10/18/2013

1. Marijuana & adolescentsFall adolescent substance use summitsponsored by the Kentucky adolescent substance abuse consortium 10/18/2013

2. Michael Gosser, LCSW, CADCclinical manager of adolescent servicesMGOSSER@THEMORTONCENTER.ORG The Morton Center 1028 Barret Avenue Louisville, KY 40204 502-451-1221

3. 1 in 5… Parents feel there is little they can do about their child’s substance use.

4. Parental Influence • Research consistently shows that parents are central to preventing teen drug use. In fact, kids themselves say that losing their parents’ trust and respect are the most important reasons to not use drugs. • Kids who learn a lot about the risks of drugs and alcohol from their parents are up to 50% less likely to use than those who do not www.timetotalk.org

5. Today’s agenda • Facts about Marijuana • The Brain and the endocannabinoid system • Cannabinoid therapeutics • Marijuana associated risks • Resources • Questions?? (special thanks to Janice Gabe for the information she provided me for this presentation)

6. Marijuana use continues to rise among U.S. teens • Marijuana use among teens rose in 2011 for the fifth straight year. Daily marijuana use among high school seniors is now at a 30 year peak among high school seniors. Source: Monitoring the Future

7. Marijuana use among teens • Of perhaps greater importance is the rise in daily or near daily marijuana use, defined as use on 20 or more occasions in the prior 30 days. The rates of current daily marijuana use rose significantly in all three grades last year, and they rose slightly higher in all three grades again this year (the increases since 2007 are highly significant at every grade level). • Current daily prevalence levels in 2011 are 1.3%, 3.6%, and 6.6% in grades 8, 10, and 12. • "Put another way, one in every fifteen high school seniors today is smoking pot on a daily or near daily basis," said Lloyd Johnston, the principal investigator of the study, "And that's the highest rate that we have seen over the past thirty years—since 1981."

9. CURRENT TREND PATTERNS • The mean age of first use of marijuana in 1966 was 20, in 1976 it was 18.5, in 1987 it was 17.9, and in 1996 it was 16.4. • Variables which most strangely correlate to marijuana use include: - Peer attitudes about marijuana use - Drug use by peers - Frequency of offers to use - Previous drug use - Belief about social consequences - Individual attitudes about use - Belief about psychological consequences of use

10. Marijuana vs. Cigarettes • Marijuana use is now ahead of cigarette smoking on some measures (due to decreases in smoking and recent increases in marijuana use). In 2010, 21.4 percent of high school seniors used marijuana in the past 30 days, while 19.2 percent smoked cigarettes. • Steady declines in cigarette smoking appear to have stalled in all three grades after several years of improvement on most measures.

12. Strategies Combating Myths HeldBy Parents and Adults I. The only problem with marijuana is it is a gateway drug • Complete lack of accurate information regarding impact of marijuana on developing brain • Confusion about medical marijuana. See it as an endorsement of its harmlessness. • Misconception about prevalence.

13. Strategies Combating Myths HeldBy Parents and Adults • Lack of understanding regarding overlap between marijuana and mental health issues. • Don’t know what to do if they wanted to. • Fear of being seen by children as hypocritical. • Belief by professionals that parents will not set limits if they themselves use. • Don’t know what to say except – it’s illegal. • Combat “I did it when I was young.”

14. Strategies Combating Myths HeldBy Parents and Adults • Non-addiction professionals need more information about teen marijuana use. • Believe that marijuana use is something kids grow out of. • Believe that occasional use won’t harm them. • Misinformation about drug laws in other countries.

15. What is the Truth? • Many people, as well as organizations, have widely differing opinions on the benefits and harms of marijuana • ONDCP v. NORML • Anti-Drug Organization v. Marijuana Dispensary • Websites, marijuana user, educator, drug dealer • People often refer to their own (+ or -) experience with marijuana rather than what scientific research has found (and that research has also widely varied) • There is a lot of correct information and a lot of incorrect information out there

16. What is Marijuana? • A plant more correctly called Cannabis Sativa • THC (Delta-9-tetrahydrocannabinol) is the primary psychoactive substance in marijuana • THC directly affects a massive range of neurotransmitters • The Central Nervous System is stimulated when THC activates specific neuroreceptors in the brain

17. The Endocannabinoid system • Located in central and peripheral nervous system • Regulates brain areas involved in physiological, psychomotor, and cognitive effects • Involved in motor behavior, perception, cognition, appetite, pain sensation, mood, memory, immune function, and learning • The only substances that can activate neurotransmitters in the brain are substances that mimic chemicals that the brain produces naturally • Marijuana will stimulate the cannabinoid receptors up to 20x more actively than any of the body’s natural neurotransmitters could

18. Endocannabinoid system response • Tolerance: the need to raise the amount of marijuana one smokes or the need to intensify from low grade (“Reggie”) to high grade (“Dro”) is known clinically as tolerance • The Brain is efficient. As it recognizes that neuroreceptors are being stimulated without the natural neurotransmitters emitting those chemical signals, the brain resourcefully lowers its chemical output so the total levels are back to normal. • Eventually, the brain can cease to produce the chemical altogether, entirely relying on the use of external supplies

19. Cannabis/THC and Cannabinoids • The terms are not interchangeable • Smoked cannabis (marijuana/weed) contains more than 460 active chemicals and more than 60 unique cannabinoids • Many cannabinoids have dose-dependent effects • Cannabis (including “medical marijuana” in dispensaries) is not standardized in dose, potency, or chemical constituency • Smoked marijuana has no FDA indications • Specific issues with smoked marijuana • Non-standardized dosing • Varying ingredients • Smoked delivery

20. What about “Medical Marijuana”? • We are aware of the delicate balance between risk and benefit, even among FDA-approved medications • However, individuals may struggle with these nuances, especially in light of the term “Medical Marijuana” • Many assume that “medical” implies “beneficial” • Many equate “marijuana” with “natural”, which they may in turn equate with “harmless” • Perception is critically important

21. The Negative Effects of Marijuana • Marijuana is Addictive • Marijuana Hurts Bodies and Mind • Marijuana Affects Learning, Academic Achievement, Athletic Performance, and Impairs Driving • Marijuana Today is Stronger Than Ever

22. The Negative Effects of Marijuana • Marijuana is Addictive • As the body stops producing its own natural chemicals, it now need the marijuana user to continue smoking in order to continue the functioning of the brain without interruption. • The body is now ordering the ingestion of the THC, making it extremely difficult to quit • Studies show that marijuana dependency is more powerful than seemingly harder drugs like cocaine (Gold, Frost-Pineda, & Jacobs, 2004)

23. The Negative Effects of Marijuana • Marijuana Affects Bodies and Minds • Cannabinoids stimulate the brain’s nucleus accumbens, affecting the brain’s natural reward centers • Cannabinoids affect the amygdala, which controls emotions and fears • Anger is a defense mechanism used to guard against emotional consequences of adversity fueled by fear. Fear is a primary function controlled by the amygdala, which is heavily stimulated by marijuana use

24. Longitudinal studies indicate a correlation between young adult marijuana use and -- - Schizophrenia: 2 X more likely to experience schizophrenia and psychotic symptoms. • In absence of family history • 2 ½ years earlier onset “There is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life” (Moore et al., 2007)

25. Longitudinal studies indicate a correlation between young adult marijuana use and -- • Depression – 2 to 3 X more likely • Anxiety – panic attacks – suicidal thoughts • If not depressed when they start – 4 X more likely to become depressed • Depressed young adults more likely to become addicted

26. The Negative Effects of Marijuana • Marijuana Affects Learning, Academic Achievement, Athletic Performance, and Impairs Driving

27. Marijuana’s Effects Learning Issues: Significantly impact the ability to process and learn new information, especially higher level concepts. • Poorer performance on thinking tasks, slower psychomotor speed, poorer complex attention, verbal memory and planning ability. • Residual effects can last for up to 24 hours, such as with complex divided attention tasks • Regular marijuana users show an impact for three or more days after use, particularly affecting motor coordination, memory, and learning

28. Marijuana’s Effects Performance Issues: • Slowed reaction time and impaired motor coordination • altered judgement and decision making • impairment of hand/eye coordination • distortion of time and distance Side-note: persons experiencing the influence of cannabis can often “pull themselves together” to concentrate on simple tasks for brief periods of time, but have more difficulty sustaining this focus for long periods or with complex decisions

29. CHANGING ATTITUDES CHANGING ATTITUDES STARTS WITH ADDRESSING OUTDATED OPINIONS ABOUT ALCOHOL AND MARIJUANA USE AMONG TEENS ADULTS NEED TO KNOW THAT: • The problem with marijuana is not that it is a gateway drug • The cognitive impact of marijuana use on the developing adolescent brain is much more significant than on a mature brain

30. ADULTS NEED TO KNOW THAT-CONTINUED • A four year longitudinal study (1995-1998) of 2236 Columbian teens between the ages of 12 and 17 indicated that marijuana use in early adolescents was significantly connected to anxiety, aggression, and decreased functioning in later adolescence and early adulthood. • A ten year longitudinal study of marijuana use among teens in the Netherlands indicated a significant increase in young adult onset of mood disorders, anxiety problems, psychosis, schizophrenia among teens that used marijuana • Kids care more about their brains and their sanity than about their lungs. They need to know that prolonged use of marijuana leads to some of the same brain changes as cocaine and heroin. It impairs their ability to concentrate, retain information, pay attention. • The brain produces internal THC. The purpose of THC is to help regulate mood. When external THC is introduced into the brain, the brain stops producing internal THC. • The earlier the age of onset, the greater the risk for lifetime problems with use patterns.

31. ADULTS NEED TO KNOW THAT – CONTINUED • Teens do go through withdrawal from marijuana. Withdrawal symptoms include headache, sleep disturbances, irritability and agitation. • There is a direct correlation between teen’s perception that their parents approve of alcohol and drug use and seriousness of the adolescents use. • Research indicates that teens who know their parents have used marijuana were significantly more (40%) likely to use marijuana. • If adults do not explicitly disapprove of adolescent drinking and drug use, teens interpret this as approval. • Teens who are allowed to drink during adolescence have more problems with drinking and drug use (not fewer) than teens whose onset of use is college • Recent brain imaging technology shows that marijuana use affects the frontal cortex. The part of the brain which helps with judgment, decision making and impulse control.

32. ADULTS NEED TO KNOW THAT – CONTINUED • Talking to teens about what you think about drug and alcohol use is good, but more effective if this discussion includes an “enforcement component.” • It is not hypocritical to tell your teen that they will not be allowed to use or drink, even if you yourself did use or drink as a teen. • The dare program does not shape their attitudes about drug use. • Young teens that use or drink are typically introduced to this by an older teen, usually a friend’s older sibling. • Adolescent use patterns tend to be influenced by same gender older siblings. • We need to talk to our kids about drug and alcohol use whenever the situation presents itself.

33. CHANGING ATTITUDES • Marijuana is a sneaky drug • Yes, marijuana is a plant. So is cocaine, opium and poison sumac • People may tell you pot is not physically addicting, but lots of people can tell you how hard it is to give up • Is marijuana any worse than alcohol and should it be legal---who cares?

34. BUT I DON’T WANT TO QUIT!Young Adult’s Top 8 Reasons to Keep Using • I like it! • It’s not a problem, I don’t do that much, I can quit any time I want! • I know people who use much worse than I do! • I still want to do it! • I’m still young, I will quit when I get older! • But I know a kid who goes to school high every day and he’s got a 4.0! • I’m still having fun doing it! • I really do have control, I don’t do it that much!

35. The Facts about Marijuana • Marijuana use directly affects the brain, specifically the parts of the brain responsible for memory, learning, attention, and reaction time. These effects can last up to 28 days after abstinence from the drug. • 1 in 10 marijuana users will become addicted to the drug. If one begins before the brain is fully developed, that number rises to 1 in 6. • Marijuana impairs motor coordination and reaction time

36. The Facts about Marijuana • Marijuana use reduces IQ by as much as 8 points among people who started using regularly before the age of 18. • Marijuana use is consistently associated with reduced grades and reduced chance of graduating from school. • Science has taught us more about marijuana in the past twenty years than in the preceding two hundred years.

37. Below is a list of tasks adolescents need to accomplish and ways drug use interferes with those tasks. • Learn to deal with feelings. • Learn to think awesome thoughts. • Learn to entertain yourself. • Develop social confidence. • Learn to develop real relationships.

38. ACCESS AND ATTITUDE GOALS DELAY ONSET REDUCE FREQUENCY REDUCE AMOUNTS ACCOMPLISH THIS BY: MONITOR CLOSE CATCH IT EARLY MAKE A BIG DEAL WHEN IT HAPPENS

39. 5 things you can do to make a difference • Give your son/daughter a clear message that it is NOT okay to drink or use other drugs.  Discuss personal, family, social, legal issues, or values, etc. to give your child reasons to not use. • Arrange to supervise your child as much as possible and know where they are and who they are with (and make sure they are being monitored).  The research suggests that at this early teen age, the times of 2 p.m. until 6 p.m. are peak hours for teen drug and alcohol experimentation and use. • Get to know your child’s friends and their families.  You can help keep each other keep your children safe. • Help your child make a plan for how he/she might avoid or resist both internal and external pressure to use. • Make sure an adult is supervising any party your child attends.

40. CHANGING ACCESS • Limit unsupervised unstructured hang time • Do not allow teens to hang out in homes where parents are not present • Limit overnights • Eyeball teens when they come home at night • Limit exposure of young teens to older teens • Make expectations clear to the teens who visit your house frequently • Network with other parents • Stay present and involved when teens are at your house

41. CHANGING ACCESS - CONTINUED • Closely monitor what teens bring into your house • Monitor for late night visitors and late night escapades (i.e. sneaking out) • Make it clear that if adults serve your child alcohol, you will hold them accountable • Your stance about alcohol and drug use needs to be consistent and not change just because you are some where that there is no drinking age • Let your child know they will be held completely responsible for anything they have in their possession and their friend’s behavior at your home

42. Talking to your child about Alcohol and other Drugs • Tell your son/daughter you LOVE him/her and that you are worried that he/she might be using drugs. • Say that: You KNOW drugs may seem like the thing to do, but doing drugs can have serious consequences. • It makes you FEEL worried and concerned about them when they do drugs. • You are there to LISTEN to them. • You WANT to be a part of the solution. • What you will do to HELP them.

43. THE “W” QUESTIONS • Parents and adults who work with youth should monitor youth activities, but not over react when the adolescent is caught experimenting. Parental monitoring means that parents always ask their adolescent the "W" questions: • Where are you going? • With whom are you going? • What are you doing? • and When will you be home?

44. Resources • The Partnership for a Drug Free America • http://www.drugfree.org/ • Parents: The AntiDrug • http://www.theantidrug.com/ • Teen focused websites: • http://www.checkyourself.com/ • http://www.freevibe.com • http://www.thecoolspot.org • National Clearinghouse of Alcohol and Drug Information • http://ncadi.samhsa.gov/

45. Bibliography • http://www.oas.samhsa.gov/2k2/YouthMJuse/YouthMJuse.htm. MARIJUANA USE AMONG YOUTHS, National Household Survey on Drug Abuse, The NHSDA Report, July 19, 2002 • http://www.oas.samhsa.gov/2k3/newMJ/newMJ.htm. CHARACTERISTICS OF NEW MARIJUANA USERS, National Household Survey on Drug Abuse, The NHSDA Report, January 24, 2003 • http://www.drugstory.org. EXPERTS. RESOURCES. RESEARCH. A PROGRAM OF THE NATIONAL YOUTH ANTI-DRUG MEDIA CAMPAIGN • http://www.oas.samhsa.gov/2k4/Mjsource/Mjsource.htm. HOW YOUTHS OBTAIN MARIJUANA. National Survey on Drug Use and Health. The NSDUH Report. • http://www.personal.com/news/a1998030910.shtml. PERSONALMD, Your Lifeline Online. MORE TEEN GIRLS USE MARIJUANA. • http://www.drug science.org/Petition/C6F.htm. HANSEN: META-ANALYSIS OF ADOLESCENT MARIJUANA USE STUDIES • http://print.info please.com/ipa/A0779154.html. AGE OF FIRST MARIJUANA USE, 1965-1997. Infoplease. All The Knowledge You Need. • http://www.recoverylane.com/news 16.htm. TEEN MARIJUANA USE CAN LEAD TO ANXIETY, DEPRESSION, OR AGGRESSION. NIDA Research News • http://www.chass.utoronto.ca/~haans/misc/inhale.html. LEARNING TO INHALE: A Look at Adolescent Marijuana Use and Social Learning Theory, December 23, 1996, Dave Haans • http://www.oas.samhsa.gov/NHSDA/BabyBoom/chapter5.htm. PREVALENCE AND ASSOCIATION OF MARIJUANA USE AMONG CHILDREN AND PARENTS • HTTP://WWW.OAS.SAMHSA.GOV/nhsda/tREATAN/TREANA17.htm. ADOLESCENT SELF-REPORTED BEHAVIORS AND THEIR ASSOCIATION • http://www.nida.nih.gov/pubs/teaching/Teaching5.html. THE BRAIN & THE ACTIONS OF COCAINE, OPIATES, AND MARIJUANA • http://www.drugstory.org/feature/LATimesArticle.asp. MARIJUANA USE IS PUSHNG TEENS INTO TREATMENT

46. Questions?Feedback?