Motivation and emotion/Book/2017/Cannabis and positive emotions

Overview


''Susan is a 35 year old woman who has never smoked cannabis before. She always viewed cannabis in a negative light after reading articles suggesting that cannabis use can lead to depression, anxiety, and schizophrenia. Throughout her life, Susan has struggled with depression and felt like a human guinea pig, trying multiple medications prescribed by her doctor. The usual medications and treatments didn't seem to have any affect on her lack of appetite, depleting energy, diminished motivation, and dark moods which controlled her life.''
 * Case Study

"After suffering through multiple side affects and even antidepressant withdrawal symptoms, Susan's doctor suggested that she use medical cannabis to treat her depression. While Susan is the same person she has always been, struggling with the same issues linked to abandonment, love, and neglect, appetite, emotions, and overall outlook on life has improved significantly."

What is the first thing you think of when you hear the word 'cannabis'? Generally, people will automatically take either a positive or negative stance stating their like or dislike for this controversial drug. Some may picture the long-lasting and damaging effects that cannabis has had on their child's brain development, while others may picture a grandparent with arthritis using cannabis oil to reduce horrid pain. There is a lack of consensus in the relevant literature as well. Research has shown that cannabis can induce positive or negative effects on people (Porche, 2013). This chapter aims to explore research and theories surrounding cannabis and positive emotions to determine how cannabis affects positive emotions.




 * 1) Define cannabis and emotion, and describe how they interact
 * 2) Explain the effect of cannabis on positive emotions
 * 3) Explore how theories explain the relationship of cannabis and positive emotion

What are positive emotions?
Emotions can be defined as multicomponent response tendencies that occur over a relatively short period of time (Fredrickson, 2001). Positive emotions, such as joy, love, and happiness can be explained as moments that mark optimal wellbeing. They are also identified by moments that are not plagued by negative emotions such as anxiety, anger, or sadness (Fredrickson, 2001). The explanation for why and how emotions occur becomes slightly more difficult. Various theories (Tracy & Randles, 2011) have been posited and are discussed later in the chapter.

What is cannabis?
Cannabis, also known as marijuana, is a drug derived from the leaves of a cannabis plant (Guy, Whittle, & Robson, 2004). Specialists have explained that there are four different cannabis plants including cannabis sativa, cannabis indica, cannabis ruderalis, and cannabis afghanica (Piomelli & Russo, 2016). The most commonly known plants are cannabis sativa and cannabis indica, which are also combined on occasions to create hybrid plants (Piomelli and Russo, 2016). There are some key physical differences between these two plants (Piomelli and Russo, 2016). Cannabis sativa can be identified by its long, thin leaf that produces long, thin buds. Cannabis indica, however, produces shorter, fatter leaves and therefore shorter, fatter buds (see Figure 2).

In addition to the physical differences, there are also key differences in the emotional effects that each plant produces. It is understood that sativa is best for day use due to its uplifting and energy producing agents. Conversely, Indica, is best for night use as is produces calming, relaxing, and sedative effects (Piomelli and Russo, 2016).

After drying out the buds of the plants, cannabis can be taken in a number of different ways. Some of these include smoking, eating, and patches (McLaren and Mattick, 2010; NIDA, 2017).

 Cannabis seeds, leaves, and roots have been used for medical use by humankind for millennia and it is only in relatively recent times that certain countries have announced it as illegal (Sinclair, 2016).

Neuroscience of cannabis


The most prominent effect that cannabis has on the human body is in relation to the Endocannabinoid system (ECS). The system's role is to regulate homeostasis at a cellular level through cannabinoid receptors, which involves the central nervous system and the peripheral nervous system (Aizpurua-Olaizola et al., 2016; Sinclair, 2016). The ECS communicates by creating cannabinoids from fat cells in a neuron, which then travel from the postsynaptic neuron to the presynaptic neuron and attach to cannabinoid receptors. The ECS affects numerous parts of the brain including the cerebellum and cerebral cortex, which then in turn influence a wide range of basic regulatory functions, such as appetite, memory, mood, and pain management. When ingested, cannabis influences this system by contributing excess amounts of two key cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main component responsible for the 'high' feeling after ingesting cannabis, due to its psychoactive properties. CBD however, is a non-psychoactive product and is produced in high doses by cannabis sativa (Piomelli and Russo, 2016).

Research has attempted to explain exactly how cannabis affects the human body on a physiological level but is still burgeoning. After exposure to cannabis, positive emotions may decrease due to feelings of anxiety, or in contrast, they may increase and manifest as a relaxing, happy experience (Hamilton, Lloyd, Monaghan, & Paton, 2014; Hayatbakhsh et al., 2007). This is highly dependent on the amount of THC and CBD released from the cannabis plant and the individual's genetic predisposition (Sinclair, 2016).

 The Endocannabinoid System was discovered whilst researchers were investigating how cannabis interacts with the human body, which explains the name (Sinclair, 2016).

Cannabis and physical health
Cannabis use has been found to reduce negative symptoms and associated negative emotions concerned with medical conditions such as epilepsy and acquired immunodeficiency syndrome (AIDS), which can increase the emergence of more positive emotions (Fredrickson, 2001). When used correctly, cannabis has been known to reduce a number of symptoms including nausea, vomiting, seizures, and wasting for patients with health implications such as epilepsy, AIDS, and cancer.

Epilepsy
Epilepsy is a neurological disorder that causes recurrent seizures due to abnormal electrical activity in the brain (Gawala and Schuele, 2016). Although there are various antiepileptic drugs (AED) available to decrease negative symptoms, many patients remain unresponsive to their effects and turn to cannabis for treatment (Porter and Jacobson, 2013; Szaflarski and Bebin, 2014). Researchers have experienced some success in using oral cannabis extracts (OCE) as a treatment method to decrease seizures for paediatric patients with epilepsy (Press, Knupp, & Chapman, 2015). However, not all participants experienced improvements; some found that their seizures increased in frequency (Press, Knupp, & Chapman, 2015). Other research was conducted to explore the effects of cannabidiol-enriched cannabis to treat severe childhood epilepsy and experienced great success. Eighty four percent of parents stated their child's seizure frequency reduced by at least 25%, with 11% reporting complete seizure freedom (Porter and Jacobson, 2013). Other benefits were also discovered whilst comparing the effects of AEDs and cannabidiol, showing overall significant decreases in negative side effects and increases in positive side effects, including positive emotions (see Table 1). The comparison of these two studies raises key questions such as:
 * Why are the results so varied?
 * Are the results dependent on the severity or type of epilepsy the patient has?
 * Are the results dependent on the type of cannabis used (e.g., higher levels of CBD or THC)?
 * Are the results dependent on how the cannabis is ingested?

Further research is necessary to investigate these inconsistencies.

 https://www.youtube.com/watch?v=LmlpoX5EGU0

Table 1.

A comparison of the side effects of cannabidiol and antiepileptic drugs (Porter and Jacobson, 2013).

Chemotherapy patients
Cancer patients undergoing chemotherapy have described nausea and vomiting side effects as the most stressful (Machado Rocha et al., 2008). These side effects can sometimes lead to depression, anxiety, and feelings of helplessness (Machado Rocha et al, 2008). Research from the late 1980s found that cannabinoids within cannabis show some promise for patients who were unable to control their chemotherapy-induced nausea and vomiting (Bowles, O'Bryant, Camidge, & Jimeno, 2012). Patients have been relieved of unnecessary stressors and ill feelings enabling positive emotions to increase. Although research has found positive results in recent times and cannabis is currently used to aid in cancer care, it is still unclear as to how effective cannabis is compared to conventional therapies (Bowles, O'Bryant, Camidge, & Jimeno, 2012).

AIDS
AIDS is a disease characterised by the human immune system progressively failing, allowing life-threatening infections and cancers to thrive (Lutge and Siegfried, 2013). One of the major struggles associated with AIDS is weight loss and the potential it has to lead to wasting or AIDS-associated anorexia (Lutge and Siegfried, 2013). Some research suggests that ingesting cannabis can result in weight gain and escalated mood due to increased appetite (Lutge and Siegfried, 2013). Not only does this effect allow positive emotions to emerge, but the patient's overall quality of life is also improved. However, much like many other cannabis related medications, research is limited. Many studies focus solely on short term effects of cannabis and involves small sample sizes (Lutge and Siegfried, 2013). Despite this, North American studies suggest that cannabis relieves physical and stress-related symptoms for one-third of people living with AIDS (Belle-Isle and Hathaway, 2007).

Cannabis use and mental health
Cannabis use has been linked over and over again to mental health problems such as anxiety and depression, suggesting that cannabis may be the cause (Hayatbakhsh et al, 2007; Smolkina et al, 2017). However, the positive effects behind using cannabis as treatment are rarely discussed.

Anxiety
Cannabis use, both authorised and unauthorised, for therapeutic purposes has risen significantly in recent years, with researchers suggesting further research is necessary to ensure effective and safe use (Piper et al, 2017; Walsh et al, 2013). Despite this, patients have shown to gain relief from multiple symptoms, such as anxiety, across various medical conditions, including anxiety disorders (Piper et al, 2017; Walsh et al, 2013). One study examined findings from a large cross-sectional study involving the use of cannabis for therapeutic use in Canada (Walsh et al, 2013). They found that cannabis aided in the decrease in multiple symptoms, with sleep, pain, and anxiety being the most common. In addition, the study reported that with the decrease in anxiety and associated negative emotions, came an increase in positive emotions and an overall improvement in quality of life. However, this study was not without its limitations. The self-report method questions the study's validity and response bias could be present due to the lax self-selection recruitment method (Walsh et al, 2013). Its clear that using cannabis to reduce anxiety can result in an increase in positive emotions (Piper et al, 2017; Walsh et al, 2013), however further research should be conducted to create valid and reliable results.

Depression
The majority of research suggests that using cannabis use can lead to depression (Hayatbakhsh et al, 2007), however there are also various studies suggesting that cannabis may have antidepressant effects (Gruber, Pope, & Brown, 1996). One neurobiological study, conducted at McGill University, suggests that, at low doses, a synthetic form of THC effectively reduces depressive symptoms, whereas high doses can worsen symptoms (McGill University, 2007). The study explains that cannabis can increase serotonin levels and therefore create the same affect as selective serotonin reuptake inhibitors (SSRI) such as Prozac and Celexia (McGill University, 2007). Although this study produced promising results, the theories were tested on laboratory animals, not humans, and the credibility of the study was questionable. Current research predominantly states that cannabis use leads to a decrease in positive emotions and an increase in negative emotions (Hayatbakhsh et al, 2007), however the effects of cannabis are still largely unknown (Gruber, Pope, & Brown, 1996).

Quiz
Here are some multiple choice questions to test your knowledge. Choose the correct answers and click "Submit": {How many different cannabis plants are there in total? - 1 - 2 - 3 + 4
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{What is the main component responsible for the 'high' feeling one receives after ingesting cannabis? - CBD + THC - THI - ABC
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Related perspectives and theories
The relationship between positive emotion and cannabis can be explained in several different ways. A neuroscientific, or neurological perspective, of emotions is helpful in understanding how cannabis can influence a person's mood and positive emotions. In addition, the broaden and build theory of positive emotions can also aid in the understanding of the relationship.

Neuroscience perspective of emotions
The neuroscientific or neurological perspective suggests that the majority of what the brain does is unconscious (Franks, 2006), and  it is suggested that around 95% of what the brain does involves unconscious processes (Franks, 2006). Researchers explain that evolution prioritised emotions first, which influence cognition and cause feelings (Franks, 2006). This is evident when discussing how cannabis and positive emotions interact. The endocannabinoid system is a part of an unconscious process and it is not possible to control how many cannabinoids are released at any point in time to produce certain responses (Piomelli and Russo, 2016). After cannabis is ingested, excess cannabinoids flood the endocannabinoid system which physiologically produce positive emotions such as happiness and relaxation (Piomelli and Russo, 2016).

Broaden and build theory
The broaden and build theory is a model that explains the mechanisms behind positive emotion. It suggests that an individual's momentary thought-action repertoire is broadened by positive emotions (Fredrickson, 2004). This means that positive emotions encourage exploratory, creative, and unpredictable new thoughts and actions which build an individual's resources. For instance,  a child who is interested or curious will explore and therefore broaden their knowledge about a particular area, object, or person. However, if a child is scared, they are less likely to explore and may miss out on potential learning opportunities. Overall, this theory suggests that positive emotions can lead to optimisation of health and wellbeing by encouraging new creative and exploratory ways of thinking and acting (Fredrickson, 2004).

Conclusion
The effects of cannabis on positive emotions continues to be controversial. The relatively recent discovery of cannabinoids such as THC and CBD, and the ECS have broadened our knowledge on cannabis and its affects on positive emotion and the human body. Further research is necessary to fully understand the underlying neurological processes of THC, CBD, and other cannabinoids. Research has provided promising signs with the use of  cannabis to successfully treat various physical health conditions such as epilepsy, chemotherapy induced nausea and vomiting, and AIDS. However, current research continues to produce varied results and long term effects remain unclear. Research exploring the effects of cannabis on mental health has also displayed controversial results, suggesting that cannabis does have a correlation with mental illnesses but the causal direction remains unclear. To date, the neuroscience perspective and the broaden and build theory best explain the effect of cannabis on positive emotions.