Marijuana and the American drug rehab industry

American drug treatment programs specializing in cannabis use disorder (CUD) achieve long term marijuana abstinence rates of only 14-to-22 percent. Opioid addictions treated using buprenorphine have a 90 percent abstinence rate over two-to-five years. The differences in treatment success highlight the fact that alleged marijuana addictions are radically different from opioid addictions.

One source of confusion is that CUD is defined by psychologists and psychiatrists rather than medical doctors or neuroscientists. For example, neuroscientists have identified addiction pathways in the brain for cocaine and opioids as well as nicotine, but no neural addiction pathways have been identified for cannabis. Medical science has moved on. Opioid addictions are now viewed as an illness comparable to a disease like diabetes.

Despite a lack of biological evidence for marijuana dependency, mental health professionals cite data hinged on adolescent users and a vague social definition of a CUD:

An estimated 9 to 30% of cannabis users become dependent on cannabis and an estimated one in six adolescent cannabis users has cannabis use disorder. People who start using cannabis before age 18 are four to seven times more likely to develop a cannabis use disorder than people who begin as adults, according to NIDA. Withdrawal symptoms can include irritability, changes in appetite, depression, and twitches and shakes.

To explain all the twitching and shaking, most psychologists and psychiatrists rely upon a self-serving definition of CUD found in the official Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5-TR. According to the manual, CUD is a “problematic pattern of cannabis use” leading to “clinically significant” impairment or distress, as characterized by at least two or more criteria occurring within a 12-month period: cannabis is often taken in larger amounts or over a longer period than intended; there exist persistent desires or unsuccessful efforts to cut down or control use; a great deal of time is spent obtaining, using, or recovering from cannabis; a strong urge persists to use cannabis; a failure to fulfill major obligations at work, school, or home due to use; continued use despite social or interpersonal problems caused by cannabis; giving up or reducing important activities because of use; use in physically hazardous situations; continued use despite physical or psychological problems caused or worsened by cannabis; tolerance or needing more cannabis to achieve the same effect; and withdrawal symptoms, or using cannabis to relieve withdrawal.

A heroin addict’s abrupt withdrawal or detox from heroin can involve many hours of vomiting up nearly everything the individual has eaten for the past three days. Ceasing heavy marijuana use does not typically create withdrawal symptoms. If someone’s cannabis supply is cut off after it’s been used medicinally for treating conditions such as anxiety disorders or major depression, then these disease symptoms are likely to reoccur, but this does not make chronic medicinal use an addiction. This idea has led some marijuana consumers to suggest that much of the wonder weed’s recreational use is actually medical use.

Marijuana-focused drug treatment programs have traditionally employed therapies such as Cognitive Behavioral Therapy (CBT) that helps users identify triggers to cannabis use. Motivational Enhancement Therapy (MET) focuses on building motivation, and Contingency Management (CT) uses rewards for meeting goals. Holistic and Supportive Approaches include mindfulness, exercise and nutritional counseling to create a sense of wellbeing. Marijuana Anonymous is the cannabis equivalent of Alcoholics Anonymous and focuses on accountability and community, said to be critical for a sustained recovery.

Pharmaceutical drug treatments for marijuana addictions involve non-FDA-approved experimental options. These include Dronabinol and Nabiximols for withdrawal symptoms, and N-acetylcysteine and gabapentin that give mixed results. None of these drugs or supplements are recommended. Dronabinol is the international non-proprietary name in a pharmaceutical context for THC.

Clinical significance widens the field since the most clinically significant social impairments that can occur with marijuana include being arrested for possession and sentenced to jail, or getting fired from one’s job because of a positive urine test. The legal connection was once a big cash cow for the marijuana rehab industry. In some parts of the US, in a legal process called diversion, a court would sentence a person convicted of marijuana possession to a rehab program with the stipulation that upon completion of the official brainwashing curriculum their criminal charges would be dropped. The anti-marijuana brainwashing effort has had little effect. As more state residents continue to opt for legalization the marijuana rehab business is falling on hard times. Aside from psychologists, psychiatrists, and politicians, it’s difficult to find a cannabis consumer or anyone else who believes marijuana is addictive.

Many elected public officials and employees of the federal government still describe marijuana as addictive. A failure by a president or a member of Congress to support marijuana prohibition along with its mythologies would mean drug rehabs and other businesses profiting from marijuana drug enforcement would lose their ability to donate money to helpful politicians to aid their re-election campaigns.

On the business side, transformations of the pharmaceutical industry are inevitable. If a specific cannabinoid or its chemical analog succeeds in replacing opioids as a non-toxic addiction-free pain reliever then certain pharmaceutical companies will suffer big losses in the global opioid market, estimated for 2025 to be $24.8 billion in total revenue. Pushback from businesses with a financial interest in promoting cannabis prohibition can be expected.

Despite a few new adjustments for the pharmaceutical industries, a freed marijuana marketplace will be good news for the economy and for democracies in general. Employment opportunities will improve, and not just for the marijuana industry. The government and its contractors will finally be allowed to hire marijuana consumers of all types who seek government jobs, including jobs that require a security clearance. The result will be the displacement of large numbers of professionally unqualified religious conservatives and true believers who owe their social and discriminatory employment status to puritanical rejections of marijuana and democracy. The current quest by organizations such as the New Apostolic Reformation to construct a new theocracy at the federal level and all other levels could be derailed. With so much to gain from cannabis legalization and so much to lose the stakes remain high.