Monday, May 14, 2018

Chronic Marijuana Use and Its Impact on Mental Health: Tips for School Counselors

Monday, May 14, 2018

The end of the year is quickly approaching and part of my job is to push seniors to the finish line.  Since January, I have been pushing one particular senior who is taking an online course with  our virtual campus.  When I speak to him about his course, he is always polite and says the right things; however, he is just not very motivated. When I say he is not motivated, I mean he has not logged into his class in two months and he is supposed to graduate in two weeks. The last time I met with him, he starred at me blankly and said, "Everything is just gray."  Confused and fed up with his empty promises, I decided to go to his school and speak to a former colleague of mine who is working as the assistant principal.  I looked at my colleague and said, "Okay, what is the deal with Chuck (not his real name). We have met with him numerous times, called his mom, offered him times to come in and meet with the teacher, but he is not taking advantage of any opportunities. Is he using?"  She gave me an affirming look and my suspicions were confirmed that he was a chronic marijuana user. 


Mental Health and Addiction

Since May is mental health awareness month, I wanted to share the impact of marijuana on students' mental health and school performance. Although marijuana use is not legal for minors in legalized states, a national report found that students, ages 12-17, believe there are nominal risks for smoking marijuana (for instance some teens believe marijuana makes you a better driver...yikes!). These beliefs have increased marijuana use and the chance for addiction. Many students with addiction to drugs, like marijuana, have a co-occurring mental health disorder and the purpose of their use is to simply alleviate their symptoms (Spotting Signs of Addiction in Students)  The National Institute on Drug Abuse  found that students who smoke have poorer academic performance than nonsmokers.  Medical studies from the New England Journal of Medicine have found that early use of marijuana can impact school progress and ultimately impact functioning of the adult brain. A University of Waterloo study also found that students with prolonged marijuana use had a significant decline in interest to attend an university after high school. Not only does marijuana use negatively impact academic performance, but can affect the mental health of adolescents as well.  The National Institute on Drug Abuse  also reported that marijuana use can increase the risk of psychosis (impaired thoughts and emotions) and schizophrenia (distressing hallucinations and paranoia) among those who who may be genetically predisposed to mental illness.  This fact is displayed in the graphic below...


Source: Di Forti et al. Biol Psychiatry. 2012.

Other negative impacts of chronic marijuana use can include dropping out of school, possible lower wages, unemployment, lower life satisfaction emergency room visits, and even suicide. Unfortunately with the rise of legalization in many states, schools will see more and more students adversely impacted by cannabis misuse. Researchers found that adults who started smoking as teens had “impaired neural connectivity".  In other words, their prolonged use impacted their "memory, alertness, and processing of basic routines." The graphics below show states that have legalized marijuana for recreational/medical purposes and the correlation between legalization and the increasing trend of marijuana use among adolescents.

States That Have Legalized Marijuana
States that have legalized marijuana
Source: Mental Health America

Daily Marijuana Use Increasing



Long Term Trends in Adolescents

Long Term Use Among Students in grade 8-12
With marijuana outselling ice cream in the US in 2017, there should be a real cause for concern for school counselors.  As a school counselor, I often feel overwhelmed and helpless in my efforts to educate and inform students and parents of the real dangers of chronic marijuana use.  Truthfully, I feel that many school counselors don't know what to do so they just don't address the issue.  In this post, I want to give you some practical information of how you can identify chronic marijuana use, how you can help students who chronically abuse marijuana, and provide some helpful resources to share with your colleagues, students, and parents.

First, let's talk about how to identify the signs of chronic marijuana use among teens.  As a school counselor, there are notable signs that may signal possible addiction. These signs include:

  • Change in academic performance; such as a decline grades;
  • Change in social group;
  • Skipping school and tardiness;
  • Decline in overall hygiene;
  • Physical signs such as bloodshot eyes, falling asleep in class, and a lack of responsiveness;
  • Conversations about drugs or getting high;
  • Apathy and feelings of ambivalence.
Although identifying chronic marijuana is important, where do you go from here?  Having the information is one thing, but helping students reduce their chances of addiction and mental health concerns is another.

So, What Can School Counselors Do?

Now that we know marijuana use is on the rise among our students and causes lifelong issues, we must have strategies for working with these students. As a school counselor, we can be the first ones to notice that a student has begun to decline academically and disengage from school.  If you suspect marijuana use, you can educate parents and students about when marijuana use has become problematic.  Mental Health America says that marijuana use becomes a problem "when it interferes with a person's ability to function in their personal and/or professional lives."  Some questions that Mental Health America has provided for marijuana users include...

In the past year have you:
  • Used marijuana in large amounts for longer than intended?
  • Wanted to stop using marijuana, but weren’t successful in attempts to quit?
  • Spent a great deal of time getting, using, or recovering from marijuana?
  • Had strong cravings or urges to use?
  • Failed to perform work, school, or home duties because of marijuana?
  • Continued use despite it causing problems with relationships?
  • Stopped participating in activities you used to enjoy because of marijuana use?
  • Used  marijuana in physically dangerous situations (driving, etc.)?
  • Continued using marijuana despite physical or mental health problems that it has caused or made worse?
  • Developed a tolerance to marijuana (needed more to get the desired effect)?
  • Felt withdrawal symptoms when you stopped using marijuana, possibly using again to relieve your discomfort?
Once identified, how can school counselors help students who have developed chronic marijuana use? When talking to students about addiction, it is easy to get into a moral discussion about consequences and legal repercussions; however, these arguments seldom make a difference in changing students minds. Instead, We Are Teachers,  recommends talking about brain science and long term impacts. The National Institute on Drug Abuse For Teens, provides great information to provide to teens and parents.  This graphic form Chen (2004), gives students a great visual on how marijuana impacts the brain.  Also, I am attaching a video from Dr. Nora Volkow that may be helpful for you to view about how drug addiction impacts the brain.






In addition, here are some tips from Mental Health America that may be helpful in working with chronic users:

  • Keep track of your marijuana use to see if you notice patterns.
  • Be specific with yourself about how you would like to change your marijuana use (how often, when, where, etc.) and your reasons for making changes.
  • Take a month-long break from marijuana. This enables your body to get rid of the drug, reduce tolerance, and get over the discomfort of withdrawal that some people feel when stopping.
  • Identify what triggers the urge to use, and think about what you can do to manage those triggers.
  • Avoid using marijuana before activities that require thinking and remembering, like school and work, or before an important or new challenge.
  • Don’t mix marijuana with alcohol or other drugs.
  • Get immediate help if you are unable to control your use or if you have a medical emergency.
Talking to students about chronic use is not easy.  Therefore, I have attached a list of talking points from The American Academy of Pediatrics that can be helpful for school counselors.  Here is a list of ten points (six for students and four for parents) that you can reference in your conversations.

For Students

  1. Marijuana is not a benign drug for teens. The teen brain is still developing, and marijuana may cause abnormal brain development.
  2. Teens who use marijuana regularly may develop serious mental health disorders, including addiction, depression, and psychosis.
  3. There are no research studies on the use of medical marijuana in teens, so actual indications, appropriate dosing, effects, and side effects are unknown. The only data available on medical marijuana in the pediatric population are limited to its use in children with severe refractory seizures.
  4. Recreational use of marijuana by minors and young adults under the age of 21 years is illegal and, if prosecuted, may result in a permanent criminal record, affecting schooling, jobs, etc.
  5. Never drive under the influence of marijuana or ride in a car with a driver who is under the influence of marijuana. Adults and teens regularly get into serious and even fatal car accidents while under the influence of marijuana.
  6. Marijuana smoke is toxic, similar to secondhand tobacco smoke. The use of vaporizers or hookahs does not eliminate the toxic chemicals in marijuana smoke.
For Parents

  1. You are role models for your children, and actions speak louder than words. So if you use marijuana in front of your teens, they are more likely to use it themselves, regardless of whether you tell them not to.
  2. It is important to keep all marijuana products away from children. As with other medications and toxic products, containers that are child-proof and kept out of reach should be used. For small children, marijuana edibles and drinks can be particularly dangerous.
  3. Remember that intoxication and euphoria are predictable effects of using marijuana products. Being “high” from your own recreational or medical marijuana use may alter your capacity to function safely as a parent or to provide a safe environment for infants and children.
  4. If your child asks you directly whether you have used marijuana, a brief, honest answer may help the child feel comfortable talking with you about drug use issues. However, it is best to not share your own histories of drug use with your children. Rather, discussion of drug use scenarios, in general, may be a more helpful approach.
In addition to education, school counselors may use Motivational Interviewing as a strategy to help adolescents who chronically use marijuana.  Motivational Interviewing is a counseling technique that is instrumental in reducing ambivalence and supporting a commitment to change. This technique is not confrontational and points out discrepancies in thought patterns.  If you are interested in learning more about Motivational Interviewing, check out Reagan North's book for school counselors.




Organizations and Other Resources

Need more information?  There are several organizations that are determined to educate the public about the non publicized side effects of marijuana.  

Organizations:


Let’s Be Clear Georgia – Website that focuses on preventing and reducing marijuana abuse among youth in Georgia. 
Smart Approaches to Marijuana (SAM) – Project SAM provides a breakdown of up-to-date information involving marijuana, such as legalization, public health and cannabis-based medications; fact sheets and talking points; and opportunities to get involved in their efforts.
The Marijuana Report – This site provides fact sheets, infographics and toolkits that detail information on the dangers of marijuana.
The American Academy of Pediatrics – Medical site that includes information about the drug, signs of use and steps parents can take in prevention.

National Institute on Drug Abuse –Provides up-to-date facts on marijuana, including how it is used, how it affects the brain and other health effects on the brain.
Resources: