Counseling Strategies For Marijuana And Alcohol Dependence

Marijuana and alcohol dependence are both chronic conditions with the potential for recovery and relapse. Effective treatments are available for both, but they depend on the severity of the disorder and are highly individualized. Treatment for marijuana dependence often involves MET, CBT, and CM, while alcohol dependence treatment typically involves gradual detoxification with medical assistance to avoid dangerous withdrawal effects. Counselling is an important aspect of treatment for both, with outpatient and inpatient options available. Self-help programs like Marijuana Anonymous and Alcoholics Anonymous can also play a significant role in recovery, and it is beneficial for families to be involved in the treatment process to help prevent relapse and maintain family bonds.

Counselling and therapy options: MET, CBT, CM, and inpatient/outpatient treatment

Counselling and therapy can be effective ways to treat marijuana and alcohol dependence. Three mainstream treatments for marijuana dependence that have been adapted from interventions initially developed to treat alcohol dependence are MET, CBT, and CM.

MET (Motivational Enhancement Therapy)

MET is a nonconfrontational counselling style that aims to guide the patient towards committing to and taking action towards change. Therapists use techniques such as strategic expression of empathy, reflecting, summarising, affirming, reinforcing self-efficacy, exploring the pros and cons of drug use, and forging goals and plans to achieve them. A typical MET regimen consists of one to four 45- to 90-minute individual sessions.

CBT (Cognitive Behavioural Therapy)

CBT focuses on teaching patients skills relevant to quitting marijuana and avoiding or managing other problems that may interfere with good outcomes. Patients learn functional analysis of marijuana use and cravings, self-management planning to avoid or cope with drug use triggers, drug refusal skills, problem-solving skills, and lifestyle management. CBT for marijuana dependence is typically delivered in 45- to 60-minute, weekly individual or group counselling sessions, with tested interventions ranging from 6 to 14 sessions.

CM (Contingency Management)

CM is a treatment approach that provides incentives for abstinence. CM has been shown to enhance the potency of MET and CBT-based treatments. For example, a CM abstinence-based voucher program enhanced drug use outcomes and abstinence when added to a potent outpatient therapy among juvenile offenders enrolled in drug court.

Inpatient/Outpatient Treatment

Inpatient treatment involves the patient staying at a residential facility full-time to receive treatment, while outpatient treatment allows the patient to continue living at home while attending therapy sessions at a clinic or other facility on a regular basis. The choice between inpatient and outpatient treatment depends on various factors, including the severity of the patient's dependence, the availability of resources, and the patient's preference.

Managing withdrawal symptoms: sickness, personality changes, loss of appetite, insomnia, nausea

Sleep disturbances are a common symptom of withdrawal from marijuana and alcohol. It is important to establish good sleep habits early in recovery to avoid a relapse. While it may be tempting to self-medicate with over-the-counter sleep aids, this should be avoided. Instead, talk to a doctor about short-term prescription medication to help with sleep during the initial phase of recovery. The physician will be able to advise on medications that are suitable given the specific substances being withdrawn from, and any potential side effects.

To aid sleep during withdrawal, natural remedies can be considered. Valerian root, for example, is an herbal supplement that is sometimes used to treat insomnia. A 2020 review found it to be effective, although results may vary depending on the quality of the extract. However, it can increase the sedative effects of other substances, so caution should be exercised. L-theanine is another natural option, being an amino acid that may promote relaxation and reduce anxiety. It is found in green and black tea and is also available as a supplement.

Other strategies to improve sleep include creating bedtime rituals and restoring the body's natural circadian rhythm.

Nausea is another common symptom of withdrawal from marijuana and alcohol. Unfortunately, no specific strategies to manage nausea during withdrawal were found in the sources available. However, it is important to remember that withdrawal symptoms are typically temporary and will subside as the body adjusts to functioning without the substance.

Personality changes during withdrawal from marijuana and alcohol can be expected, although this may manifest differently depending on the individual. While no specific strategies to manage personality changes were found, it is important to create a supportive environment for the person going through withdrawal. This may include providing emotional support and encouragement, as well as helping them develop healthy habits and coping mechanisms to manage their symptoms and avoid relapse.

Addressing co-occurring mental health issues: depression, stress, and other psychological problems

When addressing co-occurring mental health issues, such as depression, stress, anxiety, bipolar disorder, or other psychological problems, alongside marijuana and alcohol dependence, it is important to recognize the complex interplay between these disorders. Co-occurring disorders, also known as dual diagnoses, can significantly impact an individual's ability to function in various areas of life, including work, school, home life, and relationships.

An integrated approach is often recommended as the best treatment strategy for co-occurring disorders. This involves addressing both the substance abuse problem and the mental disorder simultaneously. Seeking help from a qualified healthcare provider or a specialized treatment team is crucial, as they can provide support and guidance tailored to the individual's unique needs.

Counseling and psychotherapy are essential components of treating co-occurring disorders. This can take place individually, in group settings with peers, or with family involvement, depending on what best suits the individual's situation. Evidence-based interventions such as Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT), as well as Contingency Management (CM), have been shown to be effective in treating substance dependence, including marijuana dependence. These therapies focus on enhancing coping skills, changing maladaptive thought patterns, and providing incentives for abstinence.

In addition to professional treatment, individuals can also benefit from self-help strategies and lifestyle changes. Support groups and peer support networks can provide ongoing encouragement and accountability during the recovery process. It is important to address the mental health issues that may contribute to substance use, such as stress or trauma, and to develop healthy coping mechanisms to manage these issues. This may include stress management techniques, mindfulness practices, or other therapeutic strategies to enhance overall psychological well-being.

Treating co-occurring disorders is a complex process, and long-term recovery depends on comprehensive and integrated care. It is important to ensure that the treatment program is appropriately licensed, evidence-based, and includes an aftercare plan to prevent relapse. Resources such as the Substance Abuse and Mental Health Services Administration (SAMHSA) in the US can provide information and referrals to those seeking help for co-occurring disorders.

Support groups: Marijuana Anonymous, Alcoholics Anonymous, youth support groups

Support groups can be an invaluable resource for individuals struggling with marijuana and alcohol dependence, providing a sense of community, shared experience, and ongoing encouragement throughout the recovery process. Here is an overview of some of the prominent support groups available:

Marijuana Anonymous

Marijuana Anonymous (MA) is a 12-step programme modelled after Alcoholics Anonymous. It offers a supportive environment for individuals specifically seeking recovery from marijuana addiction. MA meetings provide a safe space to share experiences, challenges, and achievements related to marijuana dependence. The 12 steps of MA guide members through a process of self-evaluation, personal growth, and ongoing recovery. Members are encouraged to find a sponsor, typically someone further along in their recovery journey, who can provide one-on-one support and guidance. MA meetings can be found worldwide, offering both in-person and virtual attendance options.

Alcoholics Anonymous

Alcoholics Anonymous (AA) is one of the most well-known and widely available support groups for individuals struggling with alcohol dependence. Like MA, AA follows a 12-step programme designed to foster personal accountability, spiritual growth, and recovery. Members are encouraged to work through the steps with a sponsor, developing a strong support system within the group. AA meetings are typically informal and centred around sharing experiences and offering mutual encouragement. AA is a global organization with meetings held daily in various locations, including community centres, churches, and other accessible venues.

Youth Support Groups: Alateen

Alateen is a support group specifically designed for teenagers affected by someone else's drinking or using behaviour. It is a part of the Al-Anon fellowship, which provides support for friends and family members of individuals struggling with addiction. Alateen meetings offer a safe and non-judgmental space for young people to share their experiences, express their feelings, and learn effective ways to cope with the challenges of having a loved one struggling with addiction. These meetings are typically facilitated by adult sponsors who have personal experience with alcoholism or drug addiction in their families. Alateen provides teens with a sense of community and understanding, helping them realise they are not alone in their struggles.

Support groups like Marijuana Anonymous, Alcoholics Anonymous, and Alateen offer individuals struggling with marijuana and alcohol dependence a network of support, understanding, and hope. These groups provide a sense of community, shared purpose, and ongoing encouragement, empowering members to navigate the challenges of recovery and build a foundation for long-term sobriety and personal growth.

Family therapy: improving communication, setting boundaries, and preventing enabling behaviours

Family therapy can be an effective way to address substance abuse issues and improve overall family functioning. It can help to improve communication, set boundaries, and prevent enabling behaviours among family members. Here are some key considerations and techniques for family therapy when counselling individuals with marijuana and alcohol dependence:

Improving Communication

The counsellor should aim to improve communication patterns within the family. This involves facilitating open and honest discussions about the adolescent's strengths and encouraging parents to praise positive behaviours. Counsellors can also provide communication skills training and help family members develop active listening skills, assertiveness, and empathy. Teaching these skills can enhance understanding and promote positive interactions within the family.

Setting Boundaries

Setting clear boundaries is essential in family therapy. The counsellor should discuss and establish boundaries around confidentiality, safety, and cultural appropriateness. Additionally, contingency contracting can be used, where family members agree on specific behaviours and expectations. For example, an adolescent may agree to certain rules or expectations set by the parents, and in return, the parents may provide privileges or rewards.

Preventing Enabling Behaviours

Family members may unintentionally enable substance use through their actions or inactions. Counsellors should help family members identify and understand their role in the person's substance use disorder. By recognising these enabling behaviours, family members can actively work towards supporting positive change. This may involve encouraging family members to set clear boundaries, refuse to provide financial support that facilitates substance use, and avoid making excuses for the person's behaviour.

Family Therapy Techniques

Multidimensional family therapy (MDFT) and brief strategic family therapy (BSFT) have been found to be effective in treating substance use disorders. MDFT addresses multiple dimensions of an adolescent's life, including family, peers, school, and community. BSFT focuses on reducing youth drug misuse and changing family interactions that support drug misuse. Another approach is behavioural family therapy (BFT), which applies evidence-based practices such as contingency management and communication skills training to family counselling.

Frequently asked questions