07 Jun Treating Teen Marijuana Use
With all the recent news stories about medical marijuana clinics, the number of states allowing access to medical marijuana, the push for legalization or decriminalization of marijuana, it might be tempting to think that marijuana is not really that bad, in the scheme of things, not really addictive or harmful at all. That would be a mistake. There are consequences to marijuana use and, while it may not approach that of hard drugs like heroin or methamphetamine use, the effects are still cause for concern – especially among teens. Parents and concerned caregivers take note: There is effective treatment for teen marijuana use.
How Big is the Problem?
Marijuana is the most frequently used illegal drug in America, and has been for decades. It is also the number one drug of choice for millions of U.S. teens. While parents may find the statistics of teen marijuana use startling, the prevalence remains fairly consistent across numerous studies. In one recent study of 11,426 teens, one-quarter (25 percent) said they had already smoked marijuana, 13 percent had smoked it during the previous month, and 6 percent had smoked cannabis more than 4 times in the previous month.
In a press release (http://www.monitoringthefuture.org/pressreleases/09drugpr.pdf) about the results of the 2009 Monitoring the Future Study (MTF), researchers pointed out that teen marijuana use has been increasing gradually over the past two years, following years of declining use. The MTF has been tracking drug use among U.S. teens since 1975. Each year, about 50,000 8th, 10th, and 12th graders are surveyed (12th graders since 1975, 8th and 10th graders since 1991).
Lloyd Johnson, the study’s principal investigator said that while marijuana use isn’t up dramatically, the trending upward stands in sharp contrast to nearly a decade of declines. More troubling are attitudes and perceptions. “Not only is use rising, but a key belief about the degree of risk associated with marijuana use has been in decline among young people even longer,” says Johnson, “and the degree to which teens disapprove of use of the drug has recently begun to decline. Changes in these beliefs and attitudes are often very influential in driving changes in use.”
The 2008 National Survey on Drug Use and Health (NSDUH) (http://www.oas.samhsa.gov/NSDUHlatest.htm) shows that of the 2.2 million recent initiates to marijuana in the past year, most (61.8 percent) were under the age of 18 at first use. Among youths aged 12 to 17, an estimated 5 percent had used marijuana for the first time within the past year.
Factors that Increase Risk of Teen Marijuana Use
Experts have identified the following factors that increase the risk that teens will begin using marijuana:
• Poor family relationships
• Household access to marijuana
• Poor school experience
• Low self-esteem
• Lack of (or little) religious identity
• Fear of dying
• Working more than 20 hours per week
• Poor grades
Potency of Marijuana Increases
Marijuana that is available in the U.S. today is much more potent than cannabis in the 1970s, according to research. Today’s levels of tetrahydrocannabinol (THC), the main ingredient in marijuana (of more than 170 different compounds), is nearly 9 percent today, compared to less than 1 percent in the 1970s. Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), has been quoted (http://jcctcc.wordpress.holton.k12.ks.us/adults-and-parents-heads-up/er-visits-for-teen-marijuana-use/) as saying, “Marijuana is not a benign drug. Marijuana can be addictive: it interferes with brain functions, like learning and memory. And it may pose a threat to the health and well-being of children and adolescents at a critical point in their lives – when they are growing, learning, maturing, and laying the foundation for their adult years.”
Negative Effects of Marijuana Use
The increased potency of marijuana available today carries with it increased risk of negative effects in the users. In other words, marijuana use by teens is far from harmless, even in small quantities. Some of the negative effects of teen marijuana use include:
• Increases in blood pressure and heart rate
• Increased risk of heart attack
• Increased tendency toward depression
• Impaired judgment and reduced coordination
• Problems with memory and learning
• Distortions in perception (sights, sounds, smells)
• Addiction – Not everyone who smokes marijuana will become dependent or addicted to the drug. But when someone feels they need to smoke it in order to feel better, to escape from their problems, to avoid tasks or responsibilities, they are said to be dependent on or addicted to it. In addition, frequent, heavy users of marijuana develop a tolerance to the drug. This means they require more of it and more often in order to achieve the same high or the same results they used to get from smoking smaller amounts. It is important to note that people can become emotionally and mentally addicted to marijuana. Getting the drug, so-called drug-seeking behavior, becomes all they think about. Their days are consumed by thoughts of, cravings for, and use of, the drug. This is classic addiction.
• Damage to brain cells – THC disrupts nerve cells in the brain where memories are formed. This makes it harder for someone who uses marijuana to recall recent events and also makes learning more difficult. Short-term memory is thus affected in learning or performing tasks that require more than 1 or 2 steps. In terms of long-term damage, researchers know that chronic marijuana use over a period of years takes its toll on the brain’s functioning. The extent of the long-term damage of marijuana use on the brain is still being studied.
• Lung and other respiratory problems – Studies show that people who smoke marijuana tend to have the same type of breathing problems that cigarette smokers do. These include frequent coughing, phlegm accumulation in the throat and chest, wheezing, and more chest colds than non-smokers.
• Compromised immune system – Studies of animals have found that THC can damage cells and tissues that protect from disease.
• Reproductive system difficulties – Heavy marijuana use can affect the reproductive systems of both males and females. The effects of THC could cause delayed puberty in males, and, in females, the drug may disturb the monthly cycle (menstruation periods and ovulation).
• Cancer potential – Scientific evidence is inconclusive whether marijuana can cause cancer, but marijuana smoke does contain many of the same – and sometimes more – cancer-causing chemicals as smoke from cigarettes. Studies have shown that someone who smokes 5 joints per week may take in as many cancer-causing chemicals as a person who smokes a pack of cigarettes daily.
• Increased risk of schizophrenia – Among persons with underlying substance abuse and mental disorders, the risk of schizophrenia (or other mental disorders) may increase with chronic, long-term cannabis use. Researchers are exploring the connection between co-occurring disorders (substance abuse and mental disorders) and marijuana use.
Marijuana usage, especially chronic, has other short- and long-term effect on teens. These include the way they are able to perform in a variety of settings. Marijuana use affects how they perform at school, at work, in extracurricular activities, sports, and other social interactions, and how they interact with parents and other family members. Since marijuana smokers tend to display reduced motivation and increased apathy, they are less likely to be on time for work, school, or appointments, and are more likely to show a lack of interest, enthusiasm or diligence in doing well at school or other activities.
Signs of Marijuana Use
Parents may fear prying into their teens’ lives, but it is important for parents and other caregivers to be on the lookout for telltale signs of marijuana use. Certainly the combination of several of the following signs should be cause for concern:
• Red, bloodshot eyes
• Smell of sweet-type smoke on the person and clothes
• Loss of interest in activities once enjoyed
• Signs of depression
• Changes in eating/sleeping patterns
• Drug-using paraphernalia (cigarette rolling papers, bongs, marijuana plants, roach clips)
Treatment for Teen Marijuana Use
Depending on how severe the marijuana use, parents may opt for outpatient or private counseling in lieu of a residential treatment facility. About 16 percent of the admissions to U.S. treatment facilities are for marijuana use – and most are males between the ages of 15 to 19. Whichever type of treatment facility is used, the important point is to get help for teen marijuana use and abuse – before it leads to a chronic behavioral pattern that can have life-long negative impact.
Local treatment programs can be very effective in helping teens to overcome marijuana use. Among the most effective are programs such as adolescent community reinforcement approach (A-CRA), motivational enhancement therapy (MET)/cognitive behavioral therapy (CBT)/, and multidimensional family therapy (MDFT). These are evidence-based, scientifically-tested approaches to treating substance abuse as identified by the National Registry of Evidence-Based Programs and Practices (NREPP) of the Substance Abuse and Mental Health Services Administration (SAMHSA).
• Adolescent Community Reinforcement Approach – A-CRA is a behavioral intervention that seeks to replace environmental contingencies that have supported drug or alcohol use with prosocial behaviors and activities that support recovery. This outpatient program targets youth aged 12 to 22 years old and DSM-IV cannabis, alcohol, and/or other substance use disorders.
o A-CRA guidelines comprehend three types of sessions: Adolescents alone, parents/caregivers alone, and adolescents and parents/caregivers together
o After assessment of the youth’s needs and self-assessment of happiness in multiple areas of functioning, therapists choose from 17 A-CRA procedures to address areas such as: communication skills, problem-solving skills to cope with day-to-day stressors, active participation in prosocial activities to help the youth improve life satisfaction and eliminate substance use and alcohol problems. Role-playing and rehearsal are a critical component of A-CRA procedures, particularly in relapse prevention and communication skills training.
• Motivational Enhancement Therapy/Cognitive Behavioral Therapy – Sometimes combined under Family Support Network (FSN), an outpatient substance abuse treatment targeting youths aged 10 to 18, FSN includes a family component along with a 12-session, adolescent-focused cognitive behavioral therapy, known as Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), and case management. Note that there are various CBT program lengths (5, 12, etc.).
o The family component engages adolescents and their parents in a joint commitment to the treatment and recovery process.
o The MET/CBT12 component includes 2 individual MET sessions to explore youth’s ambivalence about changing substance abuse behaviors and 10 CBT sessions that teach specific cognitive behavioral skills. These skills include how to refuse cannabis, solving problems, anger awareness and management, how to deal with criticism, managing depression, how to cope with cravings, planning for an emergency, managing thoughts about marijuana, building a better social network, engaging in activities unrelated to drug use, and coping with relapse.
• Multidimensional Family Therapy – MDFT is a comprehensive and multisystemic family-based outpatient or partial hospitalization (day treatment) for substance-abusing adolescents – as well as adolescents with co-occurring substance abuse and mental disorders, those at high risk for continued substance abuse and other problem behaviors such as delinquency and conduct disorder. By working with the individual youth and his or her family, MDFT helps the young person to develop more effective skills in coping and problem-solving for better decision-making, and helps the family to develop better interpersonal relationships and functioning to protect against substance abuse and related problems. MDFT is delivered in 60- to 90-minute sessions over a flexible series of 12 to 16 weeks. The manual-driven intervention consists of specific assessment and treatment modules that target four areas of social interaction:
o The youth’s interpersonal functioning with parents and peers
o The parents’ practices of parenting and level of adult functioning independent of their parenting role
o Interactions of parents and adolescents in therapy sessions
o Communication between family members and key social systems (for example, school, mental health, child welfare, and juvenile justice)
What About Medications to Treat Marijuana Use?
There are currently no medications that have been approved by the Food and Drug Administration (FDA) for the treatment of marijuana use, dependency or addiction. At this time, treatment consists of multidisciplinary counseling approaches, as listed above.
There is hope, however, following recent discoveries in pharmacology, that scientists may be able to develop a medication that will block the intoxicating effects of THC to the brain’s reward center. If so, such medication may prove useful in helping to prevent relapse by limiting or reducing the drug’s appeal (if there is no reward, drug use is curbed).
The best approach to finding treatment is to use the SAMHSA’s Substance Abuse Treatment Facility Locator. SAMHSA also operates a toll-free referral helpline at 1-800-662-HELP.
Remember, there is help available for teens who use or abuse marijuana. The sooner treatment begins, the better the chances of successful recovery.
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