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Kim Salyer

on 1 October 2013

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Transcript of Marijuana

Although controversial, marijuana may provide benefits for some individuals. However, benefits must be weighed against the risks.

Cue applause!!
Obtained from Cannabis sativa
Earliest known reference 2700 B.C.
It is the most commonly used illicit drug in the United States.
Approximately 7 million people in the United States use it at least weekly.
Medical Marijuana
A serious medical condition, as defined by SB 420, is any of the following:
Cachexia (wasting syndrome)
Chronic pain
Persistent muscle spasms (i.e., spasms associated with multiple sclerosis)
Seizures (i.e., epileptic seizures)
Severe nausea
Any other chronic or persistent medical symptom that either substantially limits a person’s ability to conduct one or more of major life activities as defined in the Americans with Disabilities Act of 1990, or if not alleviated, may cause serious harm to the person’s safety, physical, or mental health.
While in some instances marijuana use for medicinal reasons may be legal, counselors need to be aware of consequences of its use.
Methods of Ingestion

California Department of Public Health. (2013, April 12). Medical Marijuana Program.
Retrieved from http://www.cdph.ca.gov/programs/MMP/Pages/default.aspx

National Institute on Drug Abuse. (2012, December). DrugFacts: Marijuana. Retrieved
from http://www.drugabuse.gov/publications/drugfacts/marijuana

National Institute on Drug Abuse. (2011, December). Topics in Brief: Marijuana. Retrieved
from http://www.drugabuse.gov/publications/drugfacts/marijuana
References cont.

U.S. Census Bureau. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Washington, DC:
U.S. Census Bureau; 2004

Street Names
Weed Pot Reefer Grass Dope Ganja Mary Jane
Hash Herb Aunt Mary Skunk Boom Chronic
Cheeba Blunt Ashes Atshitshi Baby Bhang Bammy Blankey Bo-Bo Bobo Bush Bomber Boom Bud Broccoli Cripple Dagga Dinkie Dow Ding Dona Juana Juanita Flower Flower Tops Ganja Gasper Giggle Smoke Good Giggles Good Butt Hot Stick Jay Jolly Green Joy Smoke Joy Stick Smoke
Roach Wheezy Reefer Green Endo Buddha
Names for Marijuana Laced with Other Drugs
With PCP
- Boat Loveboat Chips Donk Illies Illing Lovelies
Love Leaf Killer Weed Supergrass Wack Woolies Zoom Fry
Dust Wets Tical Wicky Sticks Happy Sticks Frios (Spanish) Yerba Mala (Spanish)
With Formaldehyde
(embalming fluid)- Boat Loveboat Fry Amp
Drank Clickem Ill Illy Wack Wet Water-Water
With Cocaine
- Chronic Banano Caviar Champagne Cocoa Puff
Gremmies Juice Joint Lace 3750
With Crack Cocaine
- Chronic Bazooka Cocktail Crack Back
Fry Daddy Dirty Geek Gimmie Juice Joint Liprimo Primos Oolies -Dogs Torpedo Turbo Woolies Woo Woos
Slang for Marijuana Use
Blast Blast a Roach Blast a Stick Blow a Stick
Boot the Gong Airhead Bite One's Lips Bogart
Hi the Hay Burn One Fire it up Get a Gage Up
Get the Wind Fly Mexican Airlines Mow the Grass
Tea Party Toke Torch Up
Marijuana- most common, least powerful
-made from dried plant leaves and flowers
-usually smoked in a pipe, water pipe (bong), hand-rolled cigarette (joint), Blunt (cigar emptied and replaced with marijuana)
Hashish- small blocks of dried cannabis resin
-higher concentration of THC
Hash Oil- thick, oily liquid extracted from hashish
-usually spread on the tip or paper of cigarettes and smoked
-most powerful form
Synthetic marijuana, also known as K2 or "Spice"

Alcohol, Nicotine, Gambling, Sex, Gambling, & Marijuana

Affects Refraction of Neurons
Perception Magnified
Fixated Attention
Tangential Thoughts
Loss of Big Picture
Pain Modulation,
General Enhancement of an Experience
Short Term Memory
Movement Control
Higher Cognitive Function
Most Widely Used Drug in North America
34% > 12y/o

Remember 34% Western Population > 12y/o
Activation of Maturing Brain
Prefrontal Cortex
Could There be a Problem?
Affecting the HIPPOCAMPUS
Life Long Growth of Neurons
Learning and Memory
Reward & Craving + Decreased Motivation +
Memory & Learning impairment
Marijuana Similarly Excites Reward Circuitry of Brain

What’s the BRAIN Got to Do With It?

Brain Matter
The Course of Addiction: How it Starts and How it Progresses to Dependence

A compulsive, uncontrollable craving for a drug, plus the overwhelming desire to seek and use this substance means that there is an addictive impulse involved in usage.
Those with addictive or dependent tendencies on a drug will seek it out and take it compulsively.
Frequent and heavy usage can create a tolerance for cannabis, which in turn requires more use to get the same level of high.
The user can develop psychological and/or a mild physical dependence.
The effect on the user depends on the strength of the THC contained within the drug.
Population: Who Uses Cannabis?

Considered to be the most popular illicit drug in the world, according to the United Nations Office on Drugs and Crime, 2009.
Medical usage widely inflates these numbers
201 countries polled
: Cannabis use or dependence was more than 99% of the world’s population ages 15-64 years.
Cannabis use in males is significantly higher than females.
Is Cannabis the “Gateway Drug?”

“The Gateway Effect” is the idea that, while marijuana itself may not be particularly dangerous compared to other drugs, it leads to harder drugs like heroin and cocaine.
Correlation isn’t cause.
Strong correlation between marijuana use and other drug use. A person who smokes marijuana is more than 104 times more likely to use cocaine than a person who never tries pot, according to the National Institute on Drug Abuse
What accounts for the correlation between marijuana and use of other drugs?
Preference and illegality


CLIENT finds that he/she is smoking pot again despite the efforts to quit, he/she should do their best to pick up where they left off in recovery.
May have to try many different methods of treatment before finding one that really works.
Good to get into Sober living home & aftercare

Relapse is a part of recovery and will happen—even to the best of us.

Impatient Rehab – required unless your addiction is paired with a co-occurring mental illness or if you are also addicted to another drug or substance such as alcohol.

Outpatient Rehab – most common method of treatment for pot addiction and takes place on daily, weekly or even semi-weekly sessions.

Behavioral therapy – changing behaviors to more positive behaviors that will help them to be more productive and less likely to smoke pot.

Cognitive therapy – treatment will help the addict to think in a different way that does not promote them to smoke pot.

Community reinforcement – help by providing a reward to an individual for recovery goals that are met such as not smoking pot for a month or making other commitments

Support groups – Different support groups. Ex. Marijuana Anonymous groups which focus on the twelve-step recovery model which outlines a series of steps that take the addict from full-fledged addiction on through to sobriety.

Recognize Addiction Signs

Tolerance to Marijuana.

Withdrawal when marijuana is not smoked.

Smoking more pot than you intended.

Inability to control or cut down marijuana use.

Spending most of your time getting high.

Reduced activities because time is spent focused on pot.

Smoking pot despite known consequences.

Using pot to relax and becoming dependent on it for relaxation.

Every person will have different outcomes from their treatment and the recovery efforts will differ from one patient to the next.

First step
to overcoming marijuana addiction is to recognize that you have a problem and need help. 

Most often, marijuana addiction is the result of using the drug in conjunction with other substances.
Alcohol or other drugs
Keep in mind this is
always the case.

Physical reasons
Psychological reasons
Relationship related reasons
Financial Reasons
Legal Reasons
Marijuana addiction, although it is not as deadly or dire as some other addictions, is still a difficult feat to overcome and takes

Families need to stay strong and not enable the addict.

Families may want to attend counseling, 12 step and support groups, church groups, Marijuana Anonymous, & online support groups.

What's all the excitement about?
THC- Psychoactive Element in Marijuana
Increased Potency over the last 3 Decades
400 other chemicals in Marijuana
What's the Big Deal?
What Happens?
What's the Common Thread?
The effects of cannabis vary greatly among individuals. The following factors are significant variables in the research.
Dose received
Mode of administration
User’s prior experience with the drug
Attitudes of the individual using; including expectations about the effects, state of mood, and setting in which it was used.
(Hall, Dengenhardt, 2009; Metrick, et al., 2011)
Increases in heart rate by 20-100% shortly after smoking and can last up to 3 hours.
Can cause irregular heart beats including palpitations and arrhythmias.
Marijuana smoke can cause similar respiratory problems experienced by tobacco smokers such as chronic cough and risk of lung infections.
Reproductive impairments including low sperm count or irregular ovulation.
(McGuinness, 2009; Hall Degenhardt, 2009, NIDA, 2012)
Anxiety, panic reactions, paranoid thoughts and psychotic symptoms including and increased risk for schizophrenia
Suicidal thoughts among teens
Lack of motivation
Feelings of relaxation
Increased talkativeness and laughter
Intensification of ordinary experiences
Magical thinking and time and space distortion
(Hall, Dengenhardt, 2009; NIDA, 2012)

Impaired motor coordination, slower reaction time
Difficulty with thinking, problem solving, attention and tracking
Delays in learning and memory
(Hall, Dengenhardt, 2009;National Institute on Drug Abuse, 2012)
Madeline Meier, et al. (2012) followed 1,000 people from birth to age 38 and compared results of IQ tests taken by participants at age 13 before using cannabis and again as adults after years of cannabis use. Participants most dependent on the drug had an average of a 6 point loss in IQ and those that started before age 18 had an average of an 8 point loss.
The main psychoactive chemical in marijuana is delta-9-tetrahydrocannabinol or THC.
THC reacts upon the cannabinoid receptors in the brain. These receptors usually react to similar chemicals that are naturally occurring in the body which are part of the neural communication network.
The highest concentration of cannabinoid receptors is located in the part of the brain responsible for pleasure, memory, thinking, concentration, physical coordination, and sensory and time perception. Marijuana overacts the endocannabinoid system causing the effects of a high.

In all areas, cognitive, affective/emotional, and physical effects, there is much research and several studies contradict each other.
Cognitive: Some of the effects were not as significant with chronic use
Affective/Emotional: These results were sometimes skewed by expectations of the user. Also by family history as in the case of psychosis and schizophrenia
Physical: Lung cancer, lung damage, Alzheimer's
Cognitive Effects
Affective and Emotional Effects
Physical Effects
Things to Consider When Looking at the Effects of Marijuana Use
Contradictions in the Research
Reasons to Quit
Recognize Signs of Addiction
Overcoming Marijuana Addiction
Family Support
Degenhardt, L., Bucello, C., Calabria, B., Nelson, P., Roberts, A., Hall, W., Bynskey, M., Wiessing, L. (2011). What data are available on the extend of illicit drug use and dependence globally? Results of four systematic reviews. Drug and Alcohol Dependence, 117, (2-3), 85-101.

Isralowitz, R., Rawson, R. (2006). Gender differences in prevalence of drug use among high risk adolescents in Israel. Addiction Behaviors, 31(2), 355-358.

Schubart, C.D., Sommer, I.E.C., Gastel, W.A., Goetgebuer, R.L., Kahn, R.S., & Boks, P.M. (2011). Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophrenia Research, 130, 216-221.
Available treatments for marijuana use disorders. (2012, July). Retrieved from http://www.drugabuse.gov/publications/marijuana-abuse/available-treatments-marijuana-use-disorders 

Marijuana Addiction. (2013) Retrieved from http://www.addictions.com/marijuana/ 
Science-Based Addiction Treatment. (2013) Retrieved from http://www.altamirarecovery.com/drug-treatment/science-based/ 
Science is Revolutionizing Our View of Addiction—and What to Do About It. (1999, January) Retrieved

Szalavitz, Maia. (October 29, 2010). Marijuana as a gateway drug: The myth that will not die. Time Magazine.  Retrieved from http://healthland.time.com/2010/10/29/marijuna-as-a-gateway-drug-the-myth-that-will-not-die/#ixzz2fa1kpGqI

U.S. Department of Human Services, Office of Applied Studies (2005). Marijuana. Retrieved from: http://www.oas.samhsa.gov/marijuana.htm
The DANA Foundation (September 18, 2009). Your Gateway to Information about the Brain and Brain Research, Retrieved from: http://www.dana.org/news/features/detail.aspx?id=23404
University of Maryland Center for Substance Abuse and Research (August 27,2013). Retrieved from: http://www.cesar.umd.edu/cesar/drugs/marijuana.asp#physical

American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Haney, M., Hart, C. L., Vosburg, S. K., Comer, S. D., Reed, S., & Foltin, R. W. (2008). Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology, 197(1), 157-168.
Marijuana Anonymous (1992). https://www.marijuana-anonymous.org/literature/pamphlets/detoxing-from-marijuana
Smith, P.H., Homish, G. G., Leonard, K. E., & Collins, L. (2013). Marijuana withdrawal and aggression among a representative sample of U.S. marijuana users, Drug and Alcohol Dependence, 132(1–2), 63-68.
Night sweats, hand sweats and body odor
Nightmares and vivid dreams
Anger, rage, irritability
Coughing up phlegm
Emotional jags including depression, anger & euphoria
Fear or anxiety
Loss of sense of humor
Decreased or increased sex drive
Loss of concentration in the first 1-4 weeks
Loss of appetite
Tremors and dizziness

Marijuana Anonymous 1992
Because many of the symptoms of cannabis withdrawal are also symptoms of other substance withdrawal syndromes or of depressive or bipolar disorders, careful evaluation should focus on ensuring that the symptoms are not better explained by cessation from another substance, another mental disorder (generalized anxiety disorder, major depressive disorder), or another medical condition.
-Cannabis users report using cannabis to relieve withdrawal symptoms: withdrawal might contribute to ongoing expression of cannabis use disorder.
-Worse outcomes may be associated with greater withdrawal.
-Many in treatment for moderate to severe cannabis use disorder acknowledge moderate to severe withdrawal symptoms, making cessation more difficult.
-To provide relief from cannabis withdrawal symptoms, cannabis users report having relapsed to cannabis use or initiating the use of other drugs.
-Individuals living with cannabis users observe significant withdrawal effects, suggesting that such symptoms are disruptive to daily living.
Most likely, the prevalence and severity of cannabis withdrawal are greater among heavier cannabis users, and particularly among those seeking treatment for cannabis use disorders.

Withdrawal severity also appears to be positively related to the severity of comorbid symptoms of mental disorders.
Most symptoms have their onset within the first 24-72 hours of cessation, peak within the first week, and last approximately 1-2 weeks. Sleep difficulties may last more than 30 days.

Cannabis withdrawal has been documented among adolescents and adults.

Withdrawal tends to be more common and severe among adults, most likely related to the more persistent and greater frequency and quantity of use among adults.
The essential feature of cannabis withdrawal is the presence of a characteristic withdrawal syndrome that develops after the cessation of or substantial reduction in heavy and prolonged cannabis use.
For the diagnosis, withdrawal symptoms must cause clinically significant distress or impairment in important areas of functioning.
Many cannabis users report smoking cannabis or taking other substances to help relieve withdrawal symptoms, and many report that withdrawal symptoms make quitting difficult or have contributed to relapse.
Among adults and adolescents enrolled in treatment, or heavy cannabis users, 50%-95% report cannabis withdrawal.
C. The signs or symptoms in Criterion B cause clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable
to another medical condition and are not better
explained by another mental disorder, including
intoxication or withdrawal from another substance.
Diagnostic Criteria:
A. Cessation of cannabis use that has been heavy and prolonged.
B. Three or more of the following signs and symptoms develop within approximately 1 week after Criterion A:

1. Irritability, anger, or aggression, 2.Nervousness or anxiety,
3. Sleep difficulty, 4. Decreased appetite or weight loss,
5. Restlessness, 6. Depressed mood, 7. At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache.
In the DSM – IV, only two disorders were included under
Substance-Related Disorders; Substance Abuse, and
Substance Dependence.
Substance-Related Disorders
in DSM – V
are broken down by drug type, for example:
, DSM - V
Cannabis Use Disorder
Cannabis Intoxication
Cannabis Withdrawal
Other Cannabis-Induced Disorders
Unspecified Cannabis-Related Disorder

Recovery Today online, 2-2013, APA (2013)
According to the National Institute on Drug Abuse (2011), long-term marijuana users trying to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent.

Budney et al. (1999), found that clinically, marijuana smokers report using marijuana to alleviate withdrawal symptoms, suggesting that withdrawal contributes to relapse and continuance of marijuana use (Haney, 2008).

In marijuana users with a history of aggression, withdrawal was associated with 60% higher odds of past-year relationship aggression (Smith, et. all, 2013).
Cannabis Withdrawal
Diagnostic Criteria Continued
Diagnostic Features
Development and Course
Risk and Prognostic Factors
Functional Consequences of Cannabis Withdrawal
Differential Diagnosis
Most Common Symptoms of Withdrawal
Hall, W. , & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. The Lancet, 374(9698), 1383-1391
McGuinness, T. (2009). Update on marijuana. Journal Of Psychosocial Nursing & Mental Health Services, 47(10), 19-22. doi:10.3928/02793695-20090902-03
Metrik, J. , Kahler, C. , McGeary, J. , Monti, P. , & Rohsenow, D. (2011). Acute effects of marijuana smoking on negative and positive affect. Journal of Cognitive Psychotherapy, 25(1), 31-46.

Meier, M., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R., Mc Donald, K., Ward, A., Poulton, R., Moffitt, T.E., (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. PNAS 109 (40) E2657–E2664; published ahead of print August 27, 2012, doi:10.1073/pnas.1206820109.
There is mounting evidence that use and dependence on alcohol and cannabis are influenced by heritable factors.
Genetically informative studies of cannabis use and related symptomology have consistently produced evidence for genetic influences on both use and dependence phenotypes.
Alcohol Dependence criteria are met by approximately 70% of individuals with cannabis dependence.
Likelihood of developing cannabis dependence is similarly elevated in alcohol-dependent individuals.
Genetic studies in humans support the specific involvement of CB1 cannabinoid receptor in vulnerability to cannabinoid addiction.

Carolyn Sartor et al.(2010)
Maldonado et al. (2011)
Literature on the behavior of marijuana use indicates an environmental familial transmission of the behavior, particularly at the initiation level.
Parenting skills are the most prominent factor in familial transmission of marijuana use.
The study looked at the effect of marijuana use on parenting skills with children 10-14 year olds, and children older than 15.
Three main parenting factors identified were:
A. Connectedness and Bonding
B. Respectful relationships,
C. Rule setting and discipline.
The second generation whose mother’s used marijuana were at significantly higher odds of initiation of marijuana use.

Maalouf (2010)
Reduced Educational Achievement/Dropping Out
Cannabis availability
Other illicit drug use.
Adjustment problems
Suicidal Behaviors
Attendance Problems at school or Work
Lack of Parental Monitoring
Peer Group Deviancy

Gillespie, et al. 2009, Fergusson, et al. 2002
Cannabis Use and Psychosocial Outcomes in Adolescence and Young Adulthood
Intergenerational Use of Marijuana
Genetic Contributions to Alcohol and Cannabis Use and Dependence
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