Episode 158: Marijuana, Addiction, and the Body: What No One Is Telling You

If you've watched a family member struggle with addiction, you know how helpless it can feel. Treatment programs that don't work. Policies that seem disconnected from reality. Debates about legalization versus criminalization that never address what actually helps someone recover.

Dr. Kevin Sabet advised three presidential administrations on drug policy. His research reveals what most families never hear: we already know what works. Iceland, Portugal, and Hawaii figured it out. The question is why we haven't implemented it—and what families and practitioners can learn from these models.

The critical difference between decriminalization, legalization, and commercialization—and why it matters for your loved one

• Why addiction responds to incentives when other brain conditions don't

• What "meeting people where they're at" actually requires to create change

• For practitioners: how policy shapes what treatment options exist for your clients

In This Episode You'll Learn:

(01:00) Why is marijuana considered the most misunderstood drug in America?

(04:00) How has today's marijuana been genetically modified to be more potent?

(08:00) What is the difference between decriminalization, legalization, and commercialization?

(12:00) Why haven't the promises of marijuana legalization materialized?

(17:00) Why does addiction respond to incentives when other brain conditions don't?

(20:00) What does "harm reduction" actually mean—and why is there so much confusion?

(24:00) Should marijuana be used for opioid recovery—and what does the research show?

(30:00) What did Iceland's prevention model do differently to reduce drug use?

(33:00) How does Portugal's drug policy work—and why isn't it legalization?

(35:00) Why did 2 days in jail change behavior when years of probation didn't?

Notable Quotes

Dr. Kevin Sabet:

"For everybody that dies, there's 10 others revived with Narcan—severely disabled as a result of their addiction."

"I want to meet people where they're at and take them to a better place."

"Addiction is a disease unlike any other—it responds to incentives."

"We could solve 80% of the problem if we wanted to. It wouldn't even cost much."

Dr. Aimie Apigian:

"The effect marijuana has on the body shocked me—yet people still believe it's harmless."

Episode Takeaway

Understanding the difference between decriminalization, legalization, and commercialization matters for families. Decriminalization removes criminal penalties for personal use. Legalization allows regulated sales. In America, legalization became commercialization—billboards, advertising, corporate lobbying. Most families don't realize these are different policies with different outcomes. Knowing this helps you navigate what your loved one is up against.

Your loved one doesn't have to "want" recovery for treatment to work—and addiction responds to incentives unlike other brain conditions. Dr. Sabet's research shows people recover all the time when they don't want help. What matters is structure, not internal motivation. Hawaii's HOPE program proved that two days of consistent consequences changed behavior when years of probation failed. The goal is meeting people where they are AND taking them somewhere better. For families feeling hopeless: Iceland, Portugal, and Hawaii already figured out what works. The models exist.

Resources/Guides:

• Free Guide: 3 Most Common Biochemical Imbalances in Addiction — Discover which labs to ask for and what biochemical patterns show up most frequently in addictions.

• The Biology of Trauma book — Get your copy here

• Dr. Kevin Sabet — Get a copy of One Nation Under the Influence and find more resources at Smart Approaches to Marijuana

Related Podcast Episodes:

• Episode 103: Addiction & 6-Step Felt Sense Polyvagal Plan to Revolutionize Traditional Treatment with Janet Winhall

• Episode 104: How Trauma Fuels Addiction & The 4 Pillars for Recovery with Joe Polish

• Episode 109: End Your Addiction Now: How Pioneer Work Outperforms Traditional Treatment

About the Guest: Dr. Kevin Sabet is a former White House drug policy advisor who served under three presidential administrations—Clinton, Bush, and Obama. He is the president and CEO of Smart Approaches to Marijuana (SAM) and author of One Nation Under the Influence. His work focuses on evidence-based drug policy and what research shows actually reduces addiction and overdose deaths.

Your host: Dr. Aimie Apigian, double board-certified physician (Preventive/Addiction Medicine) with master's degrees in biochemistry and public health, and author of the national bestselling book "The Biology of Trauma" (foreword by Gabor Maté) that transforms our understanding of how the body experiences and holds trauma. After foster-adopting a child during medical school sparked her journey, she desperately sought for answers that would only continue as she developed chronic health issues. Through her practitioner training, podcast, YouTube channel, and international speaking, she bridges functional medicine, attachment and trauma therapy, facilitating accelerated repair of trauma's impact on the mind, body and biology.

Family Member Struggling with Addiction? Why Treatment Fails

If you've watched a family member struggle with addiction, you know how helpless it can feel. Treatment programs that don't work. Policies that seem disconnected from reality. Debates about legalization versus criminalization that never address what actually helps someone recover.

Dr. Kevin Sabet has advised three presidential administrations on drug policy. He's watched these debates unfold for decades—and started asking a different question: What if we looked at what actually works? His research across Iceland, Portugal, and Hawaii reveals something 

families rarely hear: the models exist. We just haven't implemented them.

This episode is for families navigating a loved one's addiction—and for practitioners supporting them. We explore the critical difference between decriminalization and legalization, why your loved one doesn't have to "want" recovery for treatment to work, and what structure actually helps.

The Terminology Problem: Why It Matters for Your Family

Dr. Sabet spent significant time clarifying terms. This matters because families hear these words without understanding what they actually mean—or how they affect their loved one's options.

Decriminalization removes criminal penalties for personal drug use. People aren't sent to prison for using substances. Most of America already has de facto decriminalization. People haven't been going to prison for marijuana use in decades.

Legalization allows regulated sale, manufacture, and possession. In theory, this could mean state-controlled supply with no advertising and THC limits.

Commercialization is what legalization actually became in America. Billboards. Marketing powerhouses. K Street lobbyists. Corporate interests driving policy.

When Oregon passed Measure 110 in 2020, they weren't legalizing—they already had decriminalization. What the measure did was send a message that shifted public behavior. Open-air drug use increased. They repealed it last year.

The lesson for families: terminology shapes outcomes. Understanding these distinctions helps you navigate what your loved one is up against.

Your Loved One Doesn't Have to "Want" Recovery

Dr. Sabet challenges one of the most painful beliefs families hold. The idea that someone has to hit rock bottom. That they have to want help for it to work.

His research shows the opposite. People get help when they don't want it—and they recover all the time. What matters isn't internal motivation. It's external structure.

This reframes how families think about treatment failure. When your loved one isn't "ready," you assume the timing is wrong. But the research suggests the structure might be wrong instead.

For families who've been waiting—sometimes for years—this is significant. You don't have to wait for your loved one to decide they're ready. Structure can spark what internal motivation cannot.

Why Addiction Responds to Incentives

Here's what distinguishes addiction from other brain conditions. You can't incentivize someone out of multiple sclerosis. You can't offer a promotion to make dementia disappear.

But addiction responds to incentives in ways other conditions don't.

Dr. Sabet describes Hawaii's HOPE probation program. The approach was simple. If someone tested positive or missed a drug test, they got two days in jail. Not two years. Two days. But the consequence was immediate and consistent.

This changed behavior when years of traditional probation hadn't. The threat had to be real. It had to be followed through. And it had to be proportionate.

For families wondering what kind of structure actually helps: certainty of consequence mattered more than severity.

Meeting People Where They're At—Then Taking Them Somewhere Better

"Meeting people where they're at" has become standard language in treatment conversations. Dr. Sabet doesn't reject the concept. He extends it.

The problem is when we meet people where they're at and leave them there.

Waiting for someone to be "ready" for recovery means waiting forever for most families. The substance feels good to your loved one. Nothing seems wrong from the inside. George W. Bush was a raging alcoholic until Laura gave him an ultimatum. That external structure changed the trajectory of his life.

This isn't punishment. It's providing what a dysregulated nervous system actually responds to.

What Iceland, Portugal, and Hawaii Figured Out

Dr. Sabet visited these places to understand what actually works.

Iceland invested in prevention. Not school lessons saying "don't use drugs." They looked at the whole environment. What's happening at home? What alternative activities exist? What does the community provide? Youth drug use dropped dramatically.

Portugal didn't legalize drugs. They created an administrative system. If someone gets caught with drugs, they go before a panel of three people who assess whether treatment is needed. This replaces criminal court, not consequences. The panel still has leverage.

Hawaii's HOPE program made consequences immediate and consistent. Two days for a violation. Every time. No exceptions. This worked when years of inconsistent probation hadn't.

The common thread: structure that responds to the biology of addiction. For families feeling hopeless, this matters. The models exist.

The Scope Beyond the Death Toll

For every person who dies from overdose, ten others are revived with Narcan but severely disabled. Their families are affected forever.

And we don't count the accidents. The workplace injuries. The car crashes. The relationships destroyed.

Dr. Sabet argues we could solve 80% of the problem if we chose to. The research exists. The models work. The cost wouldn't be prohibitive.

If you're a family member wondering whether anything can change—yes. The question is whether we'll implement what we already know.

What This Means for Families and Practitioners

This conversation aligns with what I teach in the Biology of Trauma® framework. The body adapts to survive. Substances become a solution when the nervous system doesn't have other options.

Policy that only criminalizes misses why people use. Policy that only enables misses that the nervous system often needs external structure to change. Both extremes ignore the biology.

For families: the insight that addiction responds to incentives means you don't have to wait indefinitely for your loved one to be "ready." External structure can create change.

For practitioners: this episode clarifies the policy landscape your clients are navigating. The difference between decriminalization and commercialization shapes what treatment options exist and what families are up against.

The models exist. Iceland, Portugal, and Hawaii figured something out. If you've been watching someone you love struggle and wondering what else might help—this episode points toward answers.

FAQ

1. What is the difference between decriminalization, legalization, and commercialization?

Decriminalization removes criminal penalties for personal drug use—people aren't jailed for possession. Legalization allows regulated sales. Commercialization is what legalization became in America: billboards, advertising, corporate lobbying. Most of America already has de facto decriminalization—people haven't gone to prison for marijuana use in decades. Understanding these terms helps families navigate what their loved one is up against.

2. Does my family member have to want help for treatment to work?

No. Dr. Sabet's research shows people recover all the time when they don't want help. Hawaii's HOPE program proved that consistent external structure changed behavior when internal motivation couldn't. The myth that someone must "hit rock bottom" keeps families waiting indefinitely. What matters isn't willingness—it's providing structure the nervous system responds to.

3. Why does addiction respond to incentives when other brain conditions don't?

You can't incentivize someone out of dementia or multiple sclerosis. But addiction behavior changes with consistent consequences. Hawaii's HOPE program reduced positive drug tests by 72% using immediate two-day consequences—not years, just two days. Certainty mattered more than severity. This has implications for how families and practitioners think about structure.

4. What did Portugal actually do—and is it legalization?

Portugal did not legalize drugs. They created administrative panels instead of criminal courts. When someone is caught with drugs, they appear before a three-person panel that assesses whether treatment is needed. Consequences still exist—the panel maintains leverage. Portugal combined this with investment in treatment infrastructure.

5. What can families do while waiting for policy to change?

You don't have to wait for policy changes. The insight that structure matters more than motivation means families can focus on consistent, proportionate boundaries. The Biology of Trauma® framework teaches that the nervous system responds to safety and structure. External support can create conditions for change even when your loved one isn't "ready."

Helpful Research

1. Hawaii's HOPE Probation Program Hawken, A., & Kleiman, M. (2009). "Managing Drug Involved Probationers with Swift and Certain Sanctions." National Institute of Justice. This randomized controlled trial showed that immediate, consistent two-day jail consequences reduced positive drug tests by 72% compared to traditional probation. The key finding: certainty of consequence mattered more than severity.

2. Iceland's Youth Prevention Model Sigfusdottir, I.D., et al. (2009). "Substance Use Prevention for Adolescents: The Icelandic Model." Health Promotion International. Iceland's community-based approach focused on environmental factors rather than individual education. Youth substance use dropped by over 50% in two decades through organized alternative activities and increased parental involvement.

3. Portugal's Drug Policy Outcomes Hughes, C.E., & Stevens, A. (2010). "What Can We Learn from the Portuguese Decriminalization of Illicit Drugs?" British Journal of Criminology. This analysis clarified that Portugal's approach combined decriminalization with significant investment in treatment infrastructure. The administrative panel system provided assessment and treatment referral rather than eliminating consequences entirely.

Disclaimer: By listening to this podcast, you agree not to use this podcast as medical, psychological, or mental health advice to treat any medical or psychological condition in yourself or others. This podcast is for informational and educational purposes only and does not constitute professional advice, diagnosis, or treatment. Always consult your own physician, therapist, psychiatrist, or other qualified health provider regarding any physical or mental health issues you may be experiencing.

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