Chapter 13 - Treatment of Regular Heavy Marijuana Users

Summary

Every clinician encounters patients compromised by marijuana, whether fully addicted or not and whether recognized by the individual or not. While adult heavy users usually seek help themselves (often in response to a partner’s pressure or for reasons seemingly unrelated to marijuana use), the parents of heavy adolescent users usually make the initial contact. The Cannabis Youth Treatment Study (CYT) demonstrated that several manualized brief treatment protocols have similar, but limited, success treating adolescents and recommended greater focus on long term monitoring and care. Although CYT established an evidence base for treatment, it was unable to evaluate the skill of individual therapists to engage patients and develop mutual ground for discussion. A motivational interviewing (MI) framework is presented emphasizing engagement and nonjudgmental exploration of patients’ experience and attachment to marijuana. The clinician’s curiosity about each individual’s favorite subjective experiences when high is used to discuss explanations for marijuana’s effects. Scientific information paves the way for introducing the concept of downregulation and potential negative side effects that create cognitive dissonance. The goal is to avoid evoking defensiveness and to help patients struggle with their own internal doubts about marijuana’s ability to help reach their life goals.