Pot vs. Booze: No Choice at All!

Wednesday, April 22nd, 2015

Teen thinking about pot and boozeMarijuana has been legalized, decriminalized, or made available for medical use in 23 states and the District of Columbia. More significantly, smoking a joint has become increasingly “normalized,” for marijuana now enjoys broad popular sanction, and pot has joined alcohol and tobacco as one of our society’s permissible toxic delights.

It’s hard to say which of these three is the most dangerous. Cigarettes are credited with the greatest kill rate. Alcohol does the most immediate and obvious physical and social damage. And marijuana may pose the greatest long-term threat to the cognitive capacity of adolescents.

So, what should a caring parent say when asked, “Would you rather your child smoke pot or drink alcohol?” In a recent New York Times article, Aaron E. Carroll, M.D., professor of pediatrics at Indiana University’s medical school and a parent himself, mounted a strong case for choosing marijuana over alcohol were he forced choose between these two mind-altering substances. On the basis of clear and present danger, Dr. Carroll’s defense of his choice seems reasonable, for alcohol’s contribution to crime and violence dwarfs that of any other consumable substance. And, since alcohol is such an inefficient intoxicant—it must be consumed in vast quantities, compared to other drugs—wear and tear on body and brain are equally profound.

But these arguments do not make Dr. Carroll right. What’s wrong here isn’t his answer. What’s wrong is the question. This isn’t an “either/or” issue. It’s a “neither/nor” one. By opting to shield his child from one toxic pleasure (if he could), Dr. Carroll is endorsing the youngster’s use of the other.  And, in this case, the other may well prove a greater threat to his child’s long-term well-being.

In the real world, Dr. Carroll’s child, as most other teens, is unlikely to leave the booze/pot decision to his or her parent. Curious adolescents are probably going to try both substances for themselves. Roughly half of all high school seniors have given pot a shot and more have had their first several drinks.

What makes this booze/pot debate and Dr. Carroll’s solution so pernicious is how it can reinforce the false notion of marijuana as a relatively benign substance, which it is not. While many adults appear to use marijuana with relatively little harm, it is proving highly hazardous for adolescents.

For openers, marijuana damages the heart and lungs, increases the incidence of anxiety, depression, and schizophrenia, and can trigger acute psychotic episodes. While less than ten percent of adult users become addicted to the drug—and, yes, pot is addictive—the rate for teen users is 16 percent or one kid out of every six.

Bear in mind that adolescents are inherently vulnerable—and not just to pot. That’s how they are programmed. They make rash and risky choices because their brains aren’t yet fully developed. The part of the brain that censors dumb or dangerous behavior is last to come on line (generally not before the mid-20s). Meanwhile, the brain’s pleasure-seeking structures are up and running strong by puberty. When you link adolescent pleasure-seeking and risk-taking to marijuana’s impairment of perception and judgment, it isn’t surprising that a 2004 study of seriously injured drivers in Maryland found half the teens tested positive for pot.

That marijuana compromises learning, judgment, and memory are no small matters during the adolescent years. And it can do lasting harm to the brain itself, impairing the cognitive function of adolescents by disrupting the normal development of the brain tissue known as “white matter,” which is what brain cells need to communicate with each other. We should add to this the recent and frightening discovery of lasting changes in the “working memory” of adolescents due to heavy use of marijuana. These are brain structures critical to memory and reasoning and are a source of ready recall for basic information, like telephone numbers, and solutions to everyday problems. The status of your child’s working memory is also a strong predictor of academic achievement.

At bottom line, teens really don’t need parental help making bad decisions. They’re perfectly capable of doing that for themselves.

Mitchell S. Rosenthal, M.D.
Founder, Phoenix House

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  • Eric Wood

    Thank you for making sense of an otherwise senseless debate. As a clinician I constantly hear marijuana compared favorably to alcohol. It has never made sense to me — much in the way it doesn’t make sense to say it would be safer to be stabbed with a knife than shot with a gun.

  • Renee Riebling

    Great analogy, Eric. Glad the post was useful to you! –Renee Riebling, Phoenix House

  • Justin Kander

    This is absolutely absurd. “It’s hard to say which of these three is the most dangerous.” I don’t think I’ve ever heard a more ridiculous statement. Cigarettes and alcohol have collectively killed millions, perhaps tens of millions, of human beings, while contributing (especially alcohol) to a great portion of violent and destructive crime. Cannabis has NEVER killed a single human in all of history. You will not find a substantiated, credible report of that.

    The evidence that it damages mental health, lungs, and heart is also extremely dubious. The cannabinoids in cannabis are actually neuroprotective and cardioprotective, reducing death from traumatic brain injury. It is an unbelievably effective medicine when used correctly.

    That said, I agree that THC-rich cannabis does pose some problems. It can be psychologically and perhaps mildly physically addictive, it probably does trigger psychosis in risky populations, and long-term heavy use is not optimal for cognition. However, CBD-rich cannabis has literally none of these drawbacks and does not get you high. It is an even more powerful antioxidant than THC and has been proven in a double-blind study to treat schizophrenia better than amisulpride.

    To truly prevent teens from using high-THC cannabis, you need to have an honest conversation. It strongly damages your credibility to say you don’t know whether cannabis is more dangerous than alcohol and tobacco. You need to be real about the risks – that cannabis can distract them from what’s important and potentially harm the developing brain, especially if very high-THC strains are used without adequate CBD.

    Justin Kander

  • ljohnson

    Thank you for your comment, Justin. We agree that alcohol and tobacco have caused physical and social damage to teens and adults in the U.S. However, recreational use of marijuana by people under the age of 21, whose brains aren’t fully developed, poses long-term consequences as well. In his blog, Dr. Rosenthal tries to steer us away from deciding which drug is safer for teens to use (because none of them are benign) and more toward preventing the use of dangerous substances altogether. For more information about marijuana research, please visit the National Institute on Drug Abuse at http://www.drugabuse.gov. –Liana Johnson, Phoenix House