The government’s review of the 1995 marijuana rescheduling
petition did not distinguish between use and abuse according
to professional standards, such as those in use by the medical
and scientific community. Widespread use of cannabis is not
an indication of its abuse potential, and widespread use of
marijuana without dependency supports the argument that marijuana
is safe for use under medical supervision.
Since marijuana, heroin and other drugs are often referred
to as “drugs of abuse", many consider each use
of these drugs “abuse”. That a clear differentiation
between the two terms if often lacking is suggested by Wish
(1990), who noted in an editorial of the Journal of the American
Medical Association on drug screenings in the workplace that
a discussion on the difference between drug use and drug abuse
was often regarded as "anachronistic and unpatriotic."
However, the term "substance abuse" is clearly
defined and should be differed from simple and unproblematic
use, which is the rule and not the exception with most drugs,
even in adolescents. Scientists usually differentiate between
use, and forms of problematic use. The most frequent terms
for problematic or pathological use are abuse, misuse, harmful
use and dependency (e.g. Gorman and Derzon 2002, Swift et
al. 2001). Definitions for these terms vary so that samples
determined using different definitions overlap. Swift et al.
(2001) compared dependency according to the DSM-IV (Diagnostic
Manual of Diseases) to the concept of dependency in the ICD-10
(The International Classification of Diseases, 10th Revision)
in a sample of 10,641 representative Australian adults:
The prevalence of DSM-IV (1.5%) and ICD-10 (1.7%) cannabis
dependence was similar. DSM-IV and ICD-10 dependence criteria
comprised unidimensional syndromes. The most common symptoms
among dependent and non-dependent users were difficulties
with controlling use and withdrawal, although there were marked
differences in symptom prevalence. Dependent users reported
a median of four symptoms. There was good to excellent diagnostic
concordance (kappas = 0.7-0.9) between systems for dependence
but not for abuse/harmful use (Y = 0.4). These findings provide
some support for the validity of cannabis dependence.
According to the newer DSM-IV definition cannabis abuse and
dependency will be observed more often than according to the
criteria of the earlier DSM-III-R:
"We assessed a clinical sample of 102 adolescents using
CIDI-SAM. Prevalence of either an abuse or dependence diagnosis
was lower with DSM-IV than DSM-III-R except for cannabis and
alcohol, and concordance rates were better for dependence
than for abuse. For most substances, rates of DSM-IV withdrawal
were lower than in DSM-III-R, but rates of DSM-IV physiological
dependence remained high. Changes in DSM-IV criteria appear
to have impacted diagnoses in these adolescents, particularly
for the substances they use most--i.e. alcohol, tobacco, and
cannabis" (Mikulich et al. 2001).
Clinical criteria for substance abuse according to DSM-IV
A. A maladaptive pattern of substance use leading to clinically
significant impairment or distress, as manifested by one or
more of the following occurring within a twelve-month period.
(1) Recurrent substance use resulting in a failure to fulfill
major role obligations at work, school, or home (e.g. repeated
absences or poor work performance related to substance use,
substance related absences, suspension, or expulsions from
school; neglect of children or household).
(2) Recurrent substance use in situations in which it is
physically hazardous (e.g. driving an automobile or operating
a machine when impaired by substance use).
(3) Recurrent substance related legal problems (e.g. arrest
for substance related disorder conduct).
(4) Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or exacerbated
by effects of substance (e.g. arguments with spouse about
consequences of intoxication, physical fights).
B. Symptoms have never met the criteria for substance dependence
for this class of substance.
When talking about the gateway theory, the Institute of Medicine
(1999) pointed out that it is necessary to differentiate between
use and dependency or abuse to draw the right conclusions
from given data:
"Many of the data on which the gateway theory is based
do not measure dependence; instead, they measure use -even
once- only use. Thus, they show only that marijuana users
are more likely to use other illicit drugs (even if only once)
than are people who never use marijuana, not that they become
dependent or even frequent users. The authors of these studies
are careful to point out that their data should not be used
as evidence of an inexorable causal progression; rather they
note that identifying stage-based user groups makes it possible
to identify the specific risk factors that predict movement
from one stage of drug use to the next -the real issue in
the gateway discussion" (Joy et al. 1999).
Modern epidemiological studies have shown that many people
who use cannabis do not differ from other people, that they
do not abuse the drug but use it. A survey of 15,000 British
children aged 14 and 15 found that young people with high
self-esteem are more likely to take illicit drugs than those
whose self-confidence is low (Observer of 11 February 2001).
The results contradict the concept that drug use is most prevalent
among anxious or insecure youth looking for an escape from
poor conditions or a way to feel better about themselves.
Heather Ashton, a professor of pharmacology at Newcastle University,
said that the results of the survey did not surprise her:
"Students all report they take drugs for pleasure and
that it has nothing to do with anxiety or stress. Years ago
young people who take drugs were seen as psychotic or low
risk-takers. Now that is not the case."
A report published by the Institute of Medicine provides
an equally clear assessment of contemporary scientific standards
for defining drug use, abuse, and dependency. The report "Pathways
of Addiction, Opportunities in Drug Abuse Research" was
published in 1996. According to its introduction:
"The report employs the standard three-stage conceptualization
of drug-taking behavior that applies to all psychoactive drugs,
whether licit of illicit. Each stage -- use, abuse, dependence
-- is marked by higher levels of use and increasing serious
consequences. Thus, when the report refers to the "use"
of drugs, the term is usually employed in a narrow sense to
distinguish it from intensified patterns of use. Conversely,
the term "abuse" is used to refer to any harmful
use, irrespective of whether the behavior constitutes a "disorder"
in the DSM-IV diagnostic nomenclature. . . . It bears emphasizing
that adverse consequences can be associated with patterns
of drug use that do not amount to abuse or dependence in a
clinical sense, although the focus of this report and the
committee's recommendations is on the more intensified patterns
of use (i.e, abuse and dependence) since they cause the majority
of serious consequences." (Committee on Opportunities
in Drug Abuse Research, 1996)
The findings above clarify marijuana’s abuse potential
relative to other drugs; the use of more dangerous drugs is
not a significant risk for most individuals whose consumption
of marijuana can be described as use rather than abuse or
dependence. These findings affirm that medical users of marijuana
are not at risk to use of other illicit drugs due to their
regular use of cannabis.
The College on the Problems on Drug Dependence recognizes
that marijuana is not a harmless drug, but they note a basis
for distinguishing marijuana from drugs such as cocaine and
heroin. They also note that serious questions have been raised
as to whether marijuana is sufficiently dangerous to justify
criminal sanctions, and are critical of DEA’s irrational
scheduling decisions with respect to marijuana:
"Despite these significant adverse effects, questions
have been raised by various investigative commissions about
whether the social costs associated with the prohibition of
marijuana are warranted by its actual harm to individuals
and society, and especially whether imprisonment for mere
possession unaccompanied by other crimes -- the law in some
states -- is appropriate. It can be argued that placing marijuana
in the same category as heroin and cocaine also sends a counterproductive
message because it erases distinctions among drugs with very
different degrees of hazard." (College on the Problems
of Drug Dependence, 1997).
Gorman (2002) uses data from several prospective longitudinal
studies (N= 3206) to examine the association between three
psychological constructs on the use, misuse, and abuse of
marijuana – providing an example of research and analytical
strategies that incorporate the distinctions discussed above.
Many drug users not only do not move on to more dangerous
drugs, many of them also stop using drugs on their own as
“[This research] examined patterns of illicit drug
use, abuse, and remission over a 25-year period and recent
treatment use. . . .[utilizing] Retrospectively obtained year-to-year
measures from the 1996-1997 survey included use and remission
of sedatives, stimulants, marijuana, cocaine, and opiates,
as well as substance abuse and psychiatric treatment use.
. . . Most drug abusers who had started using drugs by their
early 20s appeared to gradually achieve remission. Spontaneous
remission was the rule rather than the exception. Nonetheless,
considerable unmet needs existed for those who had continued
use into middle age.” (Price et al, 2001).
College on the Problems of Drug Dependence, Statement on
National Drug Policy, March 1997
Committee on Opportunities in Drug Abuse Research, Institute
of Medicine. National Academy Press. Washington, D.C. 1996.
Gorman DM, Derzon JH. Behavioral traits and marijuana use
and abuse: a meta-analysis of longitudinal studies. Addict
Mikulich SK, Hall SK, Whitmore EA, Crowley TJ. Concordance
between DSM-III-R and DSM-IV diagnoses of substance use disorders
in adolescents. Drug Alcohol Depend 2001;61(3):237-48
Price RK, Risk NK, Spitznagel EL Remission from drug abuse
over a 25-year period: patterns of remission and treatment
use. Am J Public Health 2001 Jul;91(7):1107-13
Swift W, Hall W, Teesson M. Characteristics of DSM-IV and
ICD-10 cannabis dependence among Australian adults: results
from the National Survey of Mental Health and Wellbeing. Drug
Alcohol Depend 2001;63(2):147-53.
Wish ED. Preemployment drug screening. JAMA 1990;264(20):2676-2677.