Page 9 - SilverLinings Issue 5

In my work with kids, I don’t even use the word addiction anymore. I use the word relationship. What’s your relationship with weed, or alcohol, or social media?
How are attitudes towards cannabis use changing?
A lot of kids now have attitudes that support ongoing use, which differs from denial. Some attitudes are, “It’s not bad for me,” and kids argue that the fact that they have legalized it means it “isn’t bad for me.” They use that logic. Or, they say, “everybody is doing it.”
One of the things we don’t often look at is how accessible it is. Access is a very important variable in substance use disorders and how we treat it. Can they avoid the people and places that trigger use, or are they going to put themselves in a position to be tempted or automatically start using? That’s a big challenge when these kids go to a party or go back to their dorm room. The access issue is often overlooked in the field.
Cannabis is big business now. Are adolescents receiving the right message?
Now that cannabis is being legalized, I see a similar scenario as Big Tobacco. Now there is Big Cannabis.
I wouldn’t be surprised if, years from now, there are class-action lawsuits against Big Cannabis. Once there is money behind it, it’s an industry. It behooves an industry to get long-time brand users. Thankfully, there are groups providing cannabis education and trying to challenge this stuff. Americans Against Legalization of Marijuana is one group.
Statistically, since Colorado legalized cannabis, there have been more car accidents. We’re seeing more kids in hospitals with acute reactions, psychotic episodes, and panic attacks. It’s akin to the bad trip of the hallucinogenic era. There can be cannabis withdrawal symptoms such as increased irritability for a few weeks, restlessness and difficulty sleeping.
What is the treatment for someone abusing cannabis?
That depends on whether they have crossed that invisible line into addiction. If they have shown repeated attempts to control the behavior and they can’t, why would we keep trying that? If they are using a more harmful substance, then obviously the goal is elimination.
If they are in a hospital related to use, they are likely further along the continuum. The challenge as a psychiatrist or psychologist is treating depression or anxiety and trying to figure out how much of that might be substance induced. If a kid comes in and says he is really depressed, you have to find out about their cannabis-use behavior.
We also have to determine which “stage of change” they are in. The precontemplation stage is when they don’t think there is a problem, or they think their parents or society is the problem. Typically, people don’t move out of that stage until something external happens; a consequence hits with the message, “change or else.”
When people move into the contemplation stage, they are of two minds. They are at least open to
the idea that there might be a problem, but there is ambivalence and the scales of using or not are going back and forth sometimes in the same conversation. We have to match our intervention to the stage of change by exploring the pros and cons of changing.
If they are willing to give up getting high, they have to find another way of filling down time. How are you going to fill that time?
How do you work with young people at Silver Hill who use cannabis?
I use an experiential exercise called “the angle of opportunity.” I create a scenario with them. I ask: When you leave KHouse (Silver Hill’s adolescent residential unit), will you go back to using? Let’s travel into the future and see what life is like. If you don’t stop, what does that path look like? How are you feeling about yourself?
Let’s move another six months into the future and see if the pot use has gotten worse. What’s your life look like? How’s school going? What’s your relationship with your parents? Now let’s take it a year out.
Then we come back to the present and walk the path of change. I’m not demanding they change, but we are collaboratively exploring what the future could look like. They get to try it on. Kids will often say this path is harder. The other path is easier, but it doesn’t give them the future they are looking for.
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SILVER LININGS MAGAZINE | ISSUE FIVE | 2022