1. No category

Clinical Skills in the Era of Legal Cannabis
•
•
Jennifer Wyatt, LMHC, MT-BC, CDP: [email protected]
2015 Alaska Annual School on Addictions & Behavioral Health
The ATTC Network
Ten Regional Centers
Four National Focus
Area Centers
• SBIRT
• Hispanic and
Latino
• Native AmericanAlaska Native
• Rural and Frontier
LEARNING OBJECTIVES
Participants will:
1. Gain an understanding of the varied forms of cannabis
available for consumption
2. Understand rates of use and current research findings on
the effects of cannabis on mental and physical health
3. Learn about cannabinoids and their interest to medical
science
4. Practice evidence-based clinical skills to talk with clients
about cannabis
5. Increase their knowledge of multimedia educational
resources
• Handouts
• Mobile phones
• ATTC Consent
form and
evaluations
TRAINING SPLIT INTO 4 SECTIONS
 Tues, May 5 in The Summit
 1-2:30pm
 3-4:30pm
 Wed, May 6 in The Summit
 10-11:30am
 2-3:30pm
 Please bring handouts to each section and
attend each part.
INTRODUCTIONS
• Your name
• Your agency and position
• Your hopes for this training
NATIONAL SURVEY ON DRUG USE AND HEALTH
(NSDUH)
 National and state-level data on the use of tobacco,
alcohol, illicit drugs (including non-medical use of
prescription drugs) and mental health in the US
 Began in 1971
 Conducted annually
 In 2013, approximately 70,000 individuals, age 12
and older, were randomly selected from all 50 states
plus the District of Columbia
 https://nsduhweb.rti.org/
YOUTH SURVEYS: MTF AND YRBS
YOUTH
SURVEYS:
MTFMeasures
AND YRBS
 Monitoring
the Future (MTF):
drug, alcohol, tobacco use,
and related attitudes of approximately 50,000 8th, 10th, and 12th
grade students, annually
 12th graders since 1975; and 8th and 10th graders since 1991
 http://www.monitoringthefuture.org/
 Youth Risk Behavior Survey (YRBS): Established in 1990 by the CDC
to help monitor the prevalence of behaviors that put youth at risk
for the most significant health and social problems that can occur
during adolescence and adulthood.
 Administered to high school students nationwide, it examines a
minimum of six including alcohol and drug use, sexual behaviors,
and physical activity.
 http://www.cdc.gov/HealthyYouth/yrbs/
Marijuana
Pain relievers
Inhalants
Tranquilizers
Stimulants
Hallucinogens
Sedatives
Cocaine
2.7% 2.6% 0.2% 0.1%
5.2%
6.3%
12.5%
70.3%
National Survey on Drug Use and Health, 2013
First specific drug associated with initiation of illicit drug
use among past year illicit drug initiates aged 12+: 2013
Mean Age at first use for specific illicit drugs among past year initiates aged 12 to 49: 2013
TRANQUILIZERS
SEDATIVES
HEROIN
PAIN RELIEVERS
STIMULANTS
ECSTASY
COCAINE
LSD
INHALANTS
MARIJUANA
PCP
25.4
25
24.5
21.7
21.6
20.5
20.4
19.7
19.2
18
17.1
National Survey on Drug Use and Health, 2013
Age in years
In millions
Daily or almost daily marijuana use
(Use on 20 orFROM
more days
in the
past month)
MORE HIGHLIGHTS
THE
NSDUH,
2013
9
8
7
6
5
4
3
2
1
0
8.1
5.1
2005 - 2007
2013
National Survey on Drug Use and Health, 2013
ALASKA YOUTH RISK BEHAVIOR SURVEY:
2013 HIGHLIGHTS
Current user
(Used one or more times during the past 30 days)
35%
30%
25%
20%
15%
10%
5%
0%
34.9%
23.4%
15.7%
US TRAD HS
Cannabis
22.5%
20.8% 19.7%
Cigarettes
12.8%
10.6%
AK TRAD HS
Alcohol
Binge alc
ALASKA YOUTH RISK BEHAVIOR SURVEY:
2013 HIGHLIGHTS
Current user (Used one or more times in the past 30 days)
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
38.7%
23.9%
19.2%
2003
39.7%
33.2%
20.5%
17.8%
22.7%
28.6%
21.2%
22.5%
19.7%
15.7%
2007
2009
Cannabis
Cigarettes
14.1%
2011
10.6%
2013
Alcohol
*2005 not reported because statewide representative results were not obtained.
ALASKA YOUTH RISK BEHAVIOR SURVEY: 2013
PERCENTAGE OF CURRENT MARIJUANA USERS
By grade in traditional
Alaska HS
22.6%
By race in traditional
Alaska HS
29.4%
22.4%
17.7%
15.0%
17.0%
6.9%
9th
10th
11th
12th
Asian
Alaska
Native
White
PERCENTAGE OF HIGH SCHOOL STUDENTS WHO USED
MARIJUANA ONE OR MORE TIMES DURING THE PAST 30 DAYS
(YRBS, 2013)
40%
30%
20%
10%
0%
2003
2007
Alaska Native
2009
2011
Alaska Non-Native
2013
US White
*2005 not reported because statewide representative results were not obtained.
HOW
MIGHT
DATA BE
USEFUL TO
YOU IN
CLINICAL
PRACTICE?
NEGATIVE IMPACT OF MARIJUANA USE ON
ADOLESCENTS
 Adolescents who use marijuana are at greater risk of
adverse health and psychosocial consequences including:
 Risky sexual behavior which can lead to STIs or unplanned
pregnancy
 Academic problems (e.g., dropout, increased absences)
 Legal problems, delinquency
 Driving under the influence
 Increased likelihood of suffering mental illness such as
depression, anxiety, psychosis, or other mental illness
 Lowered educational and occupational aspirations
Budney, Roffman, Stephens, & Walker. (2007); UW ADAI Fact Sheet: Marijuana & Adolescents, 2013.
The younger they start, and the more
NEGATIVE
IMPACT
OF MARIJUANA
ON
frequently
an adolescent
uses USE
marijuana,
the
ADOLESCENTS
more likely they are to suffer significant
problems.
RISK OF ADDICTION
9% of those who experiment with
marijuana will become addicted
About 17% for those who start using as
teenagers
25-50% among those who smoke daily
Source: Volkow et al., NEJM, 2014.
DSM V CRITERIA FOR CANNABIS USE DISORDERS
 11 criteria
1.
Using larger amounts, or over a longer time, than intended
2.
Persistent desire, or unsuccessful efforts, to reduce/control
3.
Spending a great deal of time obtaining, using, recovering
4.
Craving, or strong desire to use cannabis
5.
Recurrent use resulting in failure to fulfill role obligations at
work, school, home
6.
Continued use despite persistent social or interpersonal
problems exacerbated by the effects of cannabis
DSM V CRITERIA FOR CANNABIS USE DISORDERS
7.
Important social, occupational, recreational activities given
up/reduced because of cannabis use
8.
Recurrent use in physically hazardous situations
9.
Continued use despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to
have been caused or exacerbated by cannabis
10. Tolerance AEB Need for increased amounts to achieve the
same effect or diminished effect using the same amount
11. Withdrawal AEB the characteristic withdrawal syndrome for
cannabis or using cannabis or a closely related substance to
relieve or avoid withdrawal symptoms
DSM V CRITERIA FOR CANNABIS WITHDRAWAL
A. Cessation of cannabis use that was heavy or prolonged
B.
Three or more of the following symptoms develop within
approximately 1 week after stopping:
1. Irritability, anger, or aggression
2. Nervousness or anxiety
3. Sleep difficulty (e.g., insomnia, disturbing dreams)
4. Decreased appetite or weight loss
5. Restlessness
6. Depressed mood
7. At least one of the following physical symptoms causing
significant discomfort: Abdominal pain, shakiness/tremors,
sweating, fever, chills, headache
ADVERSE CONSEQUENCES OF MARIJUANA USE:
NIDA RESEARCH REPORT: MARIJUANA (2014)
ACUTE
LONG-TERM
 Impaired short-term memory
 Potential for addiction
 Impaired attention & judgment
 Potential loss of IQ
 Impaired coordination &
balance
 Increased heart rate
 Anxiety, paranoia
 Psychosis (uncommon)
 Increased risk of chronic cough,
bronchitis
 Increased risk of schizophrenia
in vulnerable people*
 Potentially increased risk of
anxiety, depression, and
amotivational syndrome*
*Often-reported co-occurring symptoms/disorders with chronic marijuana use; unclear
whether marijuana is causal or just associated.
VIDEO
NIDA Notes: Researchers Speak—Dr.
Madeline Meier on Marijuana and IQ
https://www.youtube.com/watch?v=qJXnx
HYapbE
IS THERE A LINK BETWEEN MARIJUANA
USE AND MENTAL ILLNESS?
 “Several studies have linked marijuana use to
increased risk for mental illnesses, including
psychosis (schizophrenia), depression, and anxiety,
but whether and to what extent it actually causes
these conditions is not always easy to determine.
The amount of drug used, the age at first use, and
genetic vulnerability have all been shown to
influence this relationship” (p. 8)
 NIDA Research Report Series: Marijuana. 2014.
MARIJUANA AND PSYCHOSIS
 Strongest evidence for the link between marijuana
use and psychotic disorders in those with a preexisting genetic vulnerability:
 AKT 1 gene governs an enzyme that affects dopamine,
and altered dopamine signaling is known to be involved
in schizophrenia.
 3 variants of the AKT 1 gene
 Daily marijuana users with the C/C variant were 7 times
more likely to develop psychosis than infrequent or
nonusers of marijuana. (Di Forti et al, Biological
Psychiatry: 2012).
Source: NIDA Research Report Series: Marijuana. 2014.
MARIJUANA AND PSYCHOSIS, CONTINUED
• COMT gene governs an
enzyme that breaks
down dopamine.
• Individuals with one or
two copies of the Val
variant had a higher risk
of developing
schizophrenic-type
disorders if they used
cannabis during
adolescence (dark green
bars).
Source: NIDA Research Report Series: Marijuana. 2014.
Most people who use marijuana do not go on to use other
“harder” drugs.
People who are more vulnerable to using drugs
might start with readily available substances,
including nicotine, alcohol,
and marijuana.
FEDERAL STATUS OF MARIJUANA
“The Administration steadfastly opposes
legalization of marijuana and other drugs because
legalization would increase the availability and use
of illicit drugs, and pose significant health and
safety risks to all Americans, particularly young
people.”
• Office of National Drug Control Policy: Marijuana
• https://www.whitehouse.gov/ondcp/marijuana
ALASKA: STATUS OF MARIJUANA
 Legal medical and recreational marijuana
 Ballot Measure 2, which took effect on 02 24 2015:
 Possession of up to:
 One oz. of cannabis for personal consumption
 Up to 6 plants, with no more than 3 mature
 Gifting personal quantities
 Cultivation of less than 25 marijuana plants for
personal use in a private residence is protected under
the right to privacy of the Alaska Constitution
 Consuming cannabis in public remains an offense
Source: http://dhss.alaska.gov/dph/Director/Pages/marijuana/default.aspx
DRUG POLICY ALLIANCE: INTERPRETING DATA FROM CO
Arrests
• Since 2010, MJ possession charges down by 90%,
cultivation charges down by 96%, distribution
charges down by 99%
• Black people remain 2.4 times as likely to be arrested
Tax
revenue
• $52.2 million: Funds health professionals in
schools, including nurses and social workers;
prevention and education programs; school
building and maintenance costs
Traffic
deaths
• 3% drop in traffic fatalities
• Follows 12 year long downward trend in traffic
fatalities
Source: http://www.drugpolicy.org/reforming-marijuana-laws
Monitoring Health Concerns Related to Marijuana in
Colorado: 2014
• Adolescents:
o Fewer middle school students use marijuana than high
school students (HKCS, 2013)
o Prevention efforts should be aimed at children before they
enter 9th grade (HCKS, 2013)
• Adults:
o Adult marijuana use is higher in CO than most other states
(NSDUH, 2013).
o Based on limited data from CO adult marijuana users in the
Influential Factors in Healthy Living (IFHL, 2014) survey, it
appears that among those who report using marijuana, 64%
use more than 8 times per month.
CONTROVERSY SURROUNDING CANNABIS
Legality
Access by
youth
Big
business
Public
Health
impact
Competing
information
What else?
VIDEO
How does marijuana affect the body?
From Marijuana Lit: Fact-Based
Information to assist you in providing
SUD services:
http://attcnetwork.org/marijuana/
Video: https://vimeo.com/118059010
EDIBLES
DEFINITION: Smoking
THC-rich resins, or
concentrates, extracted
from the marijuana plant
• Hash oil or honey oil
• Wax
• Shatter
DANGERS:
• Very high in THC (5080% THC
• ED visits from getting
“too
FORMS
OFhigh”
MARIJUANA
• Preparation involves
FOR CONSUMPTION
butane (lighter fluid)
VAPING: Causes the essential oils in the
VAPORIZERS
extract to heat up to the point where they
become vapors
Endocannabinoid system
ENDOCANNABINOID SYSTEM
Anandamide
2-AG (2-arachidonoyl
glycerol)
Source: www.scholastic.com/headsup:
The Science of Marijuana: How THC Affects the Brain
Cannabinoid receptors
Source: NIDA, 2014. Drugs, Brain, and Behavior: The Science of Addiction.
VIDEO
Effects of cannabis on the teenage brain
NCPIC + Turning Point
National Cannabis Prevention and
Information Centre (Australia)
Check out their Youtube channel for
more videos about cannabis
https://youtu.be/FvszaF4vcNY
VARIED USER EXPERIENCES OF MARIJUANA
 Pleasant euphoria
 Anxiety
 Sense of relaxation
 Fear
 Heightened sensory
 Distrust
perception
 Laughter
 Altered time perception
 Increased appetite
 Panic
 Acute psychosis
(Rare)
Source: NIDA Research Report Series: Marijuana, 2014, p. 3
What do your clients say about why they use marijuana?
CANNABINOIDS
IN
CANNABIS
SATIVA
Cannabinoids in
Marijuana
THC
CBD
CBC
CBG
CBN,
CBDL
And
others
Note that these compounds exist in varying percentages;
they are NOT equally represented in marijuana.
There are varying ratios in certain strains.
PSYCHOACTIVE CANNABINOIDS
THC
CBN,
CBDL
CANNABINOIDS NOT KNOWN TO BE
PSYCHOACTIVE
CBD
CBG
CBC
 Medical marijuana refers to the whole unprocessed
marijuana plantMARIJUANA
or its extracts
MEDICAL
 Not recognized or approved as medicine by FDA right now
 Two FDA-approved drugs that contain THC are used to
treat nausea (chemotherapy) and wasting disease (AIDS):
 Dronabinol & Nabilone
Source: NIDA: Apr 2015. “Is Marijuana Medicine?”
 Sativex (nabiximols): Mouth spray with equal
parts THC & CBD; approved in the UK, Canada,
and other countries to treat spasticity (MS)
 In Phase III clinical trials in the US to establish its
effectiveness and safety in treating cancer pain
 Epidiolex: CBD-based drug created to treat
certain forms of childhood epilepsy; has not yet
undergone clinical trials
Source: NIDA: Apr 2015. “Is Marijuana Medicine?”
MEDICAL MARIJUANA
STATUS OF MEDICAL MARIJUANA RESEARCH
 THC and CBD are the main cannabinoids of
interest to scientists currently
 THC increases appetite and reduces nausea
 THC may also decrease pain, inflammation, and
muscle control problems
 CBD may be useful in reducing pain and
inflammation, controlling epileptic seizures,
possibly treating mental illness and addictions
Source: NIDA Drug Facts: Is Marijuana Medicine? Updated April 2015
PRECLINICAL AND CLINICAL TRIALS RESEARCHING
HOW CANNABINOIDS MIGHT BE USED TO TREAT…
Autoimmune
diseases:
HIV/AIDS, MS,
Alzheimer's
Inflammation:
Rheumatoid
arthritis, Crohn’s
Pain
Seizures
Substance Use
Disorders
Mental
Disorders
Cancer
Source: NIDA Drug Facts: Is Marijuana Medicine? Updated April 2015
Mr. Mackey, the School Counselor from
South Park, says…
TREATMENT FOR CANNABIS USE DISORDERS IN
ADOLESCENTS AND ADULTS
 Cannabis use disorders appear to be very similar to
other substance use disorders, although to a lesser
severity.
 Adults seeking treatment for cannabis use disorder
average more than 10 years of near daily use and
more than six serious attempts at quitting.
 About half of people who enter treatment for
marijuana use are under 25 years of age.
Budney, Roffman, Stephens, & Walker (2007); NIDA, 2014.
META-ANALYSES OF WHAT WORDS IN ADOLESCENT
SUBSTANCE USE TREATMENT
 Tripodi et al (2010) looked at 16 studies focused on
interventions to reduce adolescent alcohol use and found:
 Large effect sizes: Brief MI, CBT with 12 steps, CBT with
aftercare, MDFT, Brief interventions with the adol, Brief
interventions with the adol and parent
 Medium effect sizes: Integrated family and CBT, behavioral
treatment, triple modality social learning, MDFT, Brief
interventions with the adol
 Individual-only interventions had larger effect sizes than
family –based interventions, in this meta-analysis
 Effect sizes decreased after treatment was completed
META-ANALYSES OF WHAT WORDS IN ADOLESCENT
SUBSTANCE USE TREATMENT
 Hogue et al 2014 updated the meta-analysis from
Waldron & Turner (2008) and classified approaches
based on the level of empirical support for their
effectiveness:
 Well-established stand alone treatments: CBT-Group, CBT-
Individual, Family Based Therapy-Ecological (FFT, MDFT)
 Well-established integrated treatments: MET/CBT, MET/CBT +
FBT-Behavioral
 Probably efficacious stand alone treatments: FBT-B, MI/MET
 Probably efficacious integrated treatments: FBT-E +
Contingency Management, MET/CBT + FBT-B + CM
AVAILABLE TREATMENTS FOR CANNABIS USE
DISORDERS
Marijuana Check-up (for adults) and Teen
Marijuana Check-up 1 (EBP)
Promising group and individual treatments
 Motivational Enhancement Therapy (MET) 2, 3
 Cognitive Behavioral Therapy (CBT) 2, 3
 Contingency Management (CM) 2, 3
 Adolescent Assertive Continuing Care 1 (RBP)
Sources: 1WA State Institute for Public Policy, Oct 2014; 2NIDA, 2014; 3Budney et al 2007.
AVAILABLE TREATMENTS FOR CANNABIS USE
DISORDERS
 Family treatment
 Multidimensional Family Therapy for Substance
Abusers 1 (RBP)
 Multisystemic Therapy (MST)
 SAMHSA Manuals (Available free)
 Cannabis Youth Treatment Study Volumes 1 – 5
 Brief Counseling for Marijuana Dependence: A
Manual for Treating Adults
Sources: 1WA State Institute for Public Policy, Oct 2014; 2NIDA, 2014; 3Budney et al 2007.
TALKING WITH PEOPLE ABOUT THEIR USE
BE:
Transparent
Curious
Neutral
Patient
Inviting
Present
A resource
Ready
ELICIT – PROVIDE – ELICIT:
PITFALLS OF GIVING ADVICE
“Do” component, recommendation about
personal change
Likely to elicit pushback
Most people don’t like unsolicited advice
Risk of expert trap where counselor
argues for change
ELICIT – PROVIDE – ELICIT:
HOW DO PEOPLE TEND TO RESPOND TO ADVICE?
ELICIT
• “What do
you
already
know
about…”
PROVIDE
• Info in
small
chunks
• Focus on
client
interests
Rollnick, Miller, & Butler: 2008
ELICIT
• Ask what
the person
thinks
• Use
reflections
WHAT ARE WE TRYING TO ELICIT?
DESIRE
• “I wish I could quit smoking.”
• “I want to feel better.”
ABILITY
• “I quit before; I can do it again.”
REASON
• “My PO would get off my back.”
• “I might do better in school.”
NEED
• “I’ve got to keep my driver’s
license.”
DARN STATEMENTS ARE A START; BY
THEMSELVES, THEY DO NOT TRIGGER CHANGE.
 Working toward
commitment is the next
step:
 “I will…”
 “I plan to…”
 “I intend to…”
 “I am ready to…”
 “I will think about…”
 “I will consider…”
CHANGE TALK
Mobilizing
Commitment
Preparatory
Desire
Ability
Reason
Need
 Activation
 Taking
Steps
Behavior
Change
COMMUNICATION BREAKDOWN
What the listener
thinks the speaker
means
4
What the
speaker 1
means
What the
listener
hears
2
What the
speaker
says
3
OARS: REFLECTIONS
Reflections
 Statement, not a question
 Ends with a downturn
 Hypothesis testing
 “If I understand, you mean that…”
 Affirms and validates
 Keeps the client thinking and talking
 As you improve, you can shorten the reflection.
ELICIT:
ASK PERMISSION. CLARIFY NEEDS.
“What do you already know
about…”
“What information can I help you
with?”
Miller & Rollnick, 2013, p. 139
“Would you like to know about…”
Focus on what the person wants to
know.
Avoid jargon; use plain language.
Offer small amounts, with time to
reflect.
Acknowledge freedom to
disagree/ignore.
Miller & Rollnick, 2013, p. 139
PROVIDE:
PRIORITIZE. BE CLEAR. SUPPORT AUTONOMY.
ELICIT:
ASK FOR THE PERSON’S UNDERSTANDING AND RESPONSE.
Reflect reactions that you see.
Allow time to process and
respond.
Miller & Rollnick, 2013, p. 139
Ask open-ended questions.
SUMMARIZE AND ASK A KEY QUESTION
 Summarize the conversation, with particular attention
to Change Talk.
 The key question is short and simple:
 “Where does all this leave you?”
 “What might be the next step?”
 Be careful not to pressure, or push for commitment.
 “What are you going to do?”
 “What do you think you might do?”
Miller & Rollnick, 2013, p. 265
 “What do you think you’ll do?”
VIDEO
Motivational Interviewing: Helping
People Change, DVD Set, 2013
Interview 7: The Suspicious Smoker
Notice how Dr. Rollnick engages the
client in a discussion about his smoking.
Be on the lookout for EPE…
TIME TO PRACTICE!
TIME
TO
PRACTICE!
Groups of 3: Client, Counselor,
Observer
Choose one of the scenarios.
Practice EPE. Take your time.
Observers: Give feedback.
Switch roles until everyone has
played the Counselor.
• How was using EPE different from the usual
way of providing information?
• How might this tool impact your conversations
about cannabis use?
 Field tested the effectiveness of 5 promising adolescent treatments
in the largest randomized experiment ever conducted with
adolescent cannabis users seeking outpatient treatment
 Treatments vary in:
 Length: 6-14 weeks
 Mode: Individual, group, family
 Planned number of sessions: 5-23
 Results suggested that all five treatments were more effective than
current practice
 Outcomes at one year showed that 2/3 of participants were still
having problems. Overall, the interventions were viewed as successful
and affordable.
Source: UW ADAI Evidence-based Practice for Substance Use Disorders
CANNABIS YOUTH TREATMENT STUDY
CANNABIS YOUTH TREATMENT STUDY MANUALS
 Manuals released to the field in 2000
 Vol 1: Motivational Enhancement Therapy/Cognitive
Behavioral Therapy (MET/CBT5)
 Vol 2: MET/CBT12
 Vol 3: Family Support Network (FSN)
 Vol 4: Adolescent Community Reinforcement
Approach (ACRA)
 Vol 5: Multidimensional Family Therapy (MDFT)
• Sessions 1 & 2 are
individual MET:
o Personal Feedback
report
o Goal setting
o Functional Analysis
• Sessions 3 – 5 are group
CBT:
o Marijuana refusal skills
o Enhancing social
support network
o Increasing pleasant
activities
o Coping with
unanticipated high risk
situations and relapses
• Sessions 6 – 12 are group
CBT
o Session 6: Problem-solving
o Session 7: Anger
awareness
o Session 8: Anger
management
o Session 9: Effective
communication
o Session 10: Coping with
cravings and urges to use
marijuana
o Session 11: Depression
management
o Session 12: Managing
thoughts about marijuana
• Individual MET/CBT
• Sessions 1 - 2: Enhancing
motivation using the PFR, goal
setting, encouraging social support
• S3: Coping with other life problems
• S4: Understanding marijuana use
patterns
• S5: Coping with cravings and urges
to use
• S6: Managing thoughts about
marijuana use
• S7: Problem-solving
• S8: Marijuana refusal skills
• S9: Elective (Assertiveness,
Seemingly irrelevant decisions,
Coping with a lapse, or Managing
negative moods)
ALASKAN RESOURCES
 Alaska Department of Public Health
 Lots of resources including statistics, information about laws,
and links to brochures and articles about marijuana use
 http://dhss.alaska.gov/dph/Director/Pages/marijuana/
 AK-IBIS (State of Alaska Dept of Health and Social
Services' Indicator-Based Information System for
Public Health
 http://ibis.dhss.alaska.gov/
 Provides statistical numerical data and contextual information
on the health status of Alaskans and the State of Alaska's
health care system.
RESOURCES FOR MORE INFORMATION
 National Institute on Drug Abuse: www.drugabuse.gov
 NIDA for Teens: www.teens.drugabuse.gov
 ATTC Network: www.attcnetwork.org/marijuana
 University of Washington Alcohol Drug Abuse Institute:
www.learnaboutmarijuanawa.org
 Drug Policy Alliance:
http://www.drugpolicy.org/reforming-marijuana-laws
 ACLU of WA State: https://aclu-wa.org/initiative-502
 Americans for Safe Access (Medical marijuana):
www.safeaccessnow.org
RESOURCES YOUR CLIENTS MIGHT BE VIEWING
 National Organization for the Reform of Marijuana Laws:
NORML: www.norml.org
 Leafly: www.leafly.com
 VIDEO example: “Leafly Cannabis 101: What's the
difference between Indica, Sativa & Hybrid?”
 High Times Magazine: www.hightimes.com
 Cannabis Now Magazine:
www.cannabisnowmagazine.com
 Youtube.com: Some of these sources also have a video
channel.
 Social media presence: Facebook, Instagram, Twitter
As we ride off into the sunset, what will you
take with you back to your clinical work?
Evaluations
• Thank you for sharing your feedback on our
programming with us!
• We use this information to improve our services and
to share information with SAMHSA about our work.
• Please complete the Evaluation Form and the ThirtyDay Follow Up Consent Form.
• If you complete our Thirty-Day Follow Up survey, we
will thank you with a $5 coffee card.
Visit Us Online!
• Upcoming trainings
• The range of training and technical assistance
services we offer
• Resources and links on key topics
www.attcnetwork.org/northwest