From Dr. Jordan Tishler re: “A ‘Severe’ Case of Cannabis Use Disorder”
While the DSM-V is clearly overly vague about the criteria for CUD, and the authors also do derive income from treating CUD, this patient also clearly has a problem. He clearly wants to cut down but can’t, he’s having conflict in his primary relationships, potentially spending money he can’t afford, and is missing his obligations as a result of use.
To assert that anyone treating CUD is suspect makes us suspect as clinicians treating people with Cannabis. We all derive income from treating patients.
Further, to assert that no one could have a problem with Cannabis is so patently false that is undermines the legitimacy of us as clinicians, and Cannabis as medicine that needs to be used wisely and carefully (as we do with any other medication).
Fred Gardner’s Retro Message:
Yes, anyone treating CUD as defined by the DSM is suspect from my POV —including SCC members. I’m a former editor of Scientific American and press secretary for the District Attorney of San Francisco, chosen by SCC founder Tod Mikuriya to be the Voice of the Enlightened Patient/Caregiver within the organization. For many years Tod and I talked almost daily about the medical marijuana movement —the science, politics, law, history, personalities— and related topics. We launched O’Shaughnessy’s in 2003. My Notes to the SCC provide the same kind of info from the same POV that Tod appreciated.I welcome your correspondence very much, though I take issue with it.
The DSM-V is not “overly vague” in defining CUD —it is tricky to the point of deceit. The authors justify cannabis prohibition while broadening the Treatment Racket’s catchment area. “Irritability, anger or aggression,’ “Nervousness or anxiety,’ “Restlessness,’ and “Depressed’ are listed as four distinct symptoms of withdrawal —any three of which qualify the person for a CUD diagnosis. A fifth symptom, ‘Sleep difficulty’ is usually a function of anxiety. Where is Dr. Roget when we need him?
I simply did not assert that “no one could have a problem with Cannabis.” But if the patient discussed by Brezing and Levin is a “severe” case, I’m not sure there should be a medical condition called “Cannabis Use Disorder.” Something about their case report seemed un-empathetic and slanted, as if they were compiling evidence in a legal matter. They write, “He reports liking how cannabis decreases his anxiety and helps him fall asleep, although he thinks the cannabis sometimes makes him ‘paranoid,’ which results in his avoidance of family and friends.” Serious beneficial effects reported by the patient are given half a sentence and promptly counterbalanced by his occasional unwillingness to hang out with people who disapprove of him. I suspect that the CUD diagnosis is masking the real problems in the patient’s life.Some Addiction Specialists are beginning to realize that utilizing cannabis as a harm reduction substitute for opiates and alcohol makes more sense than treating it as the source of a serious disorder.