Practitioner's Guide to Cannabis

WIN TURNER, PhD, LADC is a licensed clinical psychologist and national subject matter expert in motivational interviewing, cognitive behavior therapy, SBIRT & programs for youth/young adults, as well as policy development. He is a nationally certified trainer for the Center for Behavioral Health Integration (C4BHI), working throughout the US to help systems of care (medical, community, university, and public school settings) deliver and evaluate effective screening and interventions for substance use and/or mental health. JOSEPH HYDE, LMHC, CAS is a national subject matter expert in substance abuse early intervention and treatment. He is a practicing clinician and teacher who has advised State and Federal Agencies on substance use early intervention and treatment issues.

• Contents1 Introduction 12 What is Cannabis? 5The Geographical and Historical Origins of Cannabis 6History of the Medicinal Use of Cannabis 7Recent US History of Cannabis Use 9Factors Influencing Cannabis Legalization in the United States 103 The Chemistry of Cannabis 13Psychoactive Chemicals in Cannabis 13Synthetic Cannabinoids 15Cannabinoids and the Human Body 17The Changing Chemistry of Cannabis and Synthetics 194 Cannabis Use in the United States 20Potential Effects of Legalization of Cannabis in the United States 20Risks and CUD 22Risks Pertaining to Cannabis Delivery Methods and Potency 245 Cannabis, its Recreational Use, and its Effects 27Recreational Use of Cannabis 29Pregnancy 31Highway Safety 33Cognitive Impairment 336 Cannabis as Medicine and the User’s Experience 35Multiple Sclerosis 36Chronic Pain 36Epilepsy 38Cancer 38Psychiatric Conditions 39Medical Cannabis Patients Describe Their Experiences 39Positive Experiences 40Negative Experiences 41Recommendations 41Summary 417 A New Approach to Cannabis Screening 42Universal Screening for Substance Use Disorders 42Rationale for a Cannabis Screener 43Cannabis Intervention Screener 44Development of the CIS 45Summary of CIS Evaluation Findings 46Cannabis Use Vs. Misuse Vs. Abuse 48Implications from CIS Study Findings 51Orientation to Clinical Interventions Addressing Cannabis Use Disorder 53Motivational Interviewing and Motivational Enhancement Therapy 53Brief MI Interaction for Cannabis Misuse 54Cognitive Behavioral Therapy 55Intrapersonal Skills Training 57CBT Introduction 58The Structure of a Session Delivery: “Law of Thirds” 59Session 1. Eliciting the Life Movie 64Clinician Preparation 65Session 1 Outline and Overview 66Session 1 Protocol with Scripts 68Session 1. Eliciting Life Movie and Change Plan Handouts 78Treatment Information Sheet 79Eliciting the Life Movie: MI Conversation 81A Change Plan—Optional 84Learning New Coping Strategies (Handout) 85Session 2. Enhancing Awareness 89Clinician Preparation 90Session 2 Outline and Overview 91Session 2 Protocol with Scripts 94Session 2. Enhancing Situational Awareness Handouts 102Review of Progress and Between-Session Challenges 103Alcohol/Cannabis use Awareness Record 104Alcohol/Cannabis use Awareness Record Example 105Planning to Feel Good (Optional) 106Session 3. Learning Assertiveness 107Clinician Preparation 108Session 3 Outline and Overview 109Session 3 Protocol with Scripts 111Session 3. Learning Assertiveness Handouts 120Review of Progress and Between-Session Challenges 121Communication Styles 122Between-Session Challenge Assertiveness 124Session 4. Supporting Recovery through Enhanced Social Supports 126Enhancing Social Support 128Session 4 Outline and Overview for Enhancing Social Support 129Session 4 Protocol with Scripts 132Session 5. Supporting Recovery through Healthy Replacement Activities 136Clinician Preparation 137Session 5 Outline and Overview for Enhancing Healthy Replacement Activities 138Session 5 Protocol with Scripts 140Session 5. Supporting Recovery Through Healthy Replacement Activities Handouts 143Review of Progress and Between-Session Challenges 144Social Support 145My Social Atom 146Plan for Seeking Support 147Increasing Pleasant Activities 148Engaging in Replacement Activities 149Session 6. Problem Solving 150Clinician Preparation 151Session 6 Outline and Overview 152Session 6 Protocol with Scripts 155Session 6. Problem Solving Handouts 163Review of Progress and Between-Session Challenges 164Problem Solving 165Session 7. Handling Urges, Cravings, and Discomfort (urge Surfing) 167Clinician Preparation 168Session 7 Outline and Overview 169Session 7 Protocol with Scripts 172Session 7. Handling Urges, Cravings, and Discomfort Handouts 186Coping with Cravings and Discomfort 187Daily Record of Urges to Use 189Urge Surfing 190Session 8. Making Important Life Decisions 192Clinician Preparation 194Session 8 Outline and Overview 195Session 8 Protocol 197Session 8. Making Important Life Decisions Handouts 201Clinician’s Quick Reference to Session 8 202MI Skills and Strategies 204Readiness-to-Change Ruler 205Values Exploration 206My Values 208Decision-Making Guide 209Decision-Making Guide Example 211Thinking About My Use Option 3 213Session 9. Enhancing Self-awareness 214Clinician Preparation 215Session 9 Outline and Overview 216Session Protocol 217Session 9. Enhancing Self-Awareness Handouts 227Clinician’s Quick Reference to Session 9 228Alcohol/Cannabis Use Awareness Record 229Alcohol/Cannabis Use Awareness Record (continued) 231Alcohol/Cannabis Use Awareness Record Example 232Future Self Letter 233Relaxation Practice Exercise 234Session 10. Mindfulness, Meditation, and Stepping Back 235Clinician Preparation 238Session 10 Outline and Overview 239Session Protocol 240Session 10. Mindfulness, Meditation, and Stepping Back Handouts 246Clinician’s Quick Reference to Session 10 247Mindfulness Meditation Instructions 248Meditation Exercise: On the Riverbank 249References 250Index 267