A Practitioner's Guide to Cannabis

Contents 1 Introduction 1 2 What is Cannabis? 5 The Geographical and Historical Origins of Cannabis 6 History of the Medicinal Use of Cannabis 7 Recent US History of Cannabis Use 9 Factors Influencing Cannabis Legalization in the United States 10 3 The Chemistry of Cannabis 13 Psychoactive Chemicals in Cannabis 13 Synthetic Cannabinoids 15 Cannabinoids and the Human Body 17 The Changing Chemistry of Cannabis and Synthetics 19 4 Cannabis Use in the United States 20 Potential Effects of Legalization of Cannabis in the United States 20 Risks and CUD 22 Risks Pertaining to Cannabis Delivery Methods and Potency 24 5 Cannabis, its Recreational Use, and its Effects 27 Recreational Use of Cannabis 29 Pregnancy 31 Highway Safety 33 Cognitive Impairment 33 6 Cannabis as Medicine and the User’s Experience 35 Multiple Sclerosis 36 Chronic Pain 36 Epilepsy 38 Cancer 38 Psychiatric Conditions 39 Medical Cannabis Patients Describe Their Experiences 39 Positive Experiences 40 Negative Experiences 41 Recommendations 41 Summary 41 7 A New Approach to Cannabis Screening 42 Universal Screening for Substance Use Disorders 42 Rationale for a Cannabis Screener 43 Cannabis Intervention Screener 44 Development of the CIS 45 Summary of CIS Evaluation Findings 46 Cannabis Use Vs. Misuse Vs. Abuse 48 Implications from CIS Study Findings 51 Orientation to Clinical Interventions Addressing Cannabis Use Disorder 53 Motivational Interviewing and Motivational Enhancement Therapy 53 Brief MI Interaction for Cannabis Misuse 54 Cognitive Behavioral Therapy 55 Intrapersonal Skills Training 57 CBT Introduction 58 The Structure of a Session Delivery: “Law of Thirds” 59 Session 1. Eliciting the Life Movie 64 Clinician Preparation 65 Session 1 Outline and Overview 66 Session 1 Protocol with Scripts 68 Session 1. Eliciting Life Movie and Change Plan Handouts 78 Treatment Information Sheet 79 Eliciting the Life Movie: MI Conversation 81 A Change Plan—Optional 84 Learning New Coping Strategies (Handout) 85 Session 2. Enhancing Awareness 89 Clinician Preparation 90 Session 2 Outline and Overview 91 Session 2 Protocol with Scripts 94 Session 2. Enhancing Situational Awareness Handouts 102 Review of Progress and Between-Session Challenges 103 Alcohol/Cannabis use Awareness Record 104 Alcohol/Cannabis use Awareness Record Example 105 Planning to Feel Good (Optional) 106 Session 3. Learning Assertiveness 107 Clinician Preparation 108 Session 3 Outline and Overview 109 Session 3 Protocol with Scripts 111 Session 3. Learning Assertiveness Handouts 120 Review of Progress and Between-Session Challenges 121 Communication Styles 122 Between-Session Challenge Assertiveness 124 Session 4. Supporting Recovery through Enhanced Social Supports 126 Enhancing Social Support 128 Session 4 Outline and Overview for Enhancing Social Support 129 Session 4 Protocol with Scripts 132 Session 5. Supporting Recovery through Healthy Replacement Activities 136 Clinician Preparation 137 Session 5 Outline and Overview for Enhancing Healthy Replacement Activities 138 Session 5 Protocol with Scripts 140 Session 5. Supporting Recovery Through Healthy Replacement Activities Handouts 143 Review of Progress and Between-Session Challenges 144 Social Support 145 My Social Atom 146 Plan for Seeking Support 147 Increasing Pleasant Activities 148 Engaging in Replacement Activities 149 Session 6. Problem Solving 150 Clinician Preparation 151 Session 6 Outline and Overview 152 Session 6 Protocol with Scripts 155 Session 6. Problem Solving Handouts 163 Review of Progress and Between-Session Challenges 164 Problem Solving 165 Session 7. Handling Urges, Cravings, and Discomfort (urge Surfing) 167 Clinician Preparation 168 Session 7 Outline and Overview 169 Session 7 Protocol with Scripts 172 Session 7. Handling Urges, Cravings, and Discomfort Handouts 186 Coping with Cravings and Discomfort 187 Daily Record of Urges to Use 189 Urge Surfing 190 Session 8. Making Important Life Decisions 192 Clinician Preparation 194 Session 8 Outline and Overview 195 Session 8 Protocol 197 Session 8. Making Important Life Decisions Handouts 201 Clinician’s Quick Reference to Session 8 202 MI Skills and Strategies 204 Readiness-to-Change Ruler 205 Values Exploration 206 My Values 208 Decision-Making Guide 209 Decision-Making Guide Example 211 Thinking About My Use Option 3 213 Session 9. Enhancing Self-awareness 214 Clinician Preparation 215 Session 9 Outline and Overview 216 Session Protocol 217 Session 9. Enhancing Self-Awareness Handouts 227 Clinician’s Quick Reference to Session 9 228 Alcohol/Cannabis Use Awareness Record 229 Alcohol/Cannabis Use Awareness Record (continued) 231 Alcohol/Cannabis Use Awareness Record Example 232 Future Self Letter 233 Relaxation Practice Exercise 234 Session 10. Mindfulness, Meditation, and Stepping Back 235 Clinician Preparation 238 Session 10 Outline and Overview 239 Session Protocol 240 Session 10. Mindfulness, Meditation, and Stepping Back Handouts 246 Clinician’s Quick Reference to Session 10 247 Mindfulness Meditation Instructions 248 Meditation Exercise: On the Riverbank 249 References 250 Index 267