Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

162 III. SUBSTANCES OF ABUSEwith alcohol, or as long-lasting as that with cocaine. It may contribute torelapse in some individuals.The clinician is confronted with a wider range of marijuana users. At oneend is the individual who uses the drug only rarely, but whose use is detected ona routine drug screen and brought to the clinician’s attention, perhaps for anevaluation. Brief assessment, to make sure the problem is not more serious thanit appears, is always necessary in this case. Subsequent follow-up, to ensure thatthe initial impression was correct, is part of a thorough assessment. In thisinstance, the user is usually embarrassed and repentant, and has no objection tofuture monitoring. Users who do not have a problem with marijuana do nothave a problem giving it up. They may be able to use it in the future, once theyhave demonstrated the capacity for voluntary nonuse.On the other end of spectrum is the person, most predictably the adolescent,who uses the drug both daily and heavily. In this case, the individual mayneed much more intensive rehabilitation and may need to be admitted to a residentialdrug treatment facility. In any case, the clinician must be alert to anyunderlying comorbid condition and treat it appropriately. Many researchersbelieve that marijuana is administered as a form of self-medication (Marmor,1998).The comorbid conditions that have been suggested to be associated withmarijuana use range from the personality disorders to psychotic spectrum illness.In certain personality disorders, the drug’s sedating and anxiolytic propertiesmay be used to reduce painful affects. In some mode disorders, marijuanamay be a form of self-medication for agitation, even manic or hypomanic states.This hypothesis is still quite intriguing and controversial; at the present time,there is only anecdotal and circumstantial evidence for its existence.In recent years, there has been increased interest in “medicinal marijuana”(Iversen & Snyder, 1999) as an advocacy issue for such conditions as glaucoma(American Academy of Opthalmology, 1992; Hepler & Petrus, 1976; NationalEye Institute, 1997), epilepsy (Feeney, 1976), nausea and other symptoms associatedwith cancer and chemotherapy (Kris et al., 1996; Maurer, Henn,Dittrich, & Hofmann, 1990; Nelson et al., 1994; Sallan, Zinberg, & Frei, 1975;Tramer et al., 2001; Vinciguerra, Moore, & Brennan, 1988). In general, thereare better and safer agents for such medical conditions. Marijuana may, however,have some use, and the issue has been subject to much debate within thepublic arena, such as California voters’ passing of the Compassionate Use Act(Proposition 215) (Marmor, 1998). Although the possible medicinal benefits ofmarijuana have been a matter of perennial debate within the medical communityas well (Grinspoon & Bakalar, 1995; Kassirer, 1999), with articles andcommentary frequently appearing in the Journal of the American Medical Associationand the New England Journal of Medicine, the issue has yet to havebeen satisfactorily resolved through sound, scientifically methodical research(National Institutes of Health, 1997).