As a cofounder of NACoA, I had my own childhood experiences with an alcoholic father. Times have changed; today, opiates, methamphetamine, and cannabis are more common and polysubstance use is the norm. Despite these vicissitudes, the impact of parental addiction on children remains pretty much the same. From children’s perspectives, addiction is simply addiction—different drugs may have different characteristics, but the needs of children remain the same. What began in 1983 as the National Association for Children of Alcoholics has now broadened its mission to raise awareness of the effects all drug addiction has on children.
NACoA’s focus on the children of addiction should also include children with parents addicted to cannabis. While many in the general public still deny the existence of cannabis addiction, and far more minimize its importance, clinicians and all professionals concerned with the welfare of children should be aware of the science underlying cannabis addiction and withdrawal.
Cannabis affects the brain because its most psychoactive ingredient, THC, mimics natural transmitters in the brain (NIDA, 2019). THC does not simply mimic the brain’s natural chemistry—it more powerfully activates our brain’s cannabinoid receptors far longer and stronger than normal. In addition, THC activates the reward center, eventually bending motivation toward repeating cannabis use (NIDA, 2020).
When used too frequently, cannabis causes a reduction in the natural receptors necessary for proper functioning of our internal cannabinoid system (NIDA, 2020). Once cannabinoid receptors are reduced, THC consumption must be repeated or withdrawal will occur. Dartmouth researcher Alan Budney identified and verified the symptoms of cannabis withdrawal (Budney, Hughes, Moore, & Vandrey, 2004), but before reviewing these symptoms it is important to lend perspective: no one is jonesing in the gutter from cannabis withdrawal. These symptoms do not rival withdrawal from alcohol, opiates, or stimulants. At the same time, cannabis withdrawal is real enough to affect behavior and disrupt family dynamics.
THC changes the texture of our experience by overactivating the brain’s cannabinoid receptors, usually leading to physical and emotional relaxation, enhancement of stimuli (e.g., music) in ways that are intriguing and engaging, reduced pain, and increased sleep, to name but a few of the pleasant aspects of being high (NIDA, 2019).
Once the brain’s cannabinoid receptors have been reduced in number in response to frequent overactivation by THC, people are left in a state of underactivation of the natural cannabinoid system. The experience of this underactivation is the opposite of being high, namely irritability, restlessness, anxiety, boredom, and difficulty sleeping, the latter symptom lasting as long as six weeks. Those parents with a tendency toward violence are more likely to be repeat offenders during cannabis withdrawal. Because the action of THC clears within eight hours, symptoms of withdrawal can be present by morning.
Children learn emotional regulation by interacting with emotionally regulated adults. They learn to label their emotions and to react proportionally to events by observing and being in intimate contact with emotionally mature adults. When children observe emotional reactions such as irritability, anxiety, and restless agitation without understanding their provenance, they experience these emotions as arbitrary and random. The development of emotional intelligence occurs when children experience a logical pattern of cause and effect between events and emotional responses in those around them. This pattern is disrupted by emotional reactions stemming primarily from the level of THC in their parents. Events that provoked irritability at one point in the day and do not perturb parents at another time lack any logic for children who are unaware of the connection to their parents’ cannabis use.
The experience just described is different only in degree for children living with a parent or parents addicted to cannabis rather than to those addicted to alcohol, opiates, or stimulants. Each leads to a world of emotional unpredictability, if not chaos. Behavior that is punished one time, but not at other times, is a source of deep confusion. Floating in an environment that is random and arbitrary, children distrust their internal emotional reality and instead learn only how to manage their emotional reactions as performances designed to deal with an unpredictable world.
Parents do not have to be overtly addicted to cannabis for their use to have a negative impact on their children. When parents’ cannabis use is hidden, secrecy invades the family dynamic, breeding denial and unnamed tension. I am reminded of a couple that shared their cannabis use until their first child was born. At that point the mother stopped her use while the father’s use went underground. From time to time his wife discovered his continued use, arguments ensued about his lies, promises to quit were made, then broken, and the secrets continued until another discovery. As their two sons approached adolescence, the arguments intensified each time the husband “got caught,” once when he had crawled under the porch to hide using. It is foolish to pretend the children were not affected by the undercurrent of tension this cyclic family dynamic caused.
Not all parents keep their cannabis use secret; just as many adults are comfortable having a glass or two of wine, a few beers, or mixed drinks to relax at the end of an exhausting and tense day. “How can this be harmful?” most people ask.
Before proceeding, I hasten to make it clear that I am only presenting arguments based on what scientific research has established. When people choose to soothe themselves and manage their emotional life with moderate amounts of psychoactive substances, I consider this to be a personal decision that they have every right to make. I make no moral arguments and am not telling people how they should live. I am only interested in helping people make conscious decisions for themselves based on clear understanding of all the implications and potential consequences of their decisions.
For example, frequent open use of cannabis by adults to manage their emotions is likely to be imitated by their children no matter what the adults tell them to do. It is important to take precautions for keeping cannabis supplies safely unavailable to children. Even when children are prevented from gaining access to their parents’ stash, it remains likely that these children will eventually find the means to begin use at an early age. The younger people initiate cannabis use, the more likely it will affect the course of their neurological and psychological development. Early use leads to higher risk for addiction; Ken Winters found that 17 percent of children who begin cannabis use at age thirteen are addicted by age fifteen (Winters & Lee, 2008). Additionally, Madeline Meier found in the Dunedin Study that only individuals who began cannabis use in early adolescence experience decreases in IQ later in life (Meier et al., 2012). Early onset of use is riskier than delaying use until at least the late teen years, and preferably even later.
There are two subtle effects of cannabis use worth mentioning. Staci Gruber demonstrated that emotional centers of the brain in frequent cannabis users are less activated by subtle emotional cues than in nonusers (Gruber, Rogowska, & Yurgelun-Todd, 2009). Even on a preconscious level, emotional responses are blunted. How could it be helpful to children’s emotional development to live with parents who have a decreased ability to mirror their children’s emotional expressions?
Secondly, Jerome Yesavage demonstrated that a single use of cannabis still interferes with people’s ability to respond to novel events in a timely and organized manner twenty-four hours later (Yesavage, Leirer, Denari, & Hollister, 1985). Professional airline pilots tested on a flight simulator performed normally on routine maneuvers a day after using cannabis, but had impaired performance under unexpected circumstances. These results are subtle, but real, and not the best situation when called on to protect children during an emergency.
Responsible adults can use cannabis without harm, just as they can use alcohol safely. But too frequent use, and use without understanding the potential negative effects, can become problematic. Furthermore, when parents are experiencing negative effects from cannabis, it is impossible to shield children from collateral damage.
As with alcohol, people using cannabis have the responsibility to know their limits. This requires understanding the signs of exceeding those limits, which requires accepting the reality that limits do exist for the use of cannabis.
When parents’ limits are exceeded, children suffer too.
Timmen L Cermak, MD, is the cofounder of NACoA and the past president of the California Society of Addiction Medicine (CSAM). Dr. Cermak is also the author of From Bud to Brain: A Psychiatrist’s View of Marijuana (Cambridge University Press, May 2020).