Marijuana addiction is a condition where an individual has an intense urge to consume marijuana despite knowing and experiencing its negative consequences. Regular use of marijuana gives the user the feeling of pleasure and euphoria. According to the National Center for Drug Abuse Statistics, marijuana usage in the United States has reached significant levels, with 55 million American adults (16.9%) currently using marijuana, surpassing tobacco users by 50.68%. The data shows that 45% of Americans have tried marijuana at least once, representing approximately 78 million people, and usage rates doubled from 4.1% in 2001-02 to 9.1% in 2015. Regarding addiction and health impacts, about 10% of regular users develop marijuana use disorder, with early users (before age 12) facing twice the risk of mental illness, while 13% of young users become dependent, and regular use results in an IQ decline of up to 8 points.
The signs of Marijuana addiction include an increased tolerance for the drug, withdrawal symptoms like anxiety and irritability, and changes in appetite.
The causes of marijuana addiction are biological, environmental, psychological, social, and cultural factors. Common reasons people get addicted to Cannabis include genetics, peer pressure, and social isolation.
Risk factors for marijuana addiction include early initiation during adolescence, peer group influences, and adverse childhood experiences such as trauma or neglect. Research indicates that individuals with a family history of substance use, concurrent cigarette smoking habits, and diverse socioeconomic backgrounds exhibit increased vulnerability to developing cannabis dependency.
The effects of marijuana addiction include mental health problems like depression and anxiety as well as physical health problems like increased heart rate and chronic cough.
Treatments for marijuana addiction include support groups, behavioral therapy, individual counseling, and lifestyle changes. It is important for people struggling with this addiction to seek professional help.
What Is Marijuana Addiction?
Marijuana addiction is a condition marked by an intense urge to use marijuana despite its adverse effects. Also known as cannabis use disorder, it is similar to other substance use disorders in terms of its development, characteristics, and consequences.
A person struggling with marijuana addiction is unable to control the urge or consumption, even while the effects are manifesting. Some users experience mild symptoms of the abuse, while others struggle with severe addiction.
As reported in the 2021 National Survey on Drug Use and Health, approximately 16.3 million people) had a Marijuana addiction in the last 12 months.
What Are The Signs Of Marijuana Addiction?
The signs of marijuana addiction include developing increased tolerance, experiencing withdrawal symptoms when stopping use, and showing compulsive usage patterns. Users display behavioral changes like social isolation, persistent usage despite negative consequences, and preoccupation with obtaining and using the drug. Physical and psychological symptoms manifest as irritability, anxiety, depression, insomnia, and decreased appetite.
Here are the common signs of marijuana addiction:
- Increased tolerance: Excessive use of marijuana increases the amount necessary to achieve the desired “rewarding” effect.
- Withdrawal symptoms: When the user tries to discontinue, signs like irritability, restlessness, insomnia, decreased appetite, and mood swings occur.
- Compulsive use: Increased usage of marijuana reduces the user’s ability to control or reduce the use of marijuana, even if they try or want to.
- Preoccupation with Marijuana: A person struggling with marijuana addiction spends time looking for, obtaining, and using the drug. They constantly think of when and how they acquire marijuana and use it next.
- Persistent usage: People addicted to marijuana do not have control and continue to use the substance even when it has negative consequences.
- Social withdrawal: Marijuana addiction increases social withdrawal. Individuals with Cannabis use disorder prefer to spend time alone or with only marijuana users.
- Behavior change: Prolonged use of marijuana increases irritability, anxiety, and depression.
What Causes Marijuana Addiction?
Causes of marijuana addiction include genetic predisposition, altered brain responses, environmental accessibility, mental health challenges, and personality tendencies. The path to marijuana dependency stems from a complex interplay of biological vulnerabilities, psychological coping mechanisms, and social influences
Here are the factors that cause or contribute to the development of marijuana addiction:
Biological Factors
Some people are more prone to getting addicted to marijuana due to their genetic predispositions. According to Bevilacqua and Goldman’s 2009 study on Genes and Addictions, genetics play a moderate to significant role in the likelihood of developing addictions. This means that people with a family history of addiction have an increased chance of developing marijuana addiction themselves.
Brain chemistry and structure also play a role in influencing an individual’s response to marijuana and increasing their likelihood of getting addicted to it.
Environmental Factors
Living in an area where marijuana is readily available or legalized increases the chances of use. According to Montgomery, B. W.’s 2022 study, ‘Estimating the effects of legalizing recreational cannabis on newly incident cannabis use.’, after the legalization of recreational cannabis, there was an average increase of 0.7 percentage points in cannabis use incidence. This figure rose to 3.2% between two to four years post-legalization and further to 4.3% four to seven years after legalization for individuals aged 21 and older.
Psychological Factors
Mental health problems, such as depression, anxiety, and trauma-related disorders, increase the chances of getting addicted to marijuana. This happens when individuals with these health issues rely on marijuana as a form of self-medication, which leads to dependence and addiction. Also, using marijuana as a drug for coping with stress and anxiety puts one at risk of addiction.
According to Hyman, S. M.’s 2009 study, ‘Stress-related factors in cannabis use and misuse: implications for prevention and treatment.’, 72% of daily cannabis users cited relaxation or tension relief as their primary reason for use, while 36% used it to escape problems and 29% to alleviate anger or frustration.
Social And Cultural Factors
Some cultures generally accept the use of marijuana, and this increases the chances of getting addicted. Peer pressure also contributes to environmental factors. According to Egan, Kathleen L. et al’s 2016 study ‘More than just alcohol: Marijuana and illicit drug use at parties attended by 15–20-year-olds,’ Marijuana and or other illegal drugs are served in one-third of parties attended by those aged 15 to 20.
Personality Traits
Individuals with personality traits such as impulsivity, sensation-seeking behavior, and adrenaline-seeking have a high chance of developing an addiction to marijuana.
According to Waddell, J. T.’s 2023 study, ‘Cannabis use in context: Relations among impulsive personality traits, context, and cannabis problems.’, cannabis use patterns and personality traits showed several notable trends. The study measured five key personality traits on a 1-4 scale, with sensation seeking showing the highest mean score (2.75, SD = 0.69), followed by negative urgency (2.14, SD = 0.75), positive urgency (1.90, SD = 0.68), lack of perseverance (1.80, SD = 0.56), and lack of premeditation (1.79, SD = 0.60). Regarding cannabis use patterns, participants were more likely to use cannabis in social settings with friends (Mean = 4.21, SD = 1.47) compared to using alone (Mean = 2.49, SD = 2.14). The typical use frequency indicated monthly-to-weekly use (Mean = 6.58, SD = 3.37), and participants reported experiencing an average of 10.57 negative consequences (SD = 7.95). The sample consisted predominantly of female students (60.7%) and was majority White (76.6%), with 25.4% identifying as Hispanic/Latinx.
What Are The Risk Factors For Marijuana Addiction?
The risk factors for marijuana addiction include early initiation during adolescence, social influences from peer groups, and adverse childhood experiences like trauma or neglect. Individuals with a family history of substance use, concurrent cigarette smoking habits, and varying socioeconomic backgrounds face heightened vulnerability to developing cannabis dependency.
Here are the common risk factors for marijuana addiction in detail below:
Other significant risk factors include:
- Early Age of Initiation: Beginning cannabis use at a young age is associated with problematic cannabis use and cannabis psychosis.
According to Sewell, R. A.’s 2009 study, ‘The effect of cannabis compared with alcohol on driving.’, marijuana use typically begins at age 18, with 8% of users becoming dependent within 10 years. Most cannabis use is intermittent and time-limited, with users generally stopping in their mid-to-late 20s, while only a small minority continue daily use over multiple years. Among adolescents, risk factors for marijuana use include delinquent behavior like vandalism and shoplifting, poor academic performance, and substance use by both the individual and their peers.
- Peer pressure: Influence from friends increases the likelihood of use. According to Roditis, M. L.’s 2016 study, ‘Perceptions of social norms and exposure to pro-marijuana messages are associated with adolescent marijuana use.’, Adolescents who reported that their friends used marijuana had a 27% greater chance of using marijuana themselves.
- Childhood trauma: Experiences such as sexual abuse and neglect are linked to higher addiction rates.
- Family history: A family background of substance use disorders increases vulnerability.
According to Masataka, Y.’s 2023 study, ‘Risk factors for cannabis use disorders and cannabis psychosis in Japan: Second report of a survey on cannabis-related health problems among community cannabis users using social networking services.’, those with a family history of mental health problems were nearly twice as likely to develop the disorder (OR: 1.988, p<0.001), while people with pre-existing psychiatric conditions had 1.67 times higher risk (OR: 1.672, p=0.039). Most notably, users who consumed cannabis products other than dry flower demonstrated the highest risk, being 2.7 times more likely to develop cannabis use disorder (OR: 2.725, p<0.001).
- Cigarette use: Those who smoke cigarettes are more likely to develop marijuana dependence.
- Socioeconomic Status: Low socioeconomic status is a risk factor for substance use and related problems. According to Lemstra, M.’s 2008 study, ‘A meta-analysis of marijuana and alcohol use by socio-economic status in adolescents aged 10-15 years.‘, risk behaviors related to marijuana use were 22% more prevalent among adolescents from low SES backgrounds.
What Are The Effects Of Marijuana Addiction?
The effects of marijuana addiction include respiratory complications, cardiovascular problems, and impaired motor coordination which pose serious health risks. Users experience cognitive decline, elevated anxiety levels, and decreased motivation which impacts daily functioning. Regular cannabis use strains personal relationships leads to social isolation, and creates financial hardships through sustained drug expenses.
Here are some of the effects Marijuana addiction has on the user:
Physical Health Effects:
- Respiratory Problems: Marijuana smoking increases the chances of respiratory problems. The effects of inhaling marijuana smoke are similar to those of tobacco, including chronic bronchitis and other respiratory infections. According to Tetrault, J. M.’s 2007 study, ‘Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review.’, bronchodilation from marijuana use leads to short-term increases of 0.15-0.25 L in forced expiratory volume in 1 second, but this effect is temporary. Long-term use is linked to increased respiratory symptoms, such as cough, phlegm production, and wheezing, with a specific odds ratio of 2.00 for cough.
- Cardiovascular Issues: Marijuana has been linked to an increase in cardiovascular issues such as arrhythmia and high blood pressure.
According to Jeffers, A. M.’s 2024 study, ‘Association of cannabis use with cardiovascular outcomes among US adults’, published in the Journal of the American Heart Association, the study of 434,104 US adults aged 18-74, cannabis use shows a significant correlation with increased cardiovascular risks. While 4% reported daily cannabis use and 7.1% reported non-daily use, these users demonstrated higher odds of adverse cardiovascular events compared to non-users. Daily cannabis users showed 25% higher odds of myocardial infarction, 42% higher odds of stroke, and 28% higher odds of combined cardiovascular issues. Notably, even among those who never used tobacco, daily cannabis users still faced elevated risks – with 49% higher odds of heart attack, 116% higher odds of stroke, and 77% higher odds of overall cardiovascular problems, suggesting that cannabis independently influences cardiovascular health regardless of tobacco use. - Impaired Coordination: Marijuana causes impaired coordination, balance, and reaction time. These effects increase the risk of accidents and injuries.
- Adverse effects on pregnancy: According to 2023 research by the University of Utah Health, there is a link between cannabis use during pregnancy and a variety of adverse pregnancy outcomes, particularly low birth weight. The scientists also found that increased exposure to Cannabis heightens the risk of serious complications, including stillbirth, medically induced preterm birth, and disorders related to blood pressure.
Mental Health Effects
- Cognitive Deficits: Long-term use of marijuana increases the risk of cognitive deficits in memory, learning, and attention abilities. According to Shrivastava, A.’s 2011 study, ‘Cannabis use and cognitive dysfunction.’, long-term cannabis use is consistently associated with cognitive decline, affecting response times, word viewing duration, oculomotor function, verbal memory, executive functioning, and visuomotor skills. Some studies suggest cognitive deficits recover after four weeks of abstinence, others indicate that impairments in attention, memory, and executive functions persist, with some individuals experiencing only partial recovery.
- Mental Health Disorders: Marijuana addiction is associated with an increased risk of mental health disorders such as psychosis, schizophrenia, depression, and anxiety. According to Lowe, D. J. E.’s 2019 study, ‘Cannabis and mental illness: a review.’, approximately one in four individuals with schizophrenia have a concurrent Cannabis Use Disorder (CUD) diagnosis. The risk factors show that regular cannabis users are 2 times more likely to develop psychosis, while heavy cannabis users are 4 times more likely. Additionally, those who smoked cannabis by age 18 had twice the risk of receiving a schizophrenia diagnosis, while chronic users were at six times the risk compared to non-users. These findings come from one of the largest longitudinal studies involving over 50,000 male participants.
Social Effects
- Interpersonal Strain: Marijuana increases the risk of interpersonal strain. When an individual prioritizes marijuana over other responsibilities, they experience strain in their relationships with family, friends, work, and loved ones.
- Social Withdrawal: Marijuana causes social withdrawal. Cannabis users withdraw from social activities, friends, and family.
Legal And Financial Effects
- Legal Consequences: Marijuana remains illegal in most states and countries. Possession, distribution, or cultivation of marijuana results in legal consequences.
- Financial Strain: Marijuana addiction puts a strain on the user’s finances, as the cost of buying the drug accumulates significantly over time. According to Zvolensky, M. J.’s 2022 study, ‘Financial strain among adult African American/Black cannabis users.’, greater financial strain among African American/Black cannabis users significantly correlates with increased cannabis use problems and more perceived barriers to quitting, even when controlling for factors like age, income, and depressive symptoms. As the second largest racial/ethnic minority group in the US showing significant cannabis use disparities, this population could benefit from treatment programs that incorporate financial planning and stress management, specifically addressing the intersection of financial strain and cannabis use behaviors.
- Academic Impact: Marijuana addiction negatively impacts academic performance and attendance. According to Mullin, C. J.’s 2024 study, ‘Cannabis Use and Academic Performance in College Students: The Role of Procrastination.’, cannabis use among young adults (ages 19-30) reached historic highs in 2021, with 42.6% reporting use in the past 12 months and 28.5% reporting use in the past 30 days – the highest levels recorded since the 1980s. The academic impact of this trend appears complex, as some studies show cannabis use is linked to reduced educational attainment, higher dropout rates, and lower GPAs among college students, though the effects vary based on the frequency of use and age of initial consumption.
- Employment Challenges: Maintaining employment becomes very difficult with marijuana addiction. According to Okechukwu, C. A.’s 2019 study, ‘Associations Between Marijuana Use and Involuntary Job Loss in the United States: Representative Longitudinal and Cross-Sectional Samples.’, marijuana use significantly impacts employment stability, with daily users facing over twice the risk of involuntary job loss (OR 2.18) compared to non-users. The research shows that marijuana use among workers increased substantially from 4.53% in 2001-2002 to 10.27% in 2012-2013, with past-year users having 27% higher odds of losing their jobs involuntarily. The study also found that DSM-IV marijuana use disorder rates among workers rose from 1.21% to 2.63% during the same period, suggesting that job loss is an overlooked social cost of marijuana use in the US workforce.
What Are The Treatment Options For Marijuana Addiction?
Treatment for Marijuana addiction includes behavioral counseling, motivational enhancement approaches, peer support programs, and structured group sessions. These evidence-based interventions are combined with lifestyle modifications, family involvement, and long-term aftercare support to create comprehensive recovery plans.
Here are the common treatment options for marijuana addiction
Cognitive Behavioral Therapy
Behavioral therapy provides individuals struggling with Marijuana addiction training in stress management, coping mechanisms, and techniques to handle triggers and cravings.
According to Walther, L.’s 2016 study, ‘Evidence-based Treatment Options in Cannabis Dependency.’, Cognitive Behavioral Therapy (CBT) combined with motivational enhancement therapy (MET) and case management demonstrated impressive effects on both abstinence (Cohen’s d = 0.98) and reduction in cannabis use (d = 1.14). The CANDIS study, which combined CBT with motivational enhancement and problem-solving training, achieved significant reductions in cannabis use (d = -0.9) with improved psychosocial functioning (d = -0.7), with effects persisting after 3 months. Even brief telephone-based CBT interventions showed moderate effectiveness (d = 0.6) in reducing cannabis use.
Motivational enhancement therapy
MET is a counseling approach that helps Marijuana users by helping them resolve their mixed feelings about marijuana use and the impact it has on their lives, thereby preparing them for change. Its approach focuses on personal values, concerns, and goals related to marijuana use.
Support groups
Support groups help persons with Cannabis use disorder get peer support and encouragement to recover from their addiction. Group therapy allows individuals to connect with others facing similar challenges.
Lifestyle changes
Engaging in healthy activities like exercise, hobbies, and hanging out with supportive people helps people struggling with marijuana addiction deal with their addiction. Addressing stress, such as relationships or financial problems, makes the treatment process more effective.
Family therapy
Involving family in the therapy process has been shown to foster a supportive recovery environment. It also improves communication and repairs damages that addiction to marijuana has caused.
According to Walther, L.’s 2016 study, ‘Evidence-based Treatment Options in Cannabis Dependency.’, for younger users, Multidimensional Family Therapy (MDFT) proved particularly effective, showing better treatment adherence than standard therapy and moderate effects (d = 0.6) in reducing cannabis use among heavy users.
Aftercare
Aftercare programs help individuals remain on track and maintain their recovery from marijuana addiction. According to Liu, N.’s 2022 study, ‘Tracking Study on the Relapse and Aftercare Effect of Drug Patients Released From a Compulsory Isolated Detoxification Center.’, those in outpatient and inpatient settings had abstinence rates of 50% and 67%, respectively, compared to only 6% for those without formal aftercare. With marijuana being so easily accessible, aftercare is extremely effective in preventing relapse.
How Long Does Marijuana Stay In Your System?
Marijuana stays in your system from one hour up to 30 days, depending on various testing methods and individual factors. According to Schwilke, E. W.’s 2011 study, ‘Differentiating new cannabis use from residual urinary cannabinoid excretion in chronic, daily cannabis users.’, for those who use cannabis frequently or daily, THC is detected in urine for up to 30 days or longer. Some studies have reported detection times of up to 93 days under certain testing conditions.
Detection times vary by testing method:
- In urine: 1-3 days for occasional users, 1-7 days for regular users, and up to several weeks for chronic users
- In blood: 1-2 days after use
- In saliva: 24-72 hours after use
- In hair follicles: 2-90 days
These detection windows vary significantly based on personal factors including your metabolism, hydration levels, body fat percentage, and the potency of the marijuana consumed.
How Does Marijuana Addiction Affect The Brain?
Marijuana addiction affects the brain by disrupting neural pathways, altering reward circuits, compromising cognitive abilities, and modifying emotional processing centers. The impact extends to weakening memory formation, changing decision-making patterns, and interfering with attention mechanisms, particularly during important developmental stages.
Here are the key effects and brain regions affected by marijuana:
- Reward system: Marijuana increases the release of dopamine, which is a neurotransmitter associated with pleasure and reward. It reduces the brain’s response to natural rewards and increases the desire for marijuana.
- Brain function: Marijuana addiction alters the brain structure and function, especially those that control learning, attention, and decision-making. The brain’s memory hippocampus, the prefrontal cortex, and the part for emotional and stress responses are the areas most affected.
- Impaired cognitive function: Marijuana addiction increases the risk to the brain’s cognitive function. Its use in adolescence impairs memory, attention, and executive function.
- Mental Disorder: Marijuana addiction also increases the risk of mental disorders and has been associated with psychiatric conditions like depression, anxiety, psychosis, and schizophrenia.
- Brain development: Addiction to Marijuana in adolescence disrupts brain development and has a long-lasting effect on brain function if not discontinued and treated early enough.
Other effects of marijuana addiction on the brain include withdrawal symptoms such as:
- Neuroplasticity: Neuroplasticity refers to the brain’s ability to reorganize and form new neural connections, which are affected by marijuana addiction withdrawal as the brain adapts to the absence of the substance.
- Depression: Depression manifests as a persistent feeling of sadness and loss of interest experienced during marijuana addiction withdrawal due to changes in brain chemistry and emotional regulation.
- Anxiety: Anxiety involves heightened feelings of worry and fear, commonly experienced during marijuana withdrawal as the body adjusts to functioning without the drug’s calming effects.
- Insomnia: Insomnia refers to difficulty falling or staying asleep, frequently occurring during marijuana withdrawal as the body struggles to regulate sleep patterns without the influence of the substance.
- Decreased Appetite: Decreased appetite describes a reduced desire to eat, observed during marijuana withdrawal as the body reacts to the absence of the drug, which typically stimulates hunger.
Why is Marijuana Addictive?
Marijuana is addictive because of how it interacts with the brain’s endocannabinoid system. The key psychoactive component in Marijuana, THC, binds to cannabinoid receptors in the brain and triggers the release of dopamine, a neurotransmitter associated with pleasure and the reward system.
The surge in dopamine is what contributes to the euphoria or the ‘high’ associated with marijuana use. Over time, the brain begins to expect these dopamine spikes as normal, leading to a desire to continue using marijuana to replicate the experience.
As marijuana is used more frequently, the brain adapts to its presence. This adaptation manifests as tolerance, where more of the substance is required to achieve the same effect once obtained with smaller amounts. This need for increasing quantities escalates use, nudging the user toward addictive patterns. Psychological dependence plays a significant role in marijuana addiction. Many individuals turn to marijuana as a coping mechanism for stress, anxiety, or depression.
This reliance on marijuana for emotional regulation complicates cessation, as users feel unable to manage these issues without the drug. When use reduces or stops, withdrawal symptoms occur, including irritability, sleep disturbances, appetite changes, restlessness, and physical discomfort. These withdrawal symptoms make quitting challenging, as the immediate relief from returning to use appears more appealing than enduring discomfort.
Finally, genetic predisposition also plays a role in the development of Marijuana addiction. Just as with other types of substance use disorders, genetics has been proven to influence an individual’s susceptibility to addiction, making some more prone to developing a dependence on marijuana.
Can Marijuana Addiction Co-occur With Other Substance Use Disorders?
Yes, individuals with marijuana addiction also experience co-occurring substance use disorders involving alcohol, tobacco, or other drugs. Co-use of multiple substances exacerbates addiction symptoms, complicates treatment outcomes, and increases the risk of adverse health effects.
According to Hasin, D.’s 2020 study, ‘Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review.’, there is a strong connection between cannabis and alcohol use disorders. People who have cannabis use disorder (CUD) are 7.8 times more likely to develop an alcohol use disorder within the same year. The relationship becomes even stronger when looking at lifetime usage, where individuals with CUD are 10.3 times more likely to experience an alcohol use disorder at some point in their lives.
What Are The Potential Long-term Effects Of Chronic Marijuana Use?
Chronic marijuana use leads to various long-term effects on physical health, cognitive functioning, and mental well-being. These include respiratory issues such as bronchitis and lung infections, cognitive impairments in memory, attention, and decision-making, mental health disorders such as anxiety and depression, and adverse impacts on social and occupational functioning.
According to Tan, W. C.’s 2009 study, ‘Marijuana and chronic obstructive lung disease: a population-based study.’, smoking marijuana alone, without tobacco, did not show an increased risk of respiratory symptoms or Chronic Obstructive Pulmonary Disease (COPD). However, when marijuana was combined with tobacco use, there was a significant synergistic effect that increased the risk of both respiratory symptoms (OR 2.39) and COPD (OR 2.90), particularly when lifetime marijuana consumption exceeded 50 marijuana cigarettes.
Can Treatment Strategies For Marijuana Addiction Be Applied Cocaine Addiction?
Yes, treatment strategies for marijuana addiction are effectively applied to cocaine addiction. While both substances have distinct challenges, core treatment approaches like cognitive-behavioral therapy, support groups, and pharmacological interventions that work for marijuana addiction are successfully adapted to treat someone with cocaine addiction. These evidence-based methods are customized to address the specific needs and circumstances of cocaine users while maintaining the fundamental therapeutic principles.
How Do The Withdrawal Symptoms Of Marijuana Addiction Compare To Those Of Percocet Addiction?
The withdrawal symptoms of marijuana addiction and Percocet addiction highlight the diverse physical and psychological challenges individuals face during detoxification and early recovery. Both types of addiction present common themes, including cravings, mood disturbances, and physical discomforts, although the specific symptoms and their intensity differ between the two substances.
Is Cannabis Addictive Physically And Psychologically?
Yes, cannabis is addictive both physically and psychologically. Regular users experience physical withdrawal symptoms—such as irritability, sleep disturbances, decreased appetite, and cravings—when they stop using, indicating that their bodies have developed a dependence on THC. However, these physical symptoms are generally milder than those seen with substances like alcohol or opioids. More commonly, the addiction is psychological, as users develop intense cravings and compulsive use patterns despite negative impacts on their lives.
