Originally published in The Ottawa Citizen January 27, 2004

Original Title: The betterment of one’s life

A common student question asked at Canterbury High School focuses upon the melange of moral, ethical and consequential aspects of smoking cannabis.A previous column focused on the physiological and psychological effects of drug use, especially marijuana/cannabis. After my column about the latest research on the effects of cannabis, many readers wrote to express their opinion about the issue. One e-mail caught my attention.

Deborah is a 37 year-old single woman with three boys aged 10, 12 and 14. She first tried marijuana at age 11 and started regular use by the time she was 15. She quit during the five years encompassing her pregnancies but restarted after her youngest son’s first birthday. She smokes an average of four to 10 joints daily. She does not drink or smoke cigarettes.

She comes “from a good upper middle class family.” Her father was in the armed forces and her mother worked for the government. Her sister works at the Department of National Defence and is active in her church. Deborah works for several physicians and was a registered practical nurse for 15 years.

Deborah says, “I have always been very ambitious, adventurous and seemed to have excelled in everything I have attempted; drama, track and field, horseback riding, skiing, skydiving, rock climbing, guitar, keyboards, drums and singing.”

Her concern was that her marijuana use was jeopardizing her health. Her feelings of shame prohibited her from discussing this issue with her family doctor. She feared “what she might think of me, as a person, a mother, and a professional.”

She often feels pressure or pain in her chest and cannot breathe as easily as before. She worries that she may have cancer of the mouth, throat, lungs or stomach from her smoking.

She asked if I might help her quit using cannabis. (There was no precondition that her story would be published.)

She had three goals: to show teens the long-term physical and psychological effects of cannabis; to discourage its use; and to “get some much needed help so that three beautiful little boys will have a mom around for a long time.”

In addition to her desire to quit her cannabis use, she wanted a full physical exam and tests to determine whether she suffered any deleterious health effects.

During her first visit last October, she stated she was experiencing mild, manageable mood swings. She could concentrate and functioned well at work. She had normal sleep patterns and appetite.

She stated she was a high achiever with many goals and dreams. She expressed frustration that she could not sing as she once could or motivate herself to achieve her goals.

She smoked outside of the house and never in front of the children. However, they knew what was going on. Her guilt about the message she was sending to her children was unbearable.

Her physical exam and blood tests were normal. A lung function test indicated the smaller airways were becoming blocked. The chest X-ray was normal.

The question “why does she continue to smoke?” does not necessarily have a straightforward answer. We know she started at age 15, the middle or tribal stage of adolescent development. In this stage, there is a consolidation of body image and sexual identity. The school environment is comfortable. Peer groups become their new family and safe haven and are a form of tribalism with all its rituals, markings and lingo. Peer pressure becomes the dominant behavioural influence. In the quest for independence they test their limits and compare themselves to their friends. Paradoxically, they conform to their peer group in order to feel more independent.

Drug abuse during adolescence will arrest or hinder progression through the developmental stages that lead to independence and self-awareness. Indeed, Deborah readily admits she has difficulty defining who she is. At 37, she remains stuck in her adolescent middle stage. Although she appears to be coping with many of her responsibilities on an adult level, her sense of self remains undefined.

I usually give my adolescent patients some “homework” after the preliminary evaluation to better understand their concept of friendship, relationships and their self-image. These questions are part of the Adolescent Toolkit (http://members.rogers.com/barrydworkin/help_teens_tune_in.html) and are germane to Deborah’s situation:

– What do you like and dislike about yourself?

– What are your good and bad qualities?

– What are your definitions of a friendship and relationship?

The goal for Deborah is to understand why she smokes, gain control over her behaviour and achieve true independence.

Next week’s column will review Deborah’s progress.

© Dr. Barry Dworkin 2004