S2E3 - Addictions and Economics

Are we addicted to taxes?  Trevor and Kirk talk to Dr. Jason Childs.  He is an economist who says whether you want to reduce harm from cannabis or increase government coffers then keep taxes on cannabis low.  In fact, having the government subsidize licensed producers might be a brilliant idea.  In part 2 we have Dr. Jonathon Stea.  He is a psychologist who has studied and treated cannabis addiction.  Surprisingly, cannabis is probably going to be both worse and better than you imagine post legalization.

 

Episode Transcript

Economist - Jason Childs

Jason: Hi I'm an Associate Professor of Economics here at the University of Regina and I've been doing a lot of work on cannabis legalization and the policy structures to get it right.

Trevor: Well thank you very much for joining us. So most of us either didn't take economics or Econ 101 was a little while ago and but not to scare everyone. This is very accessible. So for example my daughter who's 16 works in a gas station last night was having this conversation with someone she was selling someone cigarettes and his comment was Yeah and a couple months I'm just going to buy I'm going to buy pot. That's going to be great. And she's a my 16 year old's comment was well if they don't tax it too much and you know the 16 year old had a 10 minute conversation with somebody about how much they're going to tax this so this this paper you've written is very interesting and very timely. So but back to Econ 101 before we get through the whole paper let's get some terms out of the way for those of us who don't remember what are externalities.

Jason: So an externality is a cost that we usually think in terms of negative externalities let's get that clear. But it's a cost or a benefit that accrues to somebody who's not directly involved in the consumption or production of something. So with cigarette smoke to use your example if I'm sitting beside you smoking a great big cigar or something I'm not the only one who's affected by that. You have to breathe the secondhand smoke.

Trevor: OK that's great. So the other one and I love this term I'm going to try and say it as much as possible for the rest of the day.  What's a Pigovian tax?

Jason: A Pigovian tax or a Pigouvian tax is a tax named after Professor Pigou a famous old dead economist.  The idea is you can use a tax to get people to consume less so that we reduce the amount of an externality that we have to put up with.

Trevor: OK so one of the ones I read and sort of applies here so sugary drinks some places like New York City and others have decided to put in a tax on sugary drinks because they think it's going to reduce obesity and other health related issues would that be a Pigovian tax.

Jason: In the New York case only weakly because health care isn't really an externality in the U.S. because it's privately funded.

Trevor: OK.

Jason: Better example would be the taxes we have on alcohol right now. Those are Pigovian tax. There are negative externalities associated the consumption of alcohol. You know in Canada we have we carry the medical costs there you know there's crime costs somebody who's not drinking can be hit by a drunk driver. That's an externality. We put a tax on it to try and reduce the amount of alcohol consumed to reduce the amount of those negative consequences we have to put up with.

Trevor: OK so we know and in Manitoba they've actually even called what their one of the things they are planning on putting on recreational cannabis. They're actually called it the social responsibility tax a 6 percent on their retail revenue and they said they want to redirect some of that towards public education safety health and addictions. So that's the kind of idea. So if governments put on a tax for reducing the negative externalities of recreational cannabis and funneling that money to to help reduce the negative externalities that's kind of the idea behind it.

Jason:  That's a rough idea again in strict textbook definition. You don't have to do anything particularly intelligent with the revenue you just have to increase the price to reduce consumption. But that's not a bad idea either.

Trevor:  OK. But I think that roles nicely into the next thing that governments like to do with taxes is just increase their general coffers. So so let's let's start getting into what your paper was talking about with with cannabis so. So we have cannabis we have an illicit market now we're going to have a legal recreational market in a month or so. What should the government be looking at when they're trying to price price. How much tax to put on it.

Jason:  Well that's a real question and nobody really knows the answer and that's one of the things we try and do in this paper is explore a range of possibilities about how people are going to respond to the legal market. We don't really know when nobody really knows what consumers are going to want to do in this environment. One of the things we can be moderately comfortable with is the idea that they're going to view cannabis purchased through the illicit market and cannabis purchase legal market as substitutes of some sort. They may not be perfect substitutes but you can maybe get people to switch based on pricing if we want to get them to switch to the legal market. We can't overprice it.

Trevor:  Okay that makes sense so you know if the guy of the shady guy in the corner sells it for five dollars and the government decides with all his taxes is going to be ten dollars a gram. Obviously I'm I'll be less than a really good reason not to I want to buy it from the shady guy on the corner.

Jason:  Right exactly and that's the problem we're facing and every time we levy a new tax be it the social responsibility tax just GST or PST you're inflating the price of the legal market cannabis and giving the illicit market more room to operate.

Trevor: OK now that another part of your paper I found really interesting is you were talking about the negative externalities from the illicit or illegal market being higher than from the from the legal one. So you know one argument would be make the taxes as high as possible. That way people use as little legal cannabis as possible at will have the least number of bad negative externalities.  What would be that. But I don't think that's the way your paper was leaning.

Jason:  No no. The idea here is if you have to two markets one in which the externalities are really high and one in which the externalities are lower if people are going to consume this product where would you rather have them consume it. Where the externalities are lower. All right so the externalities the bad things that go along with cannabis consumption are smaller in legal market. We have a really strong reason to want to move people from the illicit market to the legal market. OK. So the argument that gets made around this and this. You see this all the time is if we increase the price enough people won't consume. Well there's an easy way for people to avoid that high price that's purchased from the illicit market. So if we increase the price of legal cannabis too much we'll push people away from the legal market and back into the illicit market where the externalities are higher and we'll actually make ourselves worse off.

Trevor:  That makes a lot of sense. But let's just because you spelled out in the paper a little bit why are they external these negative externalities higher in the illicit market than they are in the legal market.

Jason:   There's a whole host of reasons a lot of the in the numbers we actually used. The difference is enforcement costs and the penal system effectively the justice system. You know every time somebody gets arrested for possession of cannabis and convicted although that doesn't happen terribly often there's a there's a jail sentence or a punishment attached. And those punishments cost money. So that whole enforcement system or on trafficking and consumption possession all that kind of stuff costs us money right now. And that's not going to stop under the legal system it's still. Once cannabis becomes legal if you're caught engaging in the illicit market there are still penalties there. So that the penalty system is one source of the difference in externality. The other source of the externality is who are these people and what are they doing with the revenue. Are they are they paying income tax or are they paying the other taxes are they. Is it clean product is it safe product is it sold in a responsible manner is it sold to youth you know and on and on and on. So there are really strong reasons to believe the externalities associated with the illicit market are higher than the externalities associated with a legal market.

Trevor:  No that's really interesting I hadn't thought about the fact. Basically we're doing more harm if we through our taxation system push more people back towards the illicit market so we really do have to be careful about the balance. So other things I hadn't thought about and they sort of go together. This one is relative preference between the the legal and the illegal market.

Jason:  Right.

Trevor:  So yeah it kind of makes sense on the face of it that you know I really might like you know Uncle Joe's strain of cannabis. So how did you sort of take customer preference into account in your paper.

Jason: Well we. Nobody knows what this looks like. Let's be really clear and there's no way to really get out the revealed preference approach to this. We can't go oh what did people buy and track it and figure this out. So everybody's going to have to guess. And one of the things we do in the papers we do a sensitivity analysis and we start to say let's say people really prefer illicit markets cannabis and we run them all the way up to people prefer cannabis purchased from the legal market to cannabis purchased on the illicit market 2 to 1. You'd rather buy from the legal provider than the illicit provider and we we look at this whole range of possibilities and what happens in that environment is if people really prefer the illicit cannabis in order to to achieve a positive outcome for society. We need the legal market cannabis to be cheaper and a lot cheaper than the illicit market cannabis as people's preference shifts towards the legal market that discount starts to shrink. But it doesn't disappear when people are indifferent. So if you're sitting there and go "Gee, I don't care where I buy my cannabis." Whether I buy it from the dealer or through this illicit mail order system or from a government store or the government licensed store if I don't care even then because of the difference in externalities it's better off to have the illicit price be higher than the legal price we still want that legal market to be cheaper to get people in that door.

Trevor: And well I think we'll talk about this a bit more later but is this something that could change. Probably something that could change over time like if the government had taxes be really low now to keep the legal price lower than the illegal price assuming you know down the road the preference really does change towards you know an Apple store like huge box store of cannabis that has you know every strain that's ever been made for really cheap at that point then the government I assume could start thinking about increasing the taxes.

Jason:  Yeah. Once we've eliminated the way of avoiding the tax then you have more power to engage in that sort of price manipulation through taxation the Pigovian in taxes that's that's absolutely correct. Until the illicit market is eliminated and we can be relatively confident it's not going to crop up again. We can't engage in that kind of pricing policy if we're serious about the policy objectives that were stated in the legalization act.

Trevor: Okay now so but back to minimizing the externalities minimizing the bad things that happen people buy recreational cannabis. Your paper had a nice little graph showing that even you know because again the argument will be just tax the snot out of it and then you know we'll have zero negative externalities because people won't use it very much at all.

Jason: Right.

Trevor:  But that wasn't what you found what what did you find was going to be the best way to have the least amount of bad things happen.

Jason: Again to minimize the externalities.  We want to move people from the high externality illegal or illicit market to the lower externality legal market so long as they've got that option to go to the high externality illicit market we need to keep the legal price low.

Trevor: That that's very succinct and because you know maybe if they put lots of tax on the cannabis I'm going to have to pay less income tax.  When you you're when you did the analysis how should the government think about doing this to maximize their profits.

Jason: The same remarkably across all three conditions we test for. The results are the same. Essentially there's there's some quantitative differences but qualitatively it all lines up again if you want to maximize the revenue from the legal market which governments can tax or collect themselves. Then you've got to get the illicit market to lose the competition and that means lower prices.

Trevor: So really across all the different areas. Everything that you adjusted in the formula all the different areas you looked at the answer for getting the best bang for our buck. The least bad things the most money for the government was all keeping the price of the legal legal cannabis lower then the the illicit one.

Jason:  We've got to be. Let me be a little bit careful here. There are some behavioural assumptions built into that and that we we see there are ranges of preference that consumers will behave in a way that allows you to price legal cannabis much higher than illicit market cannabis. So if if people really really like going to the legal provider then great go ahead and embrace it if they're not seen as substitutes at all. So people see them as radically different products and aren't willing to switch back and forth. That gives the legal market room to raise prices but if they view these goods as substitutes are reasonably close then and people don't have this radically strong preference for legal market then we've got to keep it lower got keep the price lower.

Trevor: And when you and your co-author were looking at this and developing the formulas were you looking at any other markets like say Colorado where they have basically done what Canada is doing now. But are three or four years into it. About what happened with taxes and their markets.

Jason: Yeah we watched that an informed kind of what we were doing a lot of this work actually comes from. So let me back up are informed by a number of things Colorado Washington Oregon and other jurisdictions that have gone through this sort of in the U.S. pseudo-legalization process because we can't really call it total legalization because it's still not legal at the federal level and that creates some weirdness in those industry structures but also looking at what's going on with things like alcohol and cigarettes as well.  So all those those things informed us. I mean one of the things that we have to keep in mind about this and that we haven't yet controlled for in our analysis is how is the illicit market going to respond to the entry of the legal market. And if you look at Colorado and other jurisdictions what happened is the price fell. And we're already starting to see that in the pricing data through price-of-weed-dot-com or Stats Can's own metrics we're seeing the price of illicit market cannabis start to fall already.

Trevor:  So, this could conceivably lead to like a price war or a race to the bottom on on the price price per gram.

Jason:  Yeah I think that's that's entirely possible I mean we saw Colorado have prices fall to four or five dollars a gram shortly after legalization. And that's one way to squeeze these illicit market providers out is you make it not profitable.  And then they leave. And then you've got more room to raise prices. So, there is almost an argument here for the governments who are running this you know in Quebec east or who are running the show here to really engage in what's called predatory pricing. So, price below cost and drive the illicit market providers out and then you can raise prices later.

Trevor:  So, arguably would that be the government like subsidizing a licensed producer for doing it below cost.

Jason:  That could be now illicit legal providers have license producers have prices if you go through their financial reports somewhere around 2 to 3 dollars a gram at the high end.

Trevor: OK.  But yeah I just I'm just going through the that would be a fantastic thought experiment to have our tax dollars going to subsidize a legal producer which is everything you said makes sense I just as a politician I can't imagine trying to fly that one.

Jason:  I can't see that being politically viable it's economically optimal perhaps but it's definitely not politically viable.

Trevor: Oh that's fascinating. So I think we've covered most of the stuff in the paper this has been really interesting.  And yeah the whole just may maybe a libertarian bent. I just like to keep taxes low. But you've made some fantastic arguments for why we should.

Jason:  Well you know go ahead.

Trevor: Anything else that I've missed you know I'm just I'm just a pharmacist here you're the economics prof anything else I've missed or that the our listeners of reefer medness need to understand about what the Government should consider in their taxation policies.

Jason:  Well I think it's I think you hit upon a dynamic element of this wonderfully which is really important and often gets missed. And you know looking back at history we've cranked up the price of cigarettes in this country. And one of the things that happened in the 90s is we saw the market get absolutely flooded with smuggled cigarettes. Right. Taxes were so high. So what was happening is people were buying them in the US and then smuggling them back into Canada and selling them illegally. And when we ended prohibition on alcohol it took us a very long time decades in fact to deal with the illicit market and we kept prices relatively low and enforcement relatively high in order to squeeze out the illicit market in alcohol. So we've done this before and you picked up on this wonderfully that the game will change as the illicit market gets eliminated.

Trevor: Well that was fantastic. Again thank you very much for your time. We really enjoyed geeking out on some economics 101. My cohost is just scribbling down a question. You know Kirk why don't you just jump on the mike. We're just going to switch Mikes.

Jason:  Sure tag team is fine.

Kirk:  Just ask him about health. What I'm interested in is has he built in externalities into the licit market and the repercussions of health factors.

Trevor: So just a more clarification on the externalities when when you are looking at the negative externalities on the legal side. Did you take into account health costs like and give their debate exactly what they are but like mental health and physical health cost into those externalities

Jason:  So we didn't we didn't construct that externality ourselves that's taken from another paper. I can't remember the authors of that off my head I apologize for that but they estimated the costs to cannabis and that included health care and mental health and all that kind of estimate including lost productivity as well.  And in there is it in there in the way that it really should be. That's a hard question to answer.

Trevor:  OK. But it was in there and I assume I assume we're assuming that the health related costs would be similar in the legal and illegal markets.

Jason: We were maintaining the assumption that they'll be identical.  Because we don't have any reason at this point time to to say that that will be different.  It's possible that the legal market cannabis health costs and mental health costs could ultimately end up being lower as strain's are outlawed. All right so if you find strain X Y Z has really nasty mental health outcomes for youth to just say look we're not selling that strain anywhere anybody caught with that strain is in big trouble. Right. So you could conceptually do that. So there's an argument to suggest that maybe the externality would be even lower than that but we did. We wanted to not completely load the deck.

Trevor:  No no that's that's great. So this has been fascinating. We really appreciate your time. And any any last words for our listeners before we let you get back onto to thinking big thoughts about microeconomics.

Jason: Thank you guys very much. And don't be afraid to reach out again.

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Psychologist  - Jonathon Stea -

Jonathon:  I'm Jonathon Stea. I'm a clinical psychologist I provide assessment, treatment, and counseling patient services to individuals with mental health disorders and addictive disorders.

Trevor:  Thank you very much. And you've written some interesting things on addiction in general and cannabis in particular. So we're really excited that you came and agreed to chat to us today. So before we delve deep into some of the papers and things you've written so help us out. Can you give us kind of a working definition of what what's addiction.  

Jonathon:  Yeah I mean I think I'll go with the way that it's current currently though of in what's called the Diagnostic and Statistical Manual of Mental Disorders.  That's basically the text it's used by medical professionals and psychiatrists to diagnose mental health disorders and addiction and addictive disorders. And there are others. There is basically biological symptoms of addiction like withdrawal and tolerance. There are psychological symptoms of addiction like unsuccessful attempts to control your use even though you want to cut down you're not able to do that. It's worsening using a substance and it's actually worsening other psychological problems like depression or anxiety.  There's also social social related symptoms. With respect to addiction so that means that because of the substance use you're not able to. It's interfering in your life in a number of ways. So it could it could be interfering with the relationships in your life responsibilities that you have at home or at work or at school. So. So those are sort of the things we we kind of call that that thinking about addiction in terms of a bio psychosocial model. So addiction can have bio symptoms like biology psychological and social symptoms.

Trevor:  OK. Thank you. That's really good. And I'll be jumping all over the place but I really liked one of your papers I read where you were comparing the treatment models for cannabis addiction. So you were comparing if am if I've got all my facts straight sort of someone who went to off cold turkey someone who went sort of through a treatment program where what they went through moderation which I assume they sort of slowly decreased how much cannabis they're using and then something else called a natural quitting point if I'm getting all my terminology straight was was that sort of what you're looking at in this recent paper where you're the author.

Jonathon: Yeah yeah that was some of my doctoral dissertation work.  We basically had and then we published from that we had people come to the lab that had at one point they it had a candidates election their candidates use disorder in May. They recovered from that addiction or disorder and we wanted to explore how how they did that and we looked at various subgroups so some people were able to no longer meet addiction criteria and they don't smoke or they don't use cannabis at all. So we compare that group. We also compared people that once had a cannabis addiction and they no longer meet criteria. But they still use once in a while. When we call that kind of our moderation group. So that was kind of those are a subset. And then we also compared another subset of groups where people that had a cannabis addiction recovered with the help of treatment. And then people that recovered on their own without the use of any treatment. Basically what we found you know there's lots of finding that in a nutshell though we found that you can think of cannabis addiction on a continuum of problems severity. So someone can have a more or less severe headache. Cannabis addiction that's also reflected in the DSM 5 the Diagnostic and Statistical Manual. And what we found is that the people that tended to have the more severe cannabis addiction they were those folks tended to need a recovery trajectory or recovery path that was abstinence based. So they no longer use anymore. And those people more often sought treatment for their for their difficulties and so that just posted people that had sort of a milder form of cannabis addiction. Those people were able to recover and still use once in a while. And on average those people also were able to recover without the aid of treatment. So those are the averages and that's kind of what it looks like in a dimensional setting.

Trevor:  Well and that's really interesting and I'm glad that I'm talking to somebody who explores some of the nuances. As a pharmacist I talk to people trying to quit smoking all the time and you know that's what I say in my general practice now as you know the people who are quitting for whom quitting smoking was easy have already done it because you know with all the social stigma and the taxes and you know most people almost any job site now it's very hard to smoke it at work. So it's you know it's just very difficult to be a cigarette smoker in Canada today. So people who are smoking half a pack a day are smoking socially on weekends when they had a beer. Have probably quit already. You know it's the people who have it and I guess I didn't have the right clinical definition. But a more severe addiction are the ones who are still coming to the pharmacy sort of look looking for for prescription aids to help them quit. So it sounds like that's kind of what you found in cannabis addiction as well.

Jonathon:  Yes that's exactly right. And and your point is well made because it seems the same kind of principle applies to other addiction areas too just like you know alcohol is sort of the alcohol literature looked at this stuff before the cannabis literature and they found similar findings. So there's a whole research literature on something called controlled drinking and moderated drinking so people that can control their alcohol use so to speak. We know that had an addiction versus people that people versus people that had a more severe alcohol use disorder. And the findings are kind of the same it tends to say that the people that needed treatment had a more severe alcohol addiction. So the cannabis findings are similar to that.

Trevor:  Thank you. That's really good.

Jonathon:  Which makes intuitive sense.

Trevor:  It really does and and you know sort of goes against this kind of all or all or nothing thinking that often comes when people start talking about cannabis which is you know like everything else. The real answer is probably a little more nuanced.

Jonathon:  Exactly and you know I would even broaden that to addiction because people can get into debates about addiction and whether you need treatment and whether you need complete abstinence or not. So that even extends beyond cannabis into different models like things like 12 step programs in AA. They're really great. And they can be helpful for a lot of people but they take a very abstinence based approach to treatment.  So they don't really take into consideration the problems severity versus other other sort of treatment models might take into account the severity and maybe look at it a bit more nuanced way and you know go to some of the harm reduction approaches.

Trevor:  Thank you. So we've got on to cannabis addiction. So tell us what does the literature say about what what rate you know does it have about how much. How often do people get addicted to cannabis. If you took a 100 casual cannabis users out there what does literature say about how many should end up with sort of a addiction or dependence problem.

Jonathon:  Right. Yes. There has been a lot of large scale surveys that have tried to look at this over the years. The best estimate that we have is about one in 10 people about one in 10 that ever try cannabis at least once they are likely to meet they can meet diagnostic criteria for cannabis addiction. So it's about one in 10 people that ever try it. That said the rates in that rate is actually lower compared to some of the other substances like alcohol and nicotine and cocaine.  So what that's called is a conditional prevalence rate rates conditioned on someone ever having tried the substance. So it's about one in 10 people would ever try cannabis will meet me addiction criteria. That rate though actually changes depending on some factors so age is one of them and we know that it's about 1 in 6 or 1 in 7 among youth or adolescents if they try it quite young.

Jonathon:  Then are a little more increased risk of developing a cannabis addiction. And the other important variable is frequency of use. So some of the research suggests that people that use daily or near daily cannabis use they are substantially more likely than that one in ten criteria. To meet cannabis addiction.

Trevor: And and intuitively that that makes sense right.  I think most of us will have that that friend or relative who you know you know most of us will have alcohol on say weekends at a social function but most of us have that friend relative acquaintance who seems to be having that drink every every day or was six drinks every day and sort of.

Jonathon: That's right.

Trevor:  It kind of makes sense that those would be the people who if they were told for medical reasons that they had to stop drinking or reduce their drinking you're going to have more problems so that sort of follows the same with cannabis.

Jonathon:  Yeah yeah I would agree.  The more frequently someone uses the substance the higher risk they are to become addicted to it.

Trevor:  And I'm glad you mentioned some of the other substances now. I know everyone's got their own numbers but the ones I pulled up from Stats Can survey was talking about 91 percent of people in Canada have tried alcohol and they're quoting 18 percent for dependent and tobacco about 44 percent of people in Canada have tried it. And about 16 percent have had a dependence issue so and I'm not I'm not trying to minimize people who have a cannabis use disorder but it does seem like it's less prevalent than some of her other very commonly used we'll call recreational substances out there is that fair.

Jonathon:  Yeah I would say it's fair compared to compare to alcohol and tobacco. You know the thing is you know some of the illicit substances. You know there you can call them they might say they have more addictive potential for something like heroin or cocaine. And so the thing with cannabis also cannabis would have a less addictive potential but cannabis is also more widely used. You are more likely to see those people in treatment programs. So even though the addiction might be less severe and less likely to happen to a random person the fact that it's so widely used inflates that number so that you kind of that makes sense.

Trevor:  Yeah. No and I think that's very relevant at the moment because you know less than a month now will we're going to have legal cannabis so you would assume that would make the number of people using it across Canada go up. So you know that you would think that even though the percentage is is relatively low the absolute number of people who have a cannabis use disorder is going to go up as well.

Jonathon:  Yes. Yes that's exactly right.

Trevor:  So and So cannabis addiction.  And and I'm going to compare it to opioids a little and I know that might not be entirely fair but they do seem to come up together. Is it fair to say so and this was sort of new to me when I was reading through some of this. Is it fair to say there's sort of a levels of addiction like as a pharmacist when I think about things like overdoses it's pretty easy for me to say a overdose on an opioid is worse because you know it stops you from breathing and you have a good chance of dying where a overdose of cannabis is unpleasant. And you know you might end up having to be sort of monitored for 24 hours depending on what happened but you know very unlikely to actually die is it. Is it fair to say things like opioid addiction is more quote unquote severe than a cannabis addiction or is that just not fair. Comparing the two of them.

Jonathon:  I absolutely think it's fair.  I mean if I have if I'm treating a patient and I'm given a choice if that patient has a opioid addiction or a cannabis you know I'd rather them have a cannabis addiction because I'm I'm less worried that they are going to overdose and die or you know using heroin laced with fentanyl and whatnot. So you know I think you can you can you know you can think of. You can't really compare the symptoms of addiction because symptoms of addiction are similar that you can rank order the harms associated with the use. And again you know it's not to trivialize the cannabis addiction because for that person going through it those are very real harms. I mean if someone had a cannabis addiction and their relationships were being ruined and they're not doing well at work and they can't get out of the house because they're smoking all day every day and they have anxiety and they don't want to leave the home I mean those are really the real difficulties for someone and it's worth improving their life and addressing the addiction. That said you know compared to someone with a Fentanyl addiction or a opioid addiction. Yeah I'm really scared about that because as you said they can they can overdose and die and they're not I don't have that concern with cannabis.

Trevor:  Thank you flipping through my notes here. You wrote so many interesting things. Maybe not truly addiction anymore but just a myth that I want to ask about because honestly I was a full fledged believer in this one addictive personality. So it's something I saw you write said there's really the whole idea of an addictive personality not really a thing. So I'll use an example that I like quoting so a professional person I know wholeheartedly says he's got an addictive personality. Everything he does he just sort of does it to the nth degree you know got into martial arts and that's all he would do for you know five six days a week. And then he went and decided he really liked golf. So you know goes down to Florida spends a month there getting lessons then then that's all he does. And you know he's a previous smoker and and and and it seems like everything he does he just does until he can't do it anymore and he calls himself an addictive personality and I would tend to agree. So that's that's not really a thing.

Jonathon:  Well I know I know it's it's a colloquial term that's often used but if you know that and to be honest when I was studying this stuff you know throughout my grad school and it was something I was interested in looking at and the research just really doesn't bear it out in terms of the personality models that we have. The ways that we understand things like personality traits. And you know there's no addictive personality in the DSM 5 there's no there's things like borderline personality disorder and obsessive compulsive personality disorder. There is no addictive personality disorder. And the research literature there's different models there's different ways of thinking about personality that one. It doesn't come up that said there are certain risk factors that that can predispose someone to having an addiction. So you know these are these are complicated areas of research so I'm going to make kind of global statements. But you know someone can be there is in some models of personality there's something called Sensation Seeking where someone likes to seek out like sensations and adrenaline rushes and things like that and if someone is more likely to do that than there then they may have more of a propensity for an addiction. But we don't know how that happens does that manifest in a particular kind of addiction. So it is to someone with sensation seeking or they might be more likely to have a cocaine addiction versus say a cannabis addiction where there's maybe a different quality of thrill involved and so there's certain risk factors that we can get that we can kind of pinpoint and there's genetic predispositions. So someone if you know some addictions kind of runs in families and there's a whole bunch of genes that can be connected to it and that can predisposed to someone developing an addiction. But in terms of an actual addictive personality constructs a whole bunch of things that lump together that kind of make you more likely to get an addiction that just hasn't born out.  So it's that I agree with you that it's somewhat counterintuitive but when you look at the science it's just not there. Now the research has supported it.

Trevor:  No our intuitions often lead us astray and found that very interesting.  You did touch on genetics because you know that also comes up you know my grandfather was an alcoholic my father was an alcoholic you know. So my sister and I don't don't have a chance because addiction is so complicated.  Multifactorial do we have any idea sort of how strong that that genetic link is or you know is it you know my grandfather father is an alcoholic. I now have a risk of being a cannabis addict or what do we know about genetics and addiction or is that just the thing we need the researchers to do a little more work on.

Jonathon: It's still an area of ongoing research I mean I've read some estimates or they say it's about 50 percent to 70 percent heritable based on things like twin studies. And I'm not an expert in that area but I read some of it. And there is there's another area of research called there's an area of genetic research called genome wide association tests and those things they try to look at particular genes and try to pin those down to see if they're associated with something like cannabis use disorder and that's just what my understanding is that that area of research is really new and that there's no there's no particular gene that can pin anything down it's usually clusters of genes and the clusters of genes usually predict things like addiction per se and not necessarily cannabis addiction or alcohol addiction. And they may. So, there it's hard to kind of make clarification on these things. But we do know that with you know with most with addiction per se and when with mental health disorders it's always that we know that their genetic contributions there. And we also know that there is environmental contribution. So the way that you're raised and what you've learned throughout your life and those things interact with your genes so you know even if someone is predisposed to say something like an alcohol use disorder or cannabis use disorder that doesn't mean it don't develop it based on a number of things maybe they're able to cope with emotions and maybe that they maybe they don't want to use cannabis for a number of reasons or maybe they just engage in different activities so there's things that you can do to protect yourself even if you have a genetic predisposition to developing a mental health or addiction disorder which is a very fascinating and kind of new area of research. And if people are interested. One of the terms for that is something called epigenetics and that's sort of how the environment influences genetic and genes expression.

Trevor: Yeah no the whole field of epigenetics is fascinating and unfortunately we have limited time.  So, before I let you go just another sort of rabbit hole to go down because we've talked previously on this podcast definitely comes up and reading is you know one of the potential downsides of cannabis is in people with mental health issues and whether or not cannabis causes or makes worse or triggers things like depression or anxiety. But I was reading you making a sort of passing reference to there might be some thought about cannabis being able to be used to treat things like PTSD anxiety and depression. Is that is that a thing or something that people are kind of looking at how might that work.

Jonathon:  Yeah that's one of my favorite rabbit holes.  It's a fascinating area actually. It's a very very complex and new area. You know we know that cannabis users with mental health disorders are about twice as likely as cannabis users without mental health disorders to have or developed a cannabis addiction. So that's really important because that means that one of the one of the most vulnerable populations for developing a cannabis addiction are people that experience some mental health disorders. And you know when we talk about cannabis it's really important to you know think about cannabis as sort of an umbrella term like it's such a complex substance that you know you have your CBD and you have your THC they interact in in certain ways and they have in many ways very different effects and so you know when you think of something making cannabis use to treating anxiety you know we know that cannabis low doses might THC in low doses might be may have an anxiolytic effect so be the sort of anti-anxiety but in higher doses people can have adverse effects and had a lot of anxiety. And we know that CBD is sort of it's thought of to be anxiolytic so it's important to keep these things in mind so whether someone's using the whole cannabis plant or whether they're using just pure THC or pure CBD and there's a fascinating review paper for your listeners if they ever want access to it. It's by Jacob Boradoski and Alan Bundy its new article called Cannabis Regulatory Science it's in the International Review of Psychiatry and they review this. This whole area though about the interaction between cannabis and mental health disorders. Basically the findings are mixed. So when you think of depression when you think of anxiety when you think the PTSD the research some research shows that it can help and some research shows that it actually does more harm. And the majority of it right now says that it actually does more harm. But that's not to say that in the future there can't be cannabinoid related medicines that are developed that can actually be used and probably more CBD related medicines that can be used in the treatment of these disorders.  An important point that they make is that I've tried to make is we don't want to conflate it or we don't want to conflate the reinforcing properties of cannabis with therapeutic potential. So what that means is just because cannabis can give you some euphoria so it can be positively reinforcing and it can also be negatively reinforcing means which means it takes away anxiety in the moments maybe take away some depressed feelings in the moment. We don't want to we don't want to say that that actually means that the disorder itself if someone has an anxiety disorder or depressive disorder is being treated because in some ways it can actually make the disorder worse because what it does is it robs that person the opportunity to practice healthy coping skills so you can imagine that if you're depressed you're anxious and you know you're feeling anxious maybe seven out of ten or higher. And you instead of you know processing it and talking with a friend and you know confronting the anxiety you just kind of escape via cannabis use or any addiction related substance for that matter you don't get the chance to practice the therapy skills that are required in order to overcome that anxiety disorder or that depressive disorder and so we think that's why many people with depression and anxiety are drawn to cannabis because it can be rewarding in the moment but it can actually end up harming them in the long run because it can exacerbate or make worse that that mental health disorder. So in some I mean it's a very complicated relationship between cannabis and mental health disorders of and I think it's fascinating I think it adds a lot of promise but we need to be nuanced in the way that we talked about it need to be very realistic and you know THC might not be the best for particular populations that maybe CBD can be very helpful or or some combination and you know I'm hoping that with legalization that there's a lot of research funding into these areas because it I think it holds a lot of promise and we also want to be able to help people to develop cannabis addiction.  So now a fun rabbit hole.

Trevor:  No. That was great. I will definitely look up that review paper and we'll put a link up to it on the show notes of this one. Now that was that was all really good and we're getting close to the end of your time. Thank you been very generous so for our listeners have I have I missed anything you thought and wrote a lot of about cannabis addiction use and cannabis and in general anything else that I've missed or you want the listeners to know about.

Jonathon:  No think I think you nailed it. It was a great question and I think I would just probably end by saying you know I think it's important not to I've been trying to dispel the narrative that pot isn't addicting and that it's either one way or the other I think it's important to this whole nuanced way of looking at is important and having a humble attitude towards cannabis. It's very interesting and complex substance and it can be very harmful and it can also be very helpful and so I think the best way moving forward is to acknowledge both of those things when trying to discuss it with people because if you take an all or nothing kind of side to it you kind of cheapen the reality of it and distort the reality it just it loses its significance.

 

 

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