How do I know if I have a problem? Like any drug, cannabis can cause problems and impact on your health and life. But how do you know if you have a problem? Problematic cannabis use is not just a matter of how much cannabis a person uses, but also why they use it and how it affects their life. Listed below are some questions you can ask yourself to help you decide if your cannabis use is causing problems and affecting your life. Do you find it difficult to stop using cannabis once you have started? For example: Î Do you use more cannabis than you planned to? Î Afterwards do you feel guilty? Î Do you need to use more and more cannabis to get the same effect? Do you experience withdrawal symptoms when you have had a break from using cannabis? Î See 'Coping with withdrawal' on page 12 for more information. Are there times when you feel you need to use cannabis to cope? For example: Î Do you feel you need to use cannabis to help you relax or sleep? Î Can you go to a party or socialise without using cannabis? When 'stoned', do you do things you later regret?
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Does your cannabis use affect your relationships, home-life, work or school? For example: Î Have you missed work or school because of your cannabis use? Î Does your cannabis use cause arguments with family and friends? Î Have you or someone else been injured because of your cannabis use? Has a relative, friend or health care worker shown concern about your cannabis use? Have you experienced any of the negative health effects of cannabis? See below for the effects of cannabis use.
What are some of the effects of cannabis use? Cannabis can cause problems in many areas of your life. For example: Î Relationships and family—arguments over your cannabis use and behaviour while 'stoned' can cause problems. Î Work or school—cannabis use can become more important than other things in your life, and your work or school performance can suffer. Î Î
Finances—spending too much money on cannabis or fines from legal issues can cause money problems. Your health—either through injuring yourself while under the influence of cannabis (e.g. drug driving or falling over) or due to heavy consumption over time (see 'Longterm effects' on page 4).
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Î
The health of others—cannabis smoke can be inhaled by the non-smokers around you, especially in enclosed areas. Researchers have proposed that the risks of passive cannabis smoking may be similar to those of passive tobacco smoking. (See ‘Long-term effects’ on page 4).
Short-term effects Cannabis is a depressant drug. This does not necessarily mean it makes you feel depressed but it slows down the activity of the central nervous system and the messages travelling between the brain and the body. In higher quantities cannabis can also have hallucinogenic effects. In the short-term, the effects of small doses of cannabis can include: Î feeling happy and relaxed Î fewer inhibitions and feeling friendlier Î becoming quiet and reflective Î feeling sleepy Î increased appetite Î changes in perception—for example, the perception of colour, sound, time and space Î reduced coordination Î confusion and difficulties with thinking and memory— people may lose track of what they are thinking or saying Î feeling anxious and mildly paranoid Î increased heart rate Î reduced blood pressure Î red eyes.
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People who have smoked synthetic cannabis have also reported experiencing high blood pressure (hypertension), increased breathing rate, chest pain, heart palpitations and seizures. Larger amounts of cannabis can also cause: decreased reaction time Î feelings of excitement and restlessness Î confusion, anxiety or panic Î paranoia Î feeling detached from reality Î hallucinations. Î
Long-term effects Consumption of cannabis over time can damage many parts of the body. Some of these effects, such as impaired cognitive function, may eventually disappear when a person stops using cannabis. Long-term effects can include:
Brain Î Î Î
Impaired cognitive functions such as concentration, memory and ability to learn. Reduced motivation and energy. Increased likelihood of psychotic symptoms in a person who is vulnerable due to a personal or family history of mental illness.
Mouth and throat Î
If smoked: increased risk of developing mouth and throat cancer, especially when cannabis is mixed with tobacco.
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Lungs Î
If smoked: a sore throat, an increased risk of respiratory illnesses such as asthma and bronchitis and an increased risk of lung cancer.
Heart Î
Increased risk of heart attack in people who are at risk of heart disease.
Immune system Î
Impaired immune system and increased susceptibility to illness.
Reproductive organs Î
Reduced sex drive and sperm count in men.
Î
Irregular menstrual periods in women. If used while pregnant or breastfeeding: health and development of the baby affected.
Î
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Planning to change your cannabis use Planning what you are going to do, setting some goals and having some support will make it easier to change your cannabis use. The following section outlines some issues to consider during your planning. At any stage of the planning, your health professional can provide assistance. They can check your health, discuss your options, help you set goals, and provide support and referrals.
Advantages and disadvantages of changing your cannabis use To help you decide what to do about your cannabis use it might be helpful to write down the advantages and disadvantages of making changes. Think about your list. Are there more advantages to changing your cannabis use than disadvantages? How significant are the disadvantages? This list can also be used later to help you focus on your goals if you are struggling.
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Some examples are listed in the table to help get you started.
Advantages of changing your cannabis use Î
More money to spend on other things.
Î
No more arguments with family and friends about what I did while I was stoned.
Î
Have more energy and feel better.
Disadvantages of changing your cannabis use Î
Not being able to have fun with friends when they’ve been smoking.
Î
Needing to learn other ways to relax and unwind.
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Why do you use cannabis? If you have decided you want to change your cannabis use it might be helpful to work out exactly how much you are using and why. Keeping a diary for a couple of weeks will help you see how you use cannabis and identify any patterns or risky situations. For example: Î Did you use more when you were in particular places, doing certain things or just being with certain people? Such as, watching TV with friends, at parties, or at home alone? Î How were you feeling? Were you angry, happy, bored or depressed? Certain moods in different people can increase their urge to use cannabis. Î Did your cannabis use get you into trouble with your family, friends or the police? What led up to that situation? Think about how you can change your routine so there is less chance of these situations happening or how you can handle them differently. Your support person might have some good ideas (see 'Make sure you have support' on page 10).
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What do you want to achieve? After listing the advantages and disadvantages of changing your cannabis use and keeping a diary, you will have a better understanding of how much you use, why you use cannabis and what impact it is having on your life and the lives of those around you. This information will help you start making plans to change your cannabis use. Firstly, decide how you want to change. For example, do you want to cut back how much you use, gradually reduce the amount you use until you have quit, or stop using cannabis immediately? Some things to consider when making this choice include: Î
Your health—if you have been using cannabis heavily for a long period of time, if your health has been suffering, or if your doctor recommends it, it may be best to quit using cannabis completely.
Î
How much and how you use cannabis—do you find it difficult to stop using cannabis once you have started?
Î
Have you tried to cut down or quit before?
Î
Have you experienced severe withdrawal symptoms previously?
The next step is to set some short and long-term goals. These goals need to be realistic and will depend on your overall aim. You might not be able to change everything at once so think about what you could do in the short-term (over the next week) that will get you closer to your long-term goals. It is important to set realistic goals; if you set goals that are unrealistic and don’t reach them you may be disappointed and feel like giving up.
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For example, if your overall goal is to reduce your cannabis use, some short-term goals for the week might include: Î Î Î
Not having a smoke when watching TV. Setting a minimum number of cannabis-free days you will have. Setting a limit on how much cannabis you will use for the week.
Write down your goals and when you wish to achieve them. There is space for this in the diary in the section on 'Changing your cannabis use' (page 17). You should review your goals regularly. If you reach your goals, you can set new ones. If you don’t reach your goals then have a look at what went wrong and try again. You might find it helpful to discuss your goals and whether you achieved them with your support person or a health professional (see 'Support and further information' on page 40).
Make sure you have support It is important that you find people that can help and support you change your cannabis use. This could be your medical practitioner, a counsellor, a friend, a support group, or a combination of any of these.
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Medical practitioner Your medical practitioner can provide support and assistance at all stages of changing your cannabis use. They can monitor your health and help you cope with any withdrawal symptoms you may be experiencing (see 'Coping with withdrawal' on page 12). They can also discuss the various treatment options, services and medications that may be suitable for you and provide referrals to other services and counsellors.
Counsellors Counsellors can also provide support and help you develop strategies to change your behaviour. They can also discuss the other treatment options and services that may be suitable for you. There are a number of different types of counselling services and methods available. Some provide individual counselling while others offer group counselling. There is also telephone and online counselling available.
Support groups Support groups are generally run by people who have had a drug-related problem or have been affected by drugs so the members understand what you are experiencing. They aim to help you remain drug-free and also provide social networks that do not involve drugs.
Friends and family You could ask a friend or family member to be your support person. The important thing is that they need to be someone you trust and who understands the type of life you lead. If you choose to have a support person it is important that they also read this guide and the ‘Guidelines for support people’ at the back of this booklet.
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For further information, counselling, referral or other assistance, contact the alcohol and drug information services in your state or territory (see the inside back cover for details).
Coping with withdrawal If you have been using cannabis heavily for a while and then suddenly stop using it or reduce the amount, you may experience withdrawal symptoms. This is because your body needs to adjust to functioning without cannabis. Generally these symptoms peak after a couple of days and gradually settle down over the next week or two. For most people the symptoms will be mild, but if you are experiencing severe symptoms, you should see a medical professional. Some of the symptoms of cannabis withdrawal include: Î cravings for cannabis Î anxiety, confusion, irritability and feeling angry Î restlessness Î fatigue Î sleep problems, vivid and sometimes disturbing dreams Î tremors Î sweating, especially at night Î loss of appetite Î nausea Î diarrhoea Î headaches.
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Strategies for changing your cannabis patterns Planning strategies that you can use to change your cannabis use and help you cope with risky situations will help you deal with these situations when they happen. The following section provides advice on how to develop these strategies.
Hints on cutting down If your goal is to reduce your cannabis consumption there are a number of strategies that you can use. These include: Î Delay having the first smoke of the day for a couple of hours and gradually increase this time each day. Î Aim to use a little less each day. Î
Set limits around what times you can use (e.g. only between 8pm and 10pm) and how much you can use.
Î
Do something to distract you from thinking about smoking. Go for a walk or to the gym. If you are at a party play pool or darts, dance, talk to friends. If you are going to a party where you think people might be using cannabis, arrive late and leave early so you spend less time in the risky environment.
Î
Î
Smoke at your own pace and don’t try to keep up with your friends.
Î
Think about if you really want the cannabis or if you are just using it because it’s there or you are bored.
Î
Buy less cannabis each time so there is less lying around tempting you.
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Î
Put your smoking gear and cannabis away between uses. Consider putting it in a place that is difficult to get to.
Changing the way you use cannabis can also help reduce the harms, for example: Î
Use a vaporiser. Since vaporisers don't burn the cannabis you aren’t breathing in smoke.
Î
Eat the cannabis in a cake or cookie because it is better for your respiratory system. However, it takes longer (about an hour) to feel the effects of eating cannabis, which means it’s easy to have too much.
Î
Don’t mix tobacco with the cannabis because when you try to stop or cut back you may also experience withdrawal from the nicotine in the tobacco.
Î
Smoke joints instead of bongs as joints are generally less damaging to your lungs than bongs. You also have to roll one each time and this gives you a chance to decide if it’s worth the time and effort—especially if your gear is in a place that’s difficult to get to.
Your local alcohol and drug information service can provide you with more information and tips for minimising the harms associated with cannabis use. Their contact details are on the inside back cover.
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Tips on saying no Whether your goal is to reduce your cannabis consumption or quit, you will need to think about how you will respond when someone offers you cannabis. By planning how you will respond before you are in that situation you can be prepared. Some responses might include: Î
No thanks, I’m cutting down.
Î
No thanks, I’ve given up.
Î
No thanks, I’ve had enough.
Î
No thanks, I’ll sit this one out.
Î
No thanks, I have to work/go to school tomorrow.
Î
No thanks, I promised I wouldn’t tonight.
Î
No thanks, I’m giving my lungs a rest.
It does get easier with practice. Choose a couple of these, or make up your own, and rehearse saying them by yourself so you sound confident and at ease. Some people just won’t accept no for an answer. You may have to avoid being around them, at least until you have settled into a pattern of cannabis use you are happy with or you are confident about 'saying no' rather than 'being cannabis-free'. Remember your friends may only be putting pressure on you to use cannabis so that they feel more comfortable about their own cannabis use.
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Coping with the urge to use cannabis and relapse You have given yourself the best chance of succeeding by taking time to think about your cannabis use and how you are going to change things. Even so, saying you are going to do something can often be easier than actually doing it. There may be times when you find it hard to stick to your goals or you just feel like giving up. The first thing to do is to think about why you started all this in the first place: Î If you made a list of advantages and disadvantages of changing your cannabis use, take the list out and read it again. Î Think about whether you really want to have that smoke. Î Talk to your support person, that’s what they’re there for. Î Go for a walk or do some other physical or distracting activity to take your mind off the urge. Î Delay using cannabis for 15 minutes, the urge may pass. Î If you are in a 'risky situation/environment', leave it. Î Try using relaxation techniques. Î Ring a helpline and talk to a health professional. If you do slip up and don’t stick to your goals—don’t despair. It’s only one day out of your whole life. Definitely don’t throw it all away. Think about why it happened and see if you can avoid that sort of situation again or how you would cope differently next time. Ask your support person or health professional for help and advice.
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Changing your cannabis use Now that you have decided what you want to achieve, set some goals and identified some strategies to help cope with risky situations, you are ready to change your cannabis use. This diary will help give you a record of what, when and why you are using cannabis. You can compare your progress with previous weeks and keep track of your goals. Carry this book with you whenever you go out and keep it in a handy place when at home. Fill in the diary every day and make sure you note how you were feeling and how you coped. Make sure you: Î Fill in days when you have not used cannabis. Î Note the times when the urge to use was strong but you didn’t use cannabis. Î Note down how you coped with difficult situations. If you are reducing your cannabis use, make sure you also: Enter all the cannabis you use. Î Add up the money you have spent on cannabis. Î
Once you have started to change your cannabis use, continue to keep your diary. Review your diary once a week, perhaps with your support person. Think about what happened when the urge to use cannabis was strong. How did you cope? What were you feeling when you used more than you planned? How could you deal with that situation differently next time? Once you have settled into a cannabis use pattern you are happy with, keep the diary for a week every few months to check that you haven’t slipped.
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Sample diary entries Goals: —This week I will have at least three cannabis-free days
and on the days I smoke I will have no more than 1 gram. —By December this year I want to have quit using cannabis.
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon
8pm—At home after dinner watching TV by myself
Felt a bit jittery
Tue
6pm—At home alone
Bad day at work, felt stressed & needed to unwind
Wed
7pm—At home with family
Tired & stressed about work
Thur —
—
Fri
5.30pm—At a friends house, lots of people smoking
Relaxed, but got a bit stressed when it seemed like everyone else was smoking
Sat
Listening to a band at the pub with John & Sue
Felt relaxed but had a few beers and shared a few smokes
Sun
2pm – BBQ at Jan and Pete’s
Relaxed
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Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Rang a friend for a chat
0
0
Tired, watched TV
3 smokes, about 1 gram
$25.00
Went for a walk to distract myself
0
0
Watched TV
0
0
Felt a little bit guilty afterwards but I did only have one smoke. Left the party earlier than normal so I wouldn’t be tempted to have more.
1 smoke, less than ½ gram
$12.50
Felt guilty afterwards
2 smokes, less than 1 gram
$25.00
Argued with Pat, felt guilty about smoking
3 smokes, about 1 gram
$25.00
Weekly Total
$87.50
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
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Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
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Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
24
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
26
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
28
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
30
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
32
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
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Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
36
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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Goals:
Day
What time, where & with whom
Feelings before urge to use cannabis/cannabis use
Mon Tue Wed Thur Fri Sat Sun
38
Feelin instea
use
Feelings & what happened after/ instead of using cannabis
Amount of cannabis Cost used
Weekly Total
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PO Box 818, North Melbourne, Victoria 3051 Level 12, 607 Bourke Street, Melbourne, Victoria 3001 1300 85 85 84 shop@adf.org.au www.shop.adf.org.au
Copyright Š 2013 Australian Drug Foundation For further information, counselling or other assistance, contact the alcohol and drug information service in your state or territory. ACT (02) 6207 9977 NSW (02) 9361 8000 1800 422 599 (outside Sydney) NT 1800 131 350 QLD 1800 177 833 SA 1300 131 340 TAS 1800 811 994 VIC 1300 85 85 84 (information) 1800 888 236 (counselling) WA (08) 9442 5000 1800 198 024 (outside Perth)
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