Does Cannabis Delay Emotional Maturity? More Reasons to Hold Off on Using Cannabis Until Adulthood

In an earlier blog entry, I discussed how our dialogue around cannabis has lost credibility with young people, the group more likely to use cannabis. 

I have a common kind of patient in my practice—he (it’s typically a young man, but increasingly, I see young women like this) is somewhere in his late teens or early twenties, usually living at home, maybe taking a class or two at the community college, more often working but certainly not able to support himself without the help of his parents. His hobbies are often solitary, like video games. And he’s using a lot of cannabis. 

The patient isn’t particularly depressed, and fortunately, he’s not developing a psychosis (more on this risk in a later blog entry), but it’s clear that he’s failing to launch. 

His presentation is a little nonchalant, but it’s more awkward than oppositional. Responses are brief, monotone, and without eye contact. Then there’s that laugh, that anxious chuckle that has come to be the stereotype of the young cannabis user. He looks like he can’t wait to be somewhere else. It’s become clear to me that this lack of confidence, this inability to take risks, this social isolation, are all symptoms of social anxiety. 

This should not be surprising, as Julia Buckner and her colleagues at Louisiana State University found in a 2012 paper (1), that 29% of people with a DSM-IV cannabis dependence (this is before the newer DSM5 nomenclature of “cannabis use disorder”) also had a diagnosis of social anxiety. Even more interesting was the sequence of events—85% of the subjects had the social anxiety before they began using cannabis. That is to say, the anxiety came first. 

The obvious explanation is that these socially anxious young people are self-medicating, using a drug which can, for some people, be anxiolytic. However, I suspect that the explanation is actually more complex. 

Cannabis use is common in many youth subcultures. The ritual of using cannabis is often quite social, as the old reggae lyric of “pass the duchie to the left hand side” reminds us (2). Social rituals and conventions, be they handshakes or small talk, help us to manage the anxiogenic uncertainty that comes with social meetings, and I suspect that this group use of cannabis is appealing to socially awkward young people. 

It is the cost of this ritual that concerns me the most. Young people who use cannabis heavily are more prone to cognitive declines over time (3) and more at risk to develop psychosis (4), especially individuals who are genetically vulnerable (5, 6). In addition, users who also have social anxiety were found to be less likely to be in meaningful relationships and tended not to go as far in their education. 

It’s been said that chronic cannabis use delays emotional maturation. This notion, while initially appealing and resonant with some of my clinical experiences, lacks specificity. What exactly is “emotional maturation,” anyways? I would define one aspect as “being able to manage uncomfortable social situations without resorting to avoidance.” 

Avoidance, as any behavioral therapist will tell you, is exactly the thing that keeps an anxiety-driven behavior going. So, if cannabis and the rituals surrounding its use is a means of avoiding social anxiety, is it any wonder that these young people appear to be lacking skills in navigating the adult world? 

So how do we help young people who are trying to reduce or quit using cannabis? If social anxiety is present, it’s important to identify it and treat it. There are several useful treatments for this anxiety, from SSRIs and benzodiazepines to social skills training and exposure therapy. 

Really, the best treatment for any anxiety is exposure to the anxiogenic stimulus. Can we, as clinicians, use the therapeutic opportunity of the clinical encounter to take these socially anxious young people and role-model social confidence and help them learn how to navigate the challenges of adulthood without resorting to cannabis? 

If this subject is of interest to you, please come to my session “Medicine or Menace: Working with Cannabis use in a Time of Legalization” in Orlando Florida at the 27th Annual US Psychiatric & Mental Health Congress. 

References

1. Buckner et al. Drug Alch Dep. 2012. 124(1-2). 

2. Musical Youth. YouTube. https://www.youtube.com/watch?v=dFtLONl4cNc 

3. Meier et al. PNAS. 2012;109(40). 

4. Di Forti et al. Schiz Bull. 2013;[Epub Dec 17, 2013]. 

5. Estrada G et al. Acta Psychiatr Scand. 2011;123(6):485-492. 

6. Verdejo-Garcia et al. Neuropsychopharmacology. 2013;38: 1598-1606.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Assistant Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, CA, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.