Archive for the 'Marijuana' Category

Marijuana: Family and advisor responses and recommendations

Mar. 31st 2015

Part II

As emphasized in Part I, it’s important to acknowledge the positive and enjoyable aspects of pot use to establish credibility with young adults. After all, they know many of us older folks smoked in our early days and we did indeed inhale, unlike one of our presidents.

 

However, to reiterate, marijuana’s downside is that repeated use impairs learning and executive/problem-solving brain functions. With many regular users chasing higher THC concentrations (up to 27 percent), being able to identify at-risk and dependent users becomes an imperative. Note that, in contrast, medical marijuana is effective at 9 percent THC in very small quantities (two or three times a day) – one way to identify those truly in need of pain relief vs. those gaming the system.

The survey says

Another important part of any discussion with young adults is putting marijuana use in the context of other substance use, including alcohol.

  • Surveys show within a two-week period, 13 percent of college students had 10+ drinks in one night and 5 percent had 15+ drinks in one night.

Potheads are quick to point out this comparison (binge drinking at 18 percent vs. regular pot use at 9 percent) while also noting the difference in post-use effects – namely no vomiting or hangover. But let’s not fall into the trap of arguing which type of substance is superior. Going down that rabbit hole with Alice (a.k.a. your client, son, or daughter) leads you to a land of never ending rationalizations and justifications.

 

By the way, these drinkers and smokers are two separate groups, so the total for male students with substance use symptomatology is at least 27 percent. Add in the one in nine in 2013 who used Adderall without medical supervision and smaller numbers using other drugs, and you can understand why we keep harping on the fact that this problem can no longer be ignored.

 

A recent New York Times article on 12 hospitalizations due to ingestion of “bad Molly” on the Wesleyan campus led police to discover 600 Xanax and at least 15 other prescription drugs in room searches. Noted one expert at Columbia College:

 

“Where did this kid get such a bizarre collection of drugs? … It’s very frightening, because these drugs can cause fatal reactions.”

 

Great question. The answer is everywhere. This type of use by different groups – the drinkers, smokers, and stimulant freaks – is prevalent on all campuses and upon graduation will either become part of your client base or potential work force. 

Evaluation

Clients come to us suggesting we evaluate a young adult to see if there is substance dependence. But good luck conducting an assessment based on self-reporting. All we hear is minimization and excuses. Reports from concerned family members are rejected as overreactions or one-time “experimental” events. When marijuana comes up for discussion, the attitude is “It’s legal or should be legal.” Without objective external evidence, convincing a young adult to cut back or seek help can be fruitless, particularly if they have access to trust funds or are employed.

 

Be aware that for an evaluation to be accepted in court in our state, at least three outside collateral sources are needed to verify information about the subject’s drug use. Identifying and then even suggesting talking to these collaterals can be contentious, to say the least.

 

As mentioned in Part I, by understanding marijuana’s effect on the body and why people like it, family offices and advisors can tailor an approach that focuses on education, establishes behavioral standards and performance expectations, and puts policy in place for family members.

Recommendations

For the office, drug testing is the most reliable and prudent approach to ensure you are not putting your reputation and fiscal integrity at risk. If a person wants to smoke dope or use other drugs, they can work at a coffee shop, but not for you or the families and clients who rely on you.

 

For your clients, there are two complementary tools: education (scientific advances, including brain scans) and behavioral expectations and standards.

 

Education: the science of brain scans

Showing younger generations how brains of pot smokers compare to the brains of non-smokers is an excellent educational tool. When accompanying accurate information on how weed affects the body – both the fun and unfun sides – scans can be persuasive. Another tactic is to find a respected family program, like Hazelden’s, where teenagers and their parents can learn more about substance dependence and how it is linked to brain changes.

 

Behavioral expectations and standards

Aside from the educational approach, the critical piece has to do with behavioral expectations and standards. Start with solid baseline information on aptitude, skill level, and any learning concerns. Assuming you or the parents you are advising have this information, assess whether there are underperformance or behavioral concerns that warrant evaluating the reason for the differences between expected and actual results. This may require educational or other testing to explain the disparity.

 

As you continue on, it’s necessary to come to an agreement or otherwise establish goals for the young adult in question. It is through a thoughtful goal-setting process with measureable standards that dysfunctional behavior can be identified, particularly if there is some indication drug testing is a necessary part of the process.

 

Note the connection to the Social Impairment diagnostic criteria for substance use disorders:

 

Social Impairment is the second grouping of criteria (Criteria 5-7).

  1. Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home.
  2. The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  3. Important social, occupational, or recreational activities may be given up or reduced because of substance use. The individual may withdraw from family activities and hobbies in order to use the substance.

Setting measureable goals and expectations can provide the factual basis to support findings relating to social impairment, an area of vulnerability for pot smokers. When facts become apparent, it’s a good time to introduce drug testing. Tests can now be justified to parents and families who might previously be concerned about an unwarranted invasion of privacy.

 

present in an alcoholic as you would in someone whose drug of choice is marijuana. For example, take impairment criteria 3 and 10, more common to binge drinkers:

  1. The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects.
  2. Tolerance is signaled by requiring a markedly increased dose of the substance to achieve the desired effect or a markedly reduced effect when the usual dose is consumed.

The people consuming 10-15 drinks in one sitting will have a high tolerance and spend a great deal of time recovering from the effects of doing so. Each drug presents its own set of challenges and impairments. By DSM standards, one is not better or worse than another. Disordered use is disordered use.

Three points

1. Take action or problems will get worse
Don’t let under performing, slacker, next-generation family members meander through their formative years without a plan to investigate drug or learning concerns. (Otherwise they become dependent – in the full sense of the word – 30-, 40- and 50-year-olds.)

  • Of course, this assumes the family office and governance documents contain expectations as to performance.

If not, and each branch handles these issues individually, you will be an observer of the long-term effects of drug use and living proof of affluent “falling generations.”

 

2. The code of silence

Don’t expect siblings, cousins, or friends to blow the whistle on heavy pot smokers (or other drug users or drinkers, for that matter). There is a fierce unwritten code not to rat out substance users.

  • If you do hear something, follow it up because it usually means the person of concern is in way over their head.

However, even if the information is persuasive, you will need to determine if it carries the same weight with the deciders (i.e., parents or grandparents) before you proceed. They will often either be in conflict or more concerned about reputation and succession, and thus eager to shoot down stories from their heir’s friends.

 

3. Cross-addiction

Simplistically, the brain reacts to most drugs in the same way. It doesn’t distinguish between weed, alcohol, coke, and other substances in terms of their addictive nature. So when someone comes out of treatment and says, “They told me I can’t do vodka, but I can have beer and weed,” that’s a lie. Ask them to sign a release so you can see their discharge summary with their diagnosis. This type of misinformation is a lot more common than you would imagine.

Not going away

We hear from our friends in Denver that home prices are skyrocketing due to an influx of younger folks of independent means who seem to be moving in so they can enjoy legal bud. Who knows if this is fact or old folks’ imagination, but what we know is weed is not going away. It’s going to be more pervasive and impactful on communities, including the families we serve and the people we employ. Doing nothing is not an option.

Marijuana: The fun side, the downside, and why family offices and advisors should take note

Mar. 19th 2015

Part I

Fully or partially legalized in many states, a solid majority of teens and young adults believe marijuana should be universally decriminalized, viewing weed as a relatively harmless drug in comparison to alcohol. Its use is widespread among affluent young in high school and college. For example, at one local school I hear students toke up to obtain a better grasp on abstract concepts in their advanced physics class.

 

As of 2013, one in 11 male college students are daily smokers. With marijuana use and acceptance on the rise, we advise diffusing this momentum with facts on how it affects the brain (both positive and negative) and a behavioral-based management strategy.

Why bother worrying?

As pot becomes increasingly legitimized across the country, now is a good time for family offices to get up to speed on the implications for clients and office operations. You might think, “Why bother?”

  • And, indeed, that is a fair question if your approach is to oversee investments, disburse and account for income, advise on estate planning, and leave personal conduct issues up to the individual.

Marijuana can be viewed as just another substance that clients may choose to use as part of their lifestyle. Some regular smokers even tend to be “laid back” and therefore less time-consuming and demanding compared to other clients.

When it becomes a problem

Conversely, other regular smokers may be more difficult to deal with in family meetings.

  • They ask disruptive questions and go off on tangential trains of thought.
  • They are susceptible to harebrained investment schemes, being easily talked into being the deep-pocket “lead partner” to show their family they can be successful – despite being chronically high.
  • You may also have unhappy grandparents when they discover their beloved granddaughter is moving to Colorado to raise goats after they “invested” several hundred thousand in her private school education.

So identifying the source of this behavior, understanding what marijuana does to a user and why so many find it so appealing may be helpful in responding to these unhappy senior family members. If your office or family leadership is also concerned about encouraging young adults to develop competitive skill sets and lead productive lives, as well as avoiding addictive behavior patterns, then I suggest you read on.

Consuming THC – the delivery system

THC is marijuana’s primary psychoactive ingredient. Levels today can exceed 25 percent, as compared to 3 percent in the ’90s. And as users ingest higher concentrations of THC at more frequent intervals, the chances of addiction and other disorders increases. In addition, there are many other psychoactive chemicals (cannabinoids) that are fine-tuned through plant breeding to create different strains to increase potency and appeal to consumer tastes.

 

Note that CBD and related cannabinoids are cultivated for their medicinal properties, lack any noticeable psychoactive affects and are generally sold in pills or other edibles. Exception: Pot for treating pain has THC, one reason why so so many young adults carry generalized pain diagnoses in medical marijuana states.

 

There are four stairways to heaven:

 

Burning: pipe, joint

  • Hits the lungs in minutes, lasts about two hours, but is an irritant.

Vaporizing

  • Solves the irritation problem and is hard to detect. Oil can go into an e-cig chamber.

Eating

  • THC is processed through the liver, resulting in a delayed high.

Dabbing

  • Placing concentrated hash oil against a heated surface and inhaling the smoke. These extracts have up to 90 percent THC levels and result in a rapid and very intense high.

Brain scan information[i]

From brain scans, we now have a good understanding of how pot affects various areas of the brain and the ensuing feelings:

 

In your brain:

  • Basal Ganglia: Controls many of the brain’s reward system, the part that makes you feel high
  • Amygdala: Responsible for paranoia and anxiety in smokers
  • Hypothalamus: Gives stoners time warp and munchies
  • Hippocampus: Pot mimics a temporary brain lesion, which is why smokers can’t recall so much of their high
  • Cerebellum: Nexus of motor control, especially coordination and timing, becomes sluggish under effects of cannabis
  • Brain Stem: Charged with autonomic functions like breathing and heart rate, devoid of cannabinoid receptors, which is why virtually no one fatally overdoses on pot

The last fact, that THC does not lead to overdoses, is one reason why potheads believe weed is far superior to alcohol.

 

In your mind:

  • Euphoria: The brain’s reward circuit kicks into action and intensifies feelings – usually a pleasurable experience.
  • Dysphoria: Opposite effect, for those already anxious, fearful, or worried about the increasing heart rate. Reported by 40-50 percent of users.
  • Distortion Perception: THC’s affect on the amygdala and release of dopamine induces state of absorption, can make things more vivid, and result in sound and visual distortions.
  • Time Lag: THC speeds up internal clocks so stoned people overestimate how much time has passed while high.
  • Memory Impairment: Short-term memory affected due to neural interactions and modifications.

Oh, to be back in college, or not!

 

Similarly we, have a good understanding of the physiological impact on the body:

  • Dry/cotton mouth: Lagging salivary gland response time slows the secretion of spit.
  • Bloodshot Eyes: With lowered blood pressure, capillaries in the eyes widen and blood fills the void. Dilated pupils can also make it difficult to focus on nearby objects.
  • Increased Heat Rate: In as little as 10 minutes, heart rate can spike to 160 and stay elevated for a few hours.
  • Drowsiness: THC can interfere with REM and stage-four sleep for up to five days.
  • The Munchies: Causes the hypothalamus to produce enzymes that increase hunger and messages that let your body know you’re full.

THC is stored in fat cells and is released into the blood stream for two to four weeks or more, depending on amount and intensity of prior use – one reason why professional athletes flunk drug tests while in training camp.

Have a real conversation

The best way to have a real conversation about pot is to acknowledge what’s good about getting high: It lubricates social interactions, dissipates boredom and stress, and enhances perception and euphoria. Just saying it’s all bad does not resonate with younger people and causes most to end the conversation or stop listening to the lecture.

 

For some, the not-so-good aspects include amplified anxiety, lack of motivation, and expense. Allowing people to express these experiences while also talking about the enjoyable aspects helps take the conversation to a deeper, more nuanced level.

 

For regular users, one in six teenagers and one of 11 adults become substance-dependent, with many adolescents seeking help when psychosis takes hold. With the brain developing into the mid-20s, young people who smoke early and often are more likely to have learning and mental health problems due to structural changes in the amygdala (processing memories and emotions) and the nucleus accumbens (decision-making and motivation).

 

As one expert, Dr. Hans Breiter, noted:

 

If I were to design a substance that was bad for college students, it would be         marijuana.”

 

It’s also bad for office staff as THC can impair focus, working memory, decision-making, and motivation for about 24 hours. Not exactly the qualities family offices and advisors are specifying in their job descriptions.

 

As with alcohol, moderate marijuana use among young adults might be professionally and socially acceptable. But its side effects and legality call into question how families and family offices should treat it. So as recreational marijuana use becomes legalized, de facto legalized or decriminalized in more states, it’s crucial for families and family offices to be proactive when dealing with their psychoactive offspring and clients. In Part II, we’ll talk more about how to go about this and what approaches and policies are most effective, including education and setting behavioral standards and performance expectations.

 

[i] The following information on the science of the weeds impact on the body is taken from a December 2014 article in New York Magazine titled “Your Grandmother’s Guide to Pot.”