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UK: Off your head?

Yvonne Roberts

The Observer

Sunday 19 Feb 2006

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As a series of new studies proves the link between cannabis dependency
and mental illness, an Observer investigation reveals the plight of
young users struggling to find help to deal with the disturbing effects
of a drug once considered 'safe'.

Daniel Hrekow is 23, articulate, musically talented and academically
bright. In the past five years he has dropped out of two universities
and experienced two breakdowns. At the age of 19, after several years of
feeling depressed, anxious and increasingly disconnected, he was
diagnosed as having Asperger's syndrome, a form of autism.

Signs of Asperger's include an inability to empathise or understand
other people's emotions, difficulty in tolerating change and obsessional
behaviour. In Daniel's case, this obsessional behaviour can mean periods
of smoking cannabis for several days and nights at a time. Since his
teens, out of fear and frustration, Daniel has tried to control every
aspect of his mother Mary's life. He has also become extremely violent
to her, his father, Peter, and younger brother, Ben.

Daniel is the human face of a disturbing statistic revealed last week -
an alarming 40 per cent rise in hospital admissions for mental
ill-health prompted by cannabis use since 2001, when it was first
proposed to downgrade it from a Class B to Class C drug.

A new study demonstrating the link between psychosis and cannabis -
written by Professor Tom Barnes - will be published in the Journal of
Psychiatry next month, adding yet more pressure on the government to
take a fresh look at the price paid by increasing numbers of young
people dependent on cannabis.

Daniel is just one example of this growing problem. 'When he's violent,
he bangs his head against the wall, punches and shakes me, smashes
furniture and cuts himself with kitchen knives,' says Mary. His parents
have had to ask the police to remove their son from the family home
several times - and again this weekend, Daniel has been abusive and
threatening. Meanwhile, he and his mother are waiting to hear if a place
will be funded for him at the Rookery, in Somerset, one of the few
residential settings in the UK offering education for young people with
Asperger's.

Mary has fought hard to acquire support for Daniel from the South London
and Maudsley NHS Trust, often with little success. At one point the
Hrekows, both education consultants, remortgaged their home to raise
more than UKP30,000 to pay for Daniel's care.

Last September, after 18 months in a residential unit, Daniel decided to
return to university. He was supposed to receive support but none was
forthcoming from the trust. After several weeks at Goldsmiths College in
London, he began to do what he has always done, since the age of 15, to
ease the pain of alienation - he began to smoke cannabis excessively.

'When you're trying to live life as a normal person, and you're stoned,
you disguise yourself because you're pretty much out of it,' Daniel says.

He gives a long and moving account of life with a cannabis addiction.
'At first, with cannabis, it becomes so much easier to float by
unnoticed. But then you become paranoid. You're quick to assume the
world isn't going to make a place for you. Through drugs, I've come
close to destroying myself, but sometimes the only option is to be in
this oblivious state, trying to get a break from the pressure. But it's
no break at all really.

'In my teens I used to champion cannabis but once you've taken yourself
to places I've taken myself to, you can't hide from what your brain
felt. Now, I don't get a high at all. Instead, my brain hurts so much,
and I don't sleep for days. It goes wrong so quickly that what's going
on internally becomes visible to everyone and that's frightening for me.
No one at 23 who's been into cannabis for years can get away with saying
it doesn't mess your head up. If you're smart and have potential and you
do drugs for too long, it takes you further away from a healthy balanced
way of living which is what you secretly wanted in the first place -
with that first joint.'

In 2001, 490 patients were admitted to hospital as a result of excessive
use of cannabis. There were 710 admissions in each of the past two
years. Several recent studies have demonstrated the links between
cannabis and schizophrenia. Professor Robin Murray, a consultant
psychiatrist at the Maudsley Hospital in south London and one of the
leading researchers in the field, estimates that 25,000 of the 250,000
people with schizophrenia in the UK could have avoided the illness if
they had not used of cannabis.

In addition, the Advisory Council on the Misuse of Drugs (ACMD), in a
report to Home Secretary Charles Clarke arguing against
reclassification, suggested for the first time that cannabis may not
only cause schizophrenia in those with pre-existing mental conditions,
but could also exacerbate a range of other mental health problems.

In the UK, 250,000 people experience psychosis - a term that refers to
symptoms including delusions and hallucinations, rather than a specific
diagnosis. 'Five years ago, 95 per cent of psychiatrists would have said
cannabis doesn't cause psychosis,' says Murray. 'Now, I would estimate
95 per cent say it does. It's a quiet epidemic.'

Steve Hammond, the 27-year-old son of mental health worker, Terry, began
smoking cannabis at 16, graduated to smoking up to 10 joints a night
over weekends, then, in his twenties, was diagnosed as schizophrenic.

'Steve was a brilliant sportsman: a gifted footballer, a superb runner,
a natural athlete,' says his father. 'Now, he is just a shadow, a
recluse. This is definitely an emerging issue. Everyone knows a "dope
head" who has used cannabis, the "safe" drug. It's not just the number
of cases of schizophrenia and psychosis that's a concern, it's the
thousands upon thousands who have lost a future.'

The ACMD report says that 'the mental-health effects of cannabis are
real and significant'. While it is true to say that many millions of
people have used cannabis moderately without impairment to their daily
lives, can we afford to ignore the hike in hospital admissions?

And have a number of recent court cases dealing with horrifically
violent crimes involving cannabis raised us from years of torpor about
the use of cannabis? Earlier this month, Peter Thomas, aged 21, was
given an indefinite jail sentence after beating Lisa Voice, the mother
of his former girlfriend, so severely that she needed 11 operations. 'He
smashed my skull, my nose was a pulp... he smashed my eye sockets and my
eye was hanging out,' Voice said. Medical experts said Thomas had been
suffering from 'cannabis-induced psychosis'.

Charles Clarke promised last month to 'implement energetically' the
three main recommendations of ACMD - a 'substantial' education campaign,
strengthened medical services for those dependent on cannabis and
further research into the implications of cannabis use - although
whether there will be sufficient funding is extremely doubtful. In 2005,
France spent UKP2 million to educate young people about cannabis. In
comparison, a recent British public health campaign on the same issue
received UKP230,000.

Next month, the National Treatment Agency for Substance Misuse is
launching its Young People's Effectiveness Strategy for under 18s.
Professionals say it is impossible for the strategy to encompass
excessive cannabis use because so little is known about it - who is
using it, how often, why some individuals appear more vulnerable than
others to its effects and how many are seriously impaired. Nor do we
know enough about what works in terms of 'education'. What is certain is
that, in many parts of Britain, a young person with cannabis problem
would be very fortunate indeed to find effective help. Heroin, cocaine
and crack cocaine have a more established link to crime and death, so
receive a far higher priority in public policy. Cannabis may lay waste
to lives, but often the casualties suffer a lifetime of delusion and
reclusiveness while their families privately mourn their loss.

For years, the debate on cannabis has progressed little. 'The issue has
been polarised between those who argue that if everyone smokes it, it
will lead to world peace and those who believe that a few spliffs may
send you psychotic,' says Dr Luke Mitcheson, a clinical psychologist.
'That shows a deep immaturity in the face of increasing evidence that we
need a far more sensitive dialogue.'

Cannabis is the most widely used illicit substance around the world,
particularly among young adults. Users are smoking it from a younger age
and in larger quantities for longer, not least because young people
today have more ready cash than their Sixties counterparts did and a
small quantity of cannabis is now cheaper than a packet of cigarettes or
a couple of pints.

There has been a staggering 70 per cent increase in teenage
mental-health problems since 1974, according to the Institute of
Psychiatry. Young people in the UK use more cannabis than their peers on
the continent. In the UK, latest statistics reveal that 1 per cent of
all 11-year-olds, 17 per cent of 14-year-olds and 26 per cent of
15-year-olds used cannabis last year.

Cannabis, or marijuana, comes in different forms. Hash, the resin of the
plant, is less expensive than grass or weed, which is the plant's dried
leaves. 'Skunk', at around UKP200 an ounce, is herbal cannabis grown
from selected seeds by intensive indoor methods. Skunk is twice as
potent, on average, than hash or weed.

Some say the increase in psychosis and schizophrenia is because skunk is
more readily available and easier to obtain than hash or grass, but
other professionals believe that the market is simply responding to
demand for the more 'mind-blowing' version. The ACMD said that the
evidence on whether 'skunk' was playing a major part in the apparent
increase in psychosis was 'unclear' because, there was 'too little
information about the potency and pattern of use of cannabis by consumers'.

Cannabis, often mixed with tobacco, is either smoked in a joint or in a
water pipe, or cooked into food and eaten. The plant contains more than
400 chemicals including delta-nine-tetrahydrocannabinol (THC), its main
psychoactive component. Interactions between THC and specific proteins
on the surface of the brain cells, known as cannabinoid receptors,
produce the laid-back, pleasure-enhancing awareness after smoking
cannabis and is sometimes accompanied by an urge to eat.

Recent breakthroughs in neuroscience show, contrary to earlier research,
that even in adolescence the brain is still developing. A paper to be
published soon as part of a campaign by the charity YoungMinds, explains
how the frontal cortex - where this development takes place - is
essential for functions such as response inhibition, emotional
regulation, analysing problems and planning.

Research also shows that sustained use of cannabis over several years
may result in cognitive impairment, affecting memory, attention and the
organisation and integration of complex information.

Several controversial key studies have recently shown the impact of
juvenile cannabis use. One, carried out by Murray and the University of
Otago in New Zealand, followed a group of 750 adolescents over 15 years
and found that those who had smoked cannabis at age 15 were four and
half times more likely to be schizophrenic at age 26.

Two weeks ago in Portsmouth at the inquest of 23-year-old Roy Jackson,
who died after bingeing on methadone and cough medicine, coroner David
Horsley underlined the tragic downhill spiral that cannabis dependency
can produce in a mentally ill person. Roy had begun to smoke joints at
age 14 and eventually moved on to skunk. He was diagnosed as
schizophrenic at 19. 'The use of cannabis exacerbated his mental health
problems,' Horsley said. 'It predisposed him to smoking more regularly
than was good for him.'

Roy's sister, Lisa Male, said: 'It was horrible. He was sectioned at 19
when it should have been the best time of his life. He had been a bright
boy at school. One doctor told my mother that the increasing use of
skunk had created a ticking time bomb.'

Roy's family, understandably, want the laws on cannabis tightened. But
reclassification will not stop young people rolling a joint - nor will
it encourage them to put a brake on excessive use.

Three months ago, J-Rock, an actor and a member of R&B group Big Brovaz,
decided to give up 'the weed'. Now 27, he had smoked up to 10 spliffs a
day from the age of 13. 'Everything in my life had weed around it,' he
says. 'I was paranoid, I couldn't handle my life any more, I had to stop.'

But he was helped by an early-intervention counsellor, using
motivational techniques which have proved successful in Australia and
the USA. Contrary to myth, coming off cannabis can cause withdrawal
symptoms - including insomnia, irritability and physical discomfort.

'I suddenly got my dreams back and they were really vivid. That was
strange, but my counsellor had prepared me for that.'

J-Rock and the counsellor worked together three times a week. He was
instructed to keep a diary, to look at when he smoked and why; he was
encouraged to develop activities to distract himself from smoking and to
establish goals for the future. Thirty-one days after giving up, a test
showed THC was still inside his body. Yet now, he is drug-free.

'So many young people grow up seeing Snoop Doggy Dog smoking weed and
they think you have to do that to achieve, to be creative through weed,'
he says 'I'm successful beyond some people's dreams but I was doing it
under the influence of drugs. Now, I'm acting, recording and it's a
whole lot easier. This is me.'

'Given the right help, people can change surprisingly quickly,' says
Mitcheson, who works clinical psychologist in Lambeth, south London.
'Just setting up a service for cannabis users isn't going to work. Young
people don't identify with "I have a problem and yes the problem is
cannabis". Often that's only part of a range of difficulties and
adolescence is a time of change anyway when some become unstuck.'

The government has established 109 Early Intervention projects around
the country. The concept is good but, in practice, some projects consist
of a single worker covering many hundreds of miles. 'What we still have
too often, is a service open five hours on a Monday, Wednesday and
Friday,' says Kathryn Pugh of YoungMinds. 'What a young person needs is
help on a Sunday night when he's alone in his bedsitter.'

Another problem is that a young person has to reach a crisis and
experience a psychotic episode before help is given. Little exists for
the heavy smoker who wants to cut back before it gets out of hand. Early
Intervention projects may also suffer because of the financial crisis
faced across the NHS. Government money allocated for young people's
mental health budgets, however generous, is often siphoned off for other
uses.

In-volve, a charity set up by Colin Cripps, runs 15 services for young
people around the country. 'We've never tailored intervention in any way
that made sense,' says Cripps. 'Now, following Danish research, we wait
for a couple of weeks until a young person has got enough cannabis out
of his or her system, then we work with them as a person not as a drug
user. Most of the problems are about identity. Heavy users have often
grown up feeling failures.

It takes weeks and weeks of intensive counselling of the right kind and
opportunities for education, training and employment to persuade a young
person they can make something of their lives. Only then is cannabis
recognised as the problem.

'In-volve uses texting, flyers, chat rooms events and word of mouth to
spread its message. So much of drugs education in this country ignores
the changes in communication and leaves young people cold.'

The work of Dr Jim McCambridge, of the National Addiction Centre, and
his colleagues, is beginning to demonstrate how young people are capable
of helping themselves given the right opportunity. For the centre's
ongoing study, students in colleges across London were randomly picked.
Of those, 50 per cent subsequently said they had difficulties with
cannabis. They were then interviewed for half an hour and, using
motivational techniques, encouraged to evaluate their own lives and goals.

A few months later, the students were reassessed and it was discovered
that the interview had had a positive impact on their behaviour. Studies
are now taking place to test whether training in motivational
techniques, for professionals such as teachers who come into contact
with young people every day, might have a long-term impact on reducing
drug use.

'Given the prevalence of cannabis, there's so much we don't know,'
McCambridge said. 'Who's using heavily? Why? How best can they be
helped? The tragedy is that with no overarching strategic direction, we
have pockets of good practice and and waste lands where there is no help
at all.'

James, in his twenties, began smoking cannabis at 15. 'The reason I
never did any other drugs was because their dangers were well known. I
was a sensible person,' he said, aware of the irony. 'Even when I went
to two GPs, saying I was having problems with anxiety and paranoia, they
gave me antidepressants and said if the cannabis helped me to relax, I
should carry on.'

At 19, he had a breakdown and was hospitalised with drug-induced
psychosis. At school, he achieved seven A stars in his GCSEs. Now he is
unable to hold down a job. 'My brain works but I don't do well in social
situations. If only I'd known about the risk.'

What's required now, experts in the field say, is for Charles Clarke to
put his money where his mouth is. However large or small the issue of
cannabis dependency, it needs ring-fenced sustained funding, more
research, the right support available across the country and improved
universal drug education given earlier in schools and to professionals
such as GPs.

In the meantime, Daniel Hrekow is optimistic that if he receives the
right kind of help, he will be able to build a life for himself. But his
mother, Mary, is angry.

'Everyone on the ground will tell you there's a big problem with young
people and cannabis,' she said. 'But where do they or their families go
for help? Mental health services are at the bottom of the spending list,
and cannabis is even lower.' Mary knows it will be a long and hard road,
but she wants her son back.

Why I hate my drug-taking brother

A remarkable first-person account, written for a school essay project,
by the 13-year-old sister of an 18-year-old cannabis smoker who suffered
from psychosis.

My squitsaphrenic [teacher corrects to schizophrenic] brother: Of course
I have to love him because he is a member of my family. However this
does not excuse the hatred that goes through my mind every evening that
I am forced to share with him. Peter, my brother of 18, is currently ill
with squitsaphrenia due to taking drugs (cannabis) from an early age.

He is greedy, lazy, selfish and unbearable. As well as treating myself
and my family unfairly, he has no control over his anger, also becomes
obsessed with the slightest things, for example: switching the computer
off every time it is not in use; pacing around the house; and making
pots of tea.

I am genuinely scared of him as well as furious that I have ended up
with such a meaningless brother. As a result of this, I try to avoid
making eye contact, speaking and even listening to him, as I would bear
an even huger grudge against him.

If I were to face him or stand up to him, I would most likely get
emotionally hurt or an even huger chance of getting physically hurt
because he has no respect for my feelings at all.

The world would not change if he were not here, as it is only my family
who knows the true Peter. If I were to re-live the past two years, from
when I started to detest him, I would be a carefree teenager.

Bans and busts

- Cannabis was banned in 1928 after a Chinese musician was accused of
giving hashish to three women found near-naked in his flat in Cardiff.

- A government committee looking into drug laws, headed by Baroness
Wootton, concluded in 1968 that 'the long-term consumption of cannabis
in moderation has no harmful effects'.

- Writer Sue Arnold championed cannabis. But in 2003, she told how
seeing her son almost destroyed by the drug forced her to change her
mind. 'I was so wrong on pot,' she said.

 

 

 

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