ADDRESSING MARIJUANA USE ON CAMPUS IMPROVING INTERACTIONS CAMPUS: IMPROVING INTERACTIONS AND INTERVENTIONS WITH STUDENTS

Lisa Laitman MSED, LCADCDiane Fedorchak MEDa e edo c a M

ACHAJune 2, 2011

The Hash MarijuanaThe Hash Marijuana Hemp Museum in Amsterdam

An Amsterdam marijuana shop, known as “coffee shops”

Incidence and Prevalence of Incidence and Prevalence of Marijuana Use in the College Population

30 Day Use, Student Characteristics

Off Campus w/o ParentsOff Campus w/ Parents

Fraternity/sorority member

SeniorResidence hall

Substance free residence hallFraternity / Sorority Residence

FreshmanSophomore

JuniorSenior

Age < 21Age 21-23

Age > 23Freshman

WhiteBlack/African American

Asian/Pacific Islander

0 5 10 15 20 25 30

Hispanic%

Source: Mohler-Kuo, et al. (2003)

Student Characteristics

Younger White Males Who are Fraternity membersmembers

Living in a Fraternity house

30 Day Use, School Characteristics

Small < 5 000Commuter

Noncommuter

PrivateLarge > 10,001

Medium 5,001-10,000Small < 5,000

SouthNorthest

PublicPrivate

NonreligiousWest

North CentralSout

Rural/small townSuburban/urban

Religious affiliationg

0 5 10 15 20 25 %Source: Mohler-Kuo, et al. (2003)

Institutional Characteristics

Non-religiously affiliatedNon religiously affiliated

Located in the Northeast

Strong relationship between g pinstitutional rates of marijuana, tobacco, and alcohol use

Non-commuterNon-commuteralcohol use

Monitoring the Future Study: College Marij ana Data Marijuana Data

2008 2009Males Females Total Males Females Total

2008 2009

Annual 37 29.1 32.3 Annual 32.0 25.8 28.3

30-Day 22.1 13.6 17Daily 7.3 1.7 3.9

30-Day 20.1 13.7 16.3Daily 7.4 4.1 5.4

Use of Substances, 30-Day

80

60

70

50

60

30

40

10

20

0

10

Source: MTF (2009)

College Marijuana Useg j

60

50 Ever used

30

40

Past year

10

20 Past month

0

10

991

992

993

994

995

996

997

998

999

000

001

002

003

004

005

006

007

008

Daily use

19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20

Year

Source: MTF (2009)

“It’s only weed, so what’s the big deal?”deal?

Adverse health effects of non-medical cannabis usecannabis use

Cannabis dependence syndrome (in Cannabis dependence syndrome (in

ffec

tsff

ects

Anxiety and ll Anxiety and ll ff

ects

ffec

ts Cannabis dependence syndrome (in around one in ten users)

Cannabis dependence syndrome (in around one in ten users)

Chronic bronchitis and impaired Chronic bronchitis and impaired

rse

Efrs

e Ef panic, especially in naive

userspanic, especially in naive

users

Psychotic symptoms (at Psychotic symptoms (at rse

Efrs

e Ef Chronic bronchitis and impaired

respiratory function in regular smokers

Chronic bronchitis and impaired respiratory function in regular

smokers

P h ti t d di d i P h ti t d di d i

Adv

eA

dve Psychotic symptoms (at

high doses)Psychotic symptoms (at

high doses)

R d h if R d h if Adv

eA

dve Psychotic symptoms and disorders in

heavy users, especially those with a history of psychotic symptoms or a family history of these disorders

Psychotic symptoms and disorders in heavy users, especially those with a history of psychotic symptoms or a family history of these disorders

cute

Acu

te A Road crashes if a person

drives while intoxicatedRoad crashes if a person drives while intoxicated

roni

c A

roni

c A

Impaired educational attainment in adolescents who are regular usersImpaired educational attainment in adolescents who are regular users

Ac

Ac

Chr

Chr Subtle cognitive impairment in those

who are daily users for 10 years or more

Subtle cognitive impairment in those who are daily users for 10 years or

moreWayne Hall, Louisa DegenhardtLancet 2009; 374: 1383–91

Adverse health effects of non-medical cannabis usemedical cannabis use

Behavioral disorders in Respiratory cancers

Behavioral disorders in children whose mothers

used cannabis while pregnantpregnant

Adverse effects of regular cannabis

use with unknown causal relation

Depressive disorders, mania, and

suicideUse of other illicit drugs

by adolescents

Wayne Hall, Louisa DegenhardtLancet 2009; 374: 1383–91

Health & Academic CConsequences

In this prospective longitudinal study, the authors investigated the association between marijuana use over a period of 13 years and subsequent health between marijuana use over a period of 13 years and subsequent health problems at age 27.

A community sample of 749 participants from upstate New York was d f 4 6 22 d 27 interviewed at mean ages of 14, 16, 22, and 27 years.

Marijuana use over time was significantly associated with increased health problems by the late twenties, including: respiratory problems, general p y , g p y p gmalaise, neurocognitive problems and lower academic achievement and functioning.

Effective prevention and intervention programs should consider the wide Effective prevention and intervention programs should consider the wide range of adverse physiological and psychosocial outcomes associated with marijuana use over time.

Th A i i B E li M ij U d S b A d i A hi d H l h P bl A L i di l S dThe Association Between Earlier Marijuana Use and Subsequent Academic Achievement and Health Problems: A Longitudinal Study

Judith S. Brook, EdD, Matthew A. Stimmel, MA, Chenshu Zhang, PhD, David W. Brook, MD

Department of Psychiatry, New York University School of Medicine, New York, New York (Am J Addict 2008;17:155–160)

Cognitive Impairment - Adultsg p

Chronic users have shown impairments in visual search Chronic users have shown impairments in visual search skills, which are necessary for everyday tasks like reading or safely driving a vehicle (Huestegge, Radach, & Kunert, 2009)

Experimental studies have shown that chronic adult users experience problems with attention learning and memory experience problems with attention, learning, and memory following brief periods of abstinence (as cited in Jacobus et al., 2009)

Neurocognitive deficits in adolescents with heavy marijuana use largely remit after 3 months of sustained abstinence (as cited in g y (Jacobus et al., 2009)

Cognitive Impairmentg p

Both acute and chronic exposure Both acute and chronic exposure to cannabis are associated with

dose-related cognitive impairments, most consistently

These impairments are not completely reversible upon

in attention, working memory, verbal learning, and

memory functions.

cessation of marijuana use.

T i i i i i Residual cognitive impairment

may interfere with the treatment of marijuana addiction.

Targeting cognitive impairment associated with chronic marijuana

use may be a promising novel strategy for the treatment of o a jua a add c o . s a egy o e ea e o

marijuana addiction.

Cognitive Impairments (cont)g p ( )

“Reports from several countries “Reports from several countries Thi l i Thi l i epo s o seve a cou es (including the US, UK, and the

Netherlands) indicate the average age of initiation of marijuana use is decreasing, while the average THC

f b i i

epo s o seve a cou es (including the US, UK, and the

Netherlands) indicate the average age of initiation of marijuana use is decreasing, while the average THC

f b i i

This may result in greater addictive

potential as well as

This may result in greater addictive

potential as well as content of cannabis is increasing

(ElSohly et al., 2000; Pijlman, Rigter, Hoek, Goldschmidt, &

Niesink, 2005; Potter, Clark, & Brown 2008)

content of cannabis is increasing(ElSohly et al., 2000;

Pijlman, Rigter, Hoek, Goldschmidt, & Niesink, 2005; Potter, Clark, &

Brown 2008)

increased negative consequences of marijuana use.”

increased negative consequences of marijuana use.”

Brown, 2008). Brown, 2008).

Cognitive Function as an Emerging Treatment Target forMarijuana AddictionM h t S f l D E S d K thl M C llMehmet Sofuoglu, Dawn E. Sugarman, and Kathleen M. CarrollYale University School of Medicine and VA Connecticut Healthcare SystemWest Haven, CTExperimental and Clinical Psychopharmacology © 20102010, Vol. 18, No. 2, 109–119

This Ain’t Your Parents Pot

The increased potency p yof marijuana available in the U.S. corresponds with other troubling research troubling research showing links between marijuana use and mental health problemsHigher-potency marijuana may be

t ib ti t

Heck, they still call it dope.

contributing to a substantial increase in the number of Americans in treatment for marijuana dependence.

Increased THC Content

In the US THC content of cannabis ranged from:

THC content has also increased in other countries

Mental Health Effects

• Research suggests links between marijuana and panic disorder

l L i di l di h

Schizophrenia• In a large community

survey, lifetime marijuana use was found to be associated with a panic

• Longitudinal studies have clearly demonstrated that marijuana use increases the likelihood that schizophrenia associated with a panic

disorder history• Even after controlling for

confounds like alcohol or

pwill develop in at-risk individuals

• with more frequent use linked i d i k f di i nicotine dependence

Panic to increased risk of diagnosis

Disorder(Zvolensky, Johnson, Cougle, & Bonn-Miller, 2010) (as cited in Degenhardt & Hall, 2006)

Mental Health Effects Continued

Increased Vulnerability to Psychosis and Non-Affective Psychosis

“The longer people use marijuana, the more likely they are to experience hallucinations or delusions or to suffer ppsychosis, according to a recent study.

The study found that people who first used cannabis The study found that people who first used cannabis when they were aged 15 or younger were twice as likely to develop a "non-affective psychosis" — which can include schizophrenia — than those who had never used the drug ”used the drug.”

Association Between Cannabis Use and Psychosis-Related Outcomes Using Sibling Pair Analysis in a Cohort of Young Adults John McGrath, MD, PhD, FRANZCP; Joy Welham, MAPs; James Scott, MBBS, FRANZCP; Daniel Varghese, MBBS, FRANZCP; Louisa Degenhardt, PhD; Mohammad Reza Hayatbakhsh, MD, PhD; Rosa Alati, PhD; Gail M. Williams, PhD; William Bor, MBBS, DPM, FRANZCP; Jake M. Najman, PhD Arch Gen Psychiatry. 2010;67(5):440-447. Published online March 1, 2010 (doi:10.1001/archgenpsychiatry.2010.6).

Depressionp2 million teens felt depressed at some

point during the

Self medicating could actually

point during the past year Depressed teens

are more than twice as likely than

non-depressed make things worse non depressed teens to have used

MJ

Teen marijuana Depressed teens

are twice as likely Teen marijuana use worsens depression

are twice as likely to abuse or

become dependent on MJ

(see Mental Health Weekly, May 26, 2008)

Long-Term Consequencesg q

Cognitive impairment Birth defects Dependence

Respiratory Psychosocial adjustment

Respiratory system effects

Violence/del Mental h lth /

inquency/crime

health effects

Dependence

Longitudinal d Withdrawal

About 8.5% of the U.S. population

will

studies indicate that initiating use

during Daily or weekly use

Withdrawal symptoms can

include anxiety, restlessness insomni

Withdrawal symptoms can will

experience a marijuana-use

disorder during their

adolescence leads to an

increased risk of future

weekly use also strongly

predicts future dependence₂

ssness, insomnia, appetite

disruptions, stomach

pain and

appear after only two weeks of daily use₃during their

lifetime₁ use, 1in 6 will become

dependent

pain, and mood

disturbance.

y

₁(Stinson, Ruan, Pickering, & Grant, 2006)

₂(as cited in Hall & Degenhardt, 2009; Kalant, 2004)

₃(as cited in Ashton, 2001)

INTERVENTION APPROACHES INTERVENTION APPROACHES: MOTIVATIONAL INTERVIEWINGMOTIVATIONAL INTERVIEWING

&PERSONALIZED FEEDBACK

What Motivational Interviewing Isn’t

“Motivational interviewing is a directive, person-centered

li t l f li iti counseling style for eliciting behavior change by helping

students to explore and resolve students to explore and resolve ambivalence.” (Rollnick & Miller,

2003))

Motivational Interviewing Elements

MI

g

MI spirit

Change talkOARS MI talk

MI principles

Rosengren, D. R. (2009)

Principles of Motivational Interviewing

Develop DiscrepancyDevelop Discrepancy

EmpathEmpathy

Avoid Argumentation

Roll with resistance

Support self-efficacy

Core Techniques of MIq

O: Open-A: Affirmations

pended

questionsR: Reflective

listening

S: SummarizeGather

infoCreate

empathic info empathic environment

Elicit change

talk

Brief Motivational Intervention Goals*

Reduce Reduce Encourage

• Use to lower l l

• Related harm to

lf

• Abstinence in those who have dependence levels self

and others

dependence or indicators that they should not useuse

* Must be consistent with student’s readiness to change

Stages of Changeg g

Delivered in 1-4 sessions

Personalized feedback

delivered in the Counselor guides

participant d i d delivered in the

style of Motivational Interviewing

towards increased motivation to

change

Motivational

Interviewing

Motivational Enhancement

Therapy

It’s about harm reduction

People tend to use less pot over time

Reduced use is a more common Reduced use is a more common outcome than complete abstinence

Although desired by treatment id l b i providers, total abstinence may not

be a realistic goal for all usersLee, Neighbors,Kilmer, & Larimer (2010)

MOTIVATIONAL FEEDBACK & &

THE FEEDBACK SHEET C S

C fid ti l fil b d Confidential profile based on individual responses.

May include summary of y yuse, risk factors, related

problems, financial cost, normative

Used in a stand-alone format or combined with MI

(i.e. MET format). cost, normative comparisons.

(i.e. MET format).

Good evidence in college drinking literature showing

changes to at least 6 changes to at least 6 months. Less well tested for

college mj use.

Marijuana Feedback: What’s Available?j

Develop your own through Bl Sk f db k f Develop your own through Excel or Word using

reliable and validatedinstruments

BluSky feedback for use with BASICS intervention

(www.basicsfeedback.com)instruments

No materials from publishes studies are publishes studies are

commercially available

Marijuana e-CHECKUP TO GO

( h k )

Used solo or combined with in-person approaches.

d h(www.echeckuptogo.com) Larger decreases with in-person approaches

Typical Use

Pattern of use: marijuana, alca jua a, a cohol, cigarette

sDays per th month

and time of dayof day

How time i tis spent

Financial costs

Negative consequencesconsequences

Normative data

School School specific

normative o a ve data

Typical Use

N ti Negative consequences

Readiness to change rulers

Snap shot of overall of overall alcohol

and other drug use

Differences in MI between Marijuana and AlcoholMarijuana and Alcohol

Patterns of use: Fewer assessments/ feedback helps Patterns of use: Fewer assessments/ feedback helps. Mj use may be more sporadic.

C Mj h f Consequences: Mj users may have fewer acute consequences, defend use as non-problematic.

Legal status: 14 states allow medical mj. Users may be committed to legalization subculture.

Harm reduction, protective behaviors more difficult to talk about.

Alcohol effects a badge of honor, vs. marijuana effects connected to subculture, perceived harm.

Rutgers BMI study of mandated students: marijuana use in the sampleuse in the sample

BMI data set: 348(O l li ibl bj )(Only eligible subjects):

50% ever used marijuana38% used marijuana in last year24% used marijuana in last monthj

Last year users vs. not used in last year:Mean Beck 2.4 vs. 1.9 (difference is not statistically significant)Mean GPA 2.8 vs. 3.0 (difference is significant at p<.05)4 month follow up decreased marijuana use and consequences but at 1 year use back up.

Mean number of Drug RAPI problems last year 1.8Mean number of Drug RAPI problems last year 1.8

Long-Term Effects of Brief Substance Use Interventions for Mandated College Students..White, HR; Mun, EY; Pugh, L.; Morgan, TJ Alcoholism: Clinical and Experimental Research Vol.31,No.8 August 2007ugus 007

UMass BASICS data

3073 total BASICS participants1762 positive for marijuana

2009 d ( 405)2009 data (n=405)50% screened positive for marijuana at intake44% screened positive for marijuana at 6 month follow up44% screened positive for marijuana at 6 month follow upEver bing: non-user: 66% user: 87%Freq bing: non-user: 31% user: 53%

Significant decrease in all drinking measures at 6 months.M ij d k d did h d Marijuana users drank more and did more other drugs than non users.

“Planting Seeds”g

Use evidence based interventions, read the Use evidence based interventions, read the research, pay attention to pop culture, read about new drugs and effects.gBe genuine, affirm progress and practice self efficacy, use humor.ySometimes being empathetic, honest, genuine, knowledgeable is what people will remember when they need help to make changes and decide to come back.

Thank you!

Lisa Laitman llaitman@echo.rutgers.edu

Diane Fedorchakdfedorchak@uhs.umass.edu

Thank you to the Northeast Regional Center for the Application of Prevention Technologies