|Working with teens who meet the criteria for cannabis abuse or cannabis dependence is an interesting challenge for a number of reasons:|
• Distinguishing between abuse and dependence.
• Explaining the difference once a diagnosis is made.
• Dealing with denial.
• Fielding the legalization question.
• Finding a way to educate without raising defensiveness.
• Wants versus needs.
Upon reading the above bulleted items, most are probably scratching their heads and thinking “Huh.” So, let’s break it down.
First, many users of marijuana and even nonusers, teen and adult alike, do not consider marijuana to be an addictive substance. It’s one thing if the substance in question is accepted as an addictive substance, but the person using it doesn’t believe he or she is addicted to it because of denial.
Given time, patience and a good dose of motivational interviewing, progress can be made and dawn will break over Marblehead.
The problem is compounded when the person not only doesn’t believe the use of a substance is a problem for them, but doesn’t believe it’s a problem for anyone.
Why is it that our friend “Mary Jane” is perceived as so benign? To start with, many people associate addiction with some mythological belief that in order to be addicted, a person goes through a catastrophic withdrawal period sort of like Frank Sinatra in “The Man With The Golden Arm” – locked in a room for three or four days strapped to a bed going through a personal purgatory of nightmarish proportions, writhing in agony, crying out incoherently, the sweat soaking the linens and mattress, a colossal battle with internal demons.
This scenario makes for great Hollywood fodder, but isn’t the rule. Granted, dealing with withdrawal, depending on what substance or substances to which a person is physically addicted, is no picnic; it’s a bit less dramatic.
As to withdrawal from marijuana, the physical symptoms are generally mild. It’s the mental part that presents the most challenges. THC, the active ingredient in marijuana, unlike other addictive chemical compounds, has a long half-life and leaves the system slowly. It’s THC’s lazy journey out of the body that decreases the severity of physical discomfort.
Scientists wanted to see what would happen if they could speed up THC’s journey out of the body. Ph.D.’s figured out a way to make the THC run instead of crawl – kind of like a drill sergeant extolling raw recruits to double time. The soldiers were rats, and when the THC left their little rat bodies quickly, the rats acted like our friend Frank.
So yes, marijuana can and does cause physical addiction, only the physical withdrawal symptoms tend to be milder than, say, withdrawal from stimulants, opiates or alcohol. It’s back to the mental part again.
Another challenge isn’t only explaining the difference between abuse and dependency, but also helping someone understand how what we think contributes quite a bit to what we do and feel.
In working with teens who like to smoke marijuana, the legalization question inevitably comes up. I call it the “LD” – Legalization Debate – only I don’t debate.
It usually goes like this: Just when I’m well on my way to explaining why the mental part is harder to deal with than the physical part, the question is popped, “Do you think marijuana should be legalized?”
When I don’t answer, then these gems usually come out of the mouths of babes: “No one ever died from smoking a joint. God put marijuana on the Earth for us to enjoy. People don’t get violent smoking marijuana,” and so on.
Teens everywhere have the same script, probably written by those wonderful folks at “High Times,” a pro-marijuana publication that advocates for legalization and celebrates the amotivational syndrome brought on by frequent marijuana use.
Teens often don’t know that they don’t know. This double entendre presents another challenge: how to help them become aware of that which they can’t and won’t acknowledge to be so.
What doesn’t work is trying to break down the door of denial. The old-school, get in your face, confront, wear a sign around your neck, proclaim to the world how in denial this person is like trying to put out a fire with gasoline. One doesn’t confront denial, one accepts it for what it is: a defense against perceived harm.
If a kitten is stuck up a tree, you won’t get it down by yelling and telling the kitten how stupid it is for climbing the tree in the first place. The best method for kitten tree extraction is to call a tree service. Then, send up someone who understands cats and can treat the frightened creature gently, earning its trust and help the kitten get to the safety of the ground.
Blame and shame increase resistance. Active listening and genuine caring create trust, which creates opportunities for change.
The next time you’re at work or school, pay attention to how many times people around you use the word need. In fact, pay attention to how many times you use the word need. What’s the point? When we think “need,” the brain doesn’t know the difference between whether it really is a need or if the person mistakenly believes it’s a need.
Let’s define need. A need is something that literally allows us to survive. There are only a handful of literal needs: air, food, water, temperature control.
Thoughts precede feelings and actions. Think you need something or someone, and the resulting feeling and action will seem like a “have to” instead of a “want to.” The difference between the two is simple: A “have to” is being controlled by something outside ourselves and a “want to” is a choice within our control.
This mental part presents the greatest challenge, especially with marijuana. Because the physical withdrawal from marijuana is relatively mild, the irrational belief is that it isn’t addictive. But what does the mind do? It starts to say things like, “I need a joint to get to sleep.” “I need it to have fun.” “I need it to calm down.” The mental list goes on.
Remember, the brain doesn’t know the difference between real and imagined; it responds to the thought with a subsequent action. In the case of drugs, the action is more drug use. Enough use of alcohol or other drugs alters brain chemistry.
Once the alcohol or other drug use ceases for a time, the brain tends to regain its chemical balance. It’s at this point that many users are at risk for relapse because of the irrational thought process that occurs. Teaching teens to challenge irrational thoughts and to understand that they’re in charge of their choices is empowering. Teens can use empowerment in light of how often they feel disempowered in many aspects of their lives.
Your feedback and questions are more than welcome. The next topic will be spirituality and recovery.
Until next time, stay safe out there.
Barry Timmerman is coordinator of substance abuse services at The Youth Council in Nashua. He has been a substance abuse professional for 18 years. Readers with questions may e-mail them to firstname.lastname@example.org. Questions also may be mailed to The Telegraph, Straight Talk with Mr. T, PO Box 1008, Nashua, NH 03061, or faxed to the paper at 882-2681. Timmerman is unable to answer letters individually, but readers with further questions or concerns are invited to contact The Youth Council at 889-1090.
The advice in this column is intended to provide an understanding of chemical dependency issues, but is not a substitute for treatment. It does not reflect the opinions of The Telegraph or The Youth Council, and is in no way a replacement for the services of a licensed professional counselor.
In addition, the youth council is mandated by state law to report any suspicion of child abuse or neglect. Should a letter to “Straight Talk with Mr. T’’ raise such concerns, the agency will report the information to the state Division for Children, Youth and Families or the Nashua Police Department.