SA 201 Addiction Family Policies

1. POLICIES: DRUGS AND
FAMILIES
Diane A. Tennies, PhD, LADC
https://dianetenniesphd.com/
July 2020

2. Agenda
Overarching theme is policy implications as we
discuss:
■ Job Corps as example of societal shift in marijuana
■ Trauma and the implications for families
■ So is Marijuana Use in our Brave NewWorld as ACE?
■ Humor and coping

3. Job Corps
– Largest JobTraining Program in the Country
– At least one in each state (total 125 centers)
– Over 60.000 being trained at any given time
– Run by USDA (Forest Service) and For-Profits
Corporations
– Income eligibility requirements
– I am a Drug/Alcohol Consultant for all Job Corps
across the country

4. Marijuana

5. What you Thought You Knew about
Marijuana

6. Black: fully legalized; Dark Green: medical and decriminalized;
Medium green: medical; lighter green: decriminalized: lightest green: fully illegal
12 states = fully legal
11 states = fully illegal
Updated January
2020
Black: fully legalized; Dark Green: medical and decriminalized;
Medium green: medical; lighter green: decriminalized: lightest green: fully illegal
12 states = fully legal
11 states = fully illegal
Updated January
2020

7. Number of Job Corps Where
Marijuana is Legal

8. A World Where Marijuana is Legal
■ The way the drug is viewed by the public is changing.
■ How marijuana is sold, delivered and consumed are also changing:
– apps
– infused in wine
– Edibles
– pet food
■ Celebrities marketing their own brands of pot, includingWillie
Nelson and Snoop Dogg.
■ There are subscription delivery services: Potbox and SpeedWeed.
■ Marijuana is America’s fastest growing industry.

11. Edible Marijuana
■ Product intended to be eaten.
■ Include a range of food types, baked goods, drinks, candies,
ingredients (such as oil or butter) and pills.
■ Differences with edibles versus smoked marijuana
– Fewer restrictions (can consume in public places)
– Less conspicuous consumption
– Different intoxicating effects
– Recreational marijuana sold by weight while Edibles sold by amount of
THC in them

12. Marijuana Edibles

13. Candy

14. Infused Energy Shots

16. Safety of Edibles
■ Edibles (in Colorado) were less than 1 percent of total cannabis sales (by
weight) between 2014 and 2016
■ But accounted for 10 percent of ED visits
■ Differences between those who reported smoking marijuana and using edibles:
– Those consuming edibles reported altered mental state with anxiety (but
not those who smoked).
– More acute psychiatric symptoms for edible users versus exacerbation of
MH s/s, like depression, for those who smoked.
– Eight percent of edible users had cardiovascular symptoms including rapid
or irregular heart rate compared to 3 percent of smokers (BUT generally
seeing increase in CV symptoms associated with use).
– Visits attributable to smoking cannabis were more likely to be for
cannabinoid hyperemesis syndrome.
Volkow, N. D., & Baler, R. (2019). Emergency department visits from edible versus inhalable cannabis. Annals of internal
medicine, 170(8), 569-570.

17. Consequences of this Brave New
World
■ In 25 years we moved from fully illegal to more legal than not (California first in
1996).
■ Advocates believe helps with chronic pain, PTSD s/s, multiple sclerosis-
triggered muscle spasms, side-effects of chemotherapy and possibly addiction
(very limited data).
■ Marijuana safer than alcohol or tobacco but that doesn't make marijuana safe.
■ Car crashes rose 6 percent from 2012 to 2017 in four states that legalized
marijuana during that period – Nevada, Colorado, Washington and Oregon – a
greater rate than in four comparable states that didn’t (Highway Loss Data
Institute).
■ The National Academies of Sciences, Engineering, and Medicine concluded in
2017 that schizophrenia and other psychosis are correlated with heavy
marijuana use but not caused by it.

18. More Consequences
■ The National Academy found that learning, memory and attention are
impaired immediately after cannabis use. But concluded that the evidence
that use impairs academic achievement is limited.
■ Researchers at Duke University gave subjects IQ tests at age 13, before any
of them had smoked marijuana, and again at age 38.They reported in
2012 that those who started with cannabis as a teenager showed average
decline of 10 IQ points.
■ Hospitalizations for serious mental illness more than doubled in 18-25
years old nationally from 2012 through 2018 (NIMH, 2019).
■ Colorado had 77% increase in suicide deaths from 2010 to 2015 among 10
to 19 year old individuals with marijuana detected in their system.

20. TRAUMA ANDTHE
IMPACT ON FAMILIES
Diane A. Tennies, PhD, LADC
https://dianetenniesphd.com/
February 2020

22. Adverse Childhood
Experiences Study
■ Kaiser Permanente and the Centers for Disease Control and Prevention
(CDD) recruited participants for a long-term study between 1995 and 1997
■ Why did people drop out of treatment for obesity?
■ N=17,337 participants
■ Asked about whether participants had experienced certain negative
childhood experiences such as:
– Child maltreatment (emotional, physical or sexual abuse or emotional
or physical neglect)
– Exposure to violence
– Substance abuse
– Household mental illness
– Parental separation/divorce
– Incarcerated household member

23. ACEs Study Conclusions
■ Each was counted as one ACE.
■ The higher the score, the more at risk a person was for negative
outcomes as an adult - both mental health and physically, such as:
– Substance use disorders
– Mental health issues such as depression and suicide attempts
– Poor academic achievement
– Financial stress
– Experiencing violence
– Early death
– Illnesses

24. 24

26. Which means:
BUTWHY?

27. Adversity Disrupts the
Foundation
■ Toxic stress responses impair development with lifelong consequences.
■ Positive stress response is a normal and essential part of healthy
development
– characterized by brief increases in heart rate and blood pressure
– mild or brief elevations in stress hormone levels
– Like first day of school or injection at PCP visit
■ Tolerable stress response activates the body’s alert systems to a greater
degree as a result of a more severe or longer-lasting threat
– Loss of a loved one
– natural disaster
– frightening injury
– BUT if time-limited and buffered by relationships with supportive
adults who help the child adapt then no long-term damage

29. Toxic Stress Response
■ When a child experiences major, frequent, and/or prolonged
adversity
– recurrent physical or emotional abuse
– chronic neglect
– caregiver substance abuse or mental illness
– repeated exposure to violence
– economic hardship—without adequate adult support or, worse,
where the adult is the source of both support and fear.
■ Excessive and/or prolonged activation of the stress response
systems can disrupt the development of brain architecture and
other developing organs.
■ This cumulative toll increases the risk for stress-related disease
and cognitive impairment

30. Differential reactions
■ The interaction between genetic predisposition and exposure to
significant adversity makes some children more susceptible to long-
term problems in cognitive, social, and emotional development, as well
as to impairments in health.
■ But why?

31. Shonkoff, J. P. (2017). Breakthrough impacts:What science tells us about
supporting early childhood development. YCYoungChildren, 72(2), 8-16

34. What’s Protective?
■ Resilience is a dynamic interaction between internal
predispositions and external experiences.
■ Learning to cope is critical to be resilient.
■ Resilience can be developed at any age, but earlier is better.
■ Research has identified factors that help children achieve positive
outcomes in the face of significant adversity, including:
– supportive adult-child relationships
– building a sense of self-efficacy and control in children
– strengthen adaptive skills and self-regulatory capacities
– using faith and cultural traditions as a foundation for hope and
stability

35. ACEs Core Concepts
■ Children are negatively affected when significant stresses threaten their
family/environment. Can lead to changes in the brain that can last a
lifetime and include impairments in future learning capacity and poor
physical and mental health outcomes.
■ But ACEs do not doom children to poor outcomes.
■ Development is a highly interactive process, and outcomes are not
determined solely by genes.The environment provides powerful
experiences that modify genes. For example, children are born with the
capacity for impulse control, focused attention, and retaining information
in memory, but their experiences lay a foundation for how/if these
executive functioning skills develop.
■ While attachments to parents/caregivers are primary, children benefit
from relationships with other responsive caregivers.These relationships
do not interfere with the strength of the primary attachments. Multiple
caregivers promote young children’s social and emotional development.

36. ACEs Core Concepts (continued)
■ A lot of brain architecture is shaped in first three years but not all.The
regions dedicated to higher-order functions (such as social, emotional, and
cognitive capacities) continue to develop into adolescence and early
adulthood.
■ Severe neglect is as significant of a threat as other child maltreatment –
maybe even more.Young children with prolonged periods of neglect exhibit
more serious cognitive impairments, attention problems, language deficits,
academic difficulties, withdrawn behavior, and problems with peer interaction
as they get older.
■ Removing a child from a dangerous environment will not automatically
reverse the negative impacts. Children who have been traumatized need
environments that restore their sense of safety, control, and predictability.

37. ACEs Core Concepts (continued)
■ Resilience requires relationships.The capacity to adapt and
thrive despite adversity develops through the interaction of
supportive relationships, biological systems, and gene
expression.
■ Science has shown that the reliable presence of at least one
supportive relationship and multiple opportunities for
developing effective coping skills are the essential building
blocks for strengthening the capacity to do well in the face of
significant adversity.

38. Conclusion
What counterbalances the consequences of ACEs?
■ Positive early experiences
■ High quality relationships
■ Support from adults e.g. Cookie People
■ Early development of adaptive skills/resiliencies around emotional
regulation and stress tolerance
■ Mindfulness/meditation/yoga
Both children and adults need capabilities to respond to and avoid
adversity.
These capacities can be strengthened through coaching and practice.

39. Is Marijuana Use an ACE?

40. A few facts - Marijuana Impact
■ Marijuana use can cause severe anxiety/panic attacks, especially among
inexperienced users of the drug who take a relatively large dose.
■ Marijuana slows reaction time and information processing, signal
detection and motor coordination which increases as dose increases.
■ Marijuana use is associated with psychotic illness, including schizophrenia
in vulnerable adolescents, such as those exposed to child abuse and a
family history of psychotic illness.
■ There is a clinically significant relationship between reductions of
marijuana use and reduction in depression among young women .
Important as depression most common mental illness for young adults,
particularly for young women, and depressive symptoms were reduced in
young women who reduced their use of cannabis/marijuana.

41. Marijuana and Implications for
Families
■ What do we know?
■ International research has concluded that the impact of
substance misuse on the family is remarkably similar all over
the world and is a very particular experience.
■ Distinct impacts on different family structures
■ Impact on trust, relationships, finances etc.

42. Case Law: Daggett v Sternick
(2015)
■ Mother and Father were the biological parents of a daughter born
in 2010.The district court awarded primary residence of the child
to Mother, who intended to move to Florida with the child. Father
appealed, contending the Court erred by not considering the
statutory protections afforded to him pursuant to the Maine
Medical Use of Marijuana Act (MMUMA) when it determined
custody.
■ The Supreme Court affirmed, holding (1) the custody award did not
run afoul of the statutory protections identified in MMUMA
because the court’s factual findings did not rely on Father’s legal
marijuana use but on his distraction and impairment while
parenting; and (2) the court did not abuse its discretion in granting
primary residence to Mother and allowing her to relocate to
Florida.

43. Conclusion
■ The impact is not in the diagnosis or the drug use per say but its
about the functioning.

44. To End the Presentation…
HUMOR AND COPING

45. 45
What are humor skills?
■ Ability to see the absurdity in difficult situations
■ Ability to take yourself lightly while taking work seriously
■ A sense of joy in being alive

46. 46
Humor Applied

48. 48

49. 49
Be Duck-like
■ Water off a duck’s back.
■ How do you NOT absorb what you experience
(hear, feel, and see) everyday?
■ Do not think or be a sponge.

50. 50
Humor and Coping