Vitamodo School · Bundle 1: Addictions as Symptom · Brochure 8 of 10 · Version 1.0
Andris Saulitis, MD
For those who: smoke, vape, or use cannabis regularly and want to understand what the substance has been treating beneath the act of using it.
Not for those who: are looking for a quit-by-Thursday plan or a moral verdict on either substance. The mechanisms below are about pharmacology and underlying conditions, not about will or worth.
What this is — the clinical reality
Nicotine and cannabis are different substances acting on different receptor systems. They are grouped together in this brochure because they share, more than any other substances, a single clinical reality: most people who use them are self-medicating something else, and most of them are doing so without ever having had the underlying condition identified.
Three systems carry the change.
The first system is the acute pharmacology. Nicotine acts on acetylcholine receptors that govern attention, arousal, and the dopaminergic reward circuit. In a person whose baseline is anxious or distractible, a cigarette briefly produces sharper focus, a thin layer of calm, and a small rise in mood — all of which are felt and remembered. Cannabis acts on the endocannabinoid system, which modulates pain, sleep, mood, anxiety, and the salience of memory. Depending on the strain, the dose, and the individual, cannabis can produce sedation, mild euphoria, reduced anxiety, or — in vulnerable people — agitation and psychosis-like states. Both substances do real pharmacological work. Both have effects that are recognisable to the user and that the user has, very often, been seeking.
The second system is identification. The brain is built to learn which inputs reliably produce a desired internal state. When a substance briefly addresses a chronic underlying problem — undiagnosed attention dysregulation, untreated anxiety, unprocessed trauma, insomnia, chronic pain — the brain marks that substance as important. From that point on, the use is no longer about novelty or pleasure. The use is about return to a baseline the person cannot otherwise reach. This is self-medication, and it is, in clinical practice, the most common reason long-term users continue to use.
The third system is the inversion. With sustained use, the body adapts. Receptor systems downregulate. Baseline function in the very mechanisms the substance was correcting begins to fail. The smoker who started with normal anxiety now has worse anxiety between cigarettes than they ever had before they started. The cannabis user who started with mild insomnia now cannot sleep at all without it. The substance that briefly produced relief has, over years, produced a worse version of the state it was treating. The use continues, in part, to manage the deficit the use itself has created.