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Dr. Esman has presented a judicious approach to the psychoanalyst's dilemma in treating older adolescents who use non-narcotic drugs. In my experience, marijuana is the most common and its use is quite variable, ranging from the teenagers who try it once or twice to those who use it regularly, usually on weekends. Of course, marijuana varies in its potency and effects on different individuals.
What should be elaborated on concerning Dr. Esman's point of view is the attitude of the analyst toward drugs and their effects. The analyst's attitude toward marijuana, for example, will be the resultant of his objective knowledge about the drug, his moral views about its usage and how he establishes the condition of abstinence in the analytic situation. Countertransference difficulties will become greater if the psychoanalyst does not clarify his own knowledge, attitudes and apprehensions about marijuana.
It may be helpful to be aware of a recent publication, “The Medical Letter on Drugs and Therapeutics,” in which the effects of marijuana are described as follows:
“Subjective Effects—When marijuana is smoked, the subjective effects usually start promptly and last for about four hours. A
dreamy state in which ideas and images flow freely and pleasantly is common. Time sense, spatial relationships and body image can be markedly distorted. There is an intensified sensory perception, especially of auditory and visual stimuli. The usual mood is one of euphoria or exaltation but there may be mood swings or even a predominant depression. Uncontrollable laughter and hilarity are common, especially when marijuana smoking is a group affair, as it usually is.
“Serious Reactions—Advocates of lifting the legal restrictions on the use of marijuana state that it is no more harmful than alcohol or cigarettes. However, reports of serious adverse emotional reactions and personality changes are increasing. Panic, gross confusion, impulsive and aggressive behavior, depersonalization, depression