducted over the course of ten years sought to determine whether there was a positive

correlation between the frequency of marijuana use and the loss of IQ points. Over the course of

ten years they studied six-hundred and fourteen families of twins and triplets. At the beginning

and the end of the study they administered IQ tests such as The Wechsler Abbreviated Scale of

Intelligence, along with three others. In addition, they conducted RFAB self-report analyses

throughout the study to determine the extent of each of the individuals marijuana usage (Jackson

et al., 2016, p. E501).

The results of the study showed that marijuana use was shown to have no significant

impact on IQ. The study presented no major differences between the IQs of twins who were

users and the IQs of twins who were non-users. This evidence implies that differences found in

the study were spurred by environmental factors, and not marijuana use (Jackson et al., 2016, p.

E503).

In comparison to the three previous studies, all of which conveyed minimally negative

effects of marijuana use, the remaining studies in this analysis conclude that marijuana use was

correlated to the development of psychosis and the degradation of mental faculties. One

commentary entitled Legalizing marijuana for medical purposes will increase risk of long-term,

deleterious consequences for adolescents examined possible consequences associated with the

legalization of medical marijuana through a meta-analysis of one-hundred different studies. In its

introduction it stated that over fifty percent of Americans support the legalization of marijuana,

but that recently there had been far more evidence showing the long term consequences of
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marijuana use in comparison to the benefits (Wright, 2015, p. 298). From its analysis, this

commentary determined that there was a clear relationship between frequent marijuana use and

long term cognitive impairment such as less sustained attention, lower ability to control

impulses, and degraded executive functioning. In addition, Wrights commentary also concluded

that there were far too many possible confounds such as socioeconomic status and personality

differences to determine whether marijuana could cause someones IQ to decrease (p. 299).

This commentary was two-fold in its findings. Primarily, it determined that there are

some conditions that marijuana could treat quite effectively, for example marijuana can

significantly reduce the intense seizures associated with Dravat syndrome, along with some other

serious but rare conditions. Its final conclusion however was that generally most conditions that

marijuana could be used to treat could be treated far more effectively through medications with

less potentially harmful effects than marijuana (Wright, 2015, p. 301).

Although it is obvious that the use of marijuana can cause temporary intoxication and

euphoric effects, one review entitled Cannabis use and risk of psychotic or affective mental

health outcomes: a systematic review aimed to determine whether marijuana could cause

psychotic or affective symptoms after the initial period of intoxication (Moore et al., 2007, p.

319).

This study examined both longitudinal population-based studies and case-control studies,

and did not include studies with baseline psychotics in their subject groups (Moore et al., 2007,

p. 322). The analysis found a consistent trend across several studies concerning the number of

cases of psychosis in subjects who had used marijuana. This study also found an increased risk

of psychosis in people using marijuana from a younger age, suggesting that greater exposure to
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marijuana also led to a greater risk for developing psychotic disorders (Moore et al., 2007, p.

325).

Although most of the studies covered in this particular review did a fantastic job of

eliminating their confounds, many of the studies still suffered from being unable to solve the

problem of directionality, meaning that even after eliminating baseline psychotic individuals, it

was unclear whether the marijuana use triggered the psychosis, or whether pre-existing

tendencies towards psychosis could have led to individuals use of marijuana (Moore et al., 2007,

p. 325). In addition, most of the studies included in this review were based off of self report

examinations, which have the potential to produce unreliable results.

Although this meta-analysis was very open about its possible limitation, it called into

question a very unique conjecture. It stated that a brain that is under the influence of marijuana

behaves similarly to the way that a brain of a psychotic individual would behave (Moore et al.,

2007, p. 326). Additionally, the fact that marijuana can cause psychosis-like and mood altering

symptoms could lend to the argument that there is a causal relationship between the use of

marijuana and the development of psychotic disorders (Moore et al., 2007, p. 326).

This brings up an valid point. The majority of research conducted that has attempted to

deconstruct the directionality problem between marijuana use and the development of psychosis

have generally been longitudinal self-report surveys. To further investigate this issue, researchers

may benefit from exploring other methods of observation, such as further studying the brain

itself under the influence of marijuana, and determine if there are any physiological differences

before and after the use of marijuana that could be related to the development of psychosis, or

vise-versa.
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Directionality has been a reoccurring problem pertaining to the correlation between

marijuana use and psychosis. A TRAILS study conducted in 2013 attempted to solve the issue of

directionality in regards to marijuana use and the development of psychosis. This study

attempted to test two hypotheses, the first was called Self Medication Hypothesis in which

individuals are supposed to use cannabis to relieve their psychotic symptoms, and the other was

known as the Damage Hypothesis. Unlike the Self Medication Hypothesis the Damage

Hypothesis conjectures that marijuana use can cause or worsen psychotic conditions (Griffith-

Lendering et al., 2013, p. 733). To test these hypotheses researchers sampled from a large group

of adolescents in the Netherlands (n=2120) too control for confound variables such as social

class (Griffith-Lendering et al., 2013, p. 735). The researchers then measured both marijuana

usage and psychosis vulnerability through self report questionnaires. To further eliminate

confounds they also measured tobacco use and used tests to measure the vulnerability that

participants families had for depression and anxiety disorders. (Griffith-Lendering et al., 2013, p.

735).

The results of this study showed that through the course of adolescence marijuana use

was correlated with psychosis. More significantly, when researchers examined the ordinal

relationship it became clear that the associations between marijuana use and psychosis were

bidirectional. They found that the use of marijuana at age sixteen was associated with the

development psychosis at age nineteen, and that a thirteen year who had psychosis vulnerability

would most likely be using marijuana at age sixteen. (Griffith-Lendering et al., 2013, p. 737).

The results from this study provided support for both the Damage Hypothesis and the Self-

Medication Hypothesis and as a result this study was unable to solve the directionality problem.
MARIJUANA AND MENTAL HEALTH !10

From the analysis of several studies it has become clear that marijuana has a strong

correlation with several mental health problems. One commentary entitled Adolescent

Marijuana Use and Mental Health Amidst a Changing Legal Climate, concluded that the

legalization of marijuana may be happening amidst a cloud of confusion surrounding the long

term health impacts of marijuana use (Yurasek, A. M., & Hadley, W. 287). This study also

concluded that frequent marijuana use by adolescents was directly linked to mental health

problems, and that mental health problems developed far more often in frequent users than in

occasional users or non-users (Yurasek, A. M., & Hadley, W. 287). The article also concluded

that until further information is gained concerning the causal relationship between marijuana use

and psychotic disorders, clinicians should take great care in screening for mental health problems

as well as drug use (Yurasek, A. M., & Hadley, W. 287).

Despite the serious mental health problems that have been associated with marijuana use,

the percentage of eighteen to twenty-five year olds who use marijuana continues to rise (Roditis

& Halpern-Felsher, 2015, p. 179). One study, Adolescents Perceptions of Risks and Benefits of

Conventional Cigarettes, E-cigarettes, and Marijuana, found that the reason for this may be the

result of a substantial lack of education surrounding the risks of using marijuana on a regular

basis. In this study, twenty-four adolescents were put into groups where they discussed the

possible risks and benefits of using marijuana and also the risks and benefits of using traditional

cigarettes (Roditis & Halpern-Felsher, 2015, p. 180).

During the group discussions, it was easy for the subjects to name the risks associated

with using cigarettes, but very hard for them to name any benefits of using cigarettes. In contrast

it was difficult for the subjects to name almost any the risks of marijuana, but it was easy for
MARIJUANA AND MENTAL HEALTH !11

them to name some of the supposed benefits (Roditis & Halpern-Felsher, 2015, p. 182). This

study shows that the stark contrast between the participants views of traditional cigarettes and

marijuana may be due to the strict regulation of tobacco and the education that children have

received about the dangers of its use. However, and since marijuana has recently been

transitioned to be seen as a form of medicine, students views on marijuana have also shifted from

viewing it as a recreational drug to viewing it as a medicinal drug (Roditis & Halpern-Felsher,

2015, p. 184).

The conflict surrounding the legalization of marijuana is well grounded. The research that

has been conducted to determine the effect that marijuana use has on mental well being is still

fairly unsubstantial. The duality of the benefits and risks associated with marijuana use is part of

what makes its legalization so controversial. Marijuana use has been linked to a decrease in

symptoms associated with anxiety and many other disorders, however it has also become clear

that frequent marijuana use has been bidirectionally linked to the development of psychosis. To

determine the exact effect of marijuana use on mental health there is a imperative demand for

new and in depth research, which unfortunately may not be able to keep pace of social and

political change.
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