The ATTC Network. Clinical Skills in the Era of Legal Cannabis. Clinical Skills in the Era of Legal Cannabis 3/17/2016

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1 Clinical Skills in the Era of Legal Cannabis Jennifer Wyatt, LMHC, MT-BC, CDP Seattle, WA: April 20, 2016 The ATTC Network Ten Regional Centers FourNational Focus Centers SBIRT Hispanic & Latino Native American-Alaska Native Rural & Frontier Two Centers of Excellence YMSM + LGBT PPW This training is provided in partnership with King County. Jennifer Wyatt, LMHC, MT-BC, CDP 1

2 Sign-in sheet Handouts Breaks/lunch Mobile phones Questions Freedom of movement CEUs ATTC Consent forms and evaluations LEARNING OBJECTIVES Participants will: 1.Gain an understanding of the varied forms of cannabis available for consumption 2.Understand rates of use and current research findings on the effects of cannabis on mental and physical health 3.Learn about cannabinoids and their interest to medical science 4.Practice evidence-based clinical skills to talk with clients about cannabis 5.Increase their knowledge of multimedia educational resources INTRODUCTIONS Your name Your agency and position Your hopes for this training Jennifer Wyatt, LMHC, MT-BC, CDP 2

3 NATIONAL SURVEYS: NSDUH, MTF, AND YRBS National Survey on Drug Use and Health (NSDUH) National and state data of people aged 12+ on the use of tobacco, alcohol, illicit drugs, and mental health in the US Monitoring the Future (MTF) Drug, alcohol, tobacco use, and related attitudes of 8th, 10th, and 12th grade students, annually Youth Risk Behavior Survey (YRBS) Examines a minimum of six categories, including alcohol & drug use, sexual behaviors, and physical activity of high school students WASHINGTON YOUTH SURVEYS: HYS & YAHS Washington State Healthy Youth Survey (HYS) Measures health risk behaviors that contribute to morbidity, mortality, and social problems among WA youth in grades 6, 8, 10, and 12. Behaviors surveyed include alcohol, marijuana, tobacco and other drug use; mental health; and other topics. Washington Young Adult Health Survey (YAHS) New survey that monitors the use of cannabis in people aged 18-25, which is when substance use has been shown to peak Other surveys of this age range tend to focus mostly on college students, whereas this sample is broader and diverse juana.pdf As we discuss the numbers on the following slides, think about how they might be useful to you when working with clients. Jennifer Wyatt, LMHC, MT-BC, CDP 3

4 2014 NSDUH: HIGHLIGHTS About 1 in 10 Americans (10.2%) aged 12+ reported using an illicit drug in the past 30 days (27 million people). The illicit drug use estimate for 2014 continues to be driven primarily by marijuana use and the nonmedical use of prescription pain relievers: 22.2 million people aged 12+ were current marijuana users, defined as using one or more times in the past 30 days 4.3 million people aged 12+ reported current nonmedical use of prescription pain relievers Source: Behavioral Health Trends in the US: Results from the 2014 NSDUH Of the 27 million people who reported current illicit drug use on the NSDUH in 2014 MARIJUANA & HASHISH PAIN RELIEVERS TRANQUILIZERS STIMULANTS COCAINE HALLUCINOGENS INHALANTS HEROIN SEDATIVES Millions of people 2014 NSDUH: COMPARING WA AND NATIONAL ADULT USE RATES Current user (Used one or more times in the past 30 days) 60% 60% 59% 58% 56% 50% 40% 38% 36% 30% 20% 19% 29% 28% 24% 22% 22% 20% 20% 10% 6% 11% 0% US AGES WA AGES US AGES 26+ WA AGES 26+ Jennifer Wyatt, LMHC, MT-BC, CDP 4

5 Percentage of current users ages in WA 64% 42% 2014 NSDUH: ADULT USE TRENDS IN WA FROM % 60% Percentage of current users ages 26+ in WA 58% 21% 28% 24% 22% 5% 20% 11% Cannabis Alcohol Cigarettes Cannabis Alcohol Cigarettes 2014 Healthy Youth Survey (HYS) of WA students Current user (Used one or more times in the past 30 days) 35% 33% HEALTHY YOUTH SURVEY: 2014 HIGHLIGHTS 30% 27% 25% 23% 21% 20% 18% 15% 13% 13% 10% 5% 0% 8% 8% 7% 5% 4% 3% 2% 1% 1% 6TH 8TH 10TH 12TH 2013 YRBS & 2014 HYS: COMPARING NATIONAL & WA STATE 12 TH GRADERS Current user (Used one or more times in the past 30 days) 50% 47% 12 45% TH GRADERS: CURRENT USERS 40% 35% 30% 25% 20% 28% 29% 19% 33% 31% 27% 26% 19% 18% 15% 10% 13% 11% 5% 0% NATIONAL-YRBS (2013) HYS-WA (2014) HYS-KING COUNTY (2014) Jennifer Wyatt, LMHC, MT-BC, CDP 5

6 HEALTHY YOUTH SURVEY : TRENDS IN WASHINGTON 12 TH GRADERS 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Current user (Used one or more times in the past 30 days) 43.0% 42.0% 41.0% 40.0% 36.0% 33.0% 23.0% 26.0% 19.0% 22.0% 27.0% 27.0% 20.0% 20.0% 20.0% 20.0% 16.0% 13.0% Cannabis Cigarettes Alcohol Grays Harbor MJ=33% Alc=35% King MJ=26% Alc=31% Whatcom MJ=26% Alc=35% Snohomish MJ=27% Alc=32% Spokane MJ=25% Alc=36% Thurston MJ=28% Alc=32% Pierce MJ=25% Alc=28% Yakima MJ=26% Alc=30% Comparing rates for current 12 th grade users of marijuana and alcohol across 8 WA counties (HYS, 2014) Jennifer Wyatt, LMHC, MT-BC, CDP 6

7 HOW MIGHT DATA BE USEFUL TO YOU IN CLINICAL PRACTICE? ADOLESCENTS WHO USE MARIJUANA ARE AT GREATER RISK OF Risky sexual behavior which can lead to STIsor unplanned pregnancy Academic problems (e.g., dropout, increased absences) Legal problems, delinquency Driving under the influence of MJ more than doubles the risk of an accident Increased likelihood of suffering mental illness such as depression, anxiety, psychosis, or other mental illness Lowered educational and occupational aspirations Budney, Roffman, Stephens, & Walker. (2007); UW ADAI Fact Sheet: Marijuana & Adolescents, The younger they start, and the more NEGATIVE frequently IMPACT an adolescent OF MARIJUANA uses USE marijuana, ON the ADOLESCENTS more likely they are to suffer problems. Jennifer Wyatt, LMHC, MT-BC, CDP 7

8 RISK OF ADDICTION 9% of those who experiment with marijuana will become addicted About 17% for those who start using as teenagers 25-50% among those who smoke daily Source: Volkow et al., NEJM, DSM V CRITERIA FOR CANNABIS USE DISORDERS 11 criteria 1. Using larger amounts, or over a longer time, than intended 2. Persistent desire, or unsuccessful efforts, to reduce/control 3. Spending a great deal of time obtaining, using, recovering 4. Craving, or strong desire to use cannabis 5. Recurrent use resulting in failure to fulfill role obligations at work, school, home 6. Continued use despite persistent social or interpersonal problems exacerbated by the effects of cannabis DSM V CRITERIA FOR CANNABIS USE DISORDERS 7. Important social, occupational, recreational activities given up/reduced because of cannabis use 8. Recurrent use in physically hazardous situations 9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis 10. Tolerance AEB Need for increased amounts to achieve the same effect or diminished effect using the same amount 11. Withdrawal AEB the characteristic withdrawal syndrome for cannabis or using cannabis or a closely related substance to relieve or avoid withdrawal symptoms Jennifer Wyatt, LMHC, MT-BC, CDP 8

9 DSM V CRITERIA FOR CANNABIS WITHDRAWAL A. Cessation of cannabis use that was heavy or prolonged B. Three or more of the following symptoms develop within approximately 1 week after stopping: 1. Irritability, anger, or aggression 2. Nervousness or anxiety 3. Sleep difficulty (e.g., insomnia, disturbing dreams) 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, headache ACUTE (Present during intoxication) Impaired short-term memory Impaired attention & judgment Impaired coordination & balance Increased heart rate Anxiety, paranoia Psychosis (uncommon) Adverse consequences of marijuana use: NIDA Research Report: Marijuana (2015) PERSISTENT (Lasting longer than intoxication, but may not be permanent) Impaired learning and coordination Sleep problems LONG-TERM (Cumulative effects of repeated use) Potential for addiction Potential loss of IQ Increased risk of chronic cough, bronchitis Increased risk of schizophrenia in vulnerable people* Potentially increased risk of anxiety, depression, and amotivational syndrome* *Often-reported co-occurring symptoms/disorders with chronic marijuana use; unclear whether marijuana is causal or associated. VIDEO NIDA Notes: Researchers Speak Dr. Madeline Meier on Marijuana and IQ HYapbE Jennifer Wyatt, LMHC, MT-BC, CDP 9

10 IS THERE A LINK BETWEEN MARIJUANA USE AND MENTAL ILLNESS? Several studies have linked marijuana use to increased risk for mental illnesses, including psychosis (schizophrenia), depression, and anxiety, but whether and to what extent it actually causes these conditions is not always easy to determine. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship (p. 8). NIDA Research Report Series: Marijuana MARIJUANA AND PSYCHOSIS Strongest evidence for the link between marijuana use and psychotic disorders in those with a preexisting genetic vulnerability: AKT 1 gene governs an enzyme that affects dopamine, and altered dopamine signaling is known to be involved in schizophrenia. 3 variants of the AKT 1 gene Daily marijuana users with the C/C variant were 7 times more likely to develop psychosis than infrequent or nonusers of marijuana (Di Forti et al, Biological Psychiatry: 2012). Source: NIDA Research Report Series: Marijuana MARIJUANA AND PSYCHOSIS, CONTINUED COMT gene governs an enzyme that breaks down dopamine. Individuals with one or two copies of the Val varianthad a higher risk of developing schizophrenic-type disorders if they used cannabis during adolescence (dark green bars). Source: NIDA Research Report Series: Marijuana, Jennifer Wyatt, LMHC, MT-BC, CDP 10

11 Clinical Skills in the Era of Legal Cannabis 3/17/2016 Existing studies of prenatal exposure to cannabis have shown that babies respond differently to visual stimuli, tremble more, and have a high-pitched cry, which could indicate problems with neurological development. About 1/3 of THC in the mother s blood is estimated to cross the placental barrier. More research is needed to separate the effects of marijuana from other environmental factors. Source: VIDEO From the ATTC multimedia series titled, Marijuana Lit: Fact-Based information to assist you in providing SUD services Marijuana Use and Pregnancy spx Most people who use marijuana do not go on to use other harder drugs. People who are more vulnerable to using drugs might start with readily available substances, including nicotine, alcohol, and marijuana. Jennifer Wyatt, LMHC, MT-BC, CDP 11

12 FEDERAL STATUS OF MARIJUANA The Administration steadfastly opposes legalization of marijuana and other drugs because legalization would increase the availability and use of illicit drugs, and pose significant health and safety risks to all Americans, particularly young people. Office of National Drug Control Policy: Marijuana WASHINGTON STATE STATUS OF CANNABIS 1998: Medical marijuana approved by I-692 for qualifying conditions May 2015 decision by the WA Supreme Court clarified that this law, Chapter 69.51A RCW, doesn't legalize the medical use of marijuana. It only provides qualified patients holding a valid recommendation and their designated providers with an affirmative defense to criminal prosecution. 2012: Retail marijuana approved by I-502 permitting retail sales of limited quantities of marijuana to adults 21+ beginning Jul 2014 Regulated by the renamed, Liquor & Cannabis Board (LCB) Source: CANNABIS PATIENT PROTECTION ACT (CPPA) Apr 2015: Governor Inslee signed the CPPA Adds MMJ to existing licensing and regulation of all marijuana producers, processors, and retail stores under the LCB Establishes of a medical marijuana authorization database Creates a medical marijuana consultant certification program Effective Jul 2015: PTSD and TBI added as qualifying conditions for MMJ Regulations on authorizations include that: Exams be performed at the practitioner's permanent business location Practitioners who write more than 30 authorizations per month must report the number to the DOH Practitioners may not have a practice that consists primarily of authorizing MMJ Source: Jennifer Wyatt, LMHC, MT-BC, CDP 12

13 CANNABIS PATIENT PROTECTION ACT (CPPA), continued Butane extraction is prohibited unless the person is a processor licensed by the LCB Effective Jul 2016: All MJ producers, processors, and retail stores licensed by LCB All MJ products must be tested for safety and THC/CBD levels, accurately labeled, and sold in child-resistant packaging Retail stores may get a MMJ endorsement Patients and designated providers may be entered to a database by presenting their authorization to a licensed retail store with a MMJ endorsement "Entered" in the database allows the person to purchase 3x the current limits at retail stores without sales tax RCW Driving under the influence (DUI) Within two hours after driving, a THC concentration of WASHINGTON 5ng/mL or higher STATE as DUI shown LAWS by a blood AND CANNABIS test Under the influence, or combined influence of intoxicating liquor, marijuana, or any drug Source: CONTROVERSY SURROUNDING CANNABIS Legality Public Health impact Access by youth Competing information Big business What else? Jennifer Wyatt, LMHC, MT-BC, CDP 13

14 EDIBLES DEFINITION: Inhaling vapors from THC-rich resins, or concentrates, extracted from the marijuana plant Hash oil or honey oil (BHO) Shatter (Typically translucent and sticky) Wax (Typically opaque and dryer than shatter) CONCERNS: Very high in THC (50-80%) ED visits from getting too high FORMS OF MARIJUANA Preparation involves butane FOR (lighter CONSUMPTION fluid) Jennifer Wyatt, LMHC, MT-BC, CDP 14

15 VAPING: Causes the essential oils in the extract to heat up to the point where they become vapors Photo from Grenco Science Jennifer Wyatt, LMHC, MT-BC, CDP 15

16 SIMPLE ANATOMY OF A VAPE PEN Source: Cannabis tinctures and creams Source: Jennifer Wyatt, LMHC, MT-BC, CDP 16

17 Endocannabinoid system Cannabinoid receptors Anandamide 2-AG (2-arachidonoyl glycerol) Source: The Science of Marijuana: How THC Affects the Brain Jennifer Wyatt, LMHC, MT-BC, CDP 17

18 Source: NIDA, Drugs, Brain, and Behavior: The Science of Addiction. VIDEO National Cannabis Prevention and Information Centre (NCPIC): Australia Effects of cannabis on the teenage brain" Check out their Youtube channel for more videos about cannabis VARIED USER EXPERIENCES OF MARIJUANA Pleasant euphoria Sense of relaxation Heightened sensory perception Laughter Altered time perception Increased appetite Anxiety Fear Distrust Panic Acute psychosis (Rare) Source: NIDA Research Report Series: Marijuana, 2015, p. 3 Jennifer Wyatt, LMHC, MT-BC, CDP 18

19 Clinical Skills in the Era of Legal Cannabis 3/17/2016 What do your clients say about why they use marijuana? Cannabinoids in Marijuana THC CBD CBC CBG CBN, CBDL And others Note that these compounds exist in varying percentages; they are NOT equally represented in marijuana. There are varying ratios in certain strains. PSYCHOACTIVE CANNABINOIDS THC CBN CBDL Jennifer Wyatt, LMHC, MT-BC, CDP 19

20 CANNABINOIDS NOTKNOWN TO BE PSYCHOACTIVE CBD CBG CBC Medical marijuanarefers to the whole unprocessed marijuana plant or its extracts Not recognized or approved as medicine by FDA right now Two FDA-approved drugs that contain THC are used to treat nausea (chemotherapy) and wasting disease (AIDS): Dronabinol & Nabilone Source: NIDA: Apr Is Marijuana Medicine? Jennifer Wyatt, LMHC, MT-BC, CDP 20

21 REPORTED SIDE EFFECTS OF THC-ONLY MEDICATIONS Psychoactive effects (High) SIDE EFFECTS OF THC-ONLY MEDICATIONS Short-term memory loss Impaired psychomotor function Dose-related tachycardia (rapid heart beat) When smoked, bronchitis and lung irritation Decreased sperm count in men Source: UW ADAI: Medical Cannabis and Chronic Pain Project: MEDS Dronabinol (Marinol) & Nabilone (Cesamet) ACTIVE INGRED. Synthetic THC APPROVAL STATUS FDA Approved to treat: Nausea and vomiting from chemotherapy Stimulate appetite in AIDS-Wasting Syndrome Sativex (mouth spray) Equal ratio of THC:CBD Approved in the UK, Canada,and other European countries to treat muscle control problems caused by MS InPhase III Clinical Trials in the US to test its safe use in treating cancer pain Epidiolex CBD Undergoingtests in the US for the treatment of twoforms of severe childhood epilepsy. This information should not be construed as medical advice. Source: NIDA: Apr Is Marijuana Medicine? THERAPEUTIC PROPERTIES OF CANNABINOIDS THC (delta-9-tetrahydrocannabinol) CBD (Cannabidiol) Analgesic (Relieves pain) Anti-inflammatory (Reduces swelling, tenderness, or pain) Appetite stimulant Anti-spasmodic (Decreases muscle spasms, particularly in the intestines) Analgesic Anti-inflammatory Anti-convulsant (Controls or prevents seizures) Immunomodulatory (Modifies the functioning of the immune system) Anti-emetic (Treats or prevents nausea or vomiting) Neuroprotective (Protects brain cells from degeneration) Non-euphoriant (Can Muscle relaxant attenuate/modulate THC s Source: UW ADAI: Medical Cannabis and Chronic psychoactive Pain Project: effects) Jennifer Wyatt, LMHC, MT-BC, CDP 21

22 Clinical Skills in the Era of Legal Cannabis 3/17/2016 CBD moderates the psychoactive effects of THC. PRECLINICAL AND CLINICAL TRIALS RESEARCHING HOW CANNABINOIDS MIGHT BE USED TO TREAT Autoimmune diseases: HIV/AIDS, MS, Alzheimer's Inflammation: Rheumatoid arthritis, Crohn s Pain Seizures Substance Use Disorders Mental Disorders Cancer Source: NIDA Drug Facts: Is Marijuana Medicine? Updated April 2015 Jennifer Wyatt, LMHC, MT-BC, CDP 22

23 Mr. Mackey, the School Counselor from South Park, says TREATMENT FOR CANNABIS USE DISORDERS IN ADOLESCENTS AND ADULTS Cannabis use disorders appear to be very similar to other substance use disorders, although to a lesser severity. Adults seeking treatment for cannabis use disorder average more than 10 years of near daily use and more than six serious attempts at quitting. About half of people who enter treatment for marijuana use are under 25 years of age. Budney, Roffman, Stephens, & Walker (2007); NIDA, META-ANALYSES OF WHAT WORKS IN ADOLESCENT SUBSTANCE USE TREATMENT Tripodi et al (2010) looked at 16 studies focused on interventions to reduce adolescent alcohol use and found: Large effect sizes: Brief MI, CBT with 12 steps, CBT with aftercare, MDFT, Brief interventions with the adol, Brief interventions with the adol and parent Medium effect sizes: Integrated family and CBT, behavioral treatment, triple modality social learning, MDFT, Brief interventions with the adol Individual-only interventions had larger effect sizes than family-based interventions, in this meta-analysis Effect sizes decreased after treatment was completed Jennifer Wyatt, LMHC, MT-BC, CDP 23

24 META-ANALYSES OF WHAT WORDS IN ADOLESCENT SUBSTANCE USE TREATMENT Hogue et al 2014 updated the meta-analysis from Waldron & Turner (2008) and classified approaches based on the level of empirical support for their effectiveness: Well-established stand alone treatments: CBT-Group, CBT- Individual, Family Based Therapy-Ecological (FFT, MDFT) Well-established integrated treatments: MET/CBT, MET/CBT + FBT-Behavioral Probably efficacious stand alone treatments: FBT-B, MI/MET Probably efficacious integrated treatments: FBT-E + Contingency Management, MET/CBT + FBT-B + CM AVAILABLE TREATMENTS FOR CANNABIS USE DISORDERS Marijuana Check-up (for adults) and Teen Marijuana Check-up 1 Research-based group and individual treatments Motivational Enhancement Therapy (MET) 2, 3, 4 Cognitive Behavioral Therapy (CBT) 2, 3, 4 Contingency Management (CM) 2, 3, 4 Adolescent Assertive Continuing Care 1, 4 (Follows ACRA) Sources: 1 WA State Institute for Public Policy, Oct 2014; 2 NIDA, 2014; 3 Budney et al 2007; 4 Hogue AVAILABLE TREATMENTS FOR CANNABIS USE DISORDERS Family treatment Multidimensional Family Therapy for Substance Abusers 1, 4 Multisystemic Therapy (MST) 3, 4 SAMHSA Manuals (Available free) Cannabis Youth Treatment Study Volumes 1 5 Brief Counseling for Marijuana Dependence: A Manual for Treating Adults Sources: 1 WA State Institute for Public Policy, Oct 2014; 2 NIDA, 2014; 3 Budney et al 2007; 4 Hogue Jennifer Wyatt, LMHC, MT-BC, CDP 24

25 TALKING WITH PEOPLE ABOUT THEIR USE BE: Transparent Neutral (tone) Inviting A resource Curious Patient Present Ready HOW DO PEOPLE TEND TO RESPOND WHEN THEY ARE OFFERED UNSOLICITED ADVICE OR INFORMATION? Jennifer Wyatt, LMHC, MT-BC, CDP 25

26 MOTIVATIONAL INTERVIEWING TOOL FOR EXCHANGING INFORMATION ELICIT Existing knowledge Interest Permission PROVIDE Affirmations Information one piece at a time Autonomy support ELICIT Reactions Additional questions Next steps Source: Rollnick & Miller, 2013 WHAT ARE WE TRYING TO ELICIT? CHANGE TALK DESIRE I wish I could quit smoking. I want to feel better. ABILITY REASON NEED COMMITMENT ACTIVATION TAKING STEPS I quit before; I can do it again. My PO would get off my back. I might do better in school. I ve got to keep my driver s license. I will stop smoking weed. I am ready to stop smoking weed. I took a different way home. Jennifer Wyatt, LMHC, MT-BC, CDP 26

27 Mobilizing Behavior Change Preparatory Desire Ability Reason Need Commitment Activation Taking Steps COMMUNICATION BREAKDOWN ❶What the Speaker means ❹What the Listener thinksthe Speaker means OARS: REFLECTIONS Reflections Statement, not a question Ends with a downturn Hypothesis testing If I understand, you mean that Affirms and validates Keeps the client thinking and talking As you improve, you can shorten the reflection. Jennifer Wyatt, LMHC, MT-BC, CDP 27

28 ELICIT: ASK PERMISSION. CLARIFY NEEDS. Would you like to know about What do you already know about What information can I help you with? Miller & Rollnick, 2013, p. 139 PROVIDE: PRIORITIZE. BE CLEAR. SUPPORT AUTONOMY. Focus on what the person wants to know. Avoid jargon; use plain language. Offer small amounts, with time to reflect. Acknowledge freedom to disagree/ignore. Miller & Rollnick, 2013, p. 139 ELICIT: ASK FOR THE PERSON S UNDERSTANDING AND RESPONSE. Reflect reactions that you see. Ask open-ended questions. Allow time to process and respond. Miller & Rollnick, 2013, p. 139 Jennifer Wyatt, LMHC, MT-BC, CDP 28

29 SUMMARIZE AND ASK A KEY QUESTION Summarize the conversation, with particular attention to Change Talk. The key question is short and simple: What do you think you ll do? Where does all this leave you? What might be the next step? Be careful not to pressure, or push for commitment. What are you goingto do? What do you think you might do? Miller & Rollnick, 2013, p. 265 VIDEO Motivational Interviewing: Helping People Change, DVD Set, 2013 Interview 7: The Suspicious Smoker Notice howdr. Rollnick engages the client in a discussion about his smoking. Be on the lookout for EPE BEFORE YOU PRACTICE First, the trainer will demonstrate a clinical conversation about cannabis using Elicit Provide Elicit. They will need a volunteer to role play the client. Next, find the handout titled, MI-Adherent Information-Sharing: Using Elicit Provide Elicit. Together, we will identify 2 pieces of information to share with the Jason and Elena. Jennifer Wyatt, LMHC, MT-BC, CDP 29

30 TIME TO PRACTICE! Groups of 3: Client, Counselor, Observer Choose one of the scenarios. Practice EPE. Take your time. Observers: Give feedback. Switch roles until everyone has played the Counselor. How was using EPE different from the usual way of providing information? How might this tool impact your conversations about cannabis use? CANNABIS YOUTH TREATMENT STUDY Field tested the effectiveness of 5 promising adolescent treatments in the largest randomized experiment ever conducted with adolescent cannabis users seeking outpatient treatment Treatments vary in: Length: 6-14 weeks Mode: Individual, group, family Planned number of sessions: 5-23 Results suggested that all five treatments were more effective than current practice Outcomes at one year showed that 2/3 of participants were still having problems. Overall, the interventions were viewed as successful and affordable. Source: UW ADAI Evidence-based Practice for Substance Use Disorders Jennifer Wyatt, LMHC, MT-BC, CDP 30

31 CANNABIS YOUTH TREATMENT STUDY MANUALS Manuals released to the field in 2000 Vol 1: Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT5) Vol 2: MET/CBT12 Vol 3: Family Support Network (FSN) Vol 4: Adolescent Community Reinforcement Approach (ACRA) Vol 5: Multidimensional Family Therapy (MDFT) Sessions 1 & 2 are individual MET: o Personal Feedback report o Goal setting o Functional Analysis Sessions 3 5 are group CBT: o Marijuana refusal skills o Enhancing social support network o Increasing pleasant activities o Coping with unanticipated high risk situations and relapses Sessions 6 12 are group CBT o Session 6: Problem-solving o Session 7: Anger awareness o Session 8: Anger management o Session 9: Effective communication o Session 10: Coping with cravings and urges to use marijuana o Session 11: Depression management o Session 12: Managing thoughts about marijuana Jennifer Wyatt, LMHC, MT-BC, CDP 31

32 Individual MET/CBT Sessions 1-2: Enhancing motivation using the PFR, goal setting, encouraging social support S3: Coping with other life problems S4: Understanding marijuana use patterns S5: Coping with cravings and urges to use S6: Managing thoughts about marijuana use S7: Problem-solving S8: Marijuana refusal skills S9: Elective (Assertiveness, Seemingly irrelevant decisions, Coping with a lapse, or Managing negative moods) WASHINGTON RESOURCES University of Washington Alcohol & Drug Abuse Institute: Medical Cannabis and Chronic Pain Project: WA State Department of Health Cannabis Patient Protection Act rs/healthcareprofessionsandfacilities/medicalmarijuana Cannabis ACLU of WA State: NATIONAL RESOURCES National Institute on Drug Abuse: NIDA for Teens: Marijuana Lit from the ATTC Network: Drug Policy Alliance: Americans for Safe Access (Medical marijuana): Jennifer Wyatt, LMHC, MT-BC, CDP 32

33 RESOURCES YOUR CLIENTS MIGHT BE VIEWING National Organization for the Reform of Marijuana Laws: NORML: Leafly: VIDEO example: Leafly Cannabis 101: What's the difference between Indica, Sativa & Hybrid? High Times Magazine: Cannabis Now Magazine: Youtube.com Social media: Facebook, Instagram, Twitter What caught your attention today? Evaluations Thank you for sharing your feedback on our programming with us! We use this information to improve our services and to share information with SAMHSA about our work. Please complete the Evaluation Form and the Thirty-Day Follow Up Consent Form. Jennifer Wyatt, LMHC, MT-BC, CDP 33

34 Visit Us Online! Upcoming trainings The range of training and technical assistance services we offer Resources and links on key topics Jennifer Wyatt, LMHC, MT-BC, CDP 34