1. Carin says Pot Doesn't Cause Amotivational Syndrome - 5/19/96
2. Teenage Pot Smoking - 4/18/96
3. Kawasaki Syndrome - 4/15/96
4. Disclaimer

• Read Questions & Answers in Another Column

Amotivational Syndrome & Pot - Carin Disagrees

May 19, 1996

{{ Pot causes the Amotivational Syndrome. Heavy pot smokers can't be motivated to do anything except to make sure they have more pot. They don't care about school, or work, or friends, or themselves. They only care about pot! }}

This child probably knows plenty of pot-smokers and therefore has probably seen that this is just not true! Pot has never been proven to cause Amotivational Syndrome...this is just a theory, and one that I can tell you is not correct in the majority of cases that I have seen.

I live in a small midwestern town, and many people around here happen to smoke pot on a fairly regular basis. They also hold down good jobs, are intelligent, and extremely motivated! I myself started smoking pot at age 12 which I feel was entirely too young..it wasn't the pot itself that I feel was the problem, it was the kind of environment it exposed me to, a problem you noted yourself. As an adult, I have the option of buying from other adults who would not sell to kids (adults who sell drugs to children usually are not a bit respected by your average adult user) or of growing it myself. As a kid, you are exposed to some rather unseemly people. As a result of that, and the fact that I was a stupid kid, I did try a few other types of drugs once or twice (lsd & cocaine). I did them once or twice and have not done them again, nor had the urge too, since reaching adulthood. That is why I agree that children should not use drugs. Most of the people I know who started smoking pot as adults have not had the urge to try "harder" drugs.

But, even though I was smoking pot pretty regularly in high school, I was also a National Honor Society member, a choir member, read about 4-5 books a week, etc. I still smoke at least once a week or so, and I am a competent office manager (if I say so myself) and a devoted computer enthusiast. I research my hobby, family history, regularly, and also have a pretty large web-site for members of my extended family (all over the world.) I still continue to read all the time, and have never felt like I have no motivation. Of course, I would never get stoned at work, or before I drove, etc. I have no children (yet) and will not smoke while I am pregnant when I do have children. I also realize that I should never smoke pot when I am alone with the children. I feel that many people use pot responsibly (more than seem to be able to use alcohol responsibly). Of course, as with any substance, there is a big difference between use & abuse!

Well, I just thought you may be interested to hear another opinion on the subject, though it is from a layperson!

Carin

Dear Carin: I suppose I'll be hearing from other pot smokers who feel the need to defend themselves against my "attack on pot;" however, you folks really don't need to defend yourselves because my comments were not meant to be an indictment of responsible pot smokers. In the segment of my article which you quoted in order to disagree with my comments on the Amotivational Syndrome, you didn't include the next two sentences where I make it clear that I'm concerned about kids who aren't doing well in school and whose lives revolve around getting and smoking pot. By your description, you and your friends fell into the category of kids about whom I said I wasn't too concerned - good grades , active in extracurricular activities, and looking toward your futures.

When I spoke about the Amotivational Syndrome I spoke about heavy pot smoking. I didn't define "heavy," but it means more than just regular use. In talking about your current pot smoking habits you say you would never get stoned at work or before driving. While you don't say that you used pot in the same responsible manner as a teenager, might I assume that you weren't stoned in school and that after school you had enough drug free moments to get your work done? I suspect you weren't really a heavy pot smoker.

Cause and effect can sometimes be difficult to prove, but clinically there is a very strong association between heavy pot use and the Amotivational Syndrome. Your experience with pot has been a good one, but it doesn't sound like you hang with the crowd who live to smoke pot. On the other hand, my clinical experience is with the kids who come to me in trouble. True, other patients of mine may be smoking pot and I might not even know it if they're doing fine and they don't tell me. But in the troubled kids invariably the pot contributes to their problems.

The Amotivational Syndrome probably has multiple causes. It may be that some pot smokers are predisposed to the Amotivational Syndrome because they are already approaching life the wrong way and are using pot to escape their other problems. There probably are some goal oriented teens whose life is so together that even if they smoked pot they would never let it interfere with their work, no less let it take over their lives. And there are others whose problems are so numerous that pot smoking is the least of their problems; but you can be sure that the pot will add to their troubles and that they will never solve anything while they're stoned. Most teens will fall into the middle - doing okay in school but not great; getting along with their families but not always able to communicate with their parents. Of those kids, how many will fall into the wrong crowd if they smoke pot? How many will fight with their parents about their pot smoking or their choice of friends and end up with a family rift, and seek further solace or escape in being stoned? How many will slip in their school work, fight with a friend, lose their job - and in their despair smoke more and more pot and eventually fall into the downward spiral known as the Amotivational Syndrome? Of those who would get into trouble by smoking pot, how many would have the insight to know where to draw the line? In the end, is it worth taking the risk?

Risk is what we're really talking about. A risk is something that might happen as a consequence of an action. So it is true that some pot smokers will never experience the Amotivational Syndrome, but some will. There are teens out there who don't want to try pot. They're being pressured by their peers and being told it's safe. They need to know that there are real risks to smoking pot. If just one teen can "just say 'No!'" because Dr. Warren said pot smoking has risks, I'd be very pleased. If just one troubled youngster saw himself in the description of the Amotivational Syndrome and did something to turn his life around (even if he didn't give up pot) I would have accomplished something.

Today's teens are fine young people who, because of AIDS and the proliferation of guns in the hands of kids, face a lot more serious consequences to bad choices than I did as a kid. They need information to make good choices and they need to be thinking with clear heads when they make their choices. I don't see pot, alcohol, or any drug as part of that equation.

Sincerely,

Dr. Warren

April 18, 1996

-Just Having Fun

I could write a whole other column on the dangers of alcoholism and teenage drinking. Even if pot were safer than alcohol, it causes many of the same problems as alcohol. Most importantly, marijuana is a drug that impairs your judgment. The risk of driving while under the influence is the same no matter what drug you use. DWI is a major cause of death and disability for teenagers as well as their innocent victims. Arguing that pot is safer than alcohol is like arguing whether it is better to pull the hair out of your head than to pull out your eyelashes. The real issue you need to address is, "What are the risks of smoking pot?"

I'll tell you:

The likelihood of progressing to using harder drugs is a real risk. Most teenagers who try pot never intend to try other drugs. But drug use has its own subculture, and once you use pot you become a member. Marijuana is illegal; therefore, to get it you have to hang around with people who are willing to do illegal things. Who knows what your drug pusher friend might demand from you as a "favor" in order to get you your next fix. You're already engaged in risky behavior using an illegal drug that impairs your judgment and you probably hang out with other kids who are doing the same thing, so who says you won't consider it when the guy smoking pot next to you says, "I know somebody who can get us some real cool stuff!"

Pot causes the Amotivational Syndrome. Heavy pot smokers can't be motivated to do anything except to make sure they have more pot. They don't care about school, or work, or friends, or themselves. They only care about pot! If you can tell me that your grades are good, that you're involved in all kinds of extracurricular activities, and that you're actively planning your future, I won't be too concerned about your motivation. But if you're not doing too well in school and your whole social life revolves around smoking pot and hanging out with other drug users, you have a problem. Continuing to smoke pot will make it get progressively worse and then you'll smoke more pot so that you won't care that your real friends and your future is slipping away from you.

The problems in your life that you escape from by smoking pot will still be there when the high wears off. Those problems certainly won't get better while you're not attending to them, and they may get worse. Smoking pot will rob you of what ability you have to deal with your problems and will add to your list of troubles. Ask any recovered drug users, whether they used alcohol, marijuana, or hard drugs, and they will tell you, "I used to take drugs to help me deal with my problems, and then the drug use became my biggest problem."

Sincerely,

Dr. Warren

15 April 1996

L.G.

Dear L.G.: Congratulations on being the first to Ask Dr. Warren.

Kawasaki Syndrome is a rare disease characterized by high fever for a minimum of 5 days, a red rash similar to the rash of scarlet fever, conjunctivitis, swollen lymph nodes (glands), inflammation of the mouth and tongue, swelling and redness of the palms and soles, fatigue, and irritability. The diagnosis is made on the basis of the symptoms, which may not all be present. There is no lab test to make the diagnosis. The cause of Kawasaki Syndrome is unknown.

Kawasaki Syndrome causes inflammation of blood vessels. This can result in complications involving multiple organs, especially the heart. Kawaski Syndrome is the main cause of acquired heart disease in children.

One of the heart problems caused by Kawasaki Syndrome is coronary artery aneurysms (small balloon like swellings of the wall of the artery). The coronary arteries supply blood to the heart muscle. Blockage of these arteries by atherosclerosis causes heart attacks in adults.

The risk associated with the coronary artery aneurysms of Kawasaki Syndrome is that clots may develop in the aneurysms blocking blood flow to the heart. When the diagnosis is made early, high doses of intravenous gamma globulin can often prevent or minimize aneurysm formation. When aneurysms do occur, medications like aspirin and persantine are used to help prevent clotting.

Since there has been a significant improvement in the dilation of your son's coronary artery, your doctor has every reason to be optimistic. Most of the serious cardiac (heart) complications of Kawasaki Syndrome occur early in the course of the illness. In spite of the high frequency of cardiac complications of Kawasaki Syndrome (30-50%) most patients are asymptomatic (have no symptoms).

The majority of coronary artery aneurysms from Kawaski are associated with normal coronary artery blood flow; however, stenosis (narrowing) of the coronary arteries even after regression of the aneurysms may become apparent anywhere from 6 months to 7.7 years after the acute illness. Coronary artery aneurysms resulting from previous episodes of Kawasaki Syndrome are considered an important cause of heart attacks in children.

In summary, your son will probably recover without any serious consequence, but he will clearly need the continued care of his cardiologist for a long time. His risk of heart attack later in life is certainly increased over someone who never had this illness, but if he exercises, doesn't smoke, and avoids a high fat diet, his risk will probably be less than for people who aren't "heart smart."

For more information contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
Newfield, CT 06812-8923
(203) 746-6518

Sincerely,

Dr. Warren

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