Considerations of the Dianova network on how to improve the prevention and treatment of problematic cannabis use
Por Lucía Goberna – On 27th of January, 33 professionals from 15 organizations of the Dianova network gathered online to explore the issues that could be improved with regard to the prevention and treatment of problematic cannabis use.
In view of the international debate around the legal status of cannabis, Dianova conducted an in-depth analysis of the situation at the international level, its limitations and opportunities. This analysis resulted in the publication of the “Study on the regulation and legalization of the therapeutic and recreational uses of cannabis, and their addiction social and health-related risks”. In addition, based on this study, and following months-long internal discussions among its members, Dianova eventually updated its “Position paper on addiction and cannabis policies”.
We didn’t want to focus on legal aspects exclusively, but rather to provide a closer look based on their consequences on the prevention and treatment fields. On this account, we organized an online meeting with professionals from the Dianova network to gather first-hand information about the needs they identify in the prevention and treatment of cannabis use disorder, as well as possible avenues for improvement.
The meeting’s participants addressed a variety of topics, including the profiles of problematic cannabis users, the referral system for treatment, the differences between outpatient and residential treatment programmes, the need to adapt existing programmes, the patient’s motivation for treatment, how to prevent relapse, and proposals for improving prevention programmes.
The participants made, among others, the following observations:
One should consider the different patterns of cannabis use, based on the profiles of users – for example as an anaesthetic. Although well-known, these patterns aren’t always taken into account during interventions.
Although a small number of patients in residential treatment are exclusive cannabis users, it has been observed that many request admission in Therapeutic Communities (TCs) due to the co-occurrence of mental disorders, including psychosis, ADHD, and intellectual disability. TC programmes appear important to achieve stabilization, however, in the middle- to long-term, patients should be referred to specialized outpatient or day care services.
In both residential and outpatient models, it is critical to involve families in the preparation of the treatment process.
Many people use cannabis on a regular basis with no apparent functional issues. This is likely to contribute to a low perception of cannabis-related risks, especially among young people. Since they are unaware of their potential problem, they do not tend to seek treatment.
Patients may find it difficult to problematize their use of cannabis. Addressing the routines associated with work and free time may help them to do so. It is therefore important to work on different routines on a daily basis so as to reduce the importance of cannabis use. Rather than entering in discussions about consumption, one should focus on reducing cannabis use while suggesting that people may recover their ability to function properly through their reducing of drug use. The approach to reducing cannabis use is different than that of other types of consumption.
Treatment programme should address the person’s specific relationship with the substance rather than the substance itself.
The use of genetically modified cannabis is likely to increase the onset of psychotic disorders. In these cases, the motivation for treatment is often to avoid the severe consequences of cannabis use rather than to complete the treatment programme.
One should pay special attention to the complicated pattern induced by problematic cannabis use associated with compulsive gaming. This may result in poor performance at work or at school, and relationship and family problems. Those concerned are usually between 19 and 35 years of age and supported by their parents. In the latter case, motivation for treatment can be low.
Bipolar patients may believe that there are some therapeutic benefits in cannabis use, as compared with other substances, helping them reduce anxiety levels and appease episodes of mania.
As regards interventions with youth, it is important help families develop parenting skills. One should bear in mind that when young people are given medication for their substance use, they often merely replace one drug with another. In addition, cannabis use can worsen psychotic episodes in minors of age.
On the part of the authorities, there is some confusion between prevention and treatment programmes and with the implementation of practices that are not based on evidence.
There is a great wealth of theories and tools for therapeutic interventions that are not utilized or partly utilized, especially that related to neuroscience and the science of implementation.
Regarding prevention, it is necessary to work with children at an early age to create healthy habits and promote self-care. Without self-care, problematic uses are more likely to appear. In addition, it is necessary to promote responsible use among the adult population with associated mental health problems. In all respects, prevention should rely on objective information.
This webinar was part of a series of events that Dianova is going to carry out this year on how to improve the prevention and treatment of the problematic use of cannabis. We will keep you informed of the events and their outcomes.