The truth about marijuana, mental illness, and violence: A review of Alex Berenson’s claims in ‘Tell Your Children’

Introduction

Marijuana liberalization has proliferated throughout the United States over the past decade. Though still technically illegal under federal law, marijuana is now permitted for medical use in 40 states and recreational use in 24 states and the District of Columbia. Attitudes towards marijuana use have greatly changed throughout the United States over the course of the last twenty years. According to a 2024 Pew Research poll, 88% of Americans now believe that marijuana should be made legal for at least medical use, with 57% of Americans also supporting legalization for recreational use. This sentiment stands in stark contrast to public opinion in 2000, when only 31% of Americans supported recreational legalization.

Additionally, major research organizations have concluded that marijuana can effectively treat a range of medical conditions, including chronic pain, according to a report from the National Academies of Sciences, Engineering, and Medicine (NASEM). Other studies show that marijuana is also effective in treating mental illnesses, such as post-traumatic stress disorder. Amid changing perceptions of recreational use and increased understanding of potential medical applications, the U.S. is now considering an adjustment of marijuana’s current prohibited status under federal law.

Despite these trends towards the general acceptance of marijuana legalization in the U.S., many remain skeptical of marijuana’s alleged benefits and wary of its potential consequences. In his book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, journalist Alex Berenson voices concern about the relationship between marijuana use and the increased likelihood of experiencing psychosis and developing schizophrenia. Furthermore, the onset of schizophrenia, he argues, makes one more likely to experience a violent psychotic episode, increasing the risks surrounding marijuana use. He also alleges that medical marijuana use is misguided, given that little medical evidence suggests that the drug has any effectiveness in palliating the medical complications its advocates claim it can treat.

This review examines Berenson’s claims in light of the current literature in epidemiology, public health, and economics by reviewing his research summary and analyzing government data measuring marijuana use, mental illness, and violence. Despite Berenson’s claims, much of the literature he cites concludes that marijuana is effective in treating many conditions, including chronic pain—one of many scientific findings Berenson chooses to omit in his book.

However, there does appear to be an association between mental illness and marijuana use at the individual level, including a rare onset of schizophrenia. Still, the risk of developing mental illness is less associated with marijuana use than other intoxicants, like alcohol, and the risk decreases with lower levels of consumption. Additionally, it is unclear whether marijuana use leads to an increased likelihood of developing mental illness or if people with mental illnesses, like depression, are just more likely to use marijuana. The possibility of self-medication further complicates the understanding of this relationship.

Due to predictive decreases in violence following regulated marijuana access at the state level, we conclude that benefits from further liberalization outweigh public health concerns surrounding mental illness. Additionally, the risk of schizophrenia can be materially eliminated for almost all people with no current mental health issues through reasonable moderation. Furthermore, because marijuana-induced mental illness is so rare, marijuana’s effect on violence through compounding mental illness is not measurable and marijuana legalization appears to reduce the prevalence of violent crime and suicide.

Our analysis finds that at the state level:

• Recreational and medical marijuana legalization are not followed by increases in mental illness.
• Increases in marijuana use are associated with increases in mental illness for all age groups.
• Regulated marijuana access is followed by slight reductions in suicide for young adult men.
• Recreational marijuana access is followed by reductions in homicide.
• Recreational and medical marijuana legalization are associated with reductions in drug crime arrest rates and reductions in racial disparities in drug-sale arrests.
• Recreational marijuana legalization is followed by increases in marijuana use among adults, but stable rates of marijuana use among children.

Berenson’s characterization of the academic literature studying marijuana is limited, periodically inaccurate, and not sufficient to model policy. Despite the claims made in Tell Your Children, marijuana prohibition does not reduce rates of mental illness, while legalization appears to reduce violence by eliminating dangerous illicit markets.

Full study: The truth about marijuana, mental illness, and violence: A review of Alex Berenson’s claims in Tell Your Children

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