"Higher Education"
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Presentation given in Indiana for the Indiana Collegiate Action Network to college communities around Indiana.
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"Higher Education"
- 1. Jacqueline Daniels, LCSW Indiana University Office of Alternative Screening and Intervention Services (OASIS) Division of Student Affairs
- 2. OVERVIEW General History of Marijuana Brief Physiology, Epidemiology, Myths and Facts Implications for Higher Education, Prevention Strategies and Collegiate Programming Evidence-Based Treatment Strategies Indiana University Marijuana Intervention Program Evidence-Based Practice Policy, Referral, Method Reactive VS. Proactive Intervention
- 3. Myth #1
- 4. History Part I Part II
- 5. Prevalence 28% of IN College Students Declined 1980’s report smoking past year (IUB= 40.5, decrease from 2000, annual prevalence 2010) 30-35% 19% past month (IUB=29%, decrease from 2010) By 2001, 5% population Avg. age 1st use IN= 17.3 using marijuana on Most frequent consequences monthly basis- avg 18.7 Combining substances joints) Guilt and Shame Gateway? Driving
- 6. Physiology Cannabinoid characterized by chemical compound THC Hashish (resin or sap), Hash Oil (oil in plant) and Marijuana (leaves and flowers) is smoked, cooked or in drink (tea) THC enters through lungs, reaches brain in 14 seconds Short Term? Appetite, Blood Pressure, Coordination, Perception, Memory Long Term? Emotional Maturation, Hormonal Effects, Cancer(?), Addiction (?) THC concentration of today 4-15% 1960’s 1-3% WHAT ABOUT SPICE and K2?
- 7.
- 8. Myth #2 It is possible to overdose on marijuana.
- 9. 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 Levels of Prevention: Before it starts, as it develops, or after it Prevention has developed as a problem Cannabis Specific Considerations: (i.e. Primary, Secondary or Tertiary) Risk: Transition Periods (middle school- high school- college) Levels of Intervention: Focus Role Model Beliefs/Drug Use: for the strategy (e.g., Acceptability community-focused, systems- Protection: Parents- clear focused (e.g., families, peers), boundaries and limits, expectations Educators or individual-focused) Community Leaders Protective Factors
- 10. Prevention and Programming Assorted Prevention and Intervention Programs Exist prior to College Entrance (D.A.R.E., Drug Education, Speakers, Health Classes) PSA Example College Level? E-Toke Refusal Skills Training Normative Education Participation=Protective Factors Scare Tactics? NO
- 11. Myth #3 Marijuana is Addictive. *Mark Lundholm
- 12. Treatment Models of Addiction Treatment Admissions 1 in 11 will develop dependence (NIDA, 2010) Evidence-based Marijuana Interventions Brief Interventions can Work Motivational Enhancement and CBST Family Involvement
- 13. Indiana University 43,000 Students (33,000 Undergrad, 10,000 Grad) 55.2% 49 states and D.C. 165 Countries Greek Life accounts for 17% of student body 52% Female Liberal Arts, Athletics, Greek, Extracurricular Kinsey Institute, Kelley School of Business, Jacobs School of Music International Student Population Surrounded by Bloomington and Monroe County, IN
- 14. Marijuana Intervention Program 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) Common Sanctions and Policy Violations 2011-2012 Arrests, IUPD 2011-2012 214 Marijuana Intervention Referrals 194 Marijuana Seminar Referrals 17 Repeat Offenders, 6 Suspensions
- 15. The Indiana Promise Student Responsibility H. Be responsible for their behavior, and respect the rights and dignity of others both within and outside of the university community.
- 16. 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)
- 17. 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
- 18. References 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)
Editor's Notes
- IntroductionHistory
- Rules:Keep an open mind. Objective. Political, legalistic, spiritual and medical opinions will vary.Answer Questions for prizes!
- The term originated at a CA HS in 1971. 420 was a code used to disguise teachers and parents. High Times Mag reports: “we did discover we could talk about getting nigh in front of our parents without them knowing by using the term “420”.Commonly a “holiday” on April 20th at 4:20am and pm…
- Pot has been used:Medicine, food, hospitality in different cultures, spiritual practices, hemp for different productsMarijuana can be a social symbol that affects personal beliefs about activism, revolution, political control, rebellion, free-spiritedness INFLUENCE
- I-CAN Survey 2011 Results- IN and IUB comparisonGATEWAY: Higher Education Center for AOD abuse and violence prevention:Why might it be?*Serves as introduction to other substances (sherm, “wet”, mixing of other drugs in marijuana)*Marijuana and cigarette smoking go hand in hand*Proportions of adolescents who used other illicit substances prior to marijuana is less than 5%Implications For Higher Education:*The earlier the use, the greater significance of later impairment. Students don’t usually START using marijuana in college- they do prior*Because the adolescent brain is still developing, frequent use by persons in this age group may lead to lasting consequences on cognitive processes.*Effect on functional and structural development in areas of the brain that are critical for the development of higher intellectual capabilities*Concentration and ability to retain information*Relationships, social isolation*May alter brain chemistry as a primer for other drug use/experimentation*Attraction- marijuana has it’s own marketing…music, clothing, movies, etc.*Symbol of social rebellion and revolutionDRIVING*Marijuana increases effects of alcohol*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
- Vaporizer----Vaporization is an alternative to burning (smoking) that avoids the production of irritating toxic and carcinogenic by-products by heating the material so its active compounds boil off into a vapor. Students also believe it creates less smoke, therefore, less smell. VERY expensiveTHC dosage is what impacts intoxication. Eating results in higher dosing of THC.VIDEO- Approx 4 minutesCancer-VERYhard to find objective and independent studies. However, we do know that marijuana smoking and tobacco smoking go hand in hand (okay to do one and the other). Also, smoking of marijuana in tobacco (i.e. blunts) increases exposure to nicotine and carcinogens. Difficult also to tell what illnesses are caused by tobacco use and marijuana smoking.Based on lab studies, marijuana may contain up to 50% more carcinogens than that found in tobacco smokeSmoke is often held in lungs for a long time to increase/improve high, increasing exposure to possible carcinogensThe absolute least you need to know about SPICE:Experiences similar to those produced by marijuanaAdverse physical effectsVomiting, palpitations, hypertension, seizures, heart attacks (in otherwise healthy teenagers), and deathAdverse psychiatric effectsConfusion, agitation, panic attacks, paranoia, and psychosis (including delusions, hallucinations, and disordered thinking)A few reported cases required hospitalizations > 2 weeks for resolution of psychotic symptomsAddictionTolerance and withdrawal symptoms that may be more severe than those with THC
- Hippocampus: learning, memory, and stress.Medulla: nausea/vomiting, chemoreceptor trigger zone (CTZ).Nucleus accumbens: important role in reward, pleasure, laughter, addiction, aggression, fear, and the placebo effect.Spinal cord: peripheral sensation including pain.
- Marijuana “overdose” does not always lead to death. Large doses of THC can cause “toxic psychosis” characterized by hallucinations, paranoid delusions, confusion or amnesia.OD on marijuana implies feeling very paranoid while high or feeling lethargic the next day rather than spelling out a trip to the ER.The level necessary to physically overdose from marijuana is approximately 1/3rd your body weight, consumed all at once.
- 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.
- WHY In College? Primary Prevention at IUB- Alcohol EDU contains Marijuana portion (online web-based class for incoming students)Reasons why: enjoyment, coping, boredom, celebration, sleep, perception of lower riskProblems: conformity, coping skills development, alcohol use, perception may lead to higher risk use of other drugs, exposure to unknown content in marijuana- comparable to leaving a drink unattendedDifferent culture of useAssumptions about use and social messages--- DEVELOPMENTAL STAGE, first time of independenceAddress legality and policy FIRSTE-TOKE- self driven online assessment with individualized feedback based on certain risk factors (frequency of use, family history of drug use and mental illness, medications and current mental health. Best used in combination with indvidual sessions. E-Chug currently utilized at IU for assessment for AAIP/SMART interventions.Refusal Skills training- *One’s social circle gradually narrows as marijuanause increases. Clean friends are avoided and socializationwith users increases. It is crucial that clients attemptingto stop smoking marijuana develop refusal skills.• It is best to avoid people who put users at high risk,but that is not always possible (i.e. family)• Clients need to develop refusal skills to handle pressureeffectively.• When being pressured to use marijuana, immediateand effective action is needed.• Practice will increase the likelihood that clients willuse their marijuana refusal skills effectively when pressuredNormative Education*Users are most influenced (according to research) by peer perceptions of use*Correcting norms may decrease use (cannot use alone as an intervention or prevention tactic) May also be University specific (do your own assessment)Protective Factors:Engagement. Motivation and direction in college career. Peers negative perceptionsScare Tactics- don’t work…Be aware of how your campus is marketing marijuana – What musical acts perform?
- *The deadliest side effect is the message that mj is safe.Medical Model= People can be addicted (DSM Criteria for Dependence)Harm Reduction Model= Heroin is more addictive and more dangerous. I would prefer people smoke pot.Is it safe for all to use recreationally? Anecdotally, no. “Marijuana maintanence”
- Disease Model (illness, brain) vs. Moral (sacreligious, based on will) vs. Temperance (abstinence=virtue) vs. Social (good for the economy) vs. Personality/CharacterlogicalTreatment Admissions according to TEDS: (TEDS= Treatment Episode Data Set, records treatment admissions for 1.5million treatment admissions annually SAMHSA)Marijuana was reported as a substance of abuse by approximately 740,800 treatment admissions in 2009; of these, 170,100 (23.0 percent) reported daily marijuana use at treatment entry. 1 in 11 will develop dependence according to DSM-IV criteria.Nearly one fifth (17.3 percent) of daily marijuana admissions indicated that marijuana was their primary and only substance of abuse, but the majority (82.7 percent) reported marijuana and an additional substance of abuse One third (33.0 percent) of daily marijuana admissions had a co-occurring psychiatric problem Brief Intervention- need more data, continue collecting information. Based on information on alcohol interventions.Motivational Enhancement: The goal of MET is to aid the client in clarifying his or her own perceptions and beliefs in order to direct him or her in a more decisive way. CBST serves to decrease defenses, rationalizations, justifications. Identify patterns of thinking that decrease motivation or cause academic/relationship impairment.
- The basic demographics of our campusLittle 500 2012 weekend started on 4/20
- 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
- Expectation of Integrity foundation of our interventions combine with clinical evidence-based practiceDistribution of shirts, alcohol.edu with marijuana portion
- 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-judgemental.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