Substance Use Carries Mental Health Risks—Yes, Even Marijuana

MAR. 26, 2018

By Dr. Elinore F. McCance-Katz


Each year, SAMHSA holds Prevention Day as an opportunity to share best practices and data with professionals who work day in and day out to end the cycles of substance use disorder sweeping our country. It’s usually a chance to learn what “preventionists” on the front lines are experiencing, and how our priorities at SAMHSA and their realities intersect.

I had the honor of addressing these health professionals this year—starting with a status report on the nation’s opioid crisis, providing updates and ending with a brief examination of the risks of marijuana consumption. As many of you may know, the opioid fentanyl has had a horrific impact on our nation: Its potency and often-stealthy addition to other drugs have caused the surges in fatal overdoses seen in recent years.

Training medical professionals to deliver proven-yet-underutilized treatments for the opioid crisis sweeping our country is important. These professionals are on the front line, serving as medical resources to people who need them. And our Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs rely on their insight and caring.

As SAMHSA trains medical professionals in the evidence-based practices needed to serve people with substance use disorders (SUDs) and serious mental illnesses, we’re also working to combine our resources with experts at the local level. To this end, we recently awarded a $12 million technical assistance grant to the American Academy of Addiction Psychiatry that will put federal resources into the hands of local experts to create community-relevant solutions. This effort is a clear example of SAMHSA working to support communities throughout the nation, moving beyond the valuable work performed by our grantees to assist whoever needs to be trained.


Interestingly, it was the second half of my presentation from Prevention Day that garnered stronger responses from supporters and critics alike. “The Elephant in the Room” dealt with marijuana as a drug that carries risks—risks too seldom discussed.

As a clinical psychiatrist specializing in addiction, as someone committed to treating people with substance use disorders, as a concerned American—I cannot stress enough how understated the risks and consequences tied to marijuana consumption are in our nation’s dialogue about the drug and about states’ respective moves to decriminalize or legalize aspects of consumption.

America has come a long way from the dramatics of “Reefer Madness,” the 1930’s cult film that railed against the use of marijuana. But, sadly, today, warnings about the drug often are dismissed as outdated propaganda. Amid discussions of decriminalization or of legalizing medicinal use, the topic rarely includes factual examinations of the harm that can come with marijuana consumption. Data show Americans have grown to perceive the drug as less harmful than alcohol and other drug use (slide 21).

Also ignored are data that speak to how the drug can adversely affect health (slide 24), can be associated with a decrease in IQ with chronic use, can lead to a number of undesirable social consequences (slide 31) and can reveal a predisposition to serious mental illness (slide 29).

To that last point, a study of the data on the slide “Marijuana-Associated Psychosis” shows the risk of schizophrenia increases as marijuana use increases. The same slide shows a higher risk of schizophrenia-like psychosis is directly related to younger ages of first marijuana use. It’s important to note that there is a distinction between a substance causing psychosis and one revealing a predisposition—the data I present concern the latter.

We know serious mental illness and SUDs often co-occur. And I believe there is room for researching the medical potential of marijuana’s components. But pretending that marijuana is a harmless substance is not the way to help our loved ones. It is time for medical professionals to courageously share what the data say, even if the conclusion is a socially unpopular one. Our people—particularly our young people—are depending on us.

Most important, SAMHSA offers supports for people who grapple with substance use disorders—whether tied to marijuana, alcohol, opioids or other substances. We know that, with appropriate treatment, people recover from SUDs. We’re working tirelessly to not only connect Americans to these resources, but to also get them back on the path toward fulfilling, productive lives.


Dr. Elinore F. McCance-Katz is the Assistant Secretary for Mental Health and Substance Use, and head of SAMHSA.


JUL, 17, 2018 02:31:20 AM
Bella Dushner
Hi! Mom here, everyone knows that its hard to raise a child you cannot watch them grow all the time because you are busy working for them. I have a son he is turning 19 this July and I am afraid that every time i talk to him he is not in his mind and he smells weed. I ask my co mom friends if why he's acting like that, and one of my friends told me that maybe he is using marijuana because his daughter used it also. She understands why her daughter used it. So iam afraid to ask my son if he uses it and iam a little bit confused. So, upon browsing, i read this that his signs are more obvious than a normal kid. I don't know what will I do about this. Can someone help me?

MAY, 12, 2018 12:41:20 PM
I am curious about CBD’s, does anyone have more information on how these can help with antipsychosis? My 18 year old started smoking dabs a year or so ago and has not only turned into someone who appears to be dealing with bipolar but maybe also mild schizophrenia, or psychosis. Not to mention the extreme verbal abuse that is happening. Because of a few unacceptable situations that occurred we had to call the cops which let to an arrest for menacing charges, and a week of jail time. There is a court ordered no contact so at this point I am at a loss of how to get him help. Problem is that he doesnt see the effect the dabs have on him. He is against anyone who tries to tell him what he should be doing or anyone who is trying to help him. I am a firm believer that dabs are the cause of his current mental health state. He comes from a family where bipolar is present but the phycosis is something we've not seen in the other family members with bipolar. (None of the other known family members who have bipolar are smoking MJ or using any illeagal drugs). I am not saying MJ is not helpful for some but I am without a doubt sure that the dabs are the cause of his phycosis behavior.

MAY, 02, 2018 07:47:09 AM
Norman seaton
The learned Author has very nicely worded this information, as well as a suggestive piece of excerpts that he had presented on the Prevention Day. But, there is a lot more to be taken into view, like therapeutic beneficial effects of marijuana published from time to time by the NIH, & National Cancer Institute, US Dept. of Health & Human Services. A large number of the Marijuana Specialist Clinics, like On Line Medical Marijuana Card, Los Angeles, are treating critical health conditions including Cancer and Chemotherapy & Radiation related side effects with the medical marijuana successfully where other medicines respond slowly.

APR, 17, 2018 06:07:36 AM
Marijuana has many benefits as it is being used in treating diseases like Cancer, diabetes etc. And companies like Phytoplant Research S.L help in purifying these medicinal plants so that they can be used in treatment effectively.

APR, 13, 2018 05:27:21 AM
I have a particular situation I can't find an answer for so maybe someone can help.i have a 38 year old daughter who after many years (15) left her abusive mean cruel husband.there have always been drugs and drinking thought out
the marriage. They were always hanging in by a thread for groceries to utilities.She was always in the position with no car or any oh his money(and yes it was his money) to improve her living conditions she wanted to leave her husband not her children. So she left she went every morning to get the boys on the bus ,made dinner for them and left before Mike came home. Well he didn't make it 2 days until the boys came home he was passed out face down in the dirt. They couldn't wake him and instead of calling me the oldest boy called his other grandmother (Cheryl) and she came brought 8 licking county sheffiff with her which served no purpose but to scare my grandsons and took them with her.She was in family court by 9amgetting emergency custody of the boys. Well that's when my daughter flipped. She had always battled depression ,ADHD,and other things it comes from a long line in my with her already fragile state of mind this happens she took off hitching around she would call from time to time and be frantic that people were out to get her but afraid to say
Where she was then she turned up on my doorstep thank God telling me all these people were after.Then in a couple of days she would be with it and the she became so afraid she didn't know who anyone was not her children of her parents or her sister and she thought we were all out to harm her took her to riverside hospital they onlykept her a few day. So what's going on in her brain that make this happen to her I know for sure she isn't on anything.So. In the last 2weeks she founded it nessaccry to tell me her father
My husband of 27 years had been molesting her since she was 4 years old.i married that man on my 19th birthday and he died beside in the bed after 28years.Good year my question what the hell am I to do with this.i don't believe heritage like another psychotic break.what am I supposed to do

APR, 11, 2018 10:09:27 AM
TC Baker
what the general public does not realize is that marijuana, especially today's high THC marijuana, is extremely risky for people with a certain predisposition to bipolar type one, which is predominantly mania. well for some people it can help many disorders, for this population, and some others, it may feel like it is helping relieve anxiety when actually it is only kindling mania out of control just like an ungated SSRI for people with bipolar type one or a predisposition to it even if they are not yet diagnosed. SSRI are A class of drug typically used for anxiety and depression relief. so this is especially dangerous especially for young people who might not yet be diagnosed bipolar type one but have a genetic predisposition toward it. they smoke or use cannabis, they think it makes him feel better and it might for a while, but eventually it leads to manic episodes and actually pushes them into full-blown bipolar diagnosis and eventually can cause manic psychosis and dysphoric manic episodes. please spread the word. What is good for some is not good for others, and one must usually have a fully developed adult Brain usually in order to know if one is going to have a bipolar type one tendency. many young people in their teens and early 20s start using marijuana Long before it is known or understood what the full brain development profile it will be for them. my loved one had this happen and it took a lot for her to give up her dependency on marijuana and get on the proper medications to help manage her illness. her psychiatrist treats in an area that is known for heroin addiction and states that his practice has since developed into 75% of the people coming in with mania and psychosis induced by marijuana use - he sees far fewer cases of heroin and other hard drug use these days then he does marijuana influence cases of psychosis. Incredible but true. i've used marijuana myself for years and never had a problem of that nature but after watching what my loved one has gone through I realize that legalization of marijuana should not be unrestricted but rather it should remain a controlled substance because it has vastly powerful and different effects upon different brain types.

APR, 09, 2018 10:04:17 AM
Personally, I would have to disagree with this article. I was diagnosed with Bipolar Disorder Type II in 2012, before I started using marijuana. Over the last 6 years, it has helped keep me out of my mania and manic episodes by keeping me calm, helping me eat, helping me sleep, and helping me socialize. It is important to ensure that it is actually marijuana that is being taken in and not a synthetic product. I personally know someone who did have a psychotic break and murdered his parents from smoking synthetic weed as if it was earth grown. In small dosages, marijuana can help an incredible amount of symptoms. However, just like any regulated drug, there is a limit. At the limit should help be addressed. If we flat out say that marijuana is bad from all angles, will we be back to pumping prescription pills into our system?
If someone has a psychiatric break, it won't matter what their drug of choice is. It's something much deeper deriving from our brains. I am able to say this personally because when I was diagnosed after trying to commit suicide, I wasn't smoking weed. But I did take 100 over-the-counter sleeping pills.

P.S. Currently typing this while I smoke since I have my college finals in a month and otherwise, I would be having a panic attack from the course load. However, I am not in the ability to give up due to my academic probation. Marijuana is the only thing that has helped me. This will be the first semester I have actually been able to complete since my diagnoses in 2012. I have attempted over 52 credits hours and have only earned 18

APR, 06, 2018 03:41:08 PM
Veteran with severe PTSD.
It makes ALL THE DAMNED DIFFERENCE in the world.
Military Police- never touched it and believed all the hysteria, misinformation and reefer madness.
Until I tried it...
Life Changing.
I drank heavily for years post service. Now I honestly can’t remember my last drink - 0 desire for alcohol now.
Without medical marijuana I simply can’t function in life - can’t leave the house, can’t think, etc.
I’m sometimes even friendly now (again), improving.
It’s medicinally therapeutic, from doubtful first experience- It works, wonders in some cases.

MAR, 31, 2018 06:24:15 AM
I believe ALL substance abuse is merely a symptom of mental illness. People with undiagnosed mental illness will often turn to substances which allow them to escape their problems and better cope with the mental illness. I believe this is caused by a combination of mental health issues, lack of proper coping mechanisms and a solid support system. No, I am not a Mental health professional. I am however recovering from substance abuse, long term. Without using, the symptoms come back very strong. Which is what motivated me to seek psychological help.

MAR, 30, 2018 02:44:35 PM
My daughter may have had a predisposition to BiPolar. In any case, she used marijuana to deal with some pain. She used it rather heavily, like a little is good, so more must be better. However, it wasn't helping her depression, so she was put on an anti depressant, which is bad when a person has bipolar. Acting out started to get worse, so now there are serious legal consequences in the works which will affect her and her children, and her employment possibilities, for the rest of their lives. While she was in jail, and away from the meds and marijuana, she started sounding normal after a week.

MAR, 29, 2018 01:15:40 PM
I'm curious to know who funded the studies noted in this article. If they were funded by any pharmaceutical companies, interests or entities, it would explain the fallacies noted here. The fact that marijuana can successfully treat anxiety, depression and bipolar disorder has already been studied and proven. Furthermore, this is the first time I've read anything that links marijuana use with psychosis. Of course, I'll look into that further. In the meantime, I'm extremely wary of any study funded by big pharma; they clearly have their own agenda.

MAR, 29, 2018 01:08:44 AM
Jacqueline Lewis
Thanks for the article.
The information was insightful. I completely agree with your postion.
I would love to be involved in any research on childhood trauma PTSD
Marijuana usage the damage done to the autoimmune system. This has lead to chronic illnesses. I'm fortunate I've been receiving professional assistance for PTSD. I feel fortunate that I also have a team of doctors at a prestigious hospital. Working together to help me stay comfortable. Chronic marijuana usage can damage your autoimmune system. Which could not show up until decades later.

MAR, 28, 2018 09:47:31 PM
Denise Holladay
Do dabs (highly concentrated extract of marijuana’s psychoactive ingredient tetrahydrocannabidiol, or THC, which is thick gummy, and brownish-green, and looks like hot candle wax that’s been spilled onto a piece of paper and left to dry) possibly result in drug-induced psychosis? Or, are individuals, who have family history of bipolar 2 disorder and anxiety disorders, and who do dabs 3 or more times per day, have a greater likelihood of developing mental health disorder. I am concerned for my young adult daughter. Her mental health has declined since she began doing dabs regularly about 3 years ago.

MAR, 28, 2018 08:35:23 PM
Kathy Betty
I have always wondered about the effects of marijuana on the recreational user. I, myself have never tried marijuana and I come from the hippie generation but my children have used it and one had a psychotic break recently. Sounds like a no brainer to me. People should stop hurting themselves

MAR, 28, 2018 05:12:49 PM
In response to Tang above, I agree marijuana can help many, many people. I wouldn't have believed it could also harm people until I saw what it does to my son whom I've obviously known his whole life. Maybe an overdose on marijuana doesn't kill someone but my son almost walked out into oncoming traffic while in a psychotic state last Summer which was induced by smoking pot continually. He also pulled a knife on his brother which if it had been someone else, it could have had much more severe consequences. He was hospitalized for 10 days and in psychosis for weeks. From his first psychotic break after smoking, he almost jumped into a huge river that he most likely wouldn't made it out alive. So yes, pot can be unsafe in these few examples and I can think of many more that I've seen with my son. I think the message people need to hear is that pot has the potential to harm your brain. It is not always safe for everyone and because all brains are different, it can be bad for some. Trust me, I wish my son could smoke pot. I would be the first to jump for joy. For him, pot equals the potential for a psychotic break and hospitalization. It turns him into a different person even when he's not high.
The media has been more in favor of marijuana than against it. It's in many t.v. shows joked about on them etc. and highly, highly accepted in our society which isn't a bad thing. I think the important message that needs to get out is that again, it has the potential to be very bad and harmful to some people and it can do damage.
I live in Colorado and when I share my first-hand experience on how it affects my son, I get a lot of pushback and people tend not to believe me which is okay. And yes, my son was probably predisposed to have bipolar or already did but smoking marijuana absolutely exasperates his condition and sends him into a downward spiral. Also, when people say you can't be addicted to pot, I don't believe that anymore from what I've seen with my son. He's absolutely 100% addicted to marijuana.

MAR, 28, 2018 02:32:40 PM
James Weber
I agree. I am against the recreational use of pot for just this reason. Even though I support the legitimate medical use, I know from my experience with family members that mental illness and marijuana can have devastating consequences. Just because some people use and seem to be fine, there are dangerous general risks for some that should not be ignored.

MAR, 28, 2018 01:34:40 PM
If my post is not seen then we really have a problem with freedom of speech and people will be challenging that too..."get it together please"!

MAR, 28, 2018 01:31:41 PM
Why do some continue to discredit what we have been saying in the general population for years on the effects that cannabis has had on the body? I personally know people on Psych-medications for schizophrenia and people that have been addicted to opioid addiction. In both cases I have seen know change in the way they act physically or mentally...In fact, it has helped them cope with there disorders ! Especially in the case of this opioid crisis, I've seen marijuana help keep users off of the heroin !
Does anyone know of someone who died of a overdose after using cannabis(marijuana) ? If it's about money... than use the marijuana as a tool !
The public is smarter than people think and demonization continues, the public is not going to look to those people for advice !

MAR, 27, 2018 08:33:50 PM
I couldn't agree more with this article. I have seen this first hand with my son for the past two years when he smokes regulary he will go into psychosis. This comes from an 'open minded' Mom who was fine with casual pot smoking but now I have seen what it literally does to his mind. He has been hospitalized twice and diagnosed with bipolar 1. The word needs to get out to these young kids that it can hurt you badly and it is not just a plant that can do no harm. I agree that our young kids need this info even though it is not popular to voice this.

MAR, 26, 2018 02:14:57 PM
I have been researching this for some years now since my son (who started smoking marijuana at 11 years old) had a psychotic break at the age of 22 and still hears voices 11 years later at 33. We have been using CBD's when he has an episode (which occurs in cycles of about once every 4 weeks) and he has experienced some good results so far. He is on five different prescription medications and doesn't want to add any others to his regimen. In my studies, we have found several types of cannabis that are high in CBD's and low in THC and have been recommended for patients who live with psychosis. What do you think about using CBD's as an antipsychotic?

MAR, 26, 2018 01:52:03 PM
laura lee
I am one of those people that use cannibus for my fibromyalgia and I use it for my bipolar, since I have been using it I have less suicidal thoughts, I have not been hospitalized for suicidal actions in over seven years..I get up every morning feeling blessed fore another day..I take meds for my depression and I still have suicidal thoughts but I will never try and kill myself when people jugde on how cannibus works unless you have tried it..I have my cannibus medical card so don't do a quick judgement on the situation unless you know how it feels inside...everyone have a blessed day...

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