And Now the Long Answer
Well, it certainly isn’t anything new or groundbreaking. It’s simply taking some tried and true methods of substance abuse counseling and specifically gearing them towards the needs of the cannabis user. So, if Marijuana Friendly Counseling isn’t anything new then what is it?
The cornerstones of Marijuana Friendly Counseling lie in four areas. The first three of these areas explained below are directly related to
substance abuse work while the fourth explains my basic counseling stance. In the areas of substance use I rely on the concepts of Integrated Dual Disorder Treatment (IDDT), Community Reinforcement And Family Training (CRAFT) and Motivational Interviewing (MI) to engage with clients. Each of these models fall under the umbrella of “Harm Reduction,” which is a term most folks are aware of from a public policy standpoint. From that perspective the term refers to things like providing contraceptives and clean needles that can reduce the harmful social and physical effects of various risky behaviors. In this we accept that people are going to engage in these behaviors, both legal and illegal, and simply look for ways to make things safer for both the individual and the public in general. For example, providing clean needles may not treat one’s addiction but it helps prevent the spread of diseases like hepatitis and AIDS, which is beneficial to the public in general.
When working in the context of individual therapy however the term refers more to ways to directly reduce the harmful and negative effects of substance use on the person’s life, dreams and goals. These effects can be physical, psychiatric or psychological, or perhaps spiritual or existential and may be quite subtle. Of course, the only sure way to completely reduce the harm to zero is to be abstinent but this is not a lifestyle that many individuals want to commit to. Therefore, the models discussed below may be more accurately described as “Abstinence Based Harm Reduction.”
In IDDT work the focus is on the individual’s greater life goals, and often those goals have nothing to do with changing their substance use. However, we have found that people are more likely to stay engaged in a process of change when they are working toward things that matter to them. Harm reduction principles come into play when the person begins to progress towards those goals and their substance use begins to get in the way. For example, an individual may enter treatment as a regular cannabis user and have no desire to change that. They may hold the goals of managing their anxiety and doing better in school. They may feel that cannabis helps with anxiety and sleep, and that may very well be true. However, upon engaging in harm reduction work they may find they are actually staying up later than they usually would to smoke weed. They may find that sometimes cannabis use helps with anxiety but that it also may increase their anxiety at times. Perhaps looking at what they are using, when they are using as well as what effects it has on their functioning in school and in general will spark motivation for change.
Speaking to motivation, within IDDT we use the Stages of Change model. Most harm reduction models use these stages to assess where client is at and what actions they then need to take in order to move to the next stage. In IDDT work we still asses what stage the client is at but we then turn the focus to the clinician for what we call a “stagewise response.” We determine what the appropriate clinical response is to a client in whatever respective stage they are in should be. For example, if a client is in the pre-contemplation stage, which IDDT calls the engagement stage, they are not currently considering any change. They are not even contemplating a change at this point. In IDDT work the counselor takes this stage into account when responding to the client. Rather than crafting a treatment plan that just tells the client what stage they are in and what they need to do to move to the next stage, I write a treatment plan about what my responses and approaches would be to a client in this stage. In this scenario the counselor is side by side with the client as they navigate their process of change and making changes to treatment as the client makes changes in their life. This is why we are particular about the language when discussing the stages and have our own headings. In traditional stages of change counseling, when an individual in pre-contemplation the course of action is for that individual to simply get connected to some supportive, healthy relationships. That's it. Think about it. If you take someone who has no plans to change their behavior and try and force them into treatment or a change that they are not ready, willing and able to undertake, they will get upset, frustrated, discouraged, shamed, whatever you wanna call it, it won't feel good and in fact will probably harm your relationship with the person, causing them more frustration and angst and whatever else that they will use as justification to use more cannabis. What the individual needs at that point is to engage with some healthy, supportive people, such as counselors.
If you, or a loved one, is struggling with their cannabis use and has no desire to change I would simply try and engage with them around anything. Movies, books, sports, hatred of their own life, frustration with friends, family, the universe, whatever. As the person has no desire to change their cannabis use I am not going to force the conversation with a pre-contemplative person. I am simply going to engage with her in the hopes of building a trusting relationship in which she will eventually be honest and vulnerable enough to begin to be comfortable talking about cannabis use.