Reader Request: Teens and Weed
This is not a topic I would have chosen! Adolescent substance use work can come with unique complications--which is probably why adolescent treatment is usually in even shorter supply than it is for adults.
I have very little experience with solidly high school-aged folks, but a lot of experience with "emerging adults," 18-25. My clinical internship (part of training as a counselor) was at the alcohol and drug office of a private university. Most of our patients were mandated, either because they had been hospitalized with alcohol poisoning or caught violating campus drug or alcohol policies. Following that, my first full-time job in the field was at a recovery residence (sometimes called "sober house) for college students. I loved working with this age group because it is such a dynamic phase of life. People in their late teens and early twenties are finding and building identity, a perfect backdrop for recovery work such as clarifying and implementing personal values. For young people with material security--whose basic needs are all met--there is also a great sense of hope and possibility for their lives ahead.
Now for the difficulties. I want to be clear that nothing that follows is meant to compromise either of these core principles:
1) Everyone is entitled to total bodily autonomy, including those with conditions that may label them incompetent--such as disability, substance use status, or age. All coercive approaches are unethical, and coercion rarely works anyway.
2) The first line response to any (perceived) substance use problem should be making sure 100% of the person's needs are 100% met--including their needs for pleasure and relaxation. If this sounds impossible, that's the point: blaming drug use for anything in a person's life is unfair if they have unmet needs or no other way to meet certain needs.
That said, looking specifically at cannabis, what is often a nonissue in adults does raise legitimate health concerns in adolescents. It is undisputed (to my knowledge, please correct me if I'm wrong) that frequent, high-dose THC use can impede young people's brain development. This means that the choice to use cannabis during this developmental phase, at which we are most prone to short-term thinking, may come with a lifelong sacrifice.
To make this sacrifice more explicit: In A Disorder of Choice, Gene Heyman characterizes addiction as a propensity to short-term or "local" decision-making even when long-term or "global" thinking would bring greater rewards. For example, a teen who loves art and wants to develop their portfolio might nonetheless choose, day by day, to neglect art in favor of cannabis because they felt like using at the time. Ultimately they are unhappy with their still-thin portfolio--but this did not translate to different choices along the way. I have seen how demoralized people can feel looking back on such a series of choices. And in my understanding (as a non-medical provider) the prefrontal cortex, the part of the brain responsible for decision-making, is one of the areas whose development is most affected by THC. So a high-dose, frequent teen user of cannabis may be skewing their own neurology toward local thinking for the rest of their lives.
But none of this necessarily means much to a young patient. First of all, adolescents see themselves as grown up. They do not necessarily want to hear that something that is safe for adults may not be safe for them. Even if they are concerned, that concern may become just another long-term or global thought that gets pushed aside every time they want to get high. Factors like material insecurity or trauma can also incline anyone to short-term or local thinking in the struggle for survival. A young person growing up with such survival issues may not expect ever to have the luxury of long-term decision-making, regardless of their neurology.
If the clinician's role were obvious here, Chris already would have figured it out. I no longer see anyone under 18, but Chris has seen some positive change for younger clients with harm reduction, working toward moderation (as opposed to abstinence), and being open to counter-intuitive ideas. For example, switching from vaping to smoking may reduce overall use because one cannot get away with smoking just anywhere. I will add that the young people I worked with who embraced a sober identity often immersed themselves in Young People's AA and the youth recovery movement; their most helpful interventions had nothing to do with me.
The only approach I can suggest in all cases is to stay person-centered. No matter what stake their parents (or other authorities) may have in a young person's treatment, they must know they can redirect or end it at any time, that their clinician sees and honors them, and that they can shape their own future.
