Zorba Paster: Pot Can Be Addictive

Dear Doc: My spouse uses pot every day and has been for about 20 years. He’s gotten to the point where he doesn’t want to go out of the house much, isn’t interested in socializing with friends and all that. I use pot occasionally but not every day. I tell him he should stop but he says he can’t. What’s the dope on this? — J.B.

Dear J.B.: Like alcohol and like opioids, pot can foster dependence. It’s called cannabis use disorder. It’s characterized by high daily pot use because of the body’s ability to develop tolerance. The more you smoke, the more the cannabis receptors down-regulate — requiring more and more.

Studies have shown this tolerance reduces the body’s sensitivity to dopamine, a natural chemical that makes us feel good when we do fun stuff. Hence, he doesn’t find the usual reward in normally pleasurable activities.

The problem here is that withdrawal symptoms occur in half the patients who try to stop using pot. They include anxiety, irritability, depression and restlessness. The person often has difficulty sleeping. They lose their appetite and just feel lousy. All this goes on for a week or two. It’s not as severe as opioid withdrawal at all but it’s not fun, either.

There is no good drug to reduce these symptoms. There was a recent study in the journal Lancet Psychiatry looking at a new experimental drug that appears to help with withdrawal, but that’s years away from being on the market.

My best advice is to talk to him about reducing his use — and to go to his primary care practitioner to get some meds for sleeping. That might help him to cut down or even give it up entirely. This is just like alcoholism — a complex dependence that has no quick, easy answers.