Drug War Distortions: Cannabis, Addiction and Drug Treatment

Distortion 14: Cannabis, Addiction and Drug Treatment
"Research has now established that marijuana is in fact addictive. Of the 4.3 million Americans who meet the diagnostic criteria for needing drug treatment (criteria developed by the American Psychiatric Association, not police departments or prosecutors) two-thirds are dependent on marijuana, according to HHS. These are not occasional pot smokers but people with real problems directly traceable to their use of marijuana, including significant health problems, emotional problems and difficulty in cutting down on use. Sixty percent of teens in drug treatment have a primary marijuana diagnosis."
Source: John P. Walters, "The Myth of 'Harmless' Marijuana," Washington Post, May 1, 2002, p. A25.

False overall, and the data Walters uses in this piece is misleading.

The first part, regarding those meeting APA criteria for dependence, is incorrect. What the report actually states is "Among the 5.6 million Americans classified with dependence on or abuse of illicit drugs, there were 3.5 million Americans classified with dependence on or abuse of marijuana (1.5 percent of the total population and 62.0 percent of those classified with dependence on or abuse of illicit drugs).
The distinction between the two is thus:
"Dependence reflects a more severe substance problem than abuse, and persons are classified with abuse of a particular substance only if they are not dependent on that substance."
Source: Substance Abuse and Mental Health Services Administration, "Results from the 2001 National Household Survey on Drug Abuse: Volume 1. Summary of National Findings" (Office of Applied Studies, NHSDA Series H-17, DHHS Publication No. SMA 02-3758). Rockville, MD. 2002. pp. 58, 57.

More importantly, Walters is making an assertion which the data itself does not support. The estimates are derived from responses to "a series of questions to assess dependence on and abuse of substances, as well as questions asking whether respondents had received treatment for a problem related to substance abuse." It is true that "The dependence and abuse questions are designed to measure dependence and abuse based on the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about health, emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substances used." (p. 57)

Obviously, responses to a set of questions contained in a long survey are not the same as a real clinical diagnosis of drug dependence -- something which HHS used to warn about, though that caveat fails to appear in the new report. The Household Survey in 1998 however pointed out that "Readers should not interpret reports of these problems as being necessarily equivalent to a clinical diagnosis of drug dependence. Such a diagnosis must be made by a professional after careful consideration of many factors. In general, reports of three or more drug-related problems may be suggestive of dependence and indicate the need for evaluation or services for drug use."
Source: Substance Abuse and Mental Health Services Administration, "National Household Survey on Drug Abuse: Main Findings 1998 (Office of Applied Studies, Rockville, MD, 2000), p. 131.

The last assertion is actually technically true, about the number of teens in treatment with a primary diagnosis of marijuana dependence, however it's only a small part of the story. For many of these people, drug treatment is simply a way to avoid possible criminal punishment. According to the Treatment Episode Data Set, an annual federal report on drug treatment services:
Treatment admissions in 1999, aged 12-17: 131,294
Treatment admissions in 1999, aged 12-17, with marijuana as the primary drug: 79,000 (60.2% of total
Of those, 53.6% were referred by the criminal justice system
referred by schools: 10.5%
referred by "other community" sources: 8.3%
(The "other community" referral source may include the person's defense attorney, for example.)
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set (TEDS): 1994-1999. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-14, DHHS Publication No. (SMA) 01-3550, Rockville, MD, 2001, p. 109, Table 5.2a.

Overall, for all ages, the picture is similar. According to TEDS 1999, 57.1% of treatment admissions with marijuana as the primary drug were referred through the criminal justice system directly, plus another 4.2% through the schools, 1.4% through employers, and 9.3% through "other community" sources. (Table 3.4, p. 79.)

Distortion 14: Cannabis and Drug Treatment