Is marijuana replacing alcohol as the substance that individuals in treatment for substance use problems want to hang on to, even if they successfully give up everything else?
The director of addictions services at the Houston-based Menninger treatment organization says around 36% of the patients his operation sees have moderate to severe marijuana involvement, but very few consider their use to be problematic—an attitude fueled largely by the mainstream media's notion that marijuana use is not all that harmful. The solution for providers, says John J. O'Neill, LCSW, LCDC, is not to become overly confrontational with a response, however.
“These patients have PhDs in marijuana use. They know the research, and they're more informed than alcoholics,” says O'Neill. He adds, “If we get too aggressive, they shut down automatically.”
O'Neill says it's important to initiate conversations with marijuana-using patients early on in treatment, but the approach should remain one of meeting patients where they're at. Patients seldom enter treatment with marijuana as their primary presenting issue.
“I start the conversation right away, with the assessment,” says O'Neill. “I'll ask, 'What does [marijuana] do for you?'” He then will ask what the patient thinks would happen if he/she didn't use, to get a better sense of the factors that may be linked to the individual's marijuana use.
In the six to eight weeks that Menninger generally has with patients in its dual-diagnosis focused program, O'Neill says he wants marijuana use to emerge on patients' radar. This includes exposing them to facts they might not know about marijuana, such as its potential consequences for one's ability to regulate depression or anxiety. This education can be a hard sell, particularly given the way medical marijuana is being marketed across the country.
O'Neill says that in the states with medical marijuana laws, “People are getting cards for anxiety or depression, when there is no research evidence.” With marijuana policy, “We've gone so far to the other extreme that we're missing some of the potential problems with it,” he says.
Conversations with patients who want to continue their marijuana use post-treatment become “like talking to adolescents, even if the person is 40 years old,” O'Neill says.
In the effort to help a patient move toward considering stopping marijuana use, O'Neill will stress having the person read a broader diversity of material about the drug. A typical conversation might unfold with the clinician stating, “If in the next six months you didn't smoke, could you commit six months to work on your psychiatric problems?”
The key, he says, rests in becoming more individualized with treatment approaches, and also in working to engage family members who may share the patient's view that marijuana is a relatively benign drug.
On Nov. 11 at 1 p.m. Eastern time, O'Neill will conduct a complimentary webinar on treating marijuana use, an event sponsored by Menninger.