Cyber Dyslexia

Dr. Ruwan M Jayatunge

Cyber dyslexia appears to be a distinct phenomenon that has yet to be fully recognized. This term refers to the unique challenges that individuals with dyslexia face when interacting with digital platforms, including navigating websites and understanding complex cybersecurity measures. I hope that future research will delve deeper into this uncommon condition. 

My personal experience with what I believe to be cyber dyslexia began in 2006 at Brisbane Airport, where I struggled to modify my flight dates online—a task that should have been straightforward. I found myself grappling with complex menu structures, transferring information across various digital formats, and experiencing fatigue from multi-step processes. 

During my time at York University, I frequently relied on friends for assistance with the Moodle learning management system. Initially, they assumed my challenges stemmed from a lack of technical skills, but they later recognized that I faced a different issue, which led to their understanding and support. I consider this a form of disability, yet I am confident in my ability to overcome it. 

To better understand my struggles, I engage in self-observation during IT-related tasks, documenting my difficulties and the anxiety they provoke. Over the years, I have employed various self-help strategies, such as practicing mindfulness, focusing on one task at a time, and utilizing information scaffolding. I firmly believe that cyber dyslexia is a condition that can be managed and overcome.

The last Kennedy icon

 

by Dr. Ruwan M. Jayatunge

Edward Moore Kennedy was a leading figure in the United States Senate. He served as a US senator since 1962 and served under 10 presidents—from John F. Kennedy to Barack Obama. Although he never had a chance to become the president, Ted Kennedy was one of the most influential figures respected by people around the world. He inspired the public through his commitment to social justice. He was a humanist and democratic personality who earned respect from all across the globe.

Edward Kennedy was one of the longest-serving members of the United States Senate in American history. In 2006, Time magazine named him as one of America’s “Ten Best Senators,” saying that he had “amassed a titanic record of legislation affecting the lives of virtually every man, woman, and child in the country.”

He was the last of the famous Kennedy brothers. In his personal life, he was devastated over the death of three of his own brothers. His elder brother, Jo Kennedy, died in WW2, John Kennedy was shot in Dallas, and Robert Kennedy was assassinated in California. His political path was filled with numerous obstacles.

Edward Kennedy made his maiden speech to the Senate on the Civil Rights Act of 1964, which outlawed segregation in public accommodations. It was a huge leap forward against racial discrimination in America. Kennedy was a strong supporter of the school reforms and elevation of the education system. His contribution helped to uplift the quality of school education.

He did not betray his conscience when the Vietnam question occurred. He openly questioned the Vietnam War. Edward Kennedy was a visionary and realized the emptiness of the Vietnam War was like his brother JFK. America’s involvement in the war in Vietnam, Senator Kennedy called on President Nixon to begin an immediate drawdown of US forces in that region. In his speech, Senator Kennedy argued that “American youth are too valuable to be sacrificed for a false sense of military pride.” This was one of the unique examples of his political maturity and willingness to coexist with other nations despite the political differences.

Kennedy was one of the first in Congress to speak out against going to war with Iraq. He took a gigantic step in September 2002. When the Bush administration was preparing to go to war in Iraq without the support of the international community, Senator Kennedy, in a historic speech at Johns Hopkins School of Advanced International Studies, was the first to argue that Iraq did not pose the type of threat that justified immediate war. Senator Kennedy argued that America should not rush to war. After a few years the American public realized the true meaning of his words when the nation was struck by the repercussions of the Iraqi war and the economic crisis.

Senator Kennedy could understand the contribution made by the immigrants to the US economy. In 2006, Senator Kennedy introduced a bill to reform America’s immigration laws and to bring fairness and justice to immigrant families. He fought for fair immigration reforms.

His life was like a roller coaster, ups and downs. He faced a bitter impeachment over the accidental death of Mary Jo Kopechne. In his 1991 speech at Harvard, Edward Kennedy did something that politicians from our part of the world would not even think of doing. He admitted that he was not a saint and had made human mistakes in the past. Addressing the crowd, he stated that—

“I recognize my own shortcomings, the faults and the conduct of my private life. I realize that I alone am responsible for them, and I am the one who must confront them.”

He was a master orator who spoke from his heart. In June 1968, at the eulogy for Robert F. Kennedy, Edward Moore Kennedy made an outstanding emotional speech.

He said:

My brother need not be idealized or enlarged in death beyond what he was in life to be remembered as a good and decent man who saw wrong and tried to right it, saw suffering and tried to heal it, and saw war and tried to stop it.

Those of us who loved him and who take him to his rest today pray that what he was to us and what he wished for others will someday come to pass for all the world. As an international political icon, Edward Kennedy played an important role during the independence of Bangladesh and brought peace to Northern Ireland.

Kennedy strongly supported Sinn Féin leader Gerry Adams coming to the Democratic stream. After these successful interventions, Protestant paramilitaries announced their own cease-fire.

He was a down-to-earth politician who showed enormous empathy for common people. His exceptional ability as a politician, with inspired admiration, respect, and devotion, flowed beyond the borders of America. Edward Kennedy was best known as one of the most outspoken and effective politicians of our time.

"I" (self) is a Mirage or an Illusion Created by the Mind

 

 

Dr. Ruwan M Jayatunge

Self-awareness is one's capacity for self-directed knowledge, and self-awareness is the mind becoming its own object.  However, in contemporary neuroscience and traditional philosophy, the concept of the "I" is often regarded as an illusion or mirage, as it lacks a stable, physical foundation and serves primarily as a mental construct. Neuroscience increasingly describes the "self" not as a physical entity, but as a dynamic informational entity. The brain acts as a "prediction machine," constantly generating a "self-model" to anticipate internal bodily needs (interoception) and external social threats.

Neuroscientific research suggests that the self emerges from complex brain processes rather than existing as a singular, cohesive entity. Instead, the self can be understood as an ongoing narrative that the brain constructs to weave together diverse sensory, emotional, and cognitive inputs into a unified experience. Thus, the sense of self is a mental fabrication, an effective organizational mechanism, but not a standalone, enduring reality.  

Self-awareness in Children

Jean Piaget's theory of cognitive development posits that a child's self-concept is shaped through active interaction with their environment, advancing through four universal stages from infancy to adolescence. This framework is fundamental for understanding the formation of the self, as Piaget argued that self-concept is not innate but rather a cognitive structure that develops progressively through these distinct stages.

From the moment of birth, infants possess the ability to distinguish between touches they initiate themselves and those that come from external sources. For instance, newborns tend to turn their heads more towards an external stimulus, such as a gentle touch on the cheek, rather than their own hand making contact with their face. This marks the initial awareness of their separateness from caregivers. By the age of 5 to 6 months, infants begin to recognize themselves as distinct individuals, realizing that their actions can influence their environment, such as kicking a mobile to make it move. By 18 months, many infants successfully pass the "Mirror Test," demonstrating an understanding that the reflection they see is themselves and not another child.  

How the Brain Constructs a Sense of Self?

Contemporary research indicates that the sense of "I" arises from intricate neural networks and brain activity. This sense of self is not a singular occurrence but rather a dynamic, layered process that unfolds continuously. The brain constructs identity by merging physical sensations with psychological experiences, creating a cohesive narrative. Functional MRI studies reveal that the brain regions associated with the self and close relationships often overlap, implying that our understanding of "I" is intrinsically linked to our connections with others.

The Hippocampus and Its Role in Self-Identity

The hippocampus is vital for self-identity.  The hippocampus plays a crucial role in shaping self-identity by integrating elements of space, time, and memory to create a coherent personal narrative. It serves as the primary center for developing an individual's life story, going beyond mere fact storage to construct a stable and unified account of one's experiences. The functionality of the hippocampus is often centred on enhancing the capacity to formulate meaningful and effective personal narratives.

 

The insula's role

The insula is the brain's primary receiver for interoception—the sense of the internal state of the body. It monitors heart rate, lung expansion, and gut signals. By constantly tracking these "life signals," the insula provides the most basic level of selfhood: the feeling of being a living, breathing organism. The insula is involved in a wide variety of functions, ranging from sensory and affective processing to high-level cognition, such as processes constituting the self.

 

The Role of the Anterior Precuneus (aPCu)

The anterior precuneus (aPCu) forms the physical and spatial sense of self. The anterior precuneus (aPCu) is situated in the medial parietal lobe, nestled between the two hemispheres of the brain. This region is recognized as the central hub for the physical sense of self, often referred to as the "I." It plays a crucial role in a neural network, integrating sensory data to create a cohesive mental representation of the body's position and movement in space. By processing information related to location, motion, and the positioning of muscles and joints, the aPCu helps maintain a three-dimensional understanding of the body. It serves as a physical anchor for consciousness, and when its activity is disrupted, individuals may experience self-dissociation, leading to sensations of floating, falling, or a disconnection from their own identity. The aPCu is particularly well-defined in non-human primates, including macaque monkeys and chimpanzees.

 

The Experience of Self and Time

Neuroscience postulates that the concepts of self and time are intertwined rather than separate entities, functioning as two facets of a singular mental construct. The brain integrates these elements to form a cohesive "theater of experience." Humans possess a distinctive capability known as "autonoetic consciousness," which allows them to mentally navigate both memories and future possibilities. Central to this process is the sense of "I," which acts as the focal point within this dynamic framework. As this framework shifts, the brain continuously refines the self-model, fostering the perception of a stable "I" that traverses an ever-changing landscape of time.

 

Buddha's Teaching of Anattā (non-self)

The Buddha, a prominent early advocate of the no-self doctrine, articulated the concept of Anatta, which posits that the notion of "I" is merely an illusion created by the interplay of five aggregates: physical form, sensations, perceptions, mental formations, and consciousness. This illusion resembles a mirage, appearing substantial from afar but revealing its fragmented nature upon closer examination. Central to this teaching is the idea of Sakkāya Diṭṭhi, or the belief in a permanent self, which the Buddha refuted by asserting that there is no enduring essence within us. Instead, what we perceive as the self is a transient amalgamation of ever-changing physical and mental elements, shaped by various causes and conditions.

  

Milinda Nagasena Debate- The Chariot Metaphor

The dialogue between King Milinda, known as Menander I of Greece, and the monk Nāgasena took place in the 2nd century BCE. In this philosophical exchange, Nāgasena employs the metaphor of a chariot to illustrate the concept of the self as an illusion. He argues that the term "chariot" does not denote a singular, hidden essence within its components; rather, it is a designation we apply when the parts—such as wheels, axle, and pole—are assembled in a particular manner. By equating the human self to the chariot, Nāgasena demonstrates that the self can operate effectively without being a fixed, enduring entity.

 

David Hume's Bundle Theory

David Hume, an 18th-century Scottish philosopher, argued that when he looked inward, he could never catch a glimpse of a permanent self, only a "bundle or collection of different perceptions" in constant flux. Hume argued that the concept of a permanent, unified "self" is a fiction of the mind. He noted that there is no "constant and invariable" impression that lasts an entire lifetime to serve as a base for the self. Hume theorized that introspection reveals no enduring self but rather a transient collection of perceptions. He maintained that when one seeks to identify a core identity, what emerges is not a singular, stable essence but a dynamic array of experiences—ranging from sensations of heat and cold to emotions like love and hatred. This led Hume to conclude that the notion of a fixed "I" is merely a construct of the mind, designed to unify these ever-changing experiences.

 

Thomas Metzinger's "Ego Tunnel" Theory

Thomas Metzinger's "Ego Tunnel" theory highlights that the brain constructs a highly convincing self-model, leading us to perceive it as reality. He suggests that while we may feel like individuals, we are essentially "being no one," experiencing a vivid simulation of identity. According to Metzinger, the concept of "I" is not a fixed entity but rather a dynamic, transparent model created by our brain. This theory emphasizes that our perception of reality is not direct; instead, the brain generates a simplified, real-time simulation or "tunnel" of the world around us.

 

"I" is a Biological Defense Mechanism

Compelling evidence for the concept of non-self emerges from neurostimulation research. The notion of the self as an illusion or mirage is prevalent in both neuroscience and philosophy, suggesting that the self is not a tangible entity but rather a mental construct. The brain generates a self-model, creating a seamless simulation of individuality that often goes unnoticed. Consequently, the "I" becomes a narrative fabrication, serving as a biological defense mechanism rather than a concrete reality.

 

References

Chavoix C, Insausti R. Self-awareness and the medial temporal lobe in neurodegenerative diseases. Neurosci Biobehav Rev. 2017 Jul;78:1-12. doi: 10.1016/j.neubiorev.2017.04.015. Epub 2017 Apr 19. PMID: 28433653.

Elder, C., et al. (2023). "A Fluid Self-Concept: How the Brain Maintains Coherence and Positivity." The Journal of Neuroscience. (Describes how the brain actively updates and protects the self-concept).

Lei Y. Sociality and self-awareness in animals. Front Psychol. 2023 Jan 9;13:1065638. doi: 10.3389/fpsyg.2022.1065638. PMID: 36710826; PMCID: PMC9881685.

Lyu, D., et al. (2023). "Causal evidence for the processing of bodily self in the anterior precuneus."Neuron. (Identifies the aPCu as the physical hub for the sense of "I").

Mograbi, D. C., et al. (2023). "The cognitive neuroscience of self-awareness: Current status and future directions." WIREs Cognitive Science. (Summarizes the self as a multi-layered model of various processes).

Paquola, C., et al. (2025). "The architecture of the human default mode network explored with histology and MRI." Nature Neuroscience. (Provides evidence of the DMN as an insulated core for internal reflection).

Tisserand A, Philippi N, Botzung A, Blanc F. Me, Myself and My Insula: An Oasis in the Forefront of Self-Consciousness. Biology (Basel). 2023 Apr 14;12(4):599. doi: 10.3390/biology12040599. PMID: 37106799; PMCID: PMC10135849.

Wittmann M. Modulations of the experience of self and time. Conscious Cogn. 2015 Dec 15;38:172-81. doi: 10.1016/j.concog.2015.06.008. Epub 2015 Jun 26. PMID: 26121958.

විමුක්තිගේ ආගමනය

චන්ද්‍රිකා විජයව බැන්දත් විජයට ඒ හයි සොසයිටි එකේ මූව් වෙන්න බැරි උනා. විජය ගේ පීඩිත දේශපාලනයත් ඒකේ කොටසක්. චන්ඳ්‍රිකාට තරහා ගියාම විජයට කුලය පන්තිය ඇදලා බැන්නේ. විජයගේ පුතා මේ පහල ක්ලාස් එක අතික්‍රමණය කරලා දැන් ඉහල සමාජයත් එක්ක මූව් වෙන්න පුලුවන්. ඒත් පීඩිත සමාජයට ඔහු අමුත්තෙක් ඒ වගේම විජයගේ පුතා විමුක්ති සමරිසියෙක් බව ඔහු පිලිබඳව දන්න කෙනෙක් කිව්වා. ඒක සත්‍යක්ද දන්නේ නෑ. විමුක්ති සමරිසියෙක් නම් පසුගාමී ලාංකික සමාජය ඔහුව කොහොම පිලිගනීද කියන එක ගැටලුවක්. නමුත් හරිනී වගේ චරිතයක් ශ්‍රී ලංකාවේ මධ්‍යම පාන්තිකයෝ පිලිගත්තා. ඒ කියන්නේ විමුක්තිට ලොකු බාධාවක් නෑ.. ශ්‍රී ලංකා දේශපාලනයේ තිබෙන සැහැසි - ක්‍ෂිතිමය දේවල් විමුක්ති කුඩා කාලයේ සිට අත් දුටුවා. ඒ නිසා ඔහු ශ්‍රී ලංකා දේශපාලනයට ස්ව කැමැත්තෙන් අවතීර්ණ වෙයිද කියා සැකයි. විජයට එතරම් උගත් කමක් විභවයක් තිබ්බේ නෑ. තිබ්බේ ජනප්‍රියතාව විතරයි. විජයගේ මරණය නිසා ඔහු වීර දේශපාලන චරිතයක් උනා. නමුත් බලය ලැබුනා නම් විජය මෝඩ දේශපාලකයන් ගේ ගොඩට වැටිලා මේ වෙන කොට වාසුලා වගේ අවලංගු චරිතයක් . නමුත් විමුක්ති එන්නේ උසස් අධ්‍යාපනයක් එක්ක. විජයගේ අඩුපාඩු  ඔහු තුල නෑ.  විමුක්ති වගේ සෙකන්ඬ් ජෙනරේශන් ප්‍රභූ මොඩ්ල් එකකට ලංකාවේ ජනයා කැමතියි. වර්තමාන නිර් ප්‍රභූ සහ වෙන්ඩ ප්‍රභූ මාලිමා - ජවිපෙ දේශපාලකයන් ගේ විපරීත නිසා තව වසර දෙක තුනකින් හොඳ ඇක්සන්ට් එකකින් ලස්සනට ඉංග්‍රීසි කතා කරන බටහිර සංස්කෘතියට බටහිර සංවර්ධිත සහ විනයක් තිබෙන ලෝකයකට එක්ස්පෝස් වෙච්ච චරිතයකට ලොකු ඩිමාන්ඬ් එකක් එනවා. ඒක විමුක්තිගේ චාන්ස් එක​. නමුත් පසුගාමී චින්තනයක් තියන ලංකාවේ මිනිසුන් එක්ක විමුක්ති තියා ලී ක්වාන් යූ ආවත් ලොකු සමාජ වෙනසක් නම් සිදු වෙන එකක් නෑ. ඒක කටුක යථාර්ථයක්.

අපගේ ගංජා පත්‍රිකාව

ගංජා භාවිතය සහ සෞඛ්‍ය පිලිබඳ ආචාර්‍ය මන්ඩේ  ඉග්වේ (නයිජීරියාව) , විශේෂඥ මනෝ වෛද්‍ය උපාලි පීරිස්    සහ මා විසින් ලියන ලද පත්‍රිකාව​. 

Cannabis Use and Mental Health

Dr. Monday N. Igwe, Dr. Upali P. K. Peris, and Dr. Ruwan M. Jayatunge

Cannabis sativa (marijuana) has been used throughout the world medically, recreationally, and spiritually for thousands of years (Maule, 2015). It is the most commonly used illicit drug in the world (Wittchen et al., 2009). Despite being illegal in many countries, it is easily obtained and even homegrown (Delisi et al., 2006). According to the results from the 2011 National Survey on Drug Use and Health, the rate of marijuana use has had a steady increase since 2007. Cannabis use continues to constitute a social and public health problem.

The cannabis plant (Cannabis sativa) has a long history of use both as a medicinal agent and intoxicant (ElSohly & Slade, 2005). There are over 400 chemicals in marijuana. Active compounds of cannabis, called cannabidiols, have 64 active isomers. Only one metabolite, tetrahydrocannabinol (THC), is reported to be an active metabolite responsible for its effects (Morrison et al., 2009). THC usually refers to the naturally existing isomer of delta-9-THC but also may include delta-8-THC. The delta-9-tetrahydrocannabinol contains psychoactive properties. Marijuana produces a number of characteristic behaviors in humans and animals, including memory impairment, antinociception, and locomotor and psychoactive effects (Sim-Selley, 2003).

THC leads to increased activation in frontal and paralimbic regions and the cerebellum (Chang & Chronicle, 2007). Cannabinoids act on a specific receptor that is widely distributed in the brain regions involved in cognition, memory, reward, pain perception, and motor coordination (Adams & Martin, 1996). Cannabis produces euphoria and relaxation, perceptual alterations, time distortion, and the intensification of ordinary sensory experiences (Hall, Solowij & Lemon 1994).

Although most people who smoke cannabis will develop neither severe mental health problems nor dependence, regular use of cannabis may be associated with a range of health, emotional, behavioral, social, and legal problems, particularly in young, pregnant, and severely mentally ill people (Winstock, Ford & Witton, 2010). Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems, and have poorer cessation outcomes than those who use cannabis but not tobacco (Peters, Budney & Carroll 2012).

Epidemiological studies indicate that approximately 10% of lifetime cannabis users meet the criteria for cannabis abuse or dependence (Anthony et al., 1994; Cottler et al., 1995; Hall et al., 1999). The epidemiological literature shows that cannabis use increases the risk of accidents (Hall, 2015) and the risk of motor vehicle crashes (Hall & Degenhardt, 2009). Cannabis is currently one of the leading substances reported in arrests (Dennis et al., 2002).

Tolerance and dependence on cannabinoids develop after chronic use, as demonstrated both clinically and in animal models (Sim-Selley, 2003). According to Levin and colleagues (2011), cannabis dependence is a substantial public health problem. A large body of evidence now demonstrates that cannabis dependence, both behavioral and physical, does occur in about 7-10% of regular users, and that early onset of use, and especially of weekly or daily use, is a strong predictor of future dependence (Kalant, 2004).  Cannabis dependence, or cannabis use disorder, is defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition requiring treatment (Gordon, Conley & Gordon, 2013).

Cannabis withdrawal is an important component of cannabis dependence (Lee et al., 2014). As many as 85% of users experience withdrawal (Budney et al., 2004; Winstock et al., 2010). Cannabis withdrawal is characterized by craving, irritability, nervousness, depressed mood, restlessness, sleep difficulty, and anger. With the recent publication of the DSM-5, a cannabis withdrawal syndrome is now officially recognized with defined criteria (APA, 2013).

Consequences of Cannabis Use

Studies show significant negative effects of smoking marijuana on physical and mental health as well as social and occupational functioning (Gazdek, 2014). Smoking marijuana is known to have hemodynamic consequences (Mittleman et al., 2001). Cannabis also has immunosuppressant and endocrine effects, although the clinical significance of these is still not clear (Ashton, 2001). Cannabis smoking shows a dose-response relation with pulmonary risk in the same way that tobacco smoking does. Although problems of cannabis use can arise at any level of use, however low, cannabis use disorders and other problems are more likely to arise in long-term, heavy daily users than in casual, infrequent users. (Winstock et al., 2010).

Longitudinal association between cannabis use and mental health has been studied by the researchers. Cannabis use is a known risk factor for a range of mental health problems (van Gastel et al., 2014). Cannabis use has been associated with several adverse life outcomes, including unemployment, legal problems, dependence, and early school leaving (Serafini et al., 2013). Furthermore, Monshouwer and colleagues (2006) specify that cannabis use is associated with aggression and delinquency. In addition, Fergusson and Boden (2008) point out that greater welfare dependence and lower relationship and life satisfaction are associated with cannabis abuse.

The majority of studies have suggested a significant cognitive decline in cannabis abusers compared to non-abusers and healthy controls (Shrivastava et al., 2011; Solowij, 1988). According to Kalant (2004), cannabis use has been linked to a number of both short- and long-term health consequences, including depression, paranoia, learning problems, and memory and attention deficits. In addition, cannabis use also causes symptoms of depersonalization, fear of dying, and irrational panic ideas (Khan & Akella 2009). Also, cannabis use significantly increases the risk for manic symptoms (Henquet, Krabbendam & Graaf, 2006) and mania (Leweke & Koethe, 2008). Evidence indicates that cannabis use is considerably associated with both attempted and completed suicides among healthy youths (Serafini et al., 2013; Price et al., 2009).

Cannabis intoxication can occur shortly after cannabis use. The intoxication by cannabis is associated with subjective symptoms of euphoria, perceptual distortion, continuous giggling, sedation, lethargy, impaired perception of time, difficulties in the performance of complex mental processes, impaired judgment, and social withdrawal (Crippa et al. 2012). Some clinicians have noticed panic attacks with cannabis intoxication. Cannabis intoxication symptoms are usually gone after a maximum of one week of abstinence (Lishman, 1988).

Heavy cannabis use could lead to an ‘amotivational syndrome,’ which has been described as personality deterioration with loss of energy and drive to work (Tennant & Groesbeck, 1972; Johns, 2001). Cannabis-induced amotivational syndrome negatively impacts volition, self-care, and social performance.

Cannabis-induced psychotic disorder (CIPD) refers to psychotic symptoms that arise in the context of cannabis intoxication (Morales-Muñoz et al., 2014). Cannabis use is a risk factor for the development of incident psychotic symptoms (Arendt et al., 2005; Kuepper et al., 2011) and exacerbates psychosis (Hall et al., 2004).  Hall and team (2004) state that cannabis use can precipitate schizophrenia in vulnerable individuals. Deficits in prepulse inhibition (PPI) and cannabis abuse are consistently found in schizophrenia (Morales-Muñoz et al., 2015).

Cannabis use in adolescence leads to a two- to three-fold increase in relative risk for schizophrenia or schizophreniform disorder in adulthood (Arseneault et al., 2004). The abuse of cannabis by patients with psychiatric disorders such as schizophrenia and mood and anxiety disorders has a negative impact both in the acute and advanced stages of these conditions (Diehl, Cordeiro, & Laranjeira, 2010). 

Exposure to marijuana during a critical period of neural development may interrupt maturational processes (Jacobus et al., 2009). Adolescents appear more adversely affected by heavy use than adults (Schweinsburg, Brown & Tapert, 2008). Chronic cannabis use may alter brain structure and function in adult and adolescent populations (Batalla et al., 2013). Sami and colleagues (2015) suspect cannabis use may be associated with dopamine signaling alterations. Fontes and team (2011) point out that cannabis use has been associated with prefrontal cortex (PFC) dysfunction.

Arseneault and colleagues (2004) were of the view that cases of psychotic disorder could be prevented by discouraging cannabis use among vulnerable youths. Consequently, Moore and team (2007) emphasize that there is sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

According to El Marroun and team (2009), maternal cannabis use, even for a short period, may be associated with several adverse fetal growth trajectories. Cannabinoids have the ability to cross the placental barrier to the fetus and are detectable in the breast milk of mothers who use cannabis (Liebke, 2001). Current evidence indicates that cannabis use during both pregnancy and lactation may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioral, and executive functioning. (Jaques et al., 2014). Prenatal marijuana exposure is associated with adverse perinatal effects (Astley & Little, 1990).

Medical Uses of Cannabis

The use of cannabis for medical purposes is a controversial but important topic of public and scientific interest (Ware, Adams & Guy, 2005). According to Grotenhermen and Müller-Vahl (2012), cannabinoids are useful for the treatment of various medical conditions. Medicinal marijuana has been prescribed in chronic pain management, antiepileptic treatment in partial epilepsy, and symptomatic relief in multiple sclerosis and chronic neuropathic pain. However, severe risks are associated with the non-medicinal use of cannabis. Hill (2015) emphasizes that physicians should educate patients about medical uses of marijuana to ensure that it is used appropriately and that patients will benefit from its use.

Although cannabis has valid medical applications, it has addictive potential. Heavy cannabis use may contribute to the development of significant psychosocial and health-related problems (Budney, Vandrey, and Stanger 2010). Cannabis use clearly has serious implications for young people who are particularly sensitive to its psychotogenic effects (Kolliakou et al., 2012). Early interventions are essential in treating cannabis-related disorders.

Management of Cannabis Use

The prevalence of marijuana abuse and dependence disorders has been increasing among adults and adolescents. They continue to smoke the drug despite social, psychological, and physical impairments, commonly citing consequences such as relationship and family problems, guilt associated with use of the drug, financial difficulties, low energy and self-esteem, dissatisfaction with productivity levels, sleep and memory problems, and low life satisfaction (Gruber et al., 2003; Budney et al., 2007).

Despite the fact that there are large numbers of people with cannabis dependence, relatively little attention has been paid to the treatment of this condition (Nordstrom & Levin, 2007), and also the preventative strategies are still limited (Deogan et al., 2015).

Pharmacological and psychological interventions are recommended for the cannabis use disorder. Allsop and team (2014) propose cannabis extract nabiximols (Sativex) as a medication for cannabis withdrawal. Levin and colleagues (2011) suggest dronabinol for the treatment of cannabis dependence. Haney et al. (2013) recommend the FDA-approved synthetic analogue of THC nabilone, which has higher bioavailability and clearer dose-linearity than dronabinol.

Steinberg and team (2002) suggest psychosocial treatment for cannabis dependence.  Among the psychological interventions, cognitive and behavioral therapies and motivational enhancement therapies have proven to be effective in cannabis withdrawal and dependence (Benyamina et al., 2008).

Motivational enhancement therapy is designed to help resolve ambivalence about quitting and strengthen motivation to change (Elkashef et al., 2008). Cognitive behavioral therapy (CBT) has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies (McHugh, Hearon & Otto, 2010).

CBT for marijuana dependence has typically been delivered in 45- to 60-minute individual or group counseling sessions. The overall focus is the teaching of coping skills relevant to quitting marijuana and coping with other related problems that might interfere with a good outcome. Such coping skills include functional analysis of marijuana use and cravings, development of self-management plans to avoid or cope with drug-use triggers, drug refusal skills, problem-solving skills, and lifestyle management (Elkashef et al., 2008). In addition, Litt and team (2008) highlight the efficacy of contingency management treatments for marijuana dependence.

Treatment of cannabis use among people with psychotic or depressive disorders is imperative. Available studies indicate that effectively treating the mental health disorder with standard pharmacotherapy may be associated with a reduction in cannabis use and that longer or more intensive psychological intervention rather than brief interventions may be required, particularly among heavier users of cannabis and those with more chronic mental disorders (Baker, Hides & Lubman 2010).

As a safer alternative, some propose cannabis substitution, which is a method of harm reduction.  Harm reduction refers to policies and programs that aim to reduce the harms associated with the use of drugs. Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely (Lau et al., 2015). Based on principles of public health, harm reduction offers a pragmatic yet compassionate set of strategies designed to reduce the harmful consequences of addictive behavior for both drug consumers and the communities in which they live (Marlatt, 1996).

Conclusion

Cannabis abuse can have a profound effect on the health of individuals, their families, and their communities. Prevention and intervention programs for marijuana abuse are highly essential. Early intervention initiatives and psychoeducation strategies are important in preventive actions.

Acknowledgements:

·         Mark D. Litt, Ph.D. Professor of Psychology University of Connecticut

·         Dr. Ilan Nachim, HBSc, MSc, MD, CCFP Toronto Canada

·         Dr. Krishna Balachandra, M.D., FRCPC - Assistant clinical professor at the University of Alberta

About the Authors

Dr. Monday Igwe - Lecturer/Head of Department in Department of Psychological Medicine Faculty of Medicine College of Health Sciences Ebonyi State University, Abakaliki Nigeria.

Dr M.U.P.K.Peris MBBS, MD(Psych), FSLCPsych, MRCPsych Head and Senior Lecturer in Psychiatry - Faculty of Medicine, University of Kelaniya Sri Lanka Consultant Psychiatrist - North Colombo Teaching Hospital, Ragama Sri Lanka

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