Self-Medicating with Cannabis and Alcohol: A high that does not last
Alex, a 22-year old male, came into NutriChem struggling with anxiety and mild depression. He was a busy engineering student that was feeling overwhelmed with the shift to virtual courses and general lifestyle changes during these uncertain times. He had gradually become a heavy cannabis user, and he was also using more and more alcohol to self-medicate for his worsening mood.
He had been using cannabis off-and-on for a few years, and he had found that cannabis and alcohol initially helped with his anxiety and depression, but over time, his mood actually worsened with chronic substance use. He had dealt with multiple episodes of mild to moderate depression in his medical history, and he also had chronic digestive issues. He was dealing with a lot of anxiety, but he could feel an episode of depression approaching as his mood worsened. He was hoping to reduce anxiety and prevent a full-blown episode of depression.
At the time of his first appointment in the clinic, he had actually stopped using cannabis for 2-3 days due to extreme anxiety. He rated his current anxiety experience at 8/10. His Beck depression score (a mood assessment we do on intake) was a 33 - which classified him as ‘severe depression’. Although the school year had just ended, he still had a lot of anxiety around finding a student job placement in a difficult economic climate. He went to an appointment with his GP, who had given him a prescription for the antidepressant, Cipralex 10mg once daily. He had tried multiple antidepressants and anxiolytic medications in the past with minimal benefit, so he was skeptical and reluctant to start the medication. This is when Alex’s mom suggested that he book an appointment with me. My experience with medical cannabis and being a pharmacist allowed for a nice transition into the ‘alternative health’ realm.
On our first visit, we did a full intake to review not only his cannabis use and medication history but also other areas of his health. I think many people are not used to coming into a visit for a chief complaint of a mental health concern such as depression and/or anxiety and I start asking them about their digestive health. We uncovered that he was experiencing issues with digestion such as gas and bloating and that his sleep was severely disrupted as well.
I could tell that Alex was a little bit puzzled by my initial treatment plan but because our intake appointments are one hour long I had the time to explain and educate him on my reasoning behind my recommendations.
Alex’s Treatment Plan
Referral to a Naturopathic Doctor
Alex was in serious need of a microbiome overhaul. I could tell by his intake that his digestive system was very inflamed. He experienced irregular bowel movements and chronic indigestion and bloating. I explained to him the gut-brain connection. How reducing inflammation and healing the gut not only will improve digestive health but has been shown to have an immensely positive impact on mental health. All of the leading-edge mental health clinics in North America are starting to understand this and have begun to recommend dietary changes and digestive protocols for their most severe mental health cases.
The NutriChem clinic is all about the practitioners working as a team for our patients. I could have recommended a gut protocol but I felt that Alex would benefit the most from a longer more extensive visit that focused solely on gut health and digestion improvement. I also suggested that the ND requisition some blood work to ensure adequate levels of nutrients such as B12 and Iron and test Alex’s Thyroid, Sex hormones, and inflammatory markers.
STOP all THC-containing products immediately. Alex was surprised to hear me suggest this. I explained that despite common belief, high-dose THC and chronic use of THC can actually trigger and worsen anxiety. In the short term - people find that THC can be beneficial for reducing sensations of anxiety, but over the long term, it can start to make it more severe.
Start CBD Oil in the evening (with food). Another component of cannabis, known as CBD (cannabidiol) seems to counterbalance the effects of THC and actually reduce anxiety in many individuals. Often, when patients are using a lot of THC and experiencing anxiety, they respond well to a complete discontinuation of THC- containing cannabis products and initiation of CBD oil. I made Alex a tailored dosing regime of CBD oil that would match his individual needs.
Many people in the past had suggested that Alex discontinue his Cannabis use however no one had taken the time to explain to him the biochemistry of THC/CBD on the brain. After understanding that this could not only not be helping him but actually contributing to his anxiety Alex was open to giving the switch a shot.
With Alex I also discussed the biochemistry of alcohol. Similarly to THC, many people get a short-term calming effect from alcohol, but it is actually associated with worsening mood and depression. It may feel as though drinking is helping to numb emotional pain and depression, but it is often gradually making it worse. Alcohol itself is actually considered a depressant because of its impact on mood and neurotransmitters.
I think it’s important to educate patients without judgment. Alex is self medicating to get relief from his symptoms. Rather than me telling him how ‘bad’ alcohol is I discuss physically what it is doing to the body. My suggestion to Alex was to limit/discontinue alcohol use for the next 30 days.
Often when I recommend cessation of a medication or substance - in this case - THC, I like to recommend some gentle alternatives that can help support the patient’s mood and sleep. We already had done the dose regime of CBD so for Alex I also recommended some magnesium glycinate to be taken in the evenings.
My approach with Alex was one of making suggestions that I knew would shift his mood quickly. Removing substances that can worsen mood and anxiety is always step one. Giving Alex some safe and effective mood support during that transition - using CBD and magnesium will allow him to start feeling better and be more likely to stick to my recommendations. Healing the gut, improving sleep, and assessment of hormones, inflammation, nutrition, and thyroid will be the key to long lasting mood improvement.
This is a “classic” case of overuse of THC and alcohol to acutely self-medicate for anxiety and depression. I am seeing more and more cases of especially young males in this pattern. In the short-term, many people find a pleasurable effect from using these substances, but over the long-term, they actually worsen anxiety and depression. High-dose, chronic use of THC is actually associated with anxiety, and chronic alcohol consumption is associated with depression. This makes sense when we consider that these substances are technically categorized as depressants in pharmacology.
What happened to Alex?
It doesn’t take long for a major shift when you make some significant changes.
We will be discussing Alex's one-month check in on our Facebook Page on July 23rd at 1pm. We hope you can Dr. Adam there!