DID you know marijuana use can set off one’s genetic risk for schizophrenia? In fact, consultant psychiatrist Dr Kristen Robinson-Barrett says once triggered, it cannot be turned off.

A harsh truth, but it gives new meaning to dancehall artiste Pablo YG’s comment in an interview with podcaster Jaii Frais that went viral: “Yuh see weh yuh did do, cyaa rub out.”

At least 50 per cent of Jamaicans with mental illness have substance abuse issues and vice versa, according to Dr Robinson-Barrett, director of treatment services for the National Council on Drug Abuse (NCDA).

However, she did say it is a chicken-and-egg situation, because substance use can either be the cause of the mental health challenge or the perpetuating factor.

“Sometimes the substance use is the first thing and then we see the mental health disorder coming later, and then other times we may see the mental health disorder comes first and the substance use perpetuates it,” Dr Robinson-Barrett said while speaking to editors and reporters at last week’s Jamaica Observer Monday Exchange.

“And we do know that substance use can lead to worsening of the illness,” she added. “Of course, it can lead to more hospitalisation, the need for higher amounts of medication, frequent relapses, more severe relapses, and more difficulty for the individual to return to baseline.”

Emphasising the complex relationship between substance use and mental health disorder, Dr Robinson-Barrett said it is difficult to delineate which is usually seen first in most cases.

“Sometimes there are some early signs of an illness, called prodromal sign… someone starts using [a] substance and then they become acutely unwell and severely ill. And sometimes they have their illness and then they start to self-medicate, and it causes perpetuation.

“Also, a lot of the predisposing factors for substance use are very similar to those for mental illness,” the consultant psychiatrist explained. “So we have our adverse childhood events, what we call our ACEs, which are traumatic events that would’ve happened when you were younger. Those set you up for having mental illnesses.

“They predispose you to PTSD [post-traumatic stress disorder]; it can set you up on your genetic risk for schizophrenia, depression [and] so on… but those same ACES for traumatic events also set you up for having your substance use issues to cope,” she said.

Highlighting the importance of managing substance issues as it relates to one’s overall mental health is, therefore, critical, the consultant psychiatrist said. She was part of a team from the Ministry of Health and Wellness that sat with the Observer team to discuss mental health ahead of last Friday, which is recognised as World Mental Health Day.

While Dr Robinson-Barrett could not speak to the potential impact Jamaica’s decriminalisation of possession of small amounts of marijuana has had on mental health a decade later, she acknowledged that the heavy use of cannabis is something the NCDA has noticed — especially in young people — and other countries have seen an increase in mental health issues since decriminalisation.

“I think that, as a country, it has been a problem well before [decriminalisation] so we have to start at the root of the matter, which is the education. At the NCDA we are starting people as young as we can… to allow them to understand how substances can affect them — particularly cannabis,” the consultant psychiatrist said.

She explained that often, at the community level, people do not know the effects substances can have on them.

“So, unfortunately, we have to do the education at the time of crisis and we start at… prevention,” she said, adding that a lot of people don’t know that cannabis can lead to psychosis and can impact their genetic risk for schizophrenia.

“I think that once they are armed with enough [information] to understand the impact of these substances, that is where the work is. And so with the implementation of the programmes in the schools, we want to get them before we are at a crisis level, because what’s happening in mental health in the community is that we have crisis situations, so we have to start earlier in terms of education,” Dr Robinson-Barrett insisted.

In its bid to try to eradicate substance misuse across the island and achieve a happy, healthy, drug-free Jamaica, the NCDA has research and prevention programmes for different stakeholders, including students. It also offers treatment services and counselling.

“Right now, we are currently about to start data collection for the Global Youth Tobacco Survey and Global Health Survey in high schools, and so by doing so they are able to gather a lot of information about substance use… What they are using that information to do, and they have done so before, is that it guides the programme,” the NCDA director of treatment services said, highlighting existing programmes like the Resistance Education Against Drugs (READ) programme and Operation Lighthouse, which is a substance abuse prevention programme.

“What they actually do is, they are trying to stratify and put schools in risk groups, based on the severity of needs and the [things] that they are seeing in the students. Then they are going to try and implement whichever programme is necessary for that particular school, based on their needs,” said Dr Robinson-Barrett.