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Dr. Copeland, founding director of the National Cannabis Prevention and Information Centre at University of New South Wales Australia, spoke during our Addiction Speaker Series about the rise and fall of Australia’s cannabis policy responses. We interviewed Dr. Copeland to get some deeper insights into her research and experience regarding cannabis (or marijuana) use and the prevention and treatment of cannabis use disorder.
Dr. Copeland: Research shows that even in cases where the use of cannabis cannot be prevented, there are still benefits to be gained from delaying the age at which it occurs. School-based drug education has a role to play, as does easy access to evidence-based information about the harms (and the potential benefits) of some cannabinoids at the public health level.
However, most important is the influence of family and peers over the key developmental periods. Early studies examining prevention of substance use focused on the risk factors that increased the possibility of use, but recently, research has concentrated on identifying and enhancing protective factors.
Research indicates that families can protect against adolescent substance use in instances where parenting skills, parent-adolescent communication, and levels of warmth and affection are high. Attachment to the family and low parental conflict also act as protective factors. In contrast, youth substance use is more probable when parents engage in alcohol or other drug use or when parents directly or indirectly convey that these behaviors are normal and common. The lack of emotional warmth, less open communication between parents and their children, and more frequent family conflicts increase the likelihood of adolescent substance use.
Dr. Copeland: The period of transition to full adulthood is one where young people for the first time have the financial resources and freedoms to access a range of drugs, including alcohol and cannabis. There is a degree of social tolerance for such behavior amongst this age group, especially on college campuses. In every culture, this is the age cohort that reports the highest use of psychoactive substances, particularly alcohol, cannabis and psychostimulants, such as cocaine, ecstasy, and amphetamines.
Depending on age and gender, this is a period where the brain is still maturing and decision-making is not always at its most sound.
Dr. Copeland: Cannabis-specific treatment is a relatively new development (early 1990s) and is based on the same theoretical models that have proven successful for tobacco and alcohol use disorders. The same principles of behavior change apply to modifying cannabis use as other addictive disorders. Those that have the strongest evidence-base and are most widely applied are motivational enhancement therapy and cognitive behavioral therapy.
The cannabis-specific elements include psycho-educational materials around methods of use, drug effects, addiction profile, withdrawal management, and how to manage cues to relapse prevention that are specific to cannabis.
An understanding of cannabis withdrawal is also important as it is a significant barrier to treatment completion. In many countries cannabis is used with tobacco, so an understanding of how to improve the likelihood of long-term management of cannabis use requires an understanding of how to avoid cues that might trigger relapse, such as tobacco use, and the need to address co-existing mental health conditions.
Dr. Copeland: In a recent blog, Kevin Sabet, PhD, Director of the Drug Policy Institute at the University of Florida and Co-Founder, President and CEO of Smart Approaches to Marijuana (SAM), outlined the role of Big Marijuana in the promulgation of misinformation about cannabis. This often centers around cannabis not being addictive and denying the existence of cannabis withdrawal as a discrete syndrome, despite it being described as such in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM 5).
One of the reasons for this is that, except in the U.S. and New Zealand, cannabis is used with tobacco and the withdrawal associated with stopping both was attributed only to tobacco. While they have some symptoms in common, such as irritability, they have opposite effects on symptoms such as appetite which is stimulated in tobacco withdrawal and suppressed in cannabis withdrawal. Cannabis withdrawal also may have unique consequences, such as angry feelings, night sweats, nausea, and significant effects on sleep.
As the number of people experiencing cannabis use disorder and withdrawal increases, recognition, and understanding of cannabis withdrawal amongst users and healthcare professionals will grow and research on its management will develop.
Dr. Copeland: There was a need for it. A range of studies identified the barriers to cannabis treatment seeking and the development of a free smartphone application helps overcome these barriers. It is completely anonymous and confidential and doesn’t require any self-identification as a cannabis user. It is highly accessible at any time of day and night and it is easy to use and engage with for as long as you need. Studies have found that it is acceptable to most cannabis users and that they find it engaging.
To add to that, the use of an evidence-based smartphone app is appropriate because we have some early evidence that it is able to influence the frequency and quantity of cannabis use amongst those who use it for a month. It is also cost-effective as it doesn’t involve appointments, time away from work or family during business hours, or any transport and treatment costs.
This approach is not appropriate for everyone with cannabis use disorder but is an easy first step to recognizing whether you do have a problem and how easy you find it to modify your use without formal treatment.
INTERESTED IN LEARNING MORE? DR. COPELAND HAS PROVIDED LINKS TO THE FOLLOWING RESOURCES, ALL AVAILABLE VIA CANNABISSUPPORT.COM.AU: