Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use

Darlene Walker; Casey Mace Firebaugh; Gina Craft; Patrick McKiernan; Cynthia Palmisano

doi:10.29333/ajqr/11531

Darlene Walker ¹, Casey Mace Firebaugh ² ^* , Gina Craft ¹, Patrick McKiernan ¹, Cynthia Palmisano ³

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AM J QUALITATIVE RES, Volume 6, Issue 1, pp. 85-106

https://doi.org/10.29333/ajqr/11531

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Abstract

A qualitative phenomenological study, the lived experiences of clinicians who treat clients using marijuana pre- and post-legalization in California are explored. This study was conducted to better understand the misconceptions associated with user attitudes and beliefs about marijuana use and provide clinicians, researchers, and physicians with information on the overall physical and emotional effects of marijuana use. Since legalization, investigating attitude and belief changes was essential to understanding the impact of marijuana's accessibility on user behaviors. Participants (n=10) were licensed mental health care providers working in California who provided treatment for current or recent users of marijuana products over the last year. A 20-question open-ended interview was delivered via Zoom regarding provider experiences with client marijuana use disclosure post-legalization. A thematic analysis of qualitative data was performed. The results provide clinician insights about post-legalization marijuana attitudes and beliefs about use. Findings revealed differences in reported youth and adult-use behaviors. Reduced stigma and social acceptance of marijuana post-legislation has resulted in clients’ more clearly, openly, and honestly addressing their drug use, specifically, use behaviors associated with marijuana products. There is a need for research to further explore the attitudes and beliefs of users and how often CUD is identified and treated in clinical therapy. This study has provided the perspective of the therapy provider treating individuals who use cannabis. This study provides opportunities for further study on the legalization of marijuana, potency, and accessibility of marijuana as it pertains to the practice of clinical therapy with cannabis users as legalized use continues to increase for recreational and medicinal use.

Keywords: Cannabis Use Disorder, CUD, Clinical Therapy, Qualitative, Mental Health.

References

Adinoff, B. & Reiman, A. (2019). Implementing social justice in the transition from illicit to legal cannabis. The American Journal of Drug and Alcohol Abuse, 45 (6), 673- 688, https://doi:10.1080/00952990.2019.1674862.
Azagba, S., Shan, L., Manzione, L., Qeadan, F., & Wolfson, M. (2019). Trends in opioid misuse among marijuana users and non-users in the US from 2007-2017. International Journal of Environmental Research and Public Health, 16(22), 45-85. https://doi.org/10.3390/ijerph16224585.
Bailey, J. A., Epstein, M., Roscoe, J. N., Oesterle, S., Kosterman, R., & Hill, K. G. (2020). Marijuana legalization and youth marijuana, alcohol, and cigarette use and norms. American Journal of Preventive Medicine, 59(3), 309-316. https://doi.org/10.1016/j.amepre.2020.04.008.
Bandura, A. (1977). Self-efficiency: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
Bandura, A. (2001). Social cognitive theory of mass communication. Media Psychology, 3(3), 265-299. https://doi.org/10.1207/s1532785xmep0303_03.
Bandura, A. (2011). The social and policy impact of social cognitive theory. Guilford Press.
Banys, P. (2016). Mitigation of marijuana-related legal harms to youth in California. Journal of Psychoactive Drugs, 48(1), 11-20. https://doi.org/10.1080/02791072.2015.1126770.
Bassir, N. A., Mann, C., Kaur, H., & Ranganathan, M. (2018). Cannabis use: Neurobiological, behavioral, and sex/gender considerations. Current Behavioral Neuroscience Reports, 5(4), 271-280. https://doi.org/10.1007/s40473-018-0167-4.
Best, D., Beckwith, M., Haslem, C., Jetten, J., Mawson, E., & Lubman, D. (2016). Overcoming alcohol and other drug addiction as a process of social identity transition. Addiction Research & Theory, 24(2), 111-123. https://doi.org/10.3109/16066359.2015.1075980.
Blair, R. J. R., White, S. F., Tyler, P. M., Johnson, K., Lukoff, J. Thornton, L. C., Leiker, E. K., Filbey, F., Dobbertin, M. & Blair, K. S. (2019). Threat responsiveness as a function of cannabis and alcohol use disorder severity. Journal of Child and Adolescent Psychopharmacology, 29(7), 526-534. https://doi.org/10.1089/cap.2019.0004.
Bolshakova, M., Bluthenthal, R., & Sussman, S. (2019). Opioid use and misuse: Health impact, prevalence, correlates, and interventions. Psychology & Health, 34(9), 1105–1139. https://doi.org/10.1080/08870446.2019.1622013.
Bowman-Bowen, L. C., & Menard, S. (2016). Survey design elements as influences on estimates of self-reported illicit substance use and other illegal activities. Journal of Drug Issues, 46(3), 178–197. https://doi.org/10.1177/0022042616629513.
Bozinoff, N., Anderson, B. J., Bailey, G. L., & Stein, M. D. (2018). Correlates of stigma severity among persons seeking opioid detoxification. Journal of Addiction Medicine, 12(1), 19– 23. https://doi.org/10.1097/ADM.0000000000000355.
Braun, V., & Clarke, V. (2019). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health. 13(2), 201-216. https://doi.org/10.1080/2159676X.2019.1704846.
Busetto, L., Wick, W., & Gumbinger, C. (2020). How to use and assess qualitative research methods. Neurological Research and Practice, 2(14), 1-11. https://doi.org/10.1186/s42466- 020-00059-z.
Carliner, H., Mauro, P. M., Brown, Q. L., Shmulewitz, D., Rahim-Juwel, R., Sarvet, A. L., Wall, M. M., Martins, S. S., Carliner, G., & Hasin, D. S. (2017). The widening gender gap in marijuana use prevalence in the US during a period of economic change, 2002–2014. Drug and Alcohol Dependence, (170), 51-58. https://doi.org/10.1016/j.drugalcdep.2016.10.042
Cash, M. C., Cunnane, K., Fan, C., & Romero-Sandoval, E. A. (2020). Mapping cannabis potency in medical and recreational programs in the United States. PLoS ONE 15(3), 627-636. https://doi.org/10.1371/journal.pone.0230167.
Cerdá, M., Wall, M., Feng, T., Keyes, K. M., Sarvet, A., Schulenberg, J., O'Malley, P. M., Pacula, R. L., Galea, S. G., & Hasin, D. S. (2017). Association of state recreational marijuana laws with adolescent marijuana use. Journal of the American Medical Association, Pediatrics, 171(2), 142. https://doi.org/10.1001/jamapediatrics.2016.3624.
Clarke, P., Dodge, T., & Stock, M. L. (2018). The impact of recreational marijuana legislation in Washington, DC on marijuana use cognitions. Substance Use & Misuse, 53(13), 2165-2173. https://doi.org/10.1080/10826084.2018.1461226.
Connor, J. P., Stjepanović, D., Le Foll, B., Hoch, E., Budney, A. J., & Hall, W. D. (2021). Cannabis use and cannabis use disorder. Nature Reviews Disease Primers, 7(1), 1-24.
Cragg, A., Hau, J. P., Woo, S. A., Kitchen, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2019). Risk factors for misuse of prescribed opioids: A systematic review and meta-analysis. Annals of Emergency Medicine, 74, 634–646. https://doi:10.1016/j.annemergmed.2019.04.019.
Creswell, J. W. and Poth, C. N. (2018) Qualitative inquiry and research design choosing among five approaches. 4th Edition, SAGE.
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches. Fifth edition. SAGE.
Daniller, A. (2019). Two-thirds of Americans support marijuana legalization. https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/.
Davenport, S., & Caulkins, J. (2016). Evolution of the United States marijuana market in the decade of liberalization before full legalization. Journal of Drug Issues, 46, 411 - 427. https://doi.org/10.1177/0022042616659759.
Davis, T. L. (2013). A Qualitative Study of the Effects of Employee Retention on the Organization. ProQuest LLC. 110-130.
De Luca, M. A., Castelli, M. P., Loi, B., Porcu, A., Martorelli, M., Miliano, C., Kellett, K., Davidson, C., Stair, J. L., Schifano, F., & Di Chiara, G. (2016). Native CB1 receptor affinity, intrinsic activity and accumbens shell dopamine stimulant properties of third-generation SPICE/K2 cannabinoids: BB-22, 5F-PB-22, 5F-AKB-48 and STS-135. Neuropharmacology, 105, 630–638. https://doi.org/10.1016/j.neuropharm.2015.11.017.
Di Forti, M., Quattrone, D., Freeman, T. P., Tripoli, G., Gayer-Anderson, C., Quigley, H., Rodriguez, V., Jongsma, H. E., Ferraro, L., La Cascia, C., La Barbera, D., Tarricone, I., Berardi, D., Szöke, A., Arango, C., Tortelli, A., Velthorst, E., Bernardo, M., Del-Ben, C. M., Menezes, P. R., … EU-GEI WP2 Group (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Psychiatry, 6(5), 427–436. https://doi.org/10.1016/S2215-0366(19)30048-3.
Diao, X., & Huestis, M. A. (2017). Approaches, challenges, and advances in metabolism of new synthetic cannabinoids and identification of optimal urinary marker metabolites. Clinical Pharmacology and Therapeutics 101(2), 239–253. https://doi:10.1002/cpt.534 .
ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613–619. https://doi.org/10.1016/j.biopsych.2016.01.004.
Fattore L. (2016). Synthetic cannabinoids — further evidence supporting the relationship between cannabinoids and psychosis. Biological Psychiatry 79(7), 539–548. https://doi: 10.1016/j.biopsych.2016.02.001.
Feng, B. (2017). Marijuana legalization and interest in marijuana: Evidence from google trends. Social Science Research Network: Electronic Journal. https://doi.org/10.2139/ssrn.3053263.
Gage S., Hickman, M., & Zammit S. (2016). Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry, 79(7), 549–556. https://doi.org/10.1016/j.biopsych.2015.08.001.
Gamble, J. (2018). Menace II society: A social learning perspective. The Graduate Review, (3), 24-37. http://vc.bridgew.edu/grad_rev/vol3/iss1/8.
Gerra, M. C., Manfredini, M., Cortese, E., Antonioni, M. C., Leonardi, C., Magnelli, F., Somaini, L., Jayanthi, S., Cadet, J. L., & Donnini, C. (2019). Genetic and environmental risk factors for cannabis use: Preliminary results for the role of parental care perception. Substance Use & Misuse, 54(4), 670-680. https://doi: 10.1080/10826084.2018.1531430.
Ghosh, T., Van Dyke, M., Maffey, A., Whitley, E., Gillim-Ross, L., & Wolk, L. (2016). The public health framework of legalized marijuana in Colorado. American Journal of Public Health, 106(1), 21-27. https://doi.org/10.2105/ajph.2015.302875.
Gorelick, D. A., Saxon, A. J., & Friedman, M. (2020). Cannabis withdrawal: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. https://www.uptodate.org/contents/cannabis-withdrawal-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis.
Hajihosseini, M., Norozi, E., Azimi, T., & Ahmadinia, H. (2020). Comparison of artificial neural networks and logistic regression for determination of social-cognitive factors impacting drug abstinence. Journal of Substance Use 25(3), 295-300. https://doi.org/10.1080/14659891.2017.1394382.
Hasin, D. S. (2017). US epidemiology of cannabis use and associated problems. Neuropsychopharmacology, 43(1), 195-212. https://doi.org/10.1038/npp.2017.198.
Heather, N. (2017). Q: Is addiction a brain disease or a moral failing? A: Neither. Neuroethics, 10(1), 115–124. https://doi:10.1007/s12152-016-9289-0.
Henrichson, C., & Delaney, R. (2016). The price of prisons what incarceration costs taxpayers. https://shnny.org/uploads/Price-of-Prisons.pdf.
Henssler, J., Heinz, A., Brandt, L., & Bschor, T. (2019). Antidepressant withdrawal and rebound phenomena. Deutsches Arzteblatt International, 116(20), 355–361. https://doi.org/10.3238/arztebl.2019.0355.
Hines, L. A., Morley, K. I., Rijsdijk, F., Strang, J., Agrawal, A., Nelson, E. C., Statham, D., Martin, N., & Lynskey, M. T. (2018). Overlap of heritable influences between cannabis use disorder, frequency of use and opportunity to use cannabis: Trivariate twin modelling and implications for genetic design. Psychological Medicine, 1-8. 188-197. https://doi:10.1017/S0033291718000478.
Hudak, J. (2016). Marijuana: A short history. Washington, DC: Brookings Institution Press.
Jin, J. (2020). Screening for unhealthy drug use in adults and adolescents. The Journal of the American Medical Association, 323(22), 2350. https://doi.org/10.1001/jama.2020.8192.
Kilmer, B. (2017). Recreational cannabis: Minimizing the health risks from legalization. New England Journal of Medicine, 376(8), 705-707. https://doi.org/10.1056/nejmp1614783.
Lafaye, G., Karila, L., Blecha, L., & Benyamina, A. (2017). Cannabis, cannabinoids, and health. Dialogues in Clinical Neuroscience, 19(3), 309–316. https://doi.org/10.31887/DCNS.2017.19.3/glafaye.
Lancer, D. (2018). Are you an enabler? Psychology Central. https://psychcentral.com/lib/are-you-an-enabler/.
Lipari, R. N., & Van Horn, S.L. (2017). Children living with parents who have a substance use disorder. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). PMID: 29144715.
Lloyd, M. H., & Brook, J. (2019). Drug testing in child welfare: A systematic review. Children and Youth Services Review, 104(389). https://doi.org/10.1016/j.childyouth.2019.104389.
Lowe, D., Sasiadek, J. D., Coles, A. S., & George, T. P. (2019). Cannabis and mental illness: A review. European Archives of Psychiatry and Clinical Neuroscience, 269(1), 107–120. https://doi.org/10.1007/s00406-018-0970-7.
Maxwell, J. C., & Mendelson, B. (2016). What do we know now about the impact of the laws related to marijuana? Journal of Addiction Medicine, 10(1), 3-12. https://doi.org/10.1097/adm.0000000000000188.
Memedovich, K. A., Dowsett, L. E., Spackman, E., Noseworthy, T., & Clement, F. (2018). The adverse health effects and harms related to marijuana use: An overview review. Canadian Medical Association Journal Open, 6(3), 13-29. https://doi.org/10.9778/cmajo.20180023.
Miller, N. S., Ipeku, R., & Oberbarnscheidt, T. (2020). A review of cases of marijuana and violence. International Journal of Environmental Research and Public Health, 17(5), 1578-1590. https://doi.org/10.3390/ijerph17051578.
National Institute on Drug Abuse (2019). Marijuana. http://www.drugabuse.gov.http://drugabuse.gov/publications/drugfacts/marijuana.
National Institute on Drug Abuse (2020). Drug Misuse and Addiction. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction.
Olfson, M., Wall, M. M., Liu, S. M., & Blanco, C. (2018). Cannabis use and risk of prescription opioid use disorder in the United States. American Journal of Psychiatry, 175(1), 47–53. https://doi:10.1176/appi.ajp.2017.17040413.
Resko, S., Ellis, J., Early, T.J., Szechy, K.A., Rodriguez, B., & Agius, E. (2019). Understanding public attitudes toward cannabis legalization: Qualitative findings from a statewide survey. Substance Use Misuse 54(8), 1247-1259. https://doi:10.1080/10826084.2018.1543327.
Rogers, A. H., Bakhshaie, J., Buckner, J., Orr, M. F., Paulus, D. J., Ditre, J. W., & Zvolensky, M. J. (2019). Opioid and cannabis co-use among adults with chronic pain: Relations to substance misuse, mental health, and pain experience. Journal of Addiction Medicine, 13(4), 287-294. https://doi: 10.1097/ADM.0000000000000493.
Rong, C., Lee, Y., Carmona, N. E., Cha, D. S., Ragguett, R. M., Rosenblat, J. D., Mansur, R. B., Ho, R. C., & McIntyre, R. S. (2017). Cannabidiol in medical marijuana: Research vistas and potential opportunities. Pharmacological Research, 121, 213–218. https://doi.org/10.1016/j.phrs.2017.05.005.
Rusby, J. C., Westling, E., Crowley, R., & Light, J. M. (2018). Legalization of recreational marijuana and community sales policy in Oregon: Impact on adolescent willingness and intent to use, parent use, and adolescent use. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 32(1), 84–92. https://doi.org/10.1037/adb0000327.
Sabioni, P., & Le Foll, B. (2018). Psychosocial and pharmacological interventions for the treatment of cannabis use disorder. Educational Researcher (7)1 173-180. https://doi.org/10.12688/f1000research.11191.1.
Schmidt, L. A., Jacobs, L. M., & Spetz, J., (2016). Young people's more permissive views about marijuana: Local impact of state laws or national trend? American Journal of Public Health, 106(8), 1498-1503. https://doi.org/10.2105/AJPH.2016.303153.
Schneider, N. C., Coates, W. C., & Yarris, L. M. (2017). Taking your qualitative research to the next level: A guide for the medical educator. AEM Education and Training, 1(4), 368–378. https://doi.org/10.1002/aet2.10065.
Shover, C.L., Davis, C.S., Gordon, S.C., & Humphreys, K. (2019). Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proceedings of the National Academy of Sciences (116), 12624–12626. doi: 10.1073/pnas.1903434116.
Silver, L. D., Naprawa, A. Z., & Padon, A. A. (2020). Assessment of incorporation of lessons from tobacco control in city and county laws regulating legal marijuana in California. The Journal of the American Medical Association, 3(6), 111-132. e208393. https://doi.org/10.1001/jamanetworkopen.2020.8393.
Smart, R., & Pacula, R. L. (2019). Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. The American Journal of Drug and Alcohol Abuse, 45(6), 644-663. https://doi.org/10.1080/00952990.2019.1669626.
Stuyt, E. (2018). The problem with the current high potency THC marijuana from the perspective of an addiction psychiatrist. The Journal of the Missouri State Medical Association, 115(6).
Substance Abuse and Mental Health Services Administration (2019a). Key substance use and mental health indicators in the United States: Results from the 2018 national survey on drug use and health. https://www.samhsa.gov/data/release/2018-national-survey-drug-use-and-health-nsduh-releases.
Substance Abuse and Mental Health Services Administration. (2019). Know the risks of marijuana. SAMHSA. http://www.samhsa.gov/marijuana.
Sullivan, E., & Austriaco, N. (2016). A virtue analysis of recreational marijuana use. The Linacre Quarterly, 83(2), 19-28.
Van Rijnsoever F. J. (2017). (I can't get no) Saturation: A simulation and guidelines for sample sizes in qualitative research. PloS one, 12(7),44-71 e0181689. https://doi.org/10.1371/journal.pone.0181689.
Vass, C., Rigby, D., & Payne, K. (2017). The role of qualitative research methods in discrete choice experiments. Medical decision making : an international journal of the Society for Medical Decision Making, 37(3), 298–313. https://doi.org/10.1177/0272989X16683934.
Vendel, E., Rottschäfer, V., & de Lange, E. (2020). The 3D brain unit network model to study spatial brain drug exposure under healthy and pathological conditions. Pharmaceutical Research, 37(7), 137. https://doi.org/10.1007/s11095-020-2760-y.
Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227. https://doi.org/10.1056/nejmra1402309.
Volkow, N. D., Koob, G. F., McLellan, A.T. (2016). Neurobiological advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. doi:10.1056/NEJMra1511480.
Wendt, D. C., & Gone, J. P. (2017). Group therapy for substance use disorders: A survey of clinician practices. Journal of Groups in Addiction & Recovery, 12(4), 243–259. https://doi.org/10.1080/1556035X.2017.1348280.
Xu, B., & LaBar, K. S. (2019). Advances in understanding addiction treatment and recovery. Science Advances, 5(10), 1-14. doi: 10.1126/sciadv.aaz6596.
Zvonarev, V., Fatuki, T. A., & Tregubenko, P. (2019). The public health concerns of marijuana legalization: An overview of current trends. Cureus, 11(9), 53-59. doi: 10.7759/cureus.5806.

Citation

Walker, D., Firebaugh, C. M., Craft, G., McKiernan, P., & Palmisano, C. (2022). Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use. American Journal of Qualitative Research, 6(1), 85-106. https://doi.org/10.29333/ajqr/11531

Walker, D., Firebaugh, C. M., Craft, G., McKiernan, P., and Palmisano, C. (2022). Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use. American Journal of Qualitative Research, 6(1), pp. 85-106. https://doi.org/10.29333/ajqr/11531

Walker D, Firebaugh CM, Craft G, McKiernan P, Palmisano C. Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use. AM J QUALITATIVE RES. 2022;6(1), 85-106. https://doi.org/10.29333/ajqr/11531

Walker, Darlene, Casey Mace Firebaugh, Gina Craft, Patrick McKiernan, and Cynthia Palmisano. "Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use". American Journal of Qualitative Research 2022 6 no. 1 (2022): 85-106. https://doi.org/10.29333/ajqr/11531

Walker, Darlene et al. "Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use". American Journal of Qualitative Research, vol. 6, no. 1, 2022, pp. 85-106. https://doi.org/10.29333/ajqr/11531

Walker D, Firebaugh CM, Craft G, McKiernan P, Palmisano C. Therapy in the Age of Legalized Marijuana: A Qualitative Study of Counselors’ Experience in Responding to Patient Marijuana Use. AM J QUALITATIVE RES. 2022;6(1):85-106. https://doi.org/10.29333/ajqr/11531