Aspergers Adults and Self-Medication

Question

My son is 22 and self medicates with marijuana, he has tried prescription medication but doesn’t like the side effects. He is living at home at the moment (has had a few attempts at living away from home). How do I handle this? He says he wants to give up, but will do it his way and wants no involvement from me. However, I cop the brunt of his rage when he hasn’t had his marijuana. Would appreciate any advice…

Answer

Self-medication is the use or abuse of drugs and/or alcohol in an attempt to relieve physical and/or emotional problems (e.g., depression, anxiety, sleeplessness, emotional pain, bipolar disorder, Aspergers, etc.). Self-medication is a temporary fix, because it treats the symptoms of the problem, not the problem itself. When young adults with Aspergers use drugs other than those that health-care providers prescribe, the underlying problem goes untreated – and possibly worsens! Unfortunately, self-medicating is often nothing more than short term gain WITH long term pain.

Cannabis is the second most common drug used to medicate unwanted symptoms associated with the Aspergers condition, for example:

• anger management problems
• controlling feelings such as depression, fear or anxiety
• high intelligence, and sometimes too smart for their own good
• inability to listen to others
• inability to think in abstract ways
• inflexible thinking; lack of empathy
• lack of managing appropriate social conduct
• repetitive routines provides feelings of security
• specialized fields of interest
• stress when their routine suddenly changes
• visual thinking

Having said this, we should consider the research on “marijuana use” rather than simply offering opinions about the pros and cons.

THC, the active ingredient in marijuana, increases serotonin when smoked in low doses (similar to SSRI antidepressant, such as Prozac). But at higher doses, the effect reverses itself and can actually worsen depression and other psychiatric conditions. Researchers have observed an antidepressant effect of cannabinoids and an increased activity in the neurons that produce serotonin. However, increasing the cannabinoid dose beyond a set point (which is difficult to determine) completely undoes the benefits.

The antidepressant and intoxicating effects of cannabis are due to its chemical similarity to natural substances in the brain known as "endo-cannabinoids," which are released under conditions of high stress or pain. They interact with the brain through structures called cannabinoid CB1 receptors. Studies demonstrate that these receptors have a direct effect on the cells producing serotonin, which is a neurotransmitter that regulates the mood. However, since controlling the dosage of natural cannabis is difficult (particularly when it is smoked in the form of marijuana joints), using it directly as an antidepressant is very risky. And in most cases, the well-meaning cannabis ‘user’ slips into the ‘abuser’ over time (since this drug is addictive), thus crossing the line into ‘depression-aggravation’ rather than ‘depression-alleviation’.

We’ve talked about depression so far, but it should be noted that the same holds true for anxiety. Small doses of cannabis alleviate anxiety (temporarily), but exacerbate feelings of anxiety in larger doses. In addition, the same holds true for other illegal drugs (e.g., the use of cocaine would be a temporary “fix” at best, only to worsen symptoms in the long run).

Another complicating factor for young Aspergers adults who use/abuse cannabis is a little known phenomenon called “amotivational syndrome.” This presumed psychological condition is believed to be a direct result of regular cannabis abuse and leaves those affected with a reduction in (a) motivation and (b) capacity for the usual activities required for achievement and success in today's world. Some young adult ‘Aspies’ are, by default, slightly-to-mostly “unmotivated” to take on adult-like responsibilities anyway. Thus, when “amotivational syndrome” is added to the mix via marijuana abuse, the adult’s eventual independence and self-reliance is even more compromised.

It is possible for an experienced marijuana smoker to titrate and regulate the dose to obtain the desired acute effects, and at the same time, minimize undesired effects. Thus, the question becomes: “Do the advantages of self-medication with marijuana outweigh the disadvantages?” Clearly this is personal question that only the pot smoker can answer himself or herself.

It should be noted that smoked marijuana is not a medicine since it has failed to pass the scientific trials needed for it to go to market. As a result, marijuana remains a Schedule I controlled substance as defined by the Controlled Substances Act. Therefore, abusers run the risk of legal problems in addition to emotion and health problems.

What can parents do (assuming they want to be proactive about stopping drug abuse)?

First, educate yourselves completely about drugs and drug abuse.

If your son's drug use has been purely recreational, you may only need to clearly state your position regarding abstinence and then closely monitor his behavior. If your son is more deeply into substance abuse, seek the advice of a behavioral health or substance abuse professional.

Don't show any emotions of anger or fear, and don't lose your good poker face -- but do send a strong message that drug and alcohol use is not acceptable. Don't lecture, be clear, and keep your message short and to the point.

Restrict or eliminate use of the car, take away cell phones, etc., until your son is committed to being "clean and sober."

Find out where your son is getting the money to purchase drugs (e.g., your ATM card, wallet, money you give for an allowance, lunches, gas, etc.). Don't be surprised if you find he is stealing from you or others to finance his drug use.

Purchase urine-screen kits to use at home and test your son randomly. If he refuses the screens, tell him the following: "If you choose to use drugs, you'll choose the consequence – you will have to live elsewhere."

If your son continues to use drugs, follow through with this consequence.

This sounds like tough love – because it is. Understand this very clearly: If you are allowing your son to use illegal substances in your home – or if you are using your money to purchase the drugs for him, YOU run the risk of legal ramifications as well. Explain this to your son by saying, “You’re not the only one who could get into trouble with the law if you get busted with pot– it could affect me too!”

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