Summer 2003
O'Shaughnessy's
Journal of the California Cannabis Research Medical
Group
|
Cannabis as a Substitute for Alcohol
By Tod Mikuriya, MD
SUMMARY
Ninety-two Northern Californians using cannabis as an alternative to alcohol
obtained letters of approval from the author. Their records were reviewed to
determine characteristics of the cohort and efficacy of the treatment —defined
as reduced harm to the patient. All patients reported benefit, indicating that
for at least a subset of alcoholics, cannabis use is associated with reduced
drinking. The cost of alcoholism to individual patients and society- at-large
warrants testing of the cannabis-substitution approach and study of the drug-of-choice
phenomenon.
KEYWORDS
Addiction, alcohol, alcoholism, cannabis, depression, drug-of-choice, harm
reduction, marijuana, pain, substitution.
INTRODUCTION
Physicians who treat alcoholics are familiar with the cycle from drunkenness
and disinhibition to withdrawal, drying out, and apology for behavioral lapses,
accompanied over time by illness and debility as the patient careens from one
crisis to another. (Tamert and Mendelsohn 1969)
“Harm reduction” is a treatment approach that seeks to minimize the occurrence
of drug/alcohol addiction and its impacts on the addict/alcoholic and society
at large. A harm-reduction approach to alcoholism adopted by 92 of my patients
in Northern California involved the substitution of cannabis —with its relatively
benign side-effect profile— as their intoxicant of choice.
No clinical trials of the efficacy of cannabis as a subtitute for alcohol are
reported in the literature, and there are no papers directly on point prior
to my own account (Mikuriya 1970) of a patient who used cannabis consciously
and successfully to reduce her problematic drinking.
There are ample references, however, to the use of cannabis as a substitute
for opiates (Birch 1889) and as a treatment for delirium tremens (Clendinning
1843, Moreau 1845), which were among the first uses to which it was put by
European physicians. Birch described a patient weaned off alcohol by use of
opiates, who then became addicted and was weaned off opiates by use of cannabis. “Ability
to take food returned. He began to sleep well; his pulse exhibited some volume;
and after three weeks he was able to take a turn on the verandah with the aid
of a stick. After six weeks he spoke of returning to his post, and I never
saw him again.”
Birch feared that cannabis itself might be addictive, and recommended
against revealing to patients the effective ingredient in their elixir. “Upon
one point I would insist —the necessity of concealing the name of the
remedial drug from the patient, lest in his endeavor to escape from
one form of vice he should fall into another, which can be indulged
with facility in any Indian bazaar.” This stern warning may have undercut
interest in the apparently successful two-stage treatment he was describing.
At the turn of the 19th century in the United States, cannabis was listed as
a treatment for delirium tremens in standard medical texts (Edes 1887, Potter
1895) and manuals (Lilly 1898, Merck 1899, Parke Davis 1909).
Since delirium tremens signifies advanced alcoholism, we can adduce
that patients who were prescribed cannabis and used it on a longterm
basis were making a successful substitution.
By 1941, due to prohibition, cannabis was no longer a treatment option,
but attempts to identify and synthesize its active ingredients continued
(Loewe 1950). A synthetic THC called pyrahexyl was made available to
clinical researchers, and one paper from the postwar period reports
its successful use in easing the withdrawal symptoms of 59 out of 70
alcoholics. (Thompson and Proctor 1953).
In 1970 the author reported (op cit) on Mrs. A., a 49-year-old female
patient whose drinking had become problematic. The patient had observed
that when she smoked marijuana socially, on week-ends, she decreased
her alcoholic intake. She was instructed to substitute cannabis any
time she felt the urge to drink. This regimen helped her to reduce
her alcohol intake to zero. The paper concluded, “It would appear that
for selected alcoholics the substitution of smoked cannabis for alcohol
may be of marked rehabilitative value. Certainly cannabis is not a
panacea, but it warrants further clinical trial in selected cases of
alcoholism.”
The warranted research could not be carried out under conditions of prohibition,
but in private practice and communications with colleagues I encountered more
patients like Mrs. A. and generalized that somewhere in the experience of certain
alcoholics, cannabis use is discovered to overcome pain and depression —target
conditions for which alcohol is originally used— but without the disinhibited
emotions or the physiologic damage. By substituting cannabis for alcohol, they
can reduce the harm their intoxication causes themselves and others.
Although the increasing use of marijuana starting in the late ‘60s
had renewed interest its medical properties —including possible use
as an alternative to alcohol (Scher 1971)— meaningful research was
blocked until the 1990s, when the establishment of “buyers clubs” in
California created a potential database of patients who were using
cannabis to treat a wide range of conditions. The medical marijuana
initiative passed by voters in 1996 mandated that prospective patients
get a doctor’s approval in order to treat a given condition with cannabis —resulting
in an estimated 30,000 physician approvals as of May 2002. (Gieringer
2002) As this goes to press a year later, the estimate stands at abut
50,000.
In a review of my records in the spring of 2002 by Jerry Mandel, PhD, 92 patients
were identified as using cannabis to treat alcohol abuse and related problems.
This paper describes characteristics of that cohort and the results of their
efforts to substitute cannabis for alcohol.
METHODOLOGY
Identifying Alcoholism
The initial consultation (20 minutes) provided multiple opportunities to identify
alcoholism as a problem for which treatment with cannabis might be appropriate.
The intake form asked patients to state their reason for contacting the doctor,
and enabled them to prioritize their present illnesses and describe the course
of treatment to date. The form also asked patients to identify any non-prescribed
psychoactive drugs they were taking (including alcohol), and invited remarks.
A specific question concerned injuries incurred “while or after consuming
alcohol.” My reading of patients’ medical records provided an additional
opportunity to identify alcohol abuse, as did the taking of a verbal history.
Evaluating Efficacy
At follow-up visits (typically at 12-month intervals) patients were asked to
list the conditions they had been treating with cannabis and to evaluate
their status as “stable,” “improved,” or “worse.” Patients were asked to
evaluate the efficacy of cannabis (five choices from “very effective to “ineffectual”)
and to describe any adverse events. Patients were also asked to describe
any changes in their “living and employment situation,” and if so, to elaborate.
The question about use of non-prescribed psychoactive drugs, including alcohol,
was repeated. Comparison of responses in a given patient’s initial and follow-up
questionnaires enabled us to assess the utility of cannabis as an alternative
to alcohol.
Patient Background
Gieringer (op cit) notes that “Many patients who find marijuana helpful for
otherwise intractable complaints report that their physicians are fearful of
recommending it, either because of ignorance about medical cannabis, or because
they fear federal punishment or other sanctions. This is especially true in
regions where the use of marijuana is less familiar and accepted.” The patients
whose records form the basis for this study were all seen in ad hoc settings
arranged by local cannabis clubs —72 in rural counties of Northern California,
4 in San Francisco. They form a special but not unique subset, having intentionally
sought out a physician whose clinical use of cannabis—and confidence in its
versatility and relative safety— was extensive and well known in their communities.
A majority of the patients identified themselves as blue-collar workers: carpenter
(5), construction (3), laborer (3), waitress (3), truck driver (3), fisherman
(3), heavy equipment operator (3), painter (2), contractor (2) cook (2), welder
(2), logger (2), timber faller, seaman, hardwood floor installer, bartender,
building supplies, house caretaker, ranch hand, concrete pump operator, cable
installer, silversmith, stone mason, boatwright, auto detailer, tree service
handyman cashier, nurseryman, glazier, gold miner, carpet layer, carpenter’s
apprentice, landscaper, river guide, screenprinter, glassblower.
Eleven were unemployed or didn’t list an occupation; four were disabled, two
retired, and two patients defined themselves as mothers. Others were in sales
(5), musicians (5), clerical workers (3), paralegal, teacher, actor, actress,
artist, sound engineer, computer technician.
Eighty-two of the patients were men.
Patients’ ages ranged from 20 to 69. Twenty-nine were in their twenties; 16
in their thirties; 24 in their forties; 20 in their fifties; three in their
sixties.
Exactly half —46 patients— had taken some college courses, but only four had
college degrees. Five did not complete high school.
Thirteen were veterans, all branches of the Armed Forces being represented.
All but six—five native-Americans, one African-American— were Caucasian.
Slightly more than half (49) reported being raised by at least one addict/lcoholic
parent.
Prioritizing Alcoholism
Fifty-seven of the patients identified alcoholism or cirrhosis of the liver
as their primary medical problem. Secondary problems reported by this group
were Depression (15), Pain (14), Arthritis (7), PTSD (6), Insomnia (6), Cramps
(4) Hepatitis C (4) Anxiety (3), Stress (2), gastritis, and ADHD.
Thirty-one patients identified themselves as alcohol abusers, but
reported other problems as primary: Pain (12), Depression (8), Headache
(4), Bipolar Disorder (2) Anxiety (2), Arthrtitis (2), Asthma (2) Spinal
Cord Injury/Disease (2), Paraplegia, PTSD, Crushed skull, Aneurysms
aggravated by stress, ADHD, Multiple broken bones.
Eighteen patients reported having been injured while or after drinking
heavily.
Fourteen had incurred legal problems or been ordered into rehab programs.
Cannabis Use/
Awareness of Medicinal Effect
Patients were asked when they started using cannabis and when they
realized it exerted a medicinal effect.
Three reported first using at age 9 or younger; 61 between ages 10 and 19;
nine began using in their 20s; three in their 30s; six in their 40s; two at
age 50; and one at age 65.
Twenty-four patients reported realizing immediately upon using cannabis that
it exerted a beneficial medical effect. Some of their responses still seem
to reflect their relief at the time.
• “In 1980 I had quit drinking for a month. My niece asked me if I ever tried
marijuana to calm me down. So I tried it and it worked like a miracle.”
• “Helped pain very much! Helped sleep —excellent.”
Thirty-five patients answered ambiguously with respect to time —“When
realized preferred to alcohol,” for example, or, “when I smoked when
suffering.”
Seven reported becoming aware of medical effect within a year of using cannabis.
Ten became aware within one to five years.
Three became aware of medical effect 12-15 years after first using. Ten became
aware between 20 and 30 years after first using. All but one of these patients
had resumed using cannabis after years of abstinence.
Efficacy
As could be expected among patients seeking physician approval to treat alcoholism
with cannabis, all reported that they’d found it “very effective” (41) or “effective” (38).
Efficacy was inferred from other responses on seven questionnaires. Two patients
did not make follow-up visits.
Nine patients reported that they practiced total abstinence from alcohol and
attributed their success to cannabis. Their years in sobriety: 19, 18, 16,
10, 7, 6, 4 (2), and 2.
Twenty-nine patients reported a return of symptoms when cannabis was discontinued.
Typical comments:
• “I quit using cannabis while I was in the army and my drinking doubled. I was
also involved in several violent incidents due to alcohol.”
Use of Other Drugs
Patients were asked to list other drugs —prescribed, over-the-counter, and
herbal— that they were currently using or had used in the past to treat their
illnesses. Most common of the prescription drugs were SSRIs (31), opiates (23)
NSAIDs (18) disulfaram (15) and Ritalin (8).
Delivery Systems
Seventy-eight patients smoked joints —the average amount being one joint a
day (assuming 3.5 joints per 1/8 ounce of high-quality marijuana).
All were strongly advised that smoking involves an assault on the
lungs, and that vaporization is a safer method of inhaling cannabinoids.
Twelve patients reported using a pipe, and three owned vaporizers.
All were strongly advised that smoking involves an assault on the lungs,
and that vaporization is a safer method of inhaling cannabinoids.
OBSERVATIONS
Alcoholic Parents
That a slight majority patients (51) reported being raised by at least one
alcoholic parent was not surprising. The children of alcoholics enter adulthood
with two strikes. They have endured direct emotional abuse and/or abandonment
by parent(s); and they lack role models for coping with uncomfortable feelings
other than by inebriation. It is to be expected that many, when encountering
problems early in life, are treated with, or seek out, mind-altering drugs.
Cannabis for Analgesia
The large number of patients using cannabis for pain relief (28) reflects the
high percentage of blue-collar workers who suffer musculoskeletal injury
during their careers. As expressed by a carpenter, “Nobody gets to age 40
in my business without a bad back.” Nurses who must lift gurneys, farmworkers,
desk-bound clerical workers, and many others are also prone to chronic back
and neck pain.
Fights and accidents — vehicular, sports- and job-related— also create chronic
pain patients, many of whom self-medicate with alcohol.
Eighteen patients reported having been injured while or after drinking heavily.
This comment by Jamie R., a 26-year-old truck driver, describes a typical chain-reaction
of alcohol-induced trouble: “Injured in a fight after consuming alcohol, resulted
in staph infection of right knuckle, minor surgery and four days in hospital.” Injuries
suffered while drunk add to pain and the need for relief by alcohol …or a less
destructive alternative.
A total of 26 patients reported using cannabis for both pain relief
and as an alternative to alcohol. Mike G., a 47-year old landscaper
who was run over by a vehicle at age 5, requiring multiple surgeries
and leaving him with pins in his right ankle, first used cannabis at
age 16 and appreciated its benign side-effect profile: “Given pain
pills for my right ankle, I got too drowsy. Smoked herb to relieve
pain.” And when he had to discontinue cannabis use, “was unable to
ease pain in ankle without herb, and drink when unable to have cannabis
to smoke.”
Cannabis for Mood Disorders
Twenty-three patients reported using cannabis to treat depression —39 if the
category is expanded to include anxiety, stress, and PTSD— and their comments
frequently touched on the negative synergies between mood disorders and alcoholism.
• Wendy S., a 44-year-old paralegal, suffering from depression, alcoholism, and
PMS noted simply, “Alcohol causes more depression.” When she does not have access
to cannabis, “Alcohol consumpion increases and so does depression.” At her initial
visit she reported consuming 5-10 drinks/day. At a follow-up (16 months) she
had reduced her consumption to week-ends.
• Albert G., a 33-year-old river guide (and decorated Army vet) put it this way: “I
have had a problem with violence and alcohol for a long time and I have a rap
sheet to prove it. None of the problems occurred while using cannabis. Not only
does cannabis prevent my violent tendencies, but it also helps keep me from drinking.” On
his follow-up visit (12 months) Albert reported improved communication with family
members and fewer problems relating to other people. His alcohol consumption
had decreased from 36 drinks/week to zero (one month of sobriety).
• Carol G. presented initially at age 35 as homeless and unemployed,
suffering “severe depression. Anxiety. Pain.” Her problem with alcohol
was inferred from her response concerning non-medical-psychoactive
drug use: “I drink and smoke too much —started when I couldn’t get
marijuana.”
Carol had shyly requested a recommendation for cannabis from a Humboldt County
physician but, as she recounted, “I’m paranoid and local Drs are scared, too.
They gave me paxil & stop smoking pamphlet.”
At a follow-up visit (14 months) Carol reported a change in circumstance: “Now
have a room. But am on G.R. and am paying too much.” She was still using alcohol “a
little. I’m doing good dealing with not drinking. Being able to medicate with
cannabis has helped a lot.” Eighteen months later the pattern hadn’t changed: “Alcohol
several times/week. Depends on if I have cannabis, stress still triggers.”
Fewer Adverse Effects
Patients made negative comments with respect to the efficacy of their prescribed
analgesics and anti-depressants (22), side-effects (26), and cost (11) —not
surprising, perhaps, in a cohort seeking an herbal alternative.
• Lance B. presented as a 41-year-old alcoholic also suffering from
arthritis, pain from knee- and ankle surgeries, and depression, for
which he had been prescribed Librium, Valium, Buspar, Welbutrin, Effexor,
Zoloft, and Depakote over the years; “No help!,” he wrote bluntly.
On his return visit (one year) he reported “few relapses” and that
he was able to take some classes.
• The dulling effects of Vicodin and other opiates were mentioned
by seven patients. As Harvey B. put it, “When I can get Vicodin it
helps the pain but I don’t like being that dopey.” Clarence S., whose
skull was badly damaged in an accident, also appreciated the pain relief
provided by opiates, but asserted that opiates “make me paranoid and
mean.”
• Alex A., who was diagnosed with ADHD in ninth grade, touches on
some recurring themes in describing the treatment of his primary illness: “I
was prescribed Ritalin and Zoloft. The Ritalin helped me concentrate
slightly but caused me to be up all night. The Zoloft made me sick
to my stomach and never relieved my stress or depression. I have never
been prescribed anything for my insomnia but I usually have to drink
some liquor to get to sleep. I think that is a bad thing as I have
now begun to drink excessive amounts of whisky, which has really started
to affect my stomach.” Alex first used cannabis at age 19 and became
aware of benefits immediately. “I found myself running to the refrigerator
and then sleeping better than I had for years.” At age 21 he fears
permanent damage. “From drinking (I believe) my stomach has been altered,
along with my appetite… I cannot really eat that much and feel malnourished
and weaker than a 21-year-old should. My joints ache constantly and
I am not as strong as I used to be. I also fear that I will become
or am an alcoholic and I do not want to see myself turn into my dad.”
At his follow-up visit (12 months) Alex reported cannabis to be “very effective.” He
was employed, “not partying,” doing well socially, and trying to give up cigarettes.
Drug Interactions
No negative interactions between cannabis and other drugs were reported. Several
patients (3) indicated that cannabis had a welcome amplifying effect on the
efficacy of prescription and OTC medications. “I hurt a lot more without
cannabis and can’t function as well,” reported Liz J. “It seems to relax
me so the medicines work better and faster. Additionally, cannabis is natural,
and all these other drugs —Vicodin, Soma, Aleve, Librium, Baclofen, have
lots of side effects.”
As cannabis comes into wider use in California and elsewhere, it is
important that its interactions with other medications be studied and
publicized.
As cannabis comes into wider use in California and elsewhere, it is
important that its interactions with other medications be studied and
publicized. Cannabis may also have an amplifying effect on alcohol,
enabling some patients to achieve a desired level of inhibition-reduction
or euphoria while drinking significantly less.
Defining Success
The harm-reduction approach to alcoholism is based on the recognition that
for some patients, total abstinence has been an unattainable goal. Success
is not defined as the achievement of perpetual sobriety. A treatment may
be deemed helpful if it enables a patient to reduce the frequency and quantity
of alcohol consumption; if drunken episodes and/or blackouts are reduced;
if success in the workplace can be achieved; if specific problems induced
by alcohol (suspended driver’s license, for example) can be resolved; if
ineffective or toxic drugs can be avoided.
As noted, all of the patients in this study were seeking physician’s
approval to use cannabis medicinally —a built-in bias that explains
the very high level of efficacy reported. However, the majority were
using cannabis for other conditions as well, and would have qualified
for an approval letter whether or not they reported efficacy with respect
to alcoholism. Although medicinal use of cannabis by alcoholics can
be dismissed as “just one drug replacing another,” lives mediated by
cannabis and alcohol tend to run very different courses. Even if use
is daily, cannabis replacing alcohol (or other addictive, toxic drugs)
reduces harm because of its relatively benign side-effect profile.
Cannabis is not associated with car crashes; it does not damage the
liver, the esophagus, the spleen, the digestive tract. The chronic
alcohol-inebriation-withdrawal cycle ceases with successful cannabis
substitution. Sleep and appetite are restored, ability to focus and
concentrate is enhanced, energy and activity levels are improved, pain
and muscle spasms are relieved. Family and social relationships can
be sustained as pursuit of long-term goals ends the cycle of crisis
and apology.
Carl S., a 42 year old journeyman carpenter, is a success story from
a harm-reduction perspective. At his initial visit he defined his problem
as “intermittent explosive disorder,” for which he had been prescribed
Lithium. Although drinking eight beers/day, he reported “Cannabis has
allowed me to just drink beer when I used to blackout drink vodka and
tequila.” By the time of a follow-up visit (12 months), Carl had been
sober for four months. He also reported “anger outbreaks less severe,
able to complete projects,” and, poignantly, “paranoia is now mostly
realism.” He plans to put his technical skill to use in designing a
vaporizer.
The Doctor-Patient Relationship
As a certified addictionologist I have supervised both inpatient and outpatient
treatment for thousands of patients since 1969. In the traditional alcoholism
medical-treatment model, the physician is an authority figure to a patient
whose life has spun out of control. The patient enters under coercive circumstances,
frequently under court order, with physiologies in toxic disarray. Transference
dynamics cast the physician into a parental role, producing the usual parent-child
conflicts. After detoxification when cognition has returned from the confusional
state of withdrawal, the patient leaves —usually with powers of denial intact.
Follow-up outpatient treatment is oriented to AA and/or pharmacologic substitutes.
Treating alcoholism by cannabis substitution creates a different doctor-patient
relationship. Patients seek out the physician to confer legitimacy
on what they are doing or are about to do. My most important service
is to end their criminal status —Aeschalapian protection from the criminal
justice system— which often brings an expression of relief. An alliance
is created that promotes candor and trust. The physician is permitted
to act as a coach —an enabler in a positive sense.
As enumerated by patients, the benefits can be profound: self-respect is enhanced;
family and community relationships improve; a sense of social alienation diminishes.
A recurrent theme at follow-up visits is the developing sense of freedom as
cannabis use replaces the intoxication-withdrawal-recovery cycle —freedom to
look into the future and plan instead of being mired in a dysfunctional past
and present; freedom from crisis and distraction, making possible pursuit of
long-term goals that include family and community.
Re: Alcoholics Anonymous
Although nine patients made voluntary reference to attending 12-step meetings
(three presently, six in the past), it is likely that many more actually
tried the 12-step program —but the question was not posed on the intake form.
A future study should examine the relationship between cannabis-only users
and Alcoholics Anonymous.
At AA meetings, cannabis use is considered a violation of sobriety. This puts
cannabis-only users in a bind. Those who attend meetings can’t practice the “rigorous
honesty” that AA considers essential to recovery; and those who avoid meetings
are denied support and encouragement that might help them to stay off alcohol.
Support-group meetings at which cannabis-using alcoholics are welcome would
be a positive development.
• Frank R., first seen at age 29, was diagnosed as an alcoholic in
1987 and began attending AA meetings, which he found helpful although
he could not achieve sustained sobriety. In 1998, after realizing that
cannabis reduced his cravings for alcohol, he received approval to
use it. At a follow-up in November ’99 he reported, “Have stopped drinking
for the first time in many years. I have not taken a drink of alcohol
in 14 months. I attribute some credit for this to daily use of cannabis.
My life has improved with this treatment.”
Frank R. was seen again in April ’01 and reported, “I continue to maintain
sobriety regarding alcohol. Have not had a drink for 2 1/2 years. I drank alcohol
heavy for about 10 years, and had difficulty stopping drinking and staying
stopped until I began this treatment. Pain symptoms from back spasms/scoliosis
also better.”
Factors in Drug of Choice
British psychiatrist G. Morris Carstairs spent 1951 in a large village in northern
India and reported on the two highest castes, Rajput and Brahmin, and their
traditional intoxicants of choice —alcohol and cannabis, respectively. The
Rajputs were the warriors and governors; they consumed a potent distilled
alcohol called daru. The Brahmins were the religious leaders; they were vegetarians
and drank a cannabis infusion called bhang.
“By virtue of their role as warriors, the Rajputs were accorded certain privileged
relaxations of the orthodox Hindu rules,” writes Carstairs, “in particular, those
prohibiting the use of force, the taking of life, the eating of meat and drinking
of wine.” The Rajputs viewed the daru-inspired release of emotions —notably sexual
and aggressive impulses— as admirable. Rajput lore, as shared with Carstairs,
glorified sexual and military conquests.
The priestly Brahmins, on the other hand, “were quite unanimous in reviling
daru and all those who indulged in it. They described it as foul, polluting,
carnal and destructive to that spark of Godhead which every man carries within
him.” Bhang, a Brahmin told Carstairs, “gives good bhakti.” He defined bhakti
as “emptying the mind of all worldly distractions and thinking only of God.”The
Brahmin emphasis on self-denial includes “the avoidance of anger and or any
other unseemly expression of personal feelings; abstinence from meat and alcohol
is a prime essential.” Carstairs’s stated goal was to understand how the Brahmins
could rationalize intoxicant use. He concluded:
“There are alternative ways of dealing with sexual and aggressive impulses besides
repressing them and then ‘blowing them off’ in abreactive drinking bouts in which
the superego is temporary dissolved in alcohol. The way which the Brahmins have
selected consists in a playing down of all interpersonal relationships in obedience
to a common, impersonal set of rules of Right Behavior. Not only feelings but
also appetites are played down, as impediments to the one supreme end of union
with God... Whereas the Rajput in his drinking bout knows that he is taking a
holiday from his sober concerns, the Brahmin thinks of his intoxication with
bhang as a flight not from but toward a more profound contact with reality.”
Two aspects of Carstair’s report resonate strongly with my own observations:
• The disinhibition achieved via alcohol is the Rajput kind —a flight from reality,
becoming “blotto”— whereas the disinhibition achieved via cannabis is the result
of focused or amplified contemplation.
• “Drug of choice” is strongly influenced by social and cultural factors, and,
once determined, becomes a defining element of individual self-image, i.e., possible
but not easy to change in adulthood.
Prohibition of marijuana, the intense advertising of alcohol, and its widespread
availability encourage the adoption of alcohol as a drug of choice among U.S.
adolescents.
It is likely that legal access to cannabis would result in fewer young adults
adopting alcohol as their drug of choice, with positive consequences for the
public health and countless individuals.
Ring Lardner, Jr., on Cannabis
as a Substitute for Alcohol
Screenwriter Ring Lardner, Jr. won an Oscar in 1938 for “Woman of
the Year” and another in 1970 for “M*A*S*H.” His memoir “I’d Hate Myself
in the Morning” (which takes its title from his line to the House Un-American
Activities Committee) includes this description of his colleagues Ian
Hunter and Waldo Salt.
“Ian, too, had an alcohol problem —one that, unlike mine, increased in severity
to the point of debilitation. During the period when we had to come up with an
episode for a half-hour television program every week, there were times when
I had to perform the task by myself. On occasion, he would pull himself together
and make a big effort to match what I had done single-handed. Eventually, though,
he came to the conclusion that he would have to give up drinking for good. And
he proceeded to do just that, first by enlisting in Alcoholics Anonymous, as
he went cold turkey, then, to fortify his abstinence, by substituting marijuana
for alcohol. It happened that a friend of ours, the blacklisted writer Waldo
Salt, had made the same medicinal switchover. Since Ian and Waldo also shared
a love of drawing, they could pool the cost of a model and spend an evening indulging
in pot and art. Neither of them drank again, as far as I know.
“Some years earlier, when the film community was still disproportionately Jewish,
my good friend Paul Jarrico announced a discovery. He had been wondering why
a small grup of his fellow screenwriters —Ian, Dalton Trumbo, Hugo Butler, Michael
Wilson, and I— were such a close, cozy group. What bound us together, Paul reported,
was the fact that we were all gentiles. ‘Nonsense,’ Ian declared, ‘It’s that
we’re all drunks.’ Instantly, I knew he was right. It was by far the stronger
bond.”