CANNABIS PSYCHOSIS

OFF YOUR HEAD?

As a series of new studies proves the link between cannabis
dependency and mental illness, an Observer investigation reveals the
plight of young users struggling to find help to deal with the
disturbing effects of a drug once considered 'safe'.

Daniel Hrekow is 23, articulate, musically talented and academically
bright. In the past five years he has dropped out of two universities
and experienced two breakdowns. At the age of 19, after several years
of feeling depressed, anxious and increasingly disconnected, he was
diagnosed as having Asperger's syndrome, a form of autism.

Signs of Asperger's include an inability to empathise or understand
other people's emotions, difficulty in tolerating change and
obsessional behaviour. In Daniel's case, this obsessional behaviour
can mean periods of smoking cannabis for several days and nights at a
time. Since his teens, out of fear and frustration, Daniel has tried
to control every aspect of his mother Mary's life. He has also become
extremely violent to her, his father, Peter, and younger brother, Ben.

Daniel is the human face of a disturbing statistic revealed last week
- - an alarming 40 per cent rise in hospital admissions for mental
ill-health prompted by cannabis use since 2001, when it was first
proposed to downgrade it from a Class B to Class C drug.

A new study demonstrating the link between psychosis and cannabis -
written by Professor Tom Barnes - will be published in the Journal of
Psychiatry next month, adding yet more pressure on the government to
take a fresh look at the price paid by increasing numbers of young
people dependent on cannabis.

Daniel is just one example of this growing problem. 'When he's
violent, he bangs his head against the wall, punches and shakes me,
smashes furniture and cuts himself with kitchen knives,' says Mary.
His parents have had to ask the police to remove their son from the
family home several times - and again this weekend, Daniel has been
abusive and threatening. Meanwhile, he and his mother are waiting to
hear if a place will be funded for him at the Rookery, in Somerset,
one of the few residential settings in the UK offering education for
young people with Asperger's.

Mary has fought hard to acquire support for Daniel from the South
London and Maudsley NHS Trust, often with little success. At one
point the Hrekows, both education consultants, remortgaged their home
to raise more than UKP30,000 to pay for Daniel's care.

Last September, after 18 months in a residential unit, Daniel decided
to return to university. He was supposed to receive support but none
was forthcoming from the trust. After several weeks at Goldsmiths
College in London, he began to do what he has always done, since the
age of 15, to ease the pain of alienation - he began to smoke
cannabis excessively.

'When you're trying to live life as a normal person, and you're
stoned, you disguise yourself because you're pretty much out of it,'
Daniel says.

He gives a long and moving account of life with a cannabis addiction.
'At first, with cannabis, it becomes so much easier to float by
unnoticed. But then you become paranoid. You're quick to assume the
world isn't going to make a place for you. Through drugs, I've come
close to destroying myself, but sometimes the only option is to be in
this oblivious state, trying to get a break from the pressure. But
it's no break at all really.

'In my teens I used to champion cannabis but once you've taken
yourself to places I've taken myself to, you can't hide from what
your brain felt. Now, I don't get a high at all. Instead, my brain
hurts so much, and I don't sleep for days. It goes wrong so quickly
that what's going on internally becomes visible to everyone and
that's frightening for me. No one at 23 who's been into cannabis for
years can get away with saying it doesn't mess your head up. If
you're smart and have potential and you do drugs for too long, it
takes you further away from a healthy balanced way of living which is
what you secretly wanted in the first place - with that first joint.'

In 2001, 490 patients were admitted to hospital as a result of
excessive use of cannabis. There were 710 admissions in each of the
past two years. Several recent studies have demonstrated the links
between cannabis and schizophrenia. Professor Robin Murray, a
consultant psychiatrist at the Maudsley Hospital in south London and
one of the leading researchers in the field, estimates that 25,000 of
the 250,000 people with schizophrenia in the UK could have avoided
the illness if they had not used of cannabis.

In addition, the Advisory Council on the Misuse of Drugs (ACMD), in a
report to Home Secretary Charles Clarke arguing against
reclassification, suggested for the first time that cannabis may not
only cause schizophrenia in those with pre-existing mental
conditions, but could also exacerbate a range of other mental health problems.

In the UK, 250,000 people experience psychosis - a term that refers
to symptoms including delusions and hallucinations, rather than a
specific diagnosis. 'Five years ago, 95 per cent of psychiatrists
would have said cannabis doesn't cause psychosis,' says Murray. 'Now,
I would estimate 95 per cent say it does. It's a quiet epidemic.'

Steve Hammond, the 27-year-old son of mental health worker, Terry,
began smoking cannabis at 16, graduated to smoking up to 10 joints a
night over weekends, then, in his twenties, was diagnosed as schizophrenic.

'Steve was a brilliant sportsman: a gifted footballer, a superb
runner, a natural athlete,' says his father. 'Now, he is just a
shadow, a recluse. This is definitely an emerging issue. Everyone
knows a "dope head" who has used cannabis, the "safe" drug. It's not
just the number of cases of schizophrenia and psychosis that's a
concern, it's the thousands upon thousands who have lost a future.'

The ACMD report says that 'the mental-health effects of cannabis are
real and significant'. While it is true to say that many millions of
people have used cannabis moderately without impairment to their
daily lives, can we afford to ignore the hike in hospital admissions?

And have a number of recent court cases dealing with horrifically
violent crimes involving cannabis raised us from years of torpor
about the use of cannabis? Earlier this month, Peter Thomas, aged 21,
was given an indefinite jail sentence after beating Lisa Voice, the
mother of his former girlfriend, so severely that she needed 11
operations. 'He smashed my skull, my nose was a pulp... he smashed my
eye sockets and my eye was hanging out,' Voice said. Medical experts
said Thomas had been suffering from 'cannabis-induced psychosis'.

Charles Clarke promised last month to 'implement energetically' the
three main recommendations of ACMD - a 'substantial' education
campaign, strengthened medical services for those dependent on
cannabis and further research into the implications of cannabis use -
although whether there will be sufficient funding is extremely
doubtful. In 2005, France spent UKP2 million to educate young people
about cannabis. In comparison, a recent British public health
campaign on the same issue received UKP230,000.

Next month, the National Treatment Agency for Substance Misuse is
launching its Young People's Effectiveness Strategy for under 18s.
Professionals say it is impossible for the strategy to encompass
excessive cannabis use because so little is known about it - who is
using it, how often, why some individuals appear more vulnerable than
others to its effects and how many are seriously impaired. Nor do we
know enough about what works in terms of 'education'. What is certain
is that, in many parts of Britain, a young person with cannabis
problem would be very fortunate indeed to find effective help.
Heroin, cocaine and crack cocaine have a more established link to
crime and death, so receive a far higher priority in public policy.
Cannabis may lay waste to lives, but often the casualties suffer a
lifetime of delusion and reclusiveness while their families privately
mourn their loss.

For years, the debate on cannabis has progressed little. 'The issue
has been polarised between those who argue that if everyone smokes
it, it will lead to world peace and those who believe that a few
spliffs may send you psychotic,' says Dr Luke Mitcheson, a clinical
psychologist. 'That shows a deep immaturity in the face of increasing
evidence that we need a far more sensitive dialogue.'

Cannabis is the most widely used illicit substance around the world,
particularly among young adults. Users are smoking it from a younger
age and in larger quantities for longer, not least because young
people today have more ready cash than their Sixties counterparts did
and a small quantity of cannabis is now cheaper than a packet of
cigarettes or a couple of pints.

There has been a staggering 70 per cent increase in teenage
mental-health problems since 1974, according to the Institute of
Psychiatry. Young people in the UK use more cannabis than their peers
on the continent. In the UK, latest statistics reveal that 1 per cent
of all 11-year-olds, 17 per cent of 14-year-olds and 26 per cent of
15-year-olds used cannabis last year.

Cannabis, or marijuana, comes in different forms. Hash, the resin of
the plant, is less expensive than grass or weed, which is the plant's
dried leaves. 'Skunk', at around UKP200 an ounce, is herbal cannabis
grown from selected seeds by intensive indoor methods. Skunk is twice
as potent, on average, than hash or weed.

Some say the increase in psychosis and schizophrenia is because skunk
is more readily available and easier to obtain than hash or grass,
but other professionals believe that the market is simply responding
to demand for the more 'mind-blowing' version. The ACMD said that the
evidence on whether 'skunk' was playing a major part in the apparent
increase in psychosis was 'unclear' because, there was 'too little
information about the potency and pattern of use of cannabis by consumers'.

Cannabis, often mixed with tobacco, is either smoked in a joint or in
a water pipe, or cooked into food and eaten. The plant contains more
than 400 chemicals including delta-nine-tetrahydrocannabinol (THC),
its main psychoactive component. Interactions between THC and
specific proteins on the surface of the brain cells, known as
cannabinoid receptors, produce the laid-back, pleasure-enhancing
awareness after smoking cannabis and is sometimes accompanied by an
urge to eat.

Recent breakthroughs in neuroscience show, contrary to earlier
research, that even in adolescence the brain is still developing. A
paper to be published soon as part of a campaign by the charity
YoungMinds, explains how the frontal cortex - where this development
takes place - is essential for functions such as response inhibition,
emotional regulation, analysing problems and planning.

Research also shows that sustained use of cannabis over several years
may result in cognitive impairment, affecting memory, attention and
the organisation and integration of complex information.

Several controversial key studies have recently shown the impact of
juvenile cannabis use. One, carried out by Murray and the University
of Otago in New Zealand, followed a group of 750 adolescents over 15
years and found that those who had smoked cannabis at age 15 were
four and half times more likely to be schizophrenic at age 26.

Two weeks ago in Portsmouth at the inquest of 23-year-old Roy
Jackson, who died after bingeing on methadone and cough medicine,
coroner David Horsley underlined the tragic downhill spiral that
cannabis dependency can produce in a mentally ill person. Roy had
begun to smoke joints at age 14 and eventually moved on to skunk. He
was diagnosed as schizophrenic at 19. 'The use of cannabis
exacerbated his mental health problems,' Horsley said. 'It
predisposed him to smoking more regularly than was good for him.'

Roy's sister, Lisa Male, said: 'It was horrible. He was sectioned at
19 when it should have been the best time of his life. He had been a
bright boy at school. One doctor told my mother that the increasing
use of skunk had created a ticking time bomb.'

Roy's family, understandably, want the laws on cannabis tightened.
But reclassification will not stop young people rolling a joint - nor
will it encourage them to put a brake on excessive use.

Three months ago, J-Rock, an actor and a member of R&B group Big
Brovaz, decided to give up 'the weed'. Now 27, he had smoked up to 10
spliffs a day from the age of 13. 'Everything in my life had weed
around it,' he says. 'I was paranoid, I couldn't handle my life any
more, I had to stop.'

But he was helped by an early-intervention counsellor, using
motivational techniques which have proved successful in Australia and
the USA. Contrary to myth, coming off cannabis can cause withdrawal
symptoms - including insomnia, irritability and physical discomfort.

'I suddenly got my dreams back and they were really vivid. That was
strange, but my counsellor had prepared me for that.'

J-Rock and the counsellor worked together three times a week. He was
instructed to keep a diary, to look at when he smoked and why; he was
encouraged to develop activities to distract himself from smoking and
to establish goals for the future. Thirty-one days after giving up, a
test showed THC was still inside his body. Yet now, he is drug-free.

'So many young people grow up seeing Snoop Doggy Dog smoking weed and
they think you have to do that to achieve, to be creative through
weed,' he says 'I'm successful beyond some people's dreams but I was
doing it under the influence of drugs. Now, I'm acting, recording and
it's a whole lot easier. This is me.'

'Given the right help, people can change surprisingly quickly,' says
Mitcheson, who works clinical psychologist in Lambeth, south London.
'Just setting up a service for cannabis users isn't going to work.
Young people don't identify with "I have a problem and yes the
problem is cannabis". Often that's only part of a range of
difficulties and adolescence is a time of change anyway when some
become unstuck.'

The government has established 109 Early Intervention projects around
the country. The concept is good but, in practice, some projects
consist of a single worker covering many hundreds of miles. 'What we
still have too often, is a service open five hours on a Monday,
Wednesday and Friday,' says Kathryn Pugh of YoungMinds. 'What a young
person needs is help on a Sunday night when he's alone in his bedsitter.'

Another problem is that a young person has to reach a crisis and
experience a psychotic episode before help is given. Little exists
for the heavy smoker who wants to cut back before it gets out of
hand. Early Intervention projects may also suffer because of the
financial crisis faced across the NHS. Government money allocated for
young people's mental health budgets, however generous, is often
siphoned off for other uses.

In-volve, a charity set up by Colin Cripps, runs 15 services for
young people around the country. 'We've never tailored intervention
in any way that made sense,' says Cripps. 'Now, following Danish
research, we wait for a couple of weeks until a young person has got
enough cannabis out of his or her system, then we work with them as a
person not as a drug user. Most of the problems are about identity.
Heavy users have often grown up feeling failures.

It takes weeks and weeks of intensive counselling of the right kind
and opportunities for education, training and employment to persuade
a young person they can make something of their lives. Only then is
cannabis recognised as the problem.

'In-volve uses texting, flyers, chat rooms events and word of mouth
to spread its message. So much of drugs education in this country
ignores the changes in communication and leaves young people cold.'

The work of Dr Jim McCambridge, of the National Addiction Centre, and
his colleagues, is beginning to demonstrate how young people are
capable of helping themselves given the right opportunity. For the
centre's ongoing study, students in colleges across London were
randomly picked. Of those, 50 per cent subsequently said they had
difficulties with cannabis. They were then interviewed for half an
hour and, using motivational techniques, encouraged to evaluate their
own lives and goals.

A few months later, the students were reassessed and it was
discovered that the interview had had a positive impact on their
behaviour. Studies are now taking place to test whether training in
motivational techniques, for professionals such as teachers who come
into contact with young people every day, might have a long-term
impact on reducing drug use.

'Given the prevalence of cannabis, there's so much we don't know,'
McCambridge said. 'Who's using heavily? Why? How best can they be
helped? The tragedy is that with no overarching strategic direction,
we have pockets of good practice and and waste lands where there is
no help at all.'

James, in his twenties, began smoking cannabis at 15. 'The reason I
never did any other drugs was because their dangers were well known.
I was a sensible person,' he said, aware of the irony. 'Even when I
went to two GPs, saying I was having problems with anxiety and
paranoia, they gave me antidepressants and said if the cannabis
helped me to relax, I should carry on.'

At 19, he had a breakdown and was hospitalised with drug-induced
psychosis. At school, he achieved seven A stars in his GCSEs. Now he
is unable to hold down a job. 'My brain works but I don't do well in
social situations. If only I'd known about the risk.'

What's required now, experts in the field say, is for Charles Clarke
to put his money where his mouth is. However large or small the issue
of cannabis dependency, it needs ring-fenced sustained funding, more
research, the right support available across the country and improved
universal drug education given earlier in schools and to
professionals such as GPs.

In the meantime, Daniel Hrekow is optimistic that if he receives the
right kind of help, he will be able to build a life for himself. But
his mother, Mary, is angry.

'Everyone on the ground will tell you there's a big problem with
young people and cannabis,' she said. 'But where do they or their
families go for help? Mental health services are at the bottom of the
spending list, and cannabis is even lower.' Mary knows it will be a
long and hard road, but she wants her son back.

WHY I HATE MY DRUG-TAKING BROTHER

A remarkable first-person account, written for a school essay
project, by the 13-year-old sister of an 18-year-old cannabis smoker
who suffered from psychosis.

My squitsaphrenic [teacher corrects to schizophrenic] brother: Of
course I have to love him because he is a member of my family.
However this does not excuse the hatred that goes through my mind
every evening that I am forced to share with him. Peter, my brother
of 18, is currently ill with squitsaphrenia due to taking drugs
(cannabis) from an early age.

He is greedy, lazy, selfish and unbearable. As well as treating
myself and my family unfairly, he has no control over his anger, also
becomes obsessed with the slightest things, for example: switching
the computer off every time it is not in use; pacing around the
house; and making pots of tea.

I am genuinely scared of him as well as furious that I have ended up
with such a meaningless brother. As a result of this, I try to avoid
making eye contact, speaking and even listening to him, as I would
bear an even huger grudge against him.

If I were to face him or stand up to him, I would most likely get
emotionally hurt or an even huger chance of getting physically hurt
because he has no respect for my feelings at all.

The world would not change if he were not here, as it is only my
family who knows the true Peter. If I were to re-live the past two
years, from when I started to detest him, I would be a carefree teenager.

BANS AND BUSTS

. Cannabis was banned in 1928 after a Chinese musician was accused of
giving hashish to three women found near-naked in his flat in Cardiff.

. A government committee looking into drug laws, headed by Baroness
Wootton, concluded in 1968 that 'the long-term consumption of
cannabis in moderation has no harmful effects'.

. Writer Sue Arnold championed cannabis. But in 2003, she told how
seeing her son almost destroyed by the drug forced her to change her
mind. 'I was so wrong on pot,' she said.