A young man, 17 years old, is in the morning, noon and in the evening. It started at a meeting with friends, with an euphoric feeling and absolute serenity. It developed: a joint every weekend, then always before going to bed. Finally, the first withdrawal symptoms at noon during the long break. He no longer comes to school on time, forgets upcoming class work. His parents are worried, at home it becomes unessive. The problems of her young clients look like this, Eva describes. She is a psychologist at the clinic and polyclinic for psychiatry and psychotherapy in Munich. With her team, she developed and evaluated the first treatment program for people with cannabis consumer disorders across Germany.
Highly observes an increase in cannabis consumption among young people. Among other things, the increased interest proves the report on the "drug affinity of young people", which the Federal Center for Health Education (BZGA) regularly publishes. For the report, the BZGA also raised how many youthful cannabis had tried at least once. The result: approximately ten percent of all 12 to 17 year olds and almost 50 percent of 18- to 25-year-old young adults.
Now the federal government is planning the "controlled distribution of cannabis to adults for recreational purposes in licensed shops". Even if the coalition agreement of 2021 explicitly states "to adults", the legalized drug could be more accessible to young people than before with the decision. This is alarming, because the drug changes the growing brain. How exactly is still being investigated, but the findings so far are remarkable.
Cannabis affects the impulse control and short -term memory
To understand the powerful effect of cannabis, it helps to know the ingredients. If the use of cannabis is harmful, this is most likely due to the psychoactive substances. The main one is Δ9-tetrahydrocannabinol (THC). Researchers have therefore been trying to find out for a very long time whether THC is neurotoxic – i.e. harmful to the brain.
The immediate consequences of consumption are well documented. Cannabis affects attention, impulse control and short -term memory. However, long -term consequences are controversial. Whether and, if so, which one exists, depends on the current knowledge, from what age a person consumes cannabis, how often and how much. If people start in adulthood, undesirable effects usually only appear at short notice. Few to no long -term damage arises, as studies suggest. However, if you are already in the early youth, you are much more endangered for psychoses, depression or dependency, for example.
Cannabis and psychoses
The assumption, cannabis use in adolescence is widespread leading to the development of psychoses. Now the risk factors for psychosis are similar to those for cannabis use: precarious living conditions, for example, psychological problems of parents or neglect. "But even if it succeeds in excluding these factors, it turns out that cannabis and psychoses occur particularly often together," says psychiatrist Derik Hermann.
Psychoses are encoded by a gene score consisting of more than 100 genes. If people have a particularly high number of genes from this combination, they are extremely susceptible to developing psychosis. At the same time, the combination determines how much someone likes to use cannabis.
So would these people most likely develop psychosis without cannabis? "It is not that easy. Genetics is only partially responsible, cannabis can trigger psychosis, «says Hermann. And age also seems to play an important role here, because studies show that the earlier people start with cannabis consumption, the higher the risk of psychoses.
This may be due to the fact that the brain develops significantly in the transition phase between childhood and adulthood. "In youth, synapses that network the different centers in the brain are linked and it is decided where nerve cells are placed in the brain," says the habilitated psychiatrist Derik Hermann, chief physician in the Ludwigsmühle therapy association. The endocannabinoid system (ECS) should be decisive for all of these processes, a kind of the body's own cannabis system. The most important body's own, i.e. endogenous cannabinoid is anandamide. "The interactions are very complex," says Hermann, and they are insufficiently researched. What you now know: The THC of plants is similar to the body's own cannabinoids. Therefore, the intoxication is probably created by cannabis over the receptors of the EC.
The assumption: mixes THC into the natural interplay of ECS and cannabinoids, it damages the neurological systems of adolescents. »The consequence could be missing links in the brain because the ECS was disturbed during its work. Such damage can no longer be reversed, «says Hermann.
A large number of studies indicate that the changes have lasting, negative consequences. However, evaluating the data is considered difficult. "In cross-sectional studies, consumers and non-consumers are often simply used as subjects without taking their previous history into account," says Hermann. These two groups are then examined with regard to different performances. "To put it bluntly: a group of high school students who have never used cannabis is being examined, and a group of high school students who smoke regularly, and then compared in terms of intelligence and memory performance, " says the psychiatrist. If the groups differ in the result, it is almost impossible to find a cause-effect relationship due to the numerous factors in the background. "Genetics and a number of psycho-social factors are also responsible for the development of the brain: school education and the environment, for example," says Hermann.
For example, it could be that early cannabis consumption leads to poorer academic achievements and that the brain does not develop so well due to this lack of funding. This would mean that cannabis only affects the brain indirectly.
The cerebral cortex in the area of the prefrontal cortex becomes thinner
"Long -term studies are needed in which the children and adolescents are best examined before the start of consumption and years later," says Hermann. The group around the psychologist Matthew Albaugh carried out one of these studies. She analyzed the brain of almost 800 young people using MRI recordings. At the beginning of the data collection, the participants were 14 years old and had not yet tried any cannabis. Her brain scans looked similar. In the course of the following five years, the group found that in young people who used cannabis more or less regularly, the cerebral cortex diluted in the area of the prefrontal cortex. The more cannabis the individual consumed the effect.
"However, there was a relatively small change in the brain that is difficult to interpret," says Hermann. If a person's brain weighs between 1200 and 1400 grams, this study has a change that occurs in the cubic millimeter area. "This is difficult to interpret." Nevertheless, he continues, the results would go well with the existing thesis that cannabis influence the ECS and coincide with knowledge of experiments on animals.
Cannabis as an entry -level drug?
According to the gateway model, the consumption of cannabis sooner or later leads to harder drugs. "In fact, studies show that a large part of people who consume heroin first needed cannabis in the life story," says psychologist Eva. But only a very small part of the people who regularly consume cannabis later also takes harder psychotropic substances. So is cannabis an entry -level drug or not?
If this were so, the pharmacological effect of the intoxicant could increase the propensity of a young person to use other illegal drugs. In favor of this model, adolescent rats that were given high doses of Δ9-tetrahydrocannabinol (THC) were more likely to self-administer heroin and cocaine than animals that were not given THC.
But there are also alternative explanations for the gateway model. The first is availability: people who consume cannabis have more opportunities to get more drugs. Eva Hoch knows this from the stories of her patients: "When I am at my dealer, he has other things other than cannabis." The offer increases the temptation to consume cocaine, ecstasy or other drugs, says high. According to the second thesis, people who consume cannabis early are more risk -friendly than others. Either genetic or environmentally related. Or both.
"Whether one or the other thesis is true does not play the decisive role in practice," says the psychologist. Psychotropic substances have different risks and can be addictive. Young people should be better informed and credibly informed about this. What is needed are more prevention programs, says Hoch.
Another longitudinal study shows what the changes in the brain could mean, the authors of which have accompanied the more than 1000 participants for almost 40 years. At the age of 13, intelligence tests were done with the participants. These tests were repeated at the age of 38 after partial patterns of persistent cannabis use had established themselves. "Those who only started using cannabis in adulthood only showed worse IQ services as long as they consumed," says Hermann. The participants who had already started in adolescence remained a certain deficit even after abstinence.
"In addition to its long-term design, the good thing about this study is that the researchers included the school education of the subjects in the analysis," says Hermann. This made it possible to rule out that differences in education play a role in development. At the same time, the study showed that the age of onset alone is not decisive. How long someone smokes and how intensively is also relevant.
The story of the young man who has developed a cannabis consumption disorder is an example of this. Eva Hoch as head of the Institute for Therapy Research in Munich regularly treats people like him. With the help of a behavioral therapy -oriented weaning program, those affected are intended to learn in ten sessions, to take less drugs or to stop completely. The three core elements of the therapy are motivational funding, behavioral therapy and problem solving training.
"When it comes to the motives, my clients face the question: Why do I consume?" Says Hoch. Many want to sleep better, be more relaxed, think more creatively. “On the other hand, the question arises: What do I want in my life? Could there be reasons to change my consumption? For example, to have less stress with the parents or less trouble with the police. Many want to create their school leaving certificate or the driver's license, «says Eva. Together with those affected, she develops alternative strategies to relax or find satisfaction in life. »We also set goals together. How much consumption is realistic? Is it enough to reduce, so only smoldering on some days? Or does it have to be a stop? ”Says high. A dependent brain is very difficult to control. No more cannabis to smoke, eat or inhale it is the easiest.
At the beginning, it was challenging for some clients to participate in the therapy. Some could not concentrate so well because they have been intensively stunning over a long period of time. The others are ambivalent with regard to their motivation. But that changes over time. »It is particularly nice to see how young people change in the course of treatment. They are then much more alert, more powerful and much more interested, often there are new perspectives and goals for the future, «says Hoch.
