1. Jackie Daniels, MSW, LCSW
Office of Alternative Screening and Intervention
Services (OASIS)
Indiana University
Facebook: *Full Office Name
Twitter: IUDrugAlcPrev
2. Agenda
General Information about use
Health
Physical, Addiction, The Brain
Consequences
Implications for Higher Ed
Intervention/Prevention
4. General Information
Most commonly used “illicit” drug in US, Worldwide
Commonly used as medicine, food, hospitality, spiritual practices
in many cultures
Social symbol- Revolution, freedom, political control, FREE LOVE
~4.0% of the world population use cannabis annually (162 million
people)
THC – delta-9-tetrahydrocannabinol
Main psychoactive ingredient; binds to nerve endings in several
parts of the brain
The part of marijuana that affects senses, dulls pain, and
produces a “high”
Over 70 identified cannabinoids in marijuana
Several others cannabinoids are of medical interest
Includes cannabidiol, shown to relieve convulsion, anxiety,
inflammation, and nausea
5. General Information
Marijuana has its own drug classification
Most similar to hallucinogens/psychedelics
Also shares properties with depressants and stimulants,
narcotic pain-killers
Smoking:
Can reach the brain in 14 seconds
Felt within minutes
Peaks after 10 –15 minutes
Lingers 2 –3 hours
Food and Beverage:
Depending on dose, upwards of 3 hours
6. General Information
Prevalence
34% of IN College Students Acceptance
report smoking past year
(IUB= 40.8, increase from 28.6 % feel peers would
2011 ICSUS) strongly approve of
18.7% past month “trying” once or twice
(IUB=23.5%, decrease from 6.9% feel peers would
2011 ICSUS) strongly approve of
Avg. age 1st use IN= 17.4 using regularly
Most frequent consequences Survey results show an
Combining substances upward climb of peer
Guilt and Shame approval over the last
Driving few years (significant)
8. Physical Health
Rational scale to assess
harm of drugs
Marijuana is in the least
harmful category
Relative to other drugs in
that category, marijuana
use still carries some risk
of harm
From Nutt et al, The Lancet 2007
9. Physical Health
Lungs
Smoke disables cilia which rid dirt and toxins from
the lungs
Immediate effects
Burning & stinging in mouth & throat.
Heavy coughing.
Effects with regular, long-term use
Increased phlegm production.
Increased incidence of bronchial ailments
10. Physical Health
Heart
Dramatically increased heart-rate:
Increase by 20-50 BPM (70-80 BPM baseline)
Can contribute to feelings of panic/anxiety
Immune system
Marijuana users can develop allergies to the plant
Symptoms include hives, rashes, wheezing, and
anaphylaxis (rarely)
You can become allergic to marijuana even if you have
not previously experienced symptoms
11. Addiction
Physiological Addiction:
the body becomes chemically tolerant causing
increased craving and dependency.
Psychological Addiction:
the mind becomes dependent upon the drug causing
one to obsessively think about the drug and to
develop a love-trust relationship
12. Addiction: Test Yourself
(DSM-IV) and the
The of American Psychiatric Association
World Health Organization (ICD-10) criteria for Addiction
Answer yes or no to the following seven questions.
Tolerance
Withdrawal
Difficulty controlling your use
Negative consequences
Neglecting or postponing activities
Spending significant time or emotional energy
Desire to cut down
If you answered yes to at least 3 of these questions, then you
meet the medical definition of addiction.
13. Addiction vs. Abuse
Some people aren't addicted to drugs or alcohol, but
abuse them.
The American Psychiatric Association (DSM-IV)
definition of Substance Abuse is at least one of the
following four criteria.
Continued use despite social or interpersonal problems.
Repeated use resulting in failure to fulfill obligations at work,
school, or home.
Repeated use resulting in physically hazardous situations.
Use resulting in legal problems.
14. The Brain
How do drugs affect the
brain?
All Drugs: affect dopamine receptors
16. The Brain
Acute (present during intoxication)
Impairs short-term memory
Impairs attention, judgment, and other cognitive functions
Impairs reaction time
Persistent (longer than intoxication, not permanent)
Impairs memory and learning skills (even after 24 hrs without using)
Long-term (potentially permanent effects of cumulative
use)
Can lead to addiction (~9% of users become addicted)
*Correlated with the development of mental disorders in vulnerable
individuals
*May increase risk of anxiety and depression
17. Marijuana and Other
Drugs
Marijuana has anti-emetic (anti-nausea) properties
Downside: it hinders your ability to purge after ingesting
toxic substances, especially alcohol
Taking marijuana with prescription sedatives can
lead to excessive drowsiness and significantly impair
coordination and cognitive functioning
Smoking marijuana and tobacco together increases
risks of lung cancer and other pulmonary diseases
18. What about medical
marijuana?
What is “medical marijuana”?
MARINOL
Synthetic THC
Pill form
Currently there are no FDA approved smoke-
able medicines.
19. Consequences
Implications for Higher Education
20. Academics
Marijuana has been shown to impair executive
functions, attention, and memory
Heavier users experience more impairment
Impairments persist after 24 hours
21. Academics
Divergent Learning
Finding creative
solutions to problems
Exploring ideas
Low doses of THC
have been shown to
improve this ability
22. Academics
Convergent Learning
Recalling stored
information
Applying conventional
and logical search,
recognition and
decision-making
strategies
Even small amounts of
THC impair one’s
ability to do this
23. Academics
Marijuana can affect cognition for over 24 hours
after use
In studies, people did not always realize they were
experiencing cognitive deficits
24. Current Indiana Marijuana
Rankings
Ranked 9th in the country for maximum sentences
for possession for any amount of marijuana
Ranked 3rd in the country for maximum sentences
for possession of one ounce
29th in the country for percentage of total
population who have used marijuana in the last
year
Source: Jon Gettman, Ph.D. The Bulletin
ofCannabis Reform 2007
25. Legal Consequences in
Indiana
Possession of Marijuana
Class A Misdemeanor – 30 grams or less
Class D Felony – 30 grams or less and prior conviction
Class D Felony – more than 30 grams
Class A Misdemeanor is punishable by up to 1 year
and up to a $5,000 fine
Class D Felony is punishable by six months to 3
years and up to a $10,000 fine
26. Legal Consequences
Dealing of Marijuana
Class A Misdemeanor – 30 grams or less
Class D Felony – 30 grams or less and prior conviction
Class D Felony – 30 grams or less and recipient is under age 18
Class D Felony – more than 30 grams
Class C Felony – 30 grams or less and in a park, public housing
complex, school bus, or within 1000 feet of a school
Class C Felony – 10 lbs or more
Class C Felony is punishable by 4 to 8 years and up to a
$10,000 fine
Driving under the influence (DUI) of
marijuana=progressive sentencing (MS-FELONY)
27. Indiana Drugged Driving
Law
In Indiana, a person in guilty of DUI if he or she operates a
vehicle while a controlled substance or its metabolite is
present in the person's body. Ind. Code Ann. § 9-30-5-1(c)
Indiana has a zero tolerance per se drugged driving law
enacted for cannabis, cannabis metabolites, and other
controlled substances. (Indiana Code Annotated, Section 9-
30-5-1 & Section 9-30-5-2)
A person who operates a vehicle impliedly consents to
submit to chemical tests as a condition of operating a
vehicle in Indiana. Id. § 9-30-6-1. A person must submit to
each chemical test offered by an officer, or it will be
considered a refusal. Id. § 9-30-6-2(d).
28. Career Consequences
Under federal law (Section 3002 of 50 U.S.C. 435b), current or recent
drug use prohibits federal employees from obtaining security
clearance
Many other occupations make employment decisions based on background
checks
Companies that receive federal funds are required to prohibit
marijuana use under the Drug-Free Workplace Act of 1988
Based on court rulings, companies are NOT required to make
accommodations for medical marijuana users, even if medical marijuana is legal
within the state
Institutions of Higher Education receiving government funding
Search yourself! In Indiana: mycase.in.gov
29. Career Consequences
Drug arrests/convictions are a matter of
public record; they will be visible to potential
employers for entire career
Search yourself! In Indiana: mycase.in.gov
30. Financial Aid
Higher Education Act of 1965 (amended) suspends federal
financial aid eligibility for students convicted of the sale or
possession of drugs under federal or state law (with stipulations)
The U.S. Department of Education requires students receiving
financial aid convicted of a drug crime to notify their school's
financial aid office immediately
The suspension of eligibility for Federal financial aid begins on
the date of the conviction and ends as follows:
- for Possession of a Controlled Substance 1st offense: 1 year
- for Possession of a Controlled Substance 2nd offense: 2
years
- for Possession of a Controlled Substance 3rd offense:
Indefinite
- for Sale of a C.S. 1st Offense or 2nd Offense: 2 years
- for Sale of a C.S. 3rd Offense: Indefinite
31. University Consequences
Consistent Police Involvement
Campus Conduct and Community Courts are
Concurrent (some PDP)
Progressive Sanctioning by Campus Conduct System
Suspension, Expulsion
Mandatory MIP & Marijuana Seminar Attendance
33. “Just Say No”
-Thank you Nancy Reagan
I learned it by watching you
Pot-smoking surgeon
Saw blade
Turtle trouble
34. “Just Say No”
De-legitimizes authority
Makes the authority figure seem ignorant and out of
touch
Does not respect autonomy and personal decisions
Does not respect the POSITIVE effects that drugs
might have in someone’s life
35. Be research based and
theory driven
Integrate multiple parts of
student life
The primary goals are to:
Reduce, Delay, Decrease
Transition from “use” to
“abuse”, Harm Reduction
Prevention
Primary, Secondary, IU CURRENT PREVENTION:
Tertiary Policy, Conduct, Legal
Culture of Care- STEP UP IU!
Individual, Campus
Strategic Planning Underway
(Environmental),
Community
37. Marijuana Intervention Program
MIP
Basic Structure of OASIS and Referrals from Office of
Student Affairs, Admissions Office
Continuum of Users
Campus and Community Partners
Student Life and Learning, Student Advocates, IUHC
CAPs, Student Legal Services
IUPD, Monroe County Prosecutor’s Office
IU Code of Conduct and A-Z Guide
On and Off Campus Violations (Confusing for Students)
38. Components
Survey
SCID-IV Non-Alcohol Use SUDs Questionnaire (DSM)
MSI-X (Marijuana Screening Inventory)
Marijuana Effect Expectancies
Reasons for Quitting
AUDIT (Alcohol)
Stages of Change Assessment
Session I= 1 hour, relationship development, motivational
interviewing and assessment
Psychoeducational, Individualized Feedback, Case
Management and Referral (if necessary)
39. Goals of M.I.P.
Help students take ownership of behavior, choices and
consequences
Develop critical and abstract thinking ability around these
choices, physical health and psychological well-being,
examine academic and community standing
Develop awareness of values and ethical beliefs, how
these shape decision-making
Advance self-efficacy and identity
Assess for more serious problems and refer for
counseling/treatment/campus resources
41. Statistics and Sources
National Institute on Drug Abuse.
http://www.whitehousedrugpolicy.gov/drugfact/marijuana/index.html
http://www.addictionsandrecovery.org/definition-of-addiction.htm
Indiana Collegiate Action Network (2012) Indiana College Substance Use Survey -
IUB
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental
Disorders
Jessor, R. & Jessor, S. L (1977) Problem behavior and psychosocial development: a
longitudinal study of youth.
Donovan, J.E. & Jessor, R. (1985) Structure of problem behavoir in adolescence and
young adulthood
Substance Abuse and Mental Health Services Administration (SAMHSA) (2003)
Clark County Prosecutor, Indiana ( 2010)
Indiana Prevention Resource Center (2010)
Alger, B. & Nicoll, R. ( 2004)
Center for Addition and Mental Health (2010)
Triggering Myocardial Infarction by Marijuana (2001)
42. Recources
NREPP-SAMHSA National Registry of EBP and Practices
Center for Study and Prevention of Violence- University
of Colorado
National Institute on Drug Abuse (NIDA)
Cannabis Youth Treatment
Motivational Interviewing Resources
Office of Alternative Screening and Intervention Services-
M.I.P.
National Cannabis Prevention and Information Centre
Indiana Prevention Resource Center
Substance Abuse and Mental Health Administration
(SAMHSA)
Notas do Editor
Developed by Psychopharmacology Unit, University of Bristol, 2007. Reported in “The Lancet.”Legal/governmental definitions provide one viewpoint of “harm.” This diagram was created in UK:“We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion.” i.e. Opinions of professionals across varying fields (medical, pharmaceutical, neuroscience, etc)
MEDICAL MODEL
The next 2 slides: 2 different types of learning (Divergent and Convergent). For divergent learning, MJ allows for creative processing of information and solutions to problems by relying on an external stimulus (i.e. drug)
In convergent learning, this requires much more critical thinking, memory recallscience, math and technology
Memory, information recall, “foggy”
Justification: *Vision impairments-Peripheral vision (detecting other cars’ turn signals)DrowsinessCentral vision detection (stop lights)Time reaction (braking in time)Difficulty in maintaining speedsImpairment of night driving- recovering time from glare of on-coming trafficInterpretation and quick decision making
*There are stipulations, check with DOE before sharing to make sure you know how it applies to your school and the state consequences/legal status
Goals of prevention with cannabis:reduce use, limiting the number of users and the types of substances used and2. delay use in those that will use. Regarding the second goal, delaying the start of use reduces harm during a child’s development and reduces risk for developing addiction and abusive patterns of use. Recognition that at least some proportion of the population will use psychoactive substances3. preventing the transition from “use” to “abuse,” and4. diminishing harm resulting from use. This last would include not only ways to make use safer (e.g., needle exchanges, safer-drinking strategies), but also movement into treatment and prevention of relapse once treatment is completed. Prevention:· Primary prevention refers to activities undertaken prior to an individual using. Most educational programs fit under this, but so do programs designed to reduce drug availability (e.g., law enforcement). · Secondary prevention refers to activities applied during the early stages of drug use and would encompass attempts to prevent the transition from use to abuse. Early diagnosis, crisis intervention, and economic changes such as increasing alcohol taxes can decrease use and interrupt problematic patterns of use. · Tertiary prevention takes place at later (advanced) stages of drug abuse and refers to actions to avoid relapse and maintain health status after therapy. This is essentially the extended aspect of drug treatment. Intervention: · Universal Intervention refer to efforts focused on every eligible member of a community.These are programs aimed at an entire group (rather than individuals) and include media campaigns, policies that affect all members of a community equally, such as taxes and laws, and educational programs provided to all students regardless their risk level. Potential benefits are expected to outweigh costs for everyone. · Selective Intervention are more focused at a more systems domain where higher-risk subgroups are targeted (e.g., children from homes where family members have a history of drug use or college students in general). · Indicated intervention is individual-focused interventions and represents the most time and financially-intensive programs. These include prevention efforts targeted at individuals, for example those who show signs of developing problems, e.g., after receiving a DUI or completing treatment.
Referrals:IUPD,Res Halls-Dean of Students (unique relationship) housed outside IUHC, still confidentialCommon Sanctions and Policy Violations from the CODE, Part II Student Responsibilities Section H. ACCOMPANY Marijuana ViolationsDisciplinary probation- leads to judicial recordUnauthorized possession, manufacture, sale, distribution, or use of illegal drugs, any controlled substance, or drug paraphernalia. Being under the influence of illegal drugs or unauthorized controlled substances.A violation of any Indiana or federal criminal law.Violation of smoking policy Legal consequences:Dean has zero tolerance for dealing500.00 in PDP fees$200.00 for our office 2012- death finals weekPossession under 30g, dealing over 30gJail over-crowding leads to release of non-violent offenders in communityCan be arrested for OWI if suspected of being high- breathalyzer not necessary. Up to courts to proveCannabis is a Schedule 1 drug in IN- meaning it has potential for abuse and has no recognized medical use in treatment in the USA, or lacks accepted safety for use in treatment under medical supervision. Same class as heroin, lsd, EcstasyArrests 2011/2012:201118 felony arrests168 paraphernalia161 possession3 Dealing Cannabis13 Narcotics Poss.7 Narcotics Dealing201222 felony arrests60 possession53 paraphernalia6 Dealing Cannabis8 Narcotics Poss.17 Narcotics Dealing
Students complete initial survey for first appointment. $200.00 for serviceConversation/coaching/motivational approachDealing with legalization and decriminalization- partially education and information needed, otherwise belief systems. Students will sometimes want to transfer…SCID-IV Non Alcohol Use SUDS Questionnaire- DSM Criteria- used as indicator of abuse/depMSI-X- Helps identify “risky users”Alcohol use disorders identification test- refer on to SMART, talk about alcohol and assessMEE- Evaluate expectancies, develop discrepanciesIdentify change talk through reasons for quittingAUDIT- identify alcohol use problemsDetermine stage of change for appropriate MI approaches
Follow-up appointments based on risk assessment (ambivalence, risk for future consequence, mental health and peer group, future endeavors dictated by background checks- with school and lawConversation, non-judgmental.Motivational Interviewing techniques:Motivation to change is elicited from the client, and is not imposed from outside forcesIt is the client's task, not the counselor's, to articulate and resolve his or her ambivalenceDirect persuasion is not an effective method for resolving ambivalenceThe counseling style is generally quiet and elicits information from the clientThe counselor is directive, in that they help the client to examine and resolve ambivalenceReadiness to change is not a trait of the client, but a fluctuating result of interpersonal interactionThe therapeutic relationship resembles a partnership or companionship COACHING