Marijuana: Family and advisor responses and recommendations

31/03/15 4:52 PM

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.

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