ENGAGING YOUTH & FAMILIES

IN CANNABIS TREATMENT

SERVICES

Nancy K. Hernández, MSW & Jackie Agboke, LCSW

January 28, 2019

LEAH Conference

Disclaimer

The Substance Use Prevention and Treatment Program has no relevant financial relationships with the manufacturer(s) or any commercial product(s) and/or provider of commercial products or services discussed in this CME activity.

We do not intend to discuss unapproved/investigative use of commercial product(s)/device(s) in this presentation.

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Learning Objectives

• Describe the key factors in determining if

cannabis is problematic for a young person.

• Identify how cultural factors can facilitate or

pose barriers for treatment engagement

• List 2 innovative strategies for engaging and/or

retaining youth and families in treatment.

• Develop empathy for young people who may be

reluctant to enter treatment.

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Basic Cannabis Facts

• Consumption Method: • Smoked in small pipes, rolled in cigarettes, bongs, edibles, vapes

• Cannabis Street Names: • blunt, dope, ganja, grass, herb, joints, Mary Jane, pot, skunk, yesca,

hierba, mota, juana, juanita and others

• Potential Consequences: • Euphoria • Slowed Thinking • Confusion • Impaired balance • Frequent respiratory infection • Panic attacks • Impaired memory and learning • Increased heart rate

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Forms of Cannabis

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• Wax (Hash Oil)

– Psychoactive chemicals extracted from cannabis plant with butane

– 3 or 4 times as potent as cannabis plant

– Known as dab/dabbing

• Spice or K2

– Herbal and chemical mixtures that produce experiences similar to marijuana

– The 5 most common active chemicals in synthetic marijuana are now illegal in the U.S.

Medical Marijuana, ATTC,UCLA Integrated Substance Abuse Programs, Freese, PhD

Cannabinoid

Hyperemesis

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• “Overdose” means over

the suggested amount

• It is rare & some of the

symptoms are:

– Marijuana induced

psychosis

– Rapid heart rate,

increasing the risk of

heart attack

– Hallucinations

– Mental confusion

– Panic attacks

– Extreme paranoia

• Severe cyclic nausea and

vomiting, dehydration

• Abdominal pain lasting hours

• Relief of symptoms with hot

showers or baths and

cannabis cessation for

minimum of 5 days.

• Some people with syndrome

may not be diagnosed for

several years

Marijuana

Overdose

Prevalence of Use

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• Marijuana first time use in 2017: – 1.2 million youth in the

12-17 age group. Average of 3,330/day.

– 1.3 million young adults in the 18-25 age group. Average of 3,600/day. (SAMHSA, 2017)

SAMHSA, 2017 National Survey on Drug Use and Health

• 20% of young adults 18-25

report using MJ in the past 20

days (Campbell, et al., 2016)

• High school seniors who

perceive MJ use as harmful

has decreased from 52% in

2009, to 32% in 2015.

(Campbell, et al., 2016)

SAMHSA, 2017 National Survey on Drug Use and Health

Contextual Assessment of Substance Use

• Expectations of use (e.g., relaxation, better social interactions, sleeping better, etc.)

• Internal triggers for use (e.g., emotions, thoughts, withdrawal, craving, etc.)

• External triggers for use (e.g., people, places, seeing needles, music, etc.)

• Immediate reinforcers (e.g., escaping or feeling relaxed or high)

• Positive aspects of use (e.g., make friends, be "cool", feel good, etc.)

• Negative aspects of use (e.g., expense, hangover, interpersonal problems, etc.)

• High risk or marginalized populations (e.g., LGBTQI youth, homeless youth, incarcerated youth, immigrant youth)

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Substance Use Disorders in Youth vs. Adults

•Are undergoing rapid developmental changes that may mimic or exacerbate substance effects

•Are more likely to have co-occurring problems (e.g., depression, family disruption, academic problems, problem behavior/deviance, low level conventionality, peer drug use)

•“Outgrow” patterns of use/abuse without intervention more often

•May be less amenable to confrontational/denial approaches (due to developmental independence and autonomy issues)

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https://vimeo.com/191398666

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Therapy with Historically Marginalized

Communities

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LGBTQI, Immigrant, Criminal Justice-Involved, Expectant and Teen Parents, and Homeless Youth

Trauma-Informed

Mindful of Different Learning,

Processing, and Communication

Styles

Welcoming to All

What are some issues that come up that are unique/different in

marginalized populations?

Proposition 64

• On November 8, 2016, California passed The Control, Regulate and

Tax Adult Use of Marijuana Act (Prop 64).

• Decriminalizes the personal possession and use of marijuana.

• Permits adults 21 years of age and older to possess up to 1 oz. of

marijuana and grow up to six marijuana plants inside their home

for recreational use.

• Individuals between 18-21 years old can be charged with either a

misdemeanor or infraction as a result of possession or use

• Individuals under 18 years old can be charged with an infraction in

addition to mandated substance use counseling and community

service

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https://post.ca.gov/proposition-64-the-control-regulate-and-tax-adult-use-of-marijuana-act

Prop 64 and youth

• Diversion Court/Schools

– 4 or 8 hours of counseling/education

– Community service

– Fine

What if the youth doesn’t have a SUD?

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Ask yourself….

• What is problematic use?

• What is the difference between high risk and low risk use?

• How do you think MJ affects adults and youth differently?

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Strategies

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Motivational Interviewing

Groups

Restorative Practices

Seeking Safety Safety First

Cognitive Behavioral Therapy

Interdisciplinary Care

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Practice skills,

don’t expect

perfection

Develop skills

Build rapport,

provide

information,

address other

needs

Explore ambivalence

Stages of Change

17 https://mindyourmind.ca/sites/default/files/images/gallery/Addiction-Continuum_0.jpg

Motivational Interviewing (MI)

• Motivational interviewing (MI) is a form of

collaborative conversation for

strengthening a person’s own motivation

and commitment to change.

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Motivational Interviewing

“MI with someone is like entering their home. One should enter with respect, interest and kindness, affirm

what is good, and refrain from providing unsolicited advice and rearranging their furniture.”

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Partnership

Acceptance Compassion

Evocation

Spirit

of MI

Motivational Interviewing

• Express Empathy – “Sounds like you had a difficult day”

• Develop Discrepancy – “Part of you really likes partying but you don’t like the hangovers”

• Roll with Resistance – “So, you don’t think your PO is on your side”

• Support Self-Efficacy – “You were able to cut down and feel clear headed using your plan”

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OARS

● Open-ended questioning

● Affirming

● Reflective Listening

● Summarizing

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Open Ended Questions

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Open-ended questions begin with:

How…?

What…?

Tell me about...

Describe...

Close-ended questions begin with:

Have/had/has…?

Which…?

How many…?

Did/do/does…?

Is/are…?

When…?

Affirmations

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Focused on attributes or achievements of individual

Intended to: ● Affirm what is good

● Support person’s persistence

● Encourage continued efforts

● Assist person in seeing positives

● Support individual’s proven strengths

https://www.wikihow.com/Validate-Someone%27s-Feelings#/Image:Teens-Flirt-in-Cafeteria.png

Reflective Listening

We are listening

to understand,

NOT to diagnose

and fix a problem,

which is how

many interactions

with adults are

oriented

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Summarizing

Summarizing, which may also include paraphrasing, is the skill that will help the provider and the client move through a session to transitions & closure. 1. A collective summary—“So let’s go over what we have talked about so far.” 2. A linking summary—“A minute ago you said you wanted to talk to ……Maybe now we can talk about how you might try …..” 3. A transitional summary—“So you will make an appointment today before you leave and maybe we will see you again soon.”

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Let's Practice!

Why Safety First?

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Safety first Safer use Managed

use Abstinence

• “Meet them where they’re at”

• Youth autonomy, provider as the guard rails

• Youth defines the goals, provider refines them in collaboration.

Safety First: Points of Intervention

• What they use- choice of substance(s)

• Mode of use- smoking, snorting, injecting?

• With whom

• When

• Where

• How much

• State of mind prior to use

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Safety First: Establishing Goals

•Clarify pros and cons of use – Decision tree

•Inquire about client’s priorities in treatment

•Identify with client safety issues related to use and safer ways to use

•Brainstorm options for reducing that particular harm.

•Present general suggestions in non-judgmental manner

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Developing Empathy for Young People

• Make that connection!

• Build a relationship

– Listen for change talk

– Affirm positive goals

– Listen to youth not to respond, but as a medium of getting to

know them

– Believe them

• Team work

32 https://uwsimcoemuskoka.ca/youth-united/

Let's Practice!

Youth Voice

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Groups

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Our Program: SUPT

• At the Division of Adolescent and Young

Adult Medicine (DAYAM)

• At-Risk and Treatment services for youth

and young adults ages 12-25

• Walk-in clinic on Tues., 8:30am – 11:00am

• 5000 Sunset Blvd. 7th Floor, Suite 701, LA,

CA 90027

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Resources

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• CHLA SUPT (323) 361-2463

References

• Campbell CI, Sterling S, Chi FW, Kline-Simon AH. ( 2016). Marijuana use and service utilization among adolescents 7 years post substance use treatment. Drug Alcohol Depend, 168, 1-7.

• D'Amico, E. J., Houck, J. M., Hunter, S. B., Miles, J. N., Osilla, K. C., & Ewing, B. A. (2014). Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes. Journal of consulting and clinical psychology, 83(1), 68-80.

• Foster, K. T., Li, N., McClure, E. A., Sonne, S. C., & Gray, K. M. (2016). Gender Differences in Internalizing Symptoms and Suicide Risk Among Men and Women Seeking Treatment for Cannabis Use Disorder from Late Adolescence to Middle Adulthood. Journal of substance abuse treatment, 66, 16-22.

• Schwartz, S. J., Unger, J. B., Baezconde-Garbanati, L., Zamboanga, B. L., Lorenzo-Blanco, E. I., Des Rosiers, S. E., Romero, A. J., Cano, M. Á., Gonzales-Backen, M. A., Córdova, D., Piña-Watson, B. M., Huang, S., Villamar, J. A., Soto, D. W., Pattarroyo, M., … Szapocznik, J. (2015). Trajectories of cultural stressors and effects on mental health and substance use among Hispanic immigrant adolescents. The Journal of adolescent health : official publication of the Society for Adolescent dicine, 56(4), 433-9.

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