Discussing Substance Use with College Students: Incorporating Brief Intervention Approaches into Conversations on Campus and Addressing Marijuana in a Changing Legal Climate 2 of 3
In this workshop, we will discuss the theory behind and reasons for a brief intervention approach, will provide training in and practice with specific motivational interviewing strategies, and will consider ways to incorporate these approaches into conversations already taking place with students across campus.
Additionally, there is recent research on marijuana and the clear implications for college student health that we will review, including impacts on cognitive functioning, mental health, risk for addiction, and other unwanted effects. Along with lessons learned from a legal state, we will discuss these findings in the context of the brief intervention content from earlier in the day.
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[00:00:04.510]I always like to check after break
[00:00:06.050]in case people had a chance to digest stuff
[00:00:08.240]and think about it.
[00:00:09.400]Before we resume, what questions people had
[00:00:11.330]from the morning section in terms of things
[00:00:13.550]that would need clarification for just
[00:00:15.860]thoughts or reactions before we move forward.
[00:00:17.610]So, I will stop to see comments or questions from people.
[00:00:26.820]Alright, so, oh, did you have one?
[00:00:29.188]Okay good, here we go.
[00:00:30.760]The O was, of course, open-ended questions.
[00:00:35.200]Let me give you one last example of something
[00:00:37.290]'cause I just caught myself doing it.
[00:00:39.810]One of the things we have really worked hard
[00:00:41.860]with our providers to do is we ask students for questions
[00:00:45.500]is to ask what questions do you have
[00:00:47.040]instead of any questions?
[00:00:49.600]And it's largely because of what we as human beings
[00:00:51.440]do when there are none.
[00:00:53.560]If you ask a student or a group of students, any questions,
[00:00:56.810]when there's silence, what do we typically do,
[00:00:58.230]we go no, great.
[00:01:00.410]Which is code for, don't ask any questions.
[00:01:03.070]We're saying great because we're like cool,
[00:01:04.280]you guys get it.
[00:01:05.180]But if they hear it as, oh this person wants us to be quiet
[00:01:07.760]that's where it can backfire.
[00:01:08.940]You will get more question when you ask
[00:01:10.410]what questions do you have then when you ask
[00:01:12.650]the yes, no, any questions.
[00:01:15.573]The A, take skills to find positives.
[00:01:19.700]It's probably the lowest frequency thing we do in MI,
[00:01:22.130]not because it's unimportant
[00:01:23.200]but because it has to be sincere.
[00:01:25.240]It's not a compliment
[00:01:27.160]but its a statement you make that speaks to
[00:01:29.010]a strength or characteristic of an individual.
[00:01:32.320]And strategically it can be used to support self ethicacy
[00:01:35.615]or lay the foundation for developing discrepancies.
[00:01:40.190]A person says, you know, if I don't get a 3.4
[00:01:45.020]this quarter or semester, I will lose my financial aid.
[00:01:49.320]If we say, wow, you're a great student
[00:01:51.160]that's actually a disingenuous compliment,
[00:01:54.300]what it mean is they've, I mean,
[00:01:55.480]they've actually really been struggling.
[00:01:56.820]What's an affirm that speaks to
[00:01:58.510]a strength or characteristic, it's important for you
[00:02:01.350]to be a good student.
[00:02:02.450]If they say, yes, and two seconds later tell you,
[00:02:05.928]I keep going out at night instead of working on this paper
[00:02:08.410]that's due next week,
[00:02:09.328]our affirm helps lay the foundation
[00:02:11.370]for developing discrepancy.
[00:02:13.820]If they tell you all these bravado stories
[00:02:15.750]about always being there for their friends,
[00:02:18.080]if we say, your the kind of person that sticks to your work,
[00:02:21.450]if, ten seconds later, they say, you know what,
[00:02:23.453]I'm gonna try and cut down,
[00:02:24.880]we've helped support self ethicacy.
[00:02:27.715]As a group, you guys are were fantastic
[00:02:29.750]with the open-ended questions,
[00:02:30.760]I'm gonna call an audible and go back a slide.
[00:02:33.530]I think this one is really primed for an affirm.
[00:02:36.550]Here you asked, what they're getting behind on,
[00:02:39.550]what would it feel like to get caught up on stuff,
[00:02:41.620]what would it look like if they went out.
[00:02:43.660]What's an affirm we could make
[00:02:44.877]that's a statement that speaks
[00:02:46.710]to a strength or characteristic of the individual
[00:02:49.310]in this example?
[00:02:51.614]It's important to you.
[00:02:53.055]It's important for you to be on task,
[00:02:54.680]that's an affirm, nicely done.
[00:02:57.330]What else can we do, if anything?
[00:02:59.233]Feels good to be caught up.
[00:03:01.292]Feels good to be caught up,
[00:03:02.550]that's almost more of a reflection
[00:03:03.810]and I really like that as a reflection
[00:03:04.950]which is a good transition into our reflection.
[00:03:07.940]If we said its important for you to feel, to be caught up,
[00:03:11.479]that would be more of an affirm.
[00:03:12.890]I really like it feels good to be caught up,
[00:03:14.770]let's keep that in mind as we look at reflections.
[00:03:17.930]This is the key strategy in motivation interviewing.
[00:03:21.660]Can you do it even if you're presenting in groups,
[00:03:23.610]of course, yes.
[00:03:25.119]And, absolutely the key strategy.
[00:03:29.019]I know when I was learning reflective listening
[00:03:31.100]in grad school I was so worried
[00:03:32.470]about getting a reflection wrong
[00:03:34.270]that it got, it paralyzed me, I got worried about
[00:03:37.080]don't say the wrong thing, come up with a good reflection
[00:03:40.410]and it interfered with my listening.
[00:03:42.001]I would like to take the pressure off of you.
[00:03:44.430]You don't want to be flippant and just making reflections
[00:03:46.610]left and right but it's okay if you get a reflection wrong.
[00:03:50.230]Because of how we as human beings react
[00:03:52.850]when there's a reflection,
[00:03:54.640]they perform differently.
[00:03:56.450]If you ask someone a question, what do they do?
[00:04:00.050]Think about it, and then answer it.
[00:04:02.340]When you reflect, the think about time
[00:04:04.290]almost disappears completely.
[00:04:06.250]There's more of an immediate, yes and,
[00:04:07.830]and then they keep talking.
[00:04:08.710]Or there's a, no, it's not that, it's this
[00:04:10.631]and they keep talking.
[00:04:13.820]And you can move someone really,
[00:04:15.850]why are reflections so key to a brief intervention?
[00:04:18.100]You can move someone around on, very, very quickly
[00:04:20.950]with a reflection.
[00:04:22.090]Someone tells you I don't know if I should do this or this.
[00:04:25.830]You can offer, hey, we've got 20 minutes,
[00:04:27.870]let's block out the next 20 minutes
[00:04:29.170]to weight the pros and cons of both.
[00:04:30.650]That's a cool thing to offer or you reflect.
[00:04:34.254]You're really torn about what to do.
[00:04:36.490]If they say yes, first you've got empathy,
[00:04:39.660]expressed empathy, yes, and I really like it
[00:04:42.700]if we could explore options.
[00:04:44.910]You've communicated empathy,
[00:04:46.240]and they told you what they want.
[00:04:47.820]Or you say, you're really torn about what to do,
[00:04:50.290]no, I know what I need to do,
[00:04:51.830]it's just gonna be really hard.
[00:04:54.060]With one reflection, you can move someone along
[00:04:56.030]so much more rapidly.
[00:04:57.470]So it's not that reflections en quote, better,
[00:04:59.990]it's the whole package of the OARS.
[00:05:01.830]Reflections are the key strategy in motivation interviewing.
[00:05:04.580]They're probably your best friend for expressing empathy
[00:05:07.610]and because of how they perform, can really buy you a lot
[00:05:10.670]in a short amount of time.
[00:05:13.930]There's research that's been published
[00:05:15.240]that Mary Larimer was senior author on in our lab
[00:05:17.820]that looked at a 50 minutes basic session,
[00:05:19.610]even a 10 minute session
[00:05:21.560]and you see comparable results even in a 10 minutes window
[00:05:25.180]on some of the variables.
[00:05:26.540]And the key of those is that
[00:05:27.700]fidelity to motivation interviewing for sure.
[00:05:30.480]So, in MI the researcher in me loves this.
[00:05:33.600]They say, let's look at the reflection as a hypothesis test,
[00:05:37.304]why do I like that?
[00:05:38.510]'Cause in research when we have a
[00:05:39.650]hypothesis that's supported,
[00:05:41.380]we all go yay and we write it up
[00:05:43.220]and we try and get it published.
[00:05:44.910]If we have a hypothesis that's not supported,
[00:05:47.230]we lose the yay, but we still write it up
[00:05:49.830]and try and get it published.
[00:05:51.310]'Cause you can learn as much from an unsupported hypothesis
[00:05:53.870]as you can from one is supported.
[00:05:56.350]So it's our hypothesis what we think
[00:05:58.100]the person means or is feeling.
[00:05:59.970]Feels good to get caught up on your school work,
[00:06:02.020]that's a cool hypothesis and a great reflection.
[00:06:05.260]Reflections are statements, our tone has to go down.
[00:06:08.750]The person says I got so much to do,
[00:06:10.790]I don't really know where to start.
[00:06:14.150]Closing in question would just feel mean.
[00:06:16.570]Do you wish you'd started earlier?
[00:06:17.588]I mean, come on. (students laughing)
[00:06:21.747]Are you stressed?
[00:06:22.840]Like, we can do better.
[00:06:23.910]Open-ended questions are way less offensive,
[00:06:25.620]what do you think you'll do, how you feeling,
[00:06:27.680]or we reflect, you got a lot on your plate,
[00:06:31.410]You can do either one of those,
[00:06:32.462]you got a lot on your plate and feel really overwhelmed
[00:06:33.840]or you can you say, you feel really overwhelmed,
[00:06:35.680]or you can say, you got a lot on your plate.
[00:06:38.100]All of those are our hypothesis.
[00:06:39.767]A lot of people when they're learning reflections
[00:06:42.980]start with it sounds like.
[00:06:45.230]And that's okay but what we're warned against
[00:06:47.480]is don't start every reflection with that
[00:06:49.460]'cause if you do every reflection that way,
[00:06:51.470]it sounds a bit too formulaic, less genuine,
[00:06:54.210]it might even kind of like what's going on,
[00:06:56.120]every time you say that I feel like
[00:06:57.190]I think about stuff more deeply.
[00:06:59.110]So you want to mix it up.
[00:07:00.160]If you use that once, next time, you don't need it.
[00:07:04.132]Sounds like you feel overwhelmed, you feel overwhelmed,
[00:07:07.780]either one of those would be okay.
[00:07:09.840]Yeah, I really wish things weren't this way,
[00:07:11.560]that's change talk, or neh,
[00:07:13.720]I'm just not really motivated to get things started.
[00:07:16.400]I love this quote, "Either way, you get more information,
[00:07:19.017]"and either way you're receiving feedback
[00:07:20.407]"about the accuracy of your reflection."
[00:07:23.020]What does this hypothesis test mean, it means this,
[00:07:26.020]is what the person means, what the person says,
[00:07:28.650]what we, as a listener, hear,
[00:07:30.480]our reflection is number four.
[00:07:31.770]What we think the person means.
[00:07:33.920]I will say it again, has to be a statement,
[00:07:37.110]our tone has to go down.
[00:07:39.140]Same words but the tone goes up,
[00:07:41.370]it often sounds like a horrifying, confrontational question.
[00:07:45.530]Someone tells you they're really struggling with something
[00:07:47.440]and we say, that's hard for you, reflection, tone goes down.
[00:07:51.482]Same words, tone goes up, that's hard for you?
[00:07:57.090]That sounds like, I know a little kid that's not hard for
[00:07:58.797]now get out of here, right?
[00:08:00.679]I mean that sounds so challenging.
[00:08:02.780]We talk about spoiled reflections
[00:08:04.960]or sometimes we get anxious and we bale,
[00:08:08.470]that's hard for you, is that right?
[00:08:11.250]Is that right, makes it a close and I just know,
[00:08:13.180]did I get it right.
[00:08:14.700]And the most they would be like is yep or nope,
[00:08:17.510]they're not gonna do the continue talking,
[00:08:19.486]we see with a normal reflection.
[00:08:21.210]It does take hard work and practice,
[00:08:22.680]we're gonna try and have some fun with that today.
[00:08:25.570]The most simple types of reflections
[00:08:26.923]will keep people talking.
[00:08:28.690]Miller and Rollnick say,
[00:08:29.560]you want your complex reflections to be great.
[00:08:31.870]I love that I make the alligator point this way,
[00:08:33.525]greater than your simple reflections.
[00:08:36.850]Too many simple reflections sounds too parroting
[00:08:39.720]and sounds less genuine.
[00:08:42.230]But, you know, when you're really stuck,
[00:08:43.820]sometimes repeating will help.
[00:08:45.440]A person says, I've been feeling stressed about a lot.
[00:08:48.630]You've been feeling stressed.
[00:08:49.980]Yeah, I noticed that, da, da, da, da, da.
[00:08:53.100]Moving, still simple but moving along the continuous
[00:08:56.450]to rephrase, you substitute a synonym.
[00:08:58.740]You've been feeling anxious,
[00:09:00.520]where does it get more complex, when we paraphrase,
[00:09:02.540]we take a shot at the emotional component.
[00:09:04.710]You've been feeling anxious
[00:09:05.710]and that's taking its toll on you.
[00:09:07.500]Or you go straight to the emotion component,
[00:09:09.890]that's taking its toll on you.
[00:09:13.570]Again, if someone's super stressed, that expresses empathy
[00:09:16.690]and really where they just go mm-hmm,
[00:09:18.161]yeah, plus, and they'll explain why.
[00:09:22.460]You'll move along so much more rapidly in brief session.
[00:09:25.680]So some examples, a person says my partner
[00:09:27.700]won't stop criticizing me about my drinking.
[00:09:29.870]You're feeling frustrated about that
[00:09:32.410]or you wish things weren't that way
[00:09:34.097]and we go straight for the change talk.
[00:09:36.140]Or, it feels to you like
[00:09:37.350]your partner's always on your case.
[00:09:39.540]I've trained some people on our grants that say,
[00:09:41.382]I get nervous doing reflections
[00:09:43.600]'cause I don't want to sound like
[00:09:44.433]I'm analyzing or interpreting or it's my opinion.
[00:09:48.220]Good, we should be worried that,
[00:09:49.710]we don't want to make it sound like our opinion.
[00:09:52.170]If we say, well to me, it sounds like
[00:09:53.920]your partner's always on your case,
[00:09:55.830]that's my opinion, we're actually
[00:09:57.130]bad mouthing the partner now,
[00:09:59.900]What's our hypothesis, it feels to you,
[00:10:02.440]like your partners always on your case.
[00:10:05.920]That's a less controversial thing to say,
[00:10:07.950]as they go, yeah and what sucks about that
[00:10:09.500]is I love this person more than anything.
[00:10:12.090]Or maybe they'll go no, it's not that I feel like
[00:10:13.680]they're always on my case,
[00:10:14.513]it's that I always feel like I'm letting them down
[00:10:16.410]and that sucks.
[00:10:18.500]Either way you'll get more information.
[00:10:20.320]If you get three wrong in row, that's okay,
[00:10:22.750]if you get five wrong in a row, you're missing something.
[00:10:25.040]And it's okay to say, I really want to make sure
[00:10:26.600]I'm understanding you, let me take a step back.
[00:10:29.290]So, you guys, one last example.
[00:10:32.800]If someone's truly ambivalent,
[00:10:34.740]one of the things you can do is a double-sided reflection.
[00:10:36.680]There are only two rule to a double-sided reflection,
[00:10:39.588]one, you link them with an and not a but.
[00:10:42.520]If you link them with a but, it typically get heard as,
[00:10:45.180]listen to the part that comes after the but.
[00:10:47.720]And, if to you, there's a more clear reason for change,
[00:10:51.120]end with the reason for change.
[00:10:53.120]Going back to intro to psych, the recency effect says
[00:10:55.560]the last thing we hear is the thing we will speak to first.
[00:10:59.730]So a student says,
[00:11:00.930]I've been drinking with my friends in my room,
[00:11:02.860]my parents always lecture me about it,
[00:11:04.511]they're always saying it makes my depression worse.
[00:11:07.180]Here's a nice reflection,
[00:11:08.013]you get a hard time from your parents
[00:11:09.480]about how drinking effects your depression.
[00:11:11.270]Yeah, I mean, I know it effects my mood a little,
[00:11:14.180]that's change talk, but I don't drink that much
[00:11:17.030]and when I do I really enjoy it, you know.
[00:11:19.350]Open ended question, what do you enjoy about drinking?
[00:11:21.690]I like the fact that it helps me chill out with my friends.
[00:11:24.420]So here's the double-sided, so on the one hand,
[00:11:26.210]you enjoy drinking 'cause of its social effects
[00:11:28.300]and, on the other hand, you've noticed
[00:11:29.717]it has some effect on your mood.
[00:11:32.320]It's linked with an and and with a reason for change.
[00:11:35.611]So, you did a spectacular job on the four examples
[00:11:38.650]with open ended questions,
[00:11:39.890]now, we're gonna revisit all four those statements
[00:11:42.610]but with reflections.
[00:11:44.380]Student says, so I know everything can't be perfect,
[00:11:46.270]but I really hate my roommate right now.
[00:11:48.710]What do we think the speaker means,
[00:11:50.460]what's the hypothesis that we can make as reflection
[00:11:53.230]that would get at that?
[00:12:04.357](inaudible student talking)
[00:12:07.410]I think that is as good as it gets.
[00:12:08.870]You want things to change with your roommate,
[00:12:11.320]that is such a good reflection.
[00:12:13.010]There's change talk here
[00:12:15.540]and it's not that, I mean again,
[00:12:17.290]there's certainly other reflections we could do
[00:12:18.640]and I hope I hear other examples
[00:12:20.150]but if you want a reflection that gets at the change talk
[00:12:22.020]that is spectacular, outstanding.
[00:12:25.120]What else can we do?
[00:12:38.591]What's one thing you could do with that?
[00:12:41.530]That's a good open ended question,
[00:12:44.957]but what could we do that would be a reflection,
[00:12:46.240]either gets at that or another reflection we could do?
[00:12:48.702](inaudible student talking)
[00:12:51.540]You could any version of that,
[00:12:52.610]sounds like your roommate situation's challenging,
[00:12:54.630]this is challenging, your roommate situation's challenging.
[00:12:57.990]Any of those, if everything goes wrong,
[00:13:00.380]you're gonna get empathy.
[00:13:01.740]If everything goes right, they're gonna explain why.
[00:13:03.590]What's going on with your roommate?
[00:13:04.920]They'll tell you.
[00:13:05.960]This situation's challenging, absolutely and here's why,
[00:13:09.690]they'll still tell you.
[00:13:11.270]So with the reflection,
[00:13:12.270]you'll get everything the question would of bought you
[00:13:14.680]with the added bonus of showing, I get this.
[00:13:18.540]I think those are two of the best ways you could go,
[00:13:20.800]you're having a tough time with this situation,
[00:13:23.570]home doesn't feel so great right now,
[00:13:25.580]this is challenging.
[00:13:27.610]You'd like this situation to get better,
[00:13:29.590]you'd like something to change about this,
[00:13:35.020]And again, you don't just reflect and sit back
[00:13:36.780]and watch the magic happen, this is hard
[00:13:38.300]'cause we're looking at single sentences
[00:13:39.530]taken out of context but these are great examples
[00:13:41.960]of reflections you can make.
[00:13:43.390]Let's look at another one.
[00:13:44.587]I know I'm not the smartest person in my class
[00:13:46.880]and sometimes I wonder
[00:13:48.180]if I should even be in college right now.
[00:13:51.160]What do we think the person means?
[00:13:53.260]What's a non-judgemental, non-confrontational reflection
[00:13:56.283]that we can make that captures that?
[00:14:10.545]You're really questioning your abilities.
[00:14:12.180]You're really questioning your abilities,
[00:14:13.350]I think that's a fantastic reflection.
[00:14:15.640]You're doubting yourself, your questioning your abilities
[00:14:19.690]anything that gets at that, that's what's going on here.
[00:14:22.639]I think that's a fantastic reflection.
[00:14:24.930]I asked you earlier how open ended questions
[00:14:26.610]are making sense to folks.
[00:14:27.960]How does this feel for folks in terms of what a reflection,
[00:14:29.920]how do to a reflection and what a reflection buys you?
[00:14:33.750]I again see lots nodding, if there are questions,
[00:14:35.760]and a fly, if there questions, or things I can clarify
[00:14:40.100]please let me know, what else might we do here,
[00:14:42.400]but that's a great reflection, what else might we do?
[00:14:49.320]We'll keep us moving.
[00:14:50.550]I know my partner doesn't treat me the way I'd like
[00:14:52.491]but I don't want to end up alone by breaking up.
[00:14:59.135]You'd like to be treated differently.
[00:15:00.328]You'd like to be treated differently
[00:15:01.161]is a fantastic reflection.
[00:15:03.700]Just to get examples of a double-sided,
[00:15:05.660]what's a double-sided we could do here?
[00:15:11.378](inaudible student talking)
[00:15:13.630]So, I would make that, link them with an and
[00:15:15.660]instead of a but and I went, I might flip that.
[00:15:19.230]If to you, this isn't the healthiest relationship,
[00:15:21.470]flip it, just because, again,
[00:15:23.770]the way the recency effect works, the order matters.
[00:15:26.970]You have concerns about being alone
[00:15:28.670]and want to be treated differently.
[00:15:30.550]That feels different than,
[00:15:31.586]you want to be treated differently
[00:15:33.600]and have concerns about being alone, alone, alone, alone.
[00:15:37.750]It's like, no, I don't want to be alone.
[00:15:40.330]So, that's where that, all I would do is flip that.
[00:15:46.640]Last one, we've already heard on hypothesis here
[00:15:48.950]which is that it feels good to get caught up stuff.
[00:15:52.410]My friends want to go out tonight
[00:15:53.570]but I feel like I should stay home,
[00:15:54.710]I'm getting behind on stuff.
[00:15:55.720]What do we think the speaker means?
[00:15:57.768]What's a reflection that we could in response to that?
[00:16:07.094](inaudible student talking)
[00:16:10.450]Friends are important to you and so is school,
[00:16:11.830]that's a great reflection.
[00:16:13.070]Has a cool affirm element, which is like double points
[00:16:16.030]'cause it's all about winning, remember.
[00:16:18.710]We mighty coding team,
[00:16:19.543]motivation in bringing treatment integrity coding team
[00:16:22.980]whereas some of the most kind people on this planet
[00:16:25.577]and I feel so sorry for them 'cause nobody talks to them
[00:16:28.248]'cause you're constantly worried
[00:16:29.610]that you're being coded in your head, right.
[00:16:31.790]Hi, how are you, open ended question.
[00:16:33.690]They're like, I'm not coding you.
[00:16:35.030]But, I think you'd get double coded on something like that
[00:16:37.500]'cause it has a nice reflection plus an affirm element.
[00:16:40.400]What else, what else can we do as a reflection here?
[00:16:44.658](inaudible student talking)
[00:16:46.960]You're feeling anxious, that's a great reflection,
[00:16:54.367](inaudible student talking)
[00:16:57.132]I love that reflection, I was hoping someone would say it,
[00:17:00.070]I think you're torn, either your torn about what to do
[00:17:02.720]or even specifically, you're torn between two priorities.
[00:17:06.110]I think that is so good.
[00:17:07.690]I mean, image how this,
[00:17:09.320]I was doing this training once
[00:17:10.730]with a group of academic advisors
[00:17:12.040]and their reflection was, well, you are here for school.
[00:17:15.040]I'm like whoa, whoa, whoa, that's not a reflection,
[00:17:17.810]that's like telling them what to do.
[00:17:19.860]Imagine a student's reaction to, you're torn.
[00:17:23.980]I mean, there's no world in which they'd be,
[00:17:25.750]well maybe they'd say it, nah, I'm not torn,
[00:17:27.470]I need to stay home, I gotta get this stuff done.
[00:17:30.600]Or if they go yes, exactly, I'm torn,
[00:17:32.830]what do I tell them, cause I do need to stay
[00:17:34.410]and get stuff done, what do I tell them.
[00:17:36.550]They will keep moving, fantastic.
[00:17:40.310]So, with that, the S is to summarize
[00:17:42.710]both to demonstrate through listening
[00:17:44.140]and to provide an opportunity for shifting.
[00:17:46.320]I wanted to show you, and I'm even gonna time this,
[00:17:49.640]'cause it's like, how long can you really
[00:17:51.100]pull something off.
[00:17:52.320]I wanna show you just as an example
[00:17:54.520]of pulling all of these together in one conversation.
[00:17:57.880]How many of you work in a health or counseling center?
[00:18:00.270]A few of you do, so one of the key screening surveys
[00:18:04.670]is the audit, it's 10 items long,
[00:18:06.795]the good news is, it's one of
[00:18:08.350]the most sensitive measures internationally.
[00:18:10.900]So as our campuses get more diverse
[00:18:13.030]and have more international students it's more robust too,
[00:18:16.050]the diversity of our student body.
[00:18:17.540]The downside is, it is 10 questions.
[00:18:19.720]So there's an audit C, that's only three questions.
[00:18:22.920]It lets you make budget cut jokes
[00:18:24.480]and it's only three questions
[00:18:26.010]so it's much more rapid to go through.
[00:18:28.273]Imagine we've got a student on the audit C,
[00:18:31.270]who has a score of eight.
[00:18:32.970]They say that they drink four more times a week,
[00:18:35.980]they typically have three or four drinks on a typical day
[00:18:39.000]and weekly they have six or more drinks on one occasion.
[00:18:41.760]By no means is this a gold standard,
[00:18:43.900]this is something I whipped up
[00:18:45.070]just to try and bring this to life,
[00:18:46.410]I'll show you what this could look like.
[00:18:48.480]I'm gonna time how long this conversation is.
[00:18:52.450]Patient says, let's get this shot over with,
[00:18:54.160]they're going in for a flu shot.
[00:18:55.420]Let's get this shot over with, no sickness for me.
[00:18:57.720]That waiting room is disgusting, though.
[00:18:59.940]What happened in the waiting room, open question.
[00:19:02.730]Oh, just a lot of coughing people.
[00:19:03.853]Plus I had to wait longer than I thought
[00:19:05.760]and I need to get to the library,
[00:19:06.660]I've got way too much to do.
[00:19:08.740]Reflection, on top of everything else you have going on,
[00:19:10.850]having to wait wasn't so helpful for your day.
[00:19:13.200]Exactly, thank you.
[00:19:15.920]What's going on school wise, open ended question.
[00:19:18.330]I just getting really behind in stuff,
[00:19:21.170]I really want to get into my major
[00:19:22.500]so I have to turn things around.
[00:19:25.180]Affirm, doing well academically is really important to you.
[00:19:27.980]Yeah, and that's why I fell kind of stupid.
[00:19:30.800]What makes you say that, open ended question.
[00:19:33.000]I have this paper due and I keep going out with my friends
[00:19:35.040]instead of staying home to work on it.
[00:19:37.280]You're getting behind and aren't feeling great about that,
[00:19:40.640]No, I'm not feeling great, I need better will power.
[00:19:43.580]Tell me what you mean, open question.
[00:19:46.120]We wind up partying, even when I say
[00:19:47.740]I'll just have one drink, it turns into more.
[00:19:50.660]Provider, these nights look good on paper
[00:19:52.820]and you wind up not liking how you feel
[00:19:54.550]when school work doesn't get done, reflection.
[00:19:57.380]Right, then I get so much farther behind,
[00:19:58.980]it just starts piling up.
[00:20:01.409]I want to respect that you wanted to get
[00:20:03.060]in-and-out of here today, though it sounds like
[00:20:04.730]you've got a lot on your plate and have noticed a link
[00:20:06.380]between going out with friends and not getting done
[00:20:08.430]what you want to get done.
[00:20:09.730]Prior to coming in here, you answered some questions
[00:20:11.580]about your drinking, if it's okay with you,
[00:20:13.137]I'd like to talk about that just for a minute or two.
[00:20:16.170]This is a summary and asking for permission
[00:20:18.320]to keep doing this.
[00:20:21.360]I Know what you put down on your survey
[00:20:22.590]but before we get into that, walk me through
[00:20:24.200]what a typical week looks like for you,
[00:20:25.510]in regards to your drinking.
[00:20:27.590]Lately I go out in a pretty big stretch of days,
[00:20:29.460]I don't drink Sunday, Monday night I have meetings
[00:20:31.650]for the student group I'm apart of
[00:20:33.000]and Tuesday night I don't drink because of my stupid
[00:20:34.820]early Wednesday class.
[00:20:36.110]So, I guess I drink Wednesday through Saturday.
[00:20:39.180]How much do you typically drink, remember from the survey
[00:20:40.923]that a standard drink is 12 ounces of beer,
[00:20:43.149]4 ounces of wine, one measured shot of hard alcohol.
[00:20:47.110]I pretty much only drink hard alcohol,
[00:20:48.761]I usually have three shots when I go out
[00:20:50.470]but on Fridays will have six.
[00:20:52.460]So on average you drink four nights per week,
[00:20:54.780]three of those four nights you have four shots
[00:20:56.260]and one night you have six shots.
[00:20:59.520]What are your thoughts about your drinking right now?
[00:21:02.290]I don't know, I feel like that's a lot more
[00:21:03.697]than I drink during my first year.
[00:21:06.340]That concerns you.
[00:21:09.868]Well, the reason we ask all students
[00:21:11.420]those questions about alcohol
[00:21:12.670]is to be able to identify and talk with students
[00:21:14.230]who may be experiencing some risks or issues
[00:21:16.440]related to their drinking.
[00:21:17.800]You're expressing some concern
[00:21:19.270]and that's consistent with the responses you filled out.
[00:21:21.760]What do you make of that?
[00:21:23.332]I'm not like an alcoholic or anything.
[00:21:25.194]Your drinking isn't causing issues to that level.
[00:21:28.139]No, but I do go out more than I should on school nights.
[00:21:32.320]On a scale from one to 10, where one's not at all
[00:21:34.750]and 10's a great deal, how important would you say it is
[00:21:37.200]to make a change in your drinking?
[00:21:39.410]I guess I'd say a three.
[00:21:41.260]What makes it a three instead of a two or a one?
[00:21:44.900]I really can't get any further behind in school,
[00:21:46.760]if I do, I might not get into my major.
[00:21:49.810]There are strong academic reasons for making a change.
[00:21:52.197]I think that's true.
[00:21:54.133]What do you think would be a step in
[00:21:55.540]the right direction for you, if anything.
[00:21:57.680]Instead of studying in my room
[00:21:58.780]where everybody knows where to find me,
[00:22:00.150]I could go to the library at night.
[00:22:01.570]That's a lot farther away from where we normally drink.
[00:22:04.490]A new study place will help you stick
[00:22:05.900]to what's most important.
[00:22:07.400]I think so.
[00:22:08.880]Certainly, whatever you do, what ever you choose to do
[00:22:11.150]is up to you, it sounds like you've come up with a plan
[00:22:13.250]to try and avoid situations in which it would be
[00:22:14.900]too tempting to drink when offered.
[00:22:16.930]If it's okay with you, we can check in about
[00:22:18.940]what's going on with your drinking
[00:22:19.970]at the appointment you made in three weeks.
[00:22:23.540]That's three minutes and 32 seconds.
[00:22:27.359]And, you know, certainly it's like a weird,
[00:22:29.850]choose your own adventure book
[00:22:30.880]where this could go a lot of different directions
[00:22:33.060]but the hope is that that brings to life
[00:22:34.486]what that could look like,
[00:22:36.404]even outside of a 50 minute therapy hour.
[00:22:39.180]In a short window of time,
[00:22:40.490]you can bring a lot of these to life.
[00:22:42.760]Outside of the scope of today,
[00:22:44.500]was talking about listening change talk,
[00:22:46.130]I just want to give you one example and go back to this.
[00:22:52.210]In the Miller, Rollnick, and Butler book
[00:22:54.710]about motivation and viewing health care centers,
[00:22:56.562]they said, when people go to the doctor
[00:22:59.380]they're expecting to have to rate something
[00:23:02.070]on scale of one to 10.
[00:23:03.670]Scale of one to 10, how much pain are you in?
[00:23:05.120]Scale of one to 10, how whatever.
[00:23:07.075]What they found was a lot of providers
[00:23:09.560]were asking on a scale of one to 10,
[00:23:11.430]how important would you say it is for you
[00:23:12.640]to make a change?
[00:23:14.070]What they found is when the person would say,
[00:23:15.410]I guess I'm a four, the provider would go, okay a four.
[00:23:18.410]Well, how come it's not like a five or a six?
[00:23:20.890]Which code for, why isn't this more important to you.
[00:23:24.490]Sometimes the provider goes what could I do
[00:23:26.010]to make that a six?
[00:23:27.970]That's my agenda, that's not your agenda,
[00:23:30.120]what Rollnick, Miller and Butler say is
[00:23:31.620]if you ask why a lower number wasn't given,
[00:23:33.970]their answer will be change talk.
[00:23:37.110]If they say it's a 10, I would reflect,
[00:23:39.220]this is really important to you.
[00:23:41.450]If they say a nine, I'd probably reflect.
[00:23:42.910]If they go on and on a six, so the six,
[00:23:45.940]why a six instead of like a three or a four?
[00:23:48.000]Well, I'm not getting any younger and I'm pretty awesome
[00:23:50.120]so I want to keep being awesome.
[00:23:51.550]Like, everything they say will be change talk.
[00:23:54.720]So I just wanted to step back and show you that in action.
[00:23:57.900]So with that and with the time we have before lunch,
[00:24:00.410]what I want to do to try and build in some of
[00:24:02.480]the marijuana piece.
[00:24:05.190]Is to show do we have lots of research on marijuana?
[00:24:07.860]It's growing, I mean, five years ago I would of yes
[00:24:11.350]and we need so much more.
[00:24:12.870]Today I would say yes, and we need so much more
[00:24:15.140]but the body of research has grown
[00:24:17.280]and we can say quite a bit more.
[00:24:20.300]This is gonna be less about lesson learned in Washington,
[00:24:23.150]that'll be more post lunch,
[00:24:24.650]this is gonna be more about in the context
[00:24:26.460]of motivation interviewing,
[00:24:27.720]what could come up around marijuana
[00:24:29.890]that might either on its own serve to develop a discrepancy
[00:24:32.860]or be related to hooks of importance to students.
[00:24:35.360]Before I move into that section,
[00:24:36.577]especially after having just given you
[00:24:38.210]the flu shot scenario,
[00:24:39.561]what questions or comments do people have about the OARS
[00:24:43.424]or how to incorporate those
[00:24:45.090]into conversations with students?
[00:24:50.690]Alright, so especially pre-lunch,
[00:24:52.470]my plea to you will be on any of this,
[00:24:54.780]if you're like, we know this, let me know
[00:24:57.300]and if there's any part where I'm going too slow
[00:24:58.960]or too fast, just let me know.
[00:25:00.888]I would argue if someone says you only get to give
[00:25:03.230]college students one bit of research,
[00:25:04.802]what would it be?
[00:25:06.500]It'd be marijuana and cognitive abilities.
[00:25:09.070]Is there research that's hard to interpret with marijuana?
[00:25:11.610]Yes, probably the hardest research to interpret
[00:25:14.800]is marijuana and lung function.
[00:25:17.230]How come, almost everyone that uses marijuana
[00:25:19.973]used to use or currently use tobacco.
[00:25:23.040]So for following them longitudinally for impact
[00:25:25.690]on their lung health, we can't rule out
[00:25:27.652]if what we're seeing is do to the tobacco,
[00:25:30.244]the marijuana use, or the combination of both.
[00:25:33.000]There's too big a confound.
[00:25:35.230]This is research that in an academic setting
[00:25:37.210]where I would argue, you're not gonna find a lot of students
[00:25:39.730]not willing to agree that attention, concentration,
[00:25:41.108]and memory are important.
[00:25:42.840]This is probably the feedback domain
[00:25:44.423]that we have the most clear information.
[00:25:47.100]Truly long story short, the part of the brain
[00:25:49.250]that effects among other things, attention,
[00:25:51.120]concentration, and memory is the hippocampus.
[00:25:55.177]After marijuana use, the neurons in the hippocampus
[00:25:59.450]What does that mean?
[00:26:00.460]They fire but they fire at a rate that's lower and slower
[00:26:02.948]than they could or should be firing.
[00:26:06.530]We can make the leap that if all that stuff is slowed down
[00:26:09.450]attention, concentration, and memory
[00:26:10.880]is probably slowed down.
[00:26:12.410]From a science standpoint, that leap is not acceptable.
[00:26:15.800]So Harrison Pope was the first researcher in the '90s
[00:26:19.520]who said, I want to test this with college students.
[00:26:22.870]He said, I wanna recruit college students
[00:26:24.720]that are already using marijuana
[00:26:26.280]and I don't wanna get students crazy high,
[00:26:28.700]make them take a test and say, well,
[00:26:30.300]clearly this effected their cognitive abilities.
[00:26:32.430]He said, I want to test students 24 hours
[00:26:34.518]after they use marijuana.
[00:26:38.010]If you have a drink today, I have no proof of that tomorrow.
[00:26:41.870]But if someone uses marijuana, we can actually measurer
[00:26:44.480]the impact of that use a full day later.
[00:26:46.860]Pope showed that 24 hours after marijuana use,
[00:26:49.857]there are measurable decreases in attention,
[00:26:52.064]concentration, and memory.
[00:26:54.150]And the more heavily a student typically used,
[00:26:56.521]the more pronounced those decreases tended to be.
[00:27:00.280]Critics of this research came out and said
[00:27:01.950]this is biased research 'cause it's not causal.
[00:27:06.140]What if people with attention deficits just love weed?
[00:27:10.500]I mean, you laugh but that's actually
[00:27:12.580]a pretty fair question.
[00:27:13.413]It's like, what if there's a
[00:27:14.246]differential selection going on.
[00:27:16.190]So Pope said, we can test that.
[00:27:18.370]Ethically, we can't take people who don't use
[00:27:20.700]and make them start, 'cause that's unethical.
[00:27:23.200]But, what if we get people that use marijuana everyday
[00:27:26.756]and we pay them to quit?
[00:27:30.640]And we pay them luxuriously for everyday they stay clean.
[00:27:34.120]If we follow them over time and their cognitive abilities
[00:27:36.520]stay the same, yeah, maybe that was there to start with
[00:27:40.170]but it their substance use goes away,
[00:27:42.230]if over time, their cognitive abilities improve,
[00:27:44.740]that, my friends, is causal.
[00:27:47.390]It takes four weeks, but 28 days after stopping
[00:27:50.470]daily marijuana use, there are no longer any
[00:27:52.855]significant differences in cognitive functioning
[00:27:55.740]compared to a control group of people
[00:27:57.663]that never touched marijuana in their life.
[00:28:00.490]What's the good news, takes four weeks.
[00:28:02.570]What's the not so good news, does take four weeks
[00:28:05.290]and that's with research with marijuana
[00:28:07.133]that was much less potent that we see today.
[00:28:09.760]So can we make that same four week claim
[00:28:12.331]with the marijuana of 2018, probably not
[00:28:14.980]and that research would need to be done.
[00:28:17.120]But, there was research done out of Susan Tapert's lab
[00:28:20.330]in San Diego where they looked at 15 to 19 year olds
[00:28:23.990]who used every other day.
[00:28:26.300]14 of the last 30 days, and they said,
[00:28:29.130]these are younger brains, maybe they bounce back faster.
[00:28:32.290]She showed that two weeks of abstinence required
[00:28:35.820]before you saw no differences with abstainers
[00:28:38.770]on verbal learning, three weeks before verbal working memory
[00:28:42.030]matched that of people that don't use.
[00:28:44.010]But the attention deficit seemed to take
[00:28:46.060]the full four weeks.
[00:28:47.490]Think about what that means on college campuses.
[00:28:50.010]We have more students actively being treat for
[00:28:52.086]or questioning if they have a diagnosis of ADHD,
[00:28:55.870]an attention issue.
[00:28:57.020]What is the science say, we can't pretend to diagnose
[00:29:00.570]if someone does or doesn't have an attention issue
[00:29:03.470]if they're recreationally using a substance
[00:29:05.340]that causes attention deficits.
[00:29:09.330]Our learn clinic at the University of Washington
[00:29:11.010]has gotten to the point where, if you use marijuana
[00:29:13.020]in the last 30 days, they don't do the assessment,
[00:29:15.270]we can't possibly diagnose if you do or don't
[00:29:17.940]have an attention issue if you're using
[00:29:19.621]substances that cause attention problems.
[00:29:23.350]Value, I want to do well in school.
[00:29:26.320]How you doing?
[00:29:27.153]Not so hot.
[00:29:28.819]My memory sucks and I can't sit still,
[00:29:30.930]I think I have ADHD.
[00:29:32.944]There's research on how marijuana might effect those things,
[00:29:36.100]if that's of interest to you, I can describe it,
[00:29:38.241]likely they will say yes, you can describe the research,
[00:29:41.083]what are your thoughts on that?
[00:29:43.690]That's where you can bring in information on marijuana
[00:29:46.373]in a motivational framework.
[00:29:48.230]I saw a hand, I thought, somewhere over there.
[00:29:50.260]Kind of answered, I'm more interested in
[00:29:52.567]the once or twice per week user.
[00:29:53.413]That research has not been done.
[00:29:55.060]Yeah, the once or twice per week,
[00:29:56.700]that's the research that needs to be done is
[00:29:58.470]even if someone uses once.
[00:29:59.604]Pope's '96 study showed that even if they use once,
[00:30:02.840]we can still see a day later that something's going on.
[00:30:05.950]But how long does it truly take?
[00:30:08.210]That we don't know.
[00:30:09.610]The bottom line is is that the more people that are using
[00:30:11.690]the more we're seeing those impacts.
[00:30:13.550]And so, for someone who says, you know,
[00:30:15.540]I really, really, really want to do well in school,
[00:30:17.370]and I used to be a great student,
[00:30:18.480]I feel like my memories not so hot.
[00:30:20.500]And they tell you I'm using marijuana everyday,
[00:30:24.550]Changes they make in their marijuana use,
[00:30:26.326]will pay dividends in attention, concentration, and memory.
[00:30:31.186]I tend to not share this but I added this for this training.
[00:30:35.113]The reason why I don't share this is
[00:30:36.647]the same reason why, you know,
[00:30:38.710]if a student asked about cirrhosis
[00:30:40.480]would we tell them, of course.
[00:30:42.485]It was Alan Marlatt's research in the late '80s
[00:30:44.750]and early '90s that said, we may gain more
[00:30:47.650]with an 18 year old, focusing on a consequence
[00:30:50.250]that might be 48 hours in their future
[00:30:51.940]instead of 48 years in their future.
[00:30:53.850]So cirrhosis, Korsakoff Syndrome,
[00:30:55.930]real risks of drinking heavily, of course.
[00:30:58.343]But maybe regretted decision, driving
[00:31:01.130]or something we might want to focus on more
[00:31:02.630]with a college student.
[00:31:05.190]There was research that came out of New Zealand
[00:31:07.570]and Australia of a longitudinal cohort
[00:31:09.930]following people from 13 years of age to 38 years of age.
[00:31:13.860]Your IQ now should be your IQ five years from now,
[00:31:16.840]should be your IQ 10 years from now,
[00:31:18.530]should be your IQ 15 years from now.
[00:31:20.620]IQ should be stable.
[00:31:22.580]They did intelligence tests at 18, 23, 28, 33,
[00:31:27.210]all these time points.
[00:31:28.880]And then looked, they controlled for
[00:31:30.960]as much stuff as they could and then looked at
[00:31:34.610]having used marijuana regularly, at least
[00:31:38.390]at none of the assessments and one or more.
[00:31:41.210]You may of seen this headline when it was front page news
[00:31:44.030]on things like USA Today, that chronic marijuana use
[00:31:47.190]caused loss of eight IQ points.
[00:31:49.600]The study that that came from was a 2012 study
[00:31:51.920]from Meier and colleagues.
[00:31:53.490]What they showed is those that had never used cannabis,
[00:31:56.453]their IQ at 38 years of age was their IQ at 13 years of age,
[00:32:00.480]that was stable.
[00:32:01.940]As soon as you introduced marijuana use to the equation
[00:32:04.260]but never regularly, you saw a bit of a drop,
[00:32:07.160]using regularly at least one assessment.
[00:32:10.240]At two assessments and they lump these into one category
[00:32:13.920]it was the people that used heavily,
[00:32:15.700]regularly all five time points that saw
[00:32:19.260]the loss of eight IQ points over time.
[00:32:21.770]I've talked to colleagues in the field who said
[00:32:23.144]you know, in a 25 divided by eight,
[00:32:25.960]maybe someone thinks I'm okay losing one point over college,
[00:32:29.070]so we worry if someone says
[00:32:30.530]are there long-term consequences,
[00:32:31.920]we would meet them where they are.
[00:32:34.040]But this research, that shows not only 24 hours later
[00:32:37.293]you can see impact, but the good news is
[00:32:39.580]that they seem to be reversible
[00:32:41.560]tends to be what we want to focus on more.
[00:32:43.890]Because of the short-term relevance to someone
[00:32:46.250]and the salience and relevance
[00:32:47.660]of that potential consequence.
[00:32:49.640]But if it does come up, that reference in the slide
[00:32:51.640]will be in your handouts.
[00:32:53.670]I'm not trying to say this person used marijuana
[00:32:56.240]nor am I trying to make light of this attention issue
[00:32:58.970]but you can't even make this up.
[00:33:01.270]I made the joke that one of our laws in psychology
[00:33:04.650]is everything has to spell a cool acronym.
[00:33:07.020]We had a project called MC2,
[00:33:10.430]Motivating Campus Change 'cause that's,
[00:33:13.550]that's a good project name.
[00:33:15.150]And we were like, that's so cool.
[00:33:17.510]No it's not, that's stupid little super script two,
[00:33:19.470]is a pain in the butt to make, even in word,
[00:33:22.110]depending on what program you're using,
[00:33:23.888]and especially in email.
[00:33:25.480]I used to work at another college
[00:33:27.750]and one day I was walking to my office
[00:33:29.030]and I'm like, what, how long has that been up?
[00:33:31.450]The directory in front of our building,
[00:33:33.280]here's me in front of the directory,
[00:33:34.837]and the sign said MC2 (Bob, this should be squared)
[00:33:37.890]Motivating Campus Change.
[00:33:45.893]Bob, the sign maker, hadn't thought very critically
[00:33:48.660]about the note he had received
[00:33:51.890]and that sign was up for over four years.
[00:33:55.810]I was like, can we change that?
[00:33:57.440]I'll pay for it to be changed.
[00:33:59.220]When they redid the building for construction,
[00:34:01.060]I told them, I will pay money to get that sign
[00:34:03.528]and that sign is now in my office at UW
[00:34:06.540]because my wife told me I had to get it
[00:34:07.880]out of our dining room.
[00:34:10.105]But I love that.
[00:34:12.400]I also feel guilty showing this slide
[00:34:15.050]but I decided to show it
[00:34:16.319]'cause Linda was at the same conference.
[00:34:18.400]Linda and I presented at a conference at Duke University
[00:34:21.220]in 2010 where we were super excited to be there.
[00:34:25.570]But some folks, in the Raleigh Durham area
[00:34:28.130]seemed not so excited that it was there.
[00:34:30.740]We later learned it was because of a misunderstanding.
[00:34:33.140]Here's a tip, if you're advertising for an event,
[00:34:36.060]proof it, to make sure there's not a missing word
[00:34:38.470]that would of fundamentally changed
[00:34:39.623]what you're trying to communicate.
[00:34:41.290]The conference was The College Student Drink
[00:34:43.270]and Drug Use Prevention Conference.
[00:34:45.340]What was blocked off in every parking lot
[00:34:47.330]surrounding the Duke University Conference Center,
[00:34:49.420]the following sign.
[00:34:50.970]Lot reserved for college student drinking and drug use.
[00:34:58.875]You can't even make that up.
[00:35:02.550]What I totally love about that sign
[00:35:04.010]is you gotta figure at least one person
[00:35:05.594]walking their dog was like, well,
[00:35:07.630]at least they're cutting those kids off at 5:00,
[00:35:09.560]that's a. (students laughing)
[00:35:13.430]I think they call that harm reduction.
[00:35:16.550]So, Amelia Arria, our friend and colleague
[00:35:19.620]at the University of Maryland has showed
[00:35:21.340]that the more heavily and more frequently
[00:35:23.270]students use marijuana, the more that's associated
[00:35:26.090]with discontinuous enrollment.
[00:35:27.540]Not dropping out but stopping out.
[00:35:29.860]Losing credit, taking a quarter semester off,
[00:35:32.410]dropping classes, skipping more classes
[00:35:35.140]and having a lower GPA overall.
[00:35:37.940]This article came out in 2016 that showed
[00:35:40.270]that the mere presence of knowing a student uses marijuana
[00:35:42.805]is associated with lower GPA.
[00:35:45.230]And that students over time, here's a surprising finding,
[00:35:47.870]who decrease their marijuana use
[00:35:50.230]and those that keep using frequently
[00:35:51.908]is associated with less current enrollment.
[00:35:54.050]Less likelihood of still being a student
[00:35:55.701]and being less likely to graduate on time.
[00:35:58.141]What's their explanation of those that decrease?
[00:36:00.688]If they used super heavily during
[00:36:02.870]a very important first year,
[00:36:04.610]it may be that they dug a hole
[00:36:05.860]that got really hard to get of
[00:36:08.482]and that they continue to struggle.
[00:36:10.370]These articles came out last year,
[00:36:13.030]alcohol and marijuana are both associated with lower GPA
[00:36:16.570]but when entered into the same regression equation
[00:36:18.960]to predict variance, the effects of alcohol
[00:36:22.870]Marijuana seems to be driving this ship.
[00:36:25.850]And, students that use both marijuana and alcohol
[00:36:28.130]at moderate to high levels have lower GPAs
[00:36:30.420]over a two year window.
[00:36:31.850]Students who moderate or cutdown on their substance use
[00:36:34.173]tend to improve their GPA.
[00:36:37.150]If I was ever put in front of a group of parents
[00:36:39.080]and told hey, you can tell parent stuff
[00:36:40.670]what would you tell them?
[00:36:41.890]I'd let them know that if they play any part
[00:36:43.782]in helping pay for their kids' education, their tuition,
[00:36:47.150]they would want to be mindful of this.
[00:36:49.200]'Cause we're having very important conversations
[00:36:51.330]in the United States about how do we make
[00:36:52.610]college more affordable for people
[00:36:53.705]and we could and should be having those conversations.
[00:36:56.490]One way, is to not take seven years to get out of school.
[00:37:00.320]The more heavily people using marijuana,
[00:37:02.080]the less likely they are to graduate on time,
[00:37:03.820]the longer their spent in school.
[00:37:05.770]I've heard so many parents say, well I used weed in the '70s
[00:37:08.050]and I turned out fine.
[00:37:09.230]Or, I'd way rather have my kid use marijuana than drink.
[00:37:13.230]The science suggests that's gonna mean
[00:37:15.920]probably less success in the classroom,
[00:37:18.640]longer to graduate, less likelihood of still being enrolled.
[00:37:21.440]So we want to make sure that we can look at that.
[00:37:24.670]For those of you who work in counseling centers,
[00:37:26.430]if their value is, I want my anxiety
[00:37:28.250]or my depression or whatever to get under control,
[00:37:31.572]the link between marijuana, cannabis use,
[00:37:33.950]and mental health is something we're also starting
[00:37:36.060]to understand a bit more clearly.
[00:37:38.392]Hall and Degenhardt, Wayne Hall, to me,
[00:37:41.140]is the planet's best marijuana researcher ever.
[00:37:43.980]And Wayne Hall has looked at research
[00:37:46.245]and work that's been done globally
[00:37:47.900]with world health organization that showed that
[00:37:50.530]those that use cannabis 10 or more times
[00:37:53.370]by the age of 18 were two to three times more likely
[00:37:55.910]to be diagnosed with schizophrenia.
[00:37:57.610]And went so far as to say that we could make 13%
[00:37:59.550]of schizophrenia cases go away completely
[00:38:03.070]if we made marijuana use go away.
[00:38:07.060]What have we done in my state,
[00:38:08.150]we've increased access to marijuana.
[00:38:10.920]So when you look at what we're doing about mental health
[00:38:12.610]on college campuses, particularly if a value or goal
[00:38:15.500]to a student with a family history of schizophrenia is,
[00:38:16.883]I'm worried about myself, this is data
[00:38:20.450]that could serve to develop a discrepancy.
[00:38:23.140]I had the honor of running an webinar
[00:38:25.144]that Dr. Hall was a presenter on
[00:38:28.040]and I asked my collation, you know,
[00:38:30.010]text in your answers.
[00:38:30.930]There were like, or questions for Dr. Hall,
[00:38:32.890]there were like 50 questions.
[00:38:34.370]So did what any good facilitator does,
[00:38:36.500]I went with my question first.
[00:38:39.210]And I said, if you could do one thing on college campuses
[00:38:43.060]in the state of Washington, what would it be?
[00:38:44.923]And his answer was, I would screen for cannabis use disorder
[00:38:48.710]in your counseling centers.
[00:38:50.744]And I said, why?
[00:38:52.950]And he said, we see a scary link between
[00:38:56.060]cannabis use disorder, depression,
[00:38:58.140]and suicide that we cannot explain.
[00:39:01.020]We don't know which is driving which
[00:39:03.340]but if a student is seeking counseling for depression
[00:39:06.470]and flags as cannabis dependent,
[00:39:09.840]that student poses a suicide risk to you and your school
[00:39:12.437]and if you have a waiting list,
[00:39:13.800]do not put them on your waiting list,
[00:39:15.377]assign them to a therapist immediately.
[00:39:19.290]We want peers, that if you see something, say something,
[00:39:22.400]right, check in with your friends.
[00:39:23.765]Anytime a friend brings up suicide,
[00:39:25.830]we hope they take it seriously.
[00:39:27.440]If they bring up suicide and they use weed a lot,
[00:39:29.270]take it even more seriously, something's going on.
[00:39:31.890]This is not unique to college students,
[00:39:33.380]this is data from SAMHSA,
[00:39:35.120]the national survey of drug use and health,
[00:39:37.370]they look at overall adult population 18 and older
[00:39:41.430]and then looking at the same stats
[00:39:42.900]for have you used marijuana in the last year.
[00:39:45.260]Serious thoughts of suicide more than double,
[00:39:47.980]making a suicide plan more than double,
[00:39:50.430]attempting suicide almost triple.
[00:39:54.956]When we look at risk of dependents,
[00:39:57.600]this is not unique to marijuana,
[00:39:58.840]this is substance use disorder, presence or otherwise.
[00:40:02.530]If people meet criteria for a substance use disorder,
[00:40:05.500]we up our anxiety even more.
[00:40:07.770]Serious thoughts of suicide essentially four times greater
[00:40:10.700]when there's the presence of a substance use disorder
[00:40:12.550]compared to when there's not.
[00:40:13.960]Making a suicide plan, four and a half time greater,
[00:40:16.970]attempting suicide, five and a half time greater.
[00:40:22.350]So we want to consider the context of substance use
[00:40:25.720]but go back to the motivational framework.
[00:40:27.971]I'm coming into you for counseling.
[00:40:31.320]I really want to get my depression under control.
[00:40:33.775]If they're also using marijuana,
[00:40:35.690]we would want to be mindful of ways
[00:40:37.030]in which they could be either contra-indications
[00:40:39.570]or co-occurring challenges.
[00:40:42.440]I'm presenting as much to you as, efficiently as I can
[00:40:46.078]but I don't want to lose the opportunity for questions.
[00:40:47.810]Let me call time out just for a sec
[00:40:49.540]to see what questions people have
[00:40:51.180]or I can clarify before I keep moving forward.
[00:40:54.587](inaudible student question)
[00:41:01.690]Part of what's hard with schizophrenia,
[00:41:03.103]so one of the things that the Washington Poison Center
[00:41:06.150]has reported is that we've seen an increase
[00:41:07.690]in acute toxic psychotic reactions.
[00:41:09.644]When people go, well, you can't overdose on marijuana.
[00:41:11.900]That's not true, it just manifests itself differently
[00:41:14.120]than an alcohol overdose.
[00:41:15.380]What is an alcohol overdose, dying,
[00:41:17.600]I mean, it's alcohol poisoning.
[00:41:18.720]Breathing slows and stops, heart rate slows and stops.
[00:41:21.510]With marijuana you can see delusions, hallucinations,
[00:41:27.301]depersonalization, complete out of body stuff.
[00:41:30.434]And so, there's some question about the acuity.
[00:41:33.399]What Hall looks at, what Hall tried to do is
[00:41:36.460]how much of the variance in onset of schizophrenia
[00:41:39.010]can you account for if you control for certain variables.
[00:41:42.320]And it was in the Hall and Degenhardt article
[00:41:44.330]that they said if you look at explaining variance,
[00:41:47.480]13, our hypothesis is that 13% of schizophrenia
[00:41:51.060]can be averted if cannabis use was avoided, too.
[00:41:54.260]So, are there other variables that contribute to it,
[00:41:56.973]But what that means is,
[00:41:58.320]someone has a positive family history of schizophrenia
[00:42:00.370]and says, I really want,
[00:42:01.632]I want to be on top of mental health.
[00:42:03.809]Marijuana use would be complete contraindicated,
[00:42:06.880]marijuana would arguably be the worse possible substance
[00:42:09.220]for that person to use.
[00:42:10.620]So we want to make sure that if their value is
[00:42:12.513]I'm trying to get an access two issue under control
[00:42:15.870]or their value is, I've got a really rough family history
[00:42:18.760]on mental health, I'm trying to look out for myself,
[00:42:20.955]that's their value.
[00:42:22.060]What's the status quo, I also use weed everyday.
[00:42:25.520]We went to make sure they're aware those risks
[00:42:27.740]so that if that discrepancy leads them to say,
[00:42:29.718]holy cow, I need to quit using marijuana.
[00:42:31.987]That that's how that would work.
[00:42:36.910]Do depression and suicide rates correlate
[00:42:41.003]to using marijuana... (inaudible talking)
[00:42:44.910]The question is, is depression and suicide rates,
[00:42:47.189]is that link between depression and suicide and marijuana
[00:42:50.130]increasing as we see potency go up.
[00:42:54.820]That I don't think we know
[00:42:55.890]and so much of this we're having to look at after the fact,
[00:43:00.040]I mean, we have to look at these in a correlative way
[00:43:02.330]and that's the thing Dr. Hall's always made clear
[00:43:04.200]is it's hard to find a causal link
[00:43:05.950]but there's clearly a trifecta.
[00:43:07.590]So anyone asking for help with depression
[00:43:09.560]also flags as cannabis dependent, we want to up our game
[00:43:12.880]about assessing their safety.
[00:43:17.631]So someone I'm working with right now,
[00:43:19.970]who are marijuana users. (inaudible talking)
[00:43:30.988]That I never had any information on that.
[00:43:36.540]So the question was about sometimes with folks
[00:43:39.289]that are older that using they'll say,
[00:43:40.900]well, it depends on what kind you're using.
[00:43:42.760]That's, I've got that coming up post lunch,
[00:43:44.460]so we'll talk about that after lunch.
[00:43:46.920]That's tricky of Jason Kilmer.
[00:43:49.120]Oh, it's coming later, but you have to stay here for that.
[00:43:53.733]Have there much information on...
[00:44:03.060]That research would be, the question was,
[00:44:04.610]research that's been done neurologically or biologically
[00:44:06.950]to show why that might increase.
[00:44:08.660]That's research that would involve cannabis administration
[00:44:11.430]that we would definitely have to do.
[00:44:12.990]I would think, that if we're gonna see something
[00:44:15.501]advanced on that, I mentioned Susan Tapert's name,
[00:44:19.043]to me, she's one of the leading
[00:44:20.690]functional magnetic resonance imaging,
[00:44:22.340]FMRI people on this planet.
[00:44:24.144]I think if we're gonna get an answer,
[00:44:26.840]it'll probably come out of her lab
[00:44:27.980]but the exact mechanism, that's something we don't know yet.
[00:44:33.810]Alright, I know that Megan mentioned that were traffic folks
[00:44:37.520]involved in bringing on this conference.
[00:44:39.750]So I wanted to say a bit about driving risks.
[00:44:42.170]This is the infamous mile post 420 from Idaho
[00:44:45.520]that has been stolen so many times,
[00:44:47.364]their state replaced it with 419.9.
[00:44:50.969]And people bad at decimals are like, where am I?
[00:44:56.077]But, when you look at our initiative,
[00:44:58.720]the authors of initiative 502 said
[00:45:01.010]we're gonna have a clear, per se limit
[00:45:04.070]for driving under the influence.
[00:45:05.750]I didn't know what per se meant legally,
[00:45:07.550]I would use it in a sentence,
[00:45:09.060]you know, I would say that, per se,
[00:45:10.780]'cause I wanted to sound French
[00:45:12.160]but, (students laughing)
[00:45:14.310]that might not be accurate.
[00:45:16.160]But, per se means, no questions asked,
[00:45:19.090]you know, if you're above this it meets criteria.
[00:45:21.250]And set a per se limit at five nanograms of THC
[00:45:26.450]per milliliter of blood for those over the age of 21
[00:45:29.290]and any positive amount for those under 21.
[00:45:31.530]Why did they pick five nanograms?
[00:45:33.701]Because you see limited research that shows
[00:45:36.510]similarities in impairment to .08 for alcohol.
[00:45:39.580]Largely in reaction time and inability to shift focus
[00:45:43.250]when there are multiple competing stimuli.
[00:45:45.910]The million dollar question is
[00:45:46.937]who long does it take to drop below five nanograms?
[00:45:49.590]Well, the only published article that was out
[00:45:51.880]at the time our initiative was written
[00:45:53.880]was done in Europe with men who average 154 pounds
[00:45:56.970]and it showed it took three hours for them to drop to 4.9.
[00:46:02.120]The article made clear, if it was a heavier guy,
[00:46:04.410]if it was a women because of body fat differences,
[00:46:06.670]it could take longer.
[00:46:08.212]Now, even with that research, think about what that means.
[00:46:10.560]If someone uses weed at 8:00 PM, and at 9:00
[00:46:13.274]they're like, who wants to go out for food?
[00:46:14.620]They're driving high, they're driving under the influence.
[00:46:16.730]No different that driving drunk.
[00:46:19.290]If someone uses marijuana at 8:00 and at 11:00 says,
[00:46:21.640]who wants to go out for food?
[00:46:22.830]They could still be driving under the influence.
[00:46:24.940]During the webinar, Dr. Hall said,
[00:46:26.481]heads up Washington, I'd say five hours
[00:46:30.060]'cause marijuana's more potent now
[00:46:32.060]than when Grotenhermen and colleagues did their research
[00:46:34.152]and the article came out in 2017 that said,
[00:46:36.820]yeah, we should tell people to wait six hours.
[00:46:40.180]In a context of motivation interviewing,
[00:46:42.260]what's my value, I wanna stay out of legal trouble
[00:46:44.840]and I would never want to hurt somebody.
[00:46:46.920]I would never want to endanger myself or other people.
[00:46:49.340]What's the status quo?
[00:46:50.570]You could be driving high every time you go out.
[00:46:54.380]I'm principle investigator on our young adult health survey
[00:46:56.870]in the state of Washington,
[00:46:58.130]that our division of behavioral health and recovery,
[00:46:59.980]who just changed their name, has funded.
[00:47:02.210]We asked thousands of 18 to 25 year olds in Washington
[00:47:05.861]have you used marijuana in the last 30 days?
[00:47:08.850]Those that said yes, we've asked,
[00:47:10.380]do you drive under the influence?
[00:47:12.440]Of course not.
[00:47:13.820]Have you driven within three hours of use?
[00:47:16.750]Which would be driving under the influence,
[00:47:19.110]thank god, we're see a statistically significant change
[00:47:22.511]in this but when we asked it in 2014,
[00:47:25.640]half of them had driven within there hours of use.
[00:47:28.700]You do not see half of people who drink drive drunk.
[00:47:32.500]But half of 18 to 25 year olds
[00:47:34.300]in the state of Washington that had used marijuana,
[00:47:36.936]also said at least once they'd driven
[00:47:39.910]within the last 30 days.
[00:47:41.450]Thank goodness we're seeing that never...
[00:47:44.180]Oh light sensor, ah! (laughing)
[00:47:48.420]I'm just gonna stand over here.
[00:47:51.430]Well, this is the most terrifying podium in the world,
[00:47:53.720]it says do not touch this.
[00:47:55.930]Totally want to touch it.
[00:47:58.630]Before this day's over, I might.
[00:48:00.870]But, see that the never is 50.59,
[00:48:04.640]the never is getting bigger.
[00:48:06.270]What we found when we looked at that further,
[00:48:09.010]is that the never getting bigger
[00:48:10.880]is being driven by the 21 to 25 year olds.
[00:48:13.350]We're not seeing a change in the 18, 19, and 20 year olds.
[00:48:18.320]That's scary, it's scary from a public health standpoint
[00:48:21.830]and it's scary when you look at the data.
[00:48:23.623]For fear of sounding too editorial,
[00:48:25.380]I'll allow the headlines to do the talking for me.
[00:48:26.876]In 2015, it was reported in the state of Washington
[00:48:30.050]fatalities with THC onboard in my state doubled in one year.
[00:48:35.580]They're not testing for it differently,
[00:48:37.057]fatalities with THC present doubled in one year.
[00:48:40.740]In April, 2017, this report came out that showed
[00:48:43.673]that in the state of Washington, drugged driving deaths
[00:48:46.650]exceeded drunk driving deaths.
[00:48:50.080]Again, from a public health standpoint, that's terrifying.
[00:48:52.810]From a motivation interviewing standpoint,
[00:48:54.432]the student that says, listen, I like using weed
[00:48:57.530]but obviously I'd never want to endanger myself
[00:48:59.290]or other people.
[00:49:00.123]That's their value, the status quo is,
[00:49:02.130]you could be driving high every time you step out the door
[00:49:05.120]two hours after using.
[00:49:08.300]So, I hope this is making sense.
[00:49:09.550]Do we have good information, I hope so.
[00:49:11.418]Can you deliver it in a motivational framework,
[00:49:13.709]each of these instances I'm trying to show where we can.
[00:49:16.449]In this very room, I have presented in the past
[00:49:19.900]about alcohol and sleep.
[00:49:22.560]And I didn't want to spend too much time
[00:49:23.650]talking about alcohol and sleep for fear
[00:49:25.310]of having that be redundant.
[00:49:26.790]But the bottom line is, the research shows that
[00:49:28.260]when people drink, the onset of sleep tends to be faster
[00:49:31.190]but their quality of sleep changes.
[00:49:33.080]You can ask a student, on nights you've been drinking,
[00:49:35.490]what do you notice about your sleep?
[00:49:36.950]Tell me about your dreaming?
[00:49:38.600]And they'll be like, whoa, how'd you know?
[00:49:40.000]Like, I don't dream at all.
[00:49:42.210]Or if I do, it's crazy vividly,
[00:49:43.730]right before the end of the night.
[00:49:45.640]That's because when alcohol's in the brain,
[00:49:47.690]the brainwaves need to kick into REM sleep,
[00:49:49.520]rapid eye movement sleep, don't happen.
[00:49:52.360]When they finally hit a zero BAC,
[00:49:54.290]they do enter REM but they enter it in,
[00:49:58.256]as an acute REM rebound.
[00:49:59.990]With marijuana, marijuana's classified as sedative hypnotic.
[00:50:03.410]Sedative means sedating, hypnotic means sleep inducing.
[00:50:06.450]So, if someone says when I use weed I fall asleep faster,
[00:50:09.322]they could be telling the truth.
[00:50:11.850]But you can also ask them,
[00:50:12.910]what do you notice about your sleep?
[00:50:15.040]We tend to hear two things, I feel like I sleep hard
[00:50:18.660]and don't dream.
[00:50:21.840]Here's why, great article by Angarita and colleagues
[00:50:25.410]from 2016, with weed, two things happen.
[00:50:28.710]Stage four or deep sleep gets extended,
[00:50:31.960]that can account for the person's subjective impression
[00:50:34.580]that they slept hard and no REM.
[00:50:38.360]Quality of sleep is completely compromised.
[00:50:40.700]What are the main effects of REM deprived sleep?
[00:50:44.090]Next day, increase in anxiety,
[00:50:47.520]increase in daytime sleepiness,
[00:50:50.000]increase in irritability,
[00:50:51.770]increase in physical jumpiness.
[00:50:54.160]In the national college health assessment data
[00:50:56.030]when we asked college students nation wide
[00:50:57.690]here's 31 things that could get in the way
[00:50:59.480]of your school work, pick all of those
[00:51:02.390]that have been barriers to your academic success.
[00:51:04.650]Guess what the top three are,
[00:51:05.803]stress, sleep problems and anxiety.
[00:51:09.960]Those could be coming from their nighttime substance use.
[00:51:14.140]So, if you've got a student that says
[00:51:15.330]my weed use is the only thing that's helping me sleep,
[00:51:17.450]I'm tired all the time and I'm anxious all the time.
[00:51:20.520]This could be this vicious cycle of when they use,
[00:51:23.640]they fall asleep faster but because of REM deprived sleep,
[00:51:26.840]increases the next day in anxiety, daytime sleepiness,
[00:51:30.260]irritability and jumpiness.
[00:51:33.100]The hard part is and we'll talk about this after lunch
[00:51:35.020]is that this is where marijuana is kind of the gift
[00:51:37.110]that keeps on giving.
[00:51:37.943]'Cause it's not like if you stop using the next day
[00:51:39.697]your sleep goes back to normal,
[00:51:41.570]people might have a tough night on those,
[00:51:43.390]and we'll talk about that in a bit.
[00:51:46.185]People joke about the idea of the munchies.
[00:51:49.670]We had a study where we asked students that use marijuana
[00:51:53.260]at least five times per month up to multiple times per day,
[00:51:56.940]list up to five of the not so good things
[00:51:58.990]you've experienced from marijuana use, that you didn't like.
[00:52:02.100]The number one thing students mentioned, the munchies.
[00:52:06.850]People get surprised by that until you read
[00:52:08.550]some of their comments, it's heartbreaking.
[00:52:10.690]Students will say, I hate how I look,
[00:52:12.740]I hate my body image and I eat crap when I'm high.
[00:52:16.320]Or, I workout for an hour and then I undo all of that
[00:52:18.627]'cause I eat junk after I use weed.
[00:52:22.060]So, as much as people joke about the munchies,
[00:52:24.380]there are students that say, yeah, that sucks.
[00:52:27.340]And there is a very clear physiological reason behind it.
[00:52:30.960]There also is an expectancy and cultural element to it
[00:52:34.260]that I'll talk about in a bit.
[00:52:35.810]The bottom line is, there is an endogenous cannabinoid
[00:52:40.220]and an endogenous cannabinoid receptor called anandamide.
[00:52:43.017]And when stimulated, it almost works like a double negative,
[00:52:46.520]it's not that people get hungry, it's that they get un-full.
[00:52:50.220]The thing that tells us we're full gets inhibited.
[00:52:53.720]So, it's less a matter of oh my God I'm so hungry,
[00:52:55.440]it's more a matter of I could eat.
[00:52:58.130]But the key is testing this with humans is hard,
[00:53:00.850]why, 'cause so many people have seen movies
[00:53:03.790]and TV shows that kind of play out
[00:53:05.693]what the munchies should look like.
[00:53:07.400]They're entire movies dedicated
[00:53:09.210]to the concept of the munchies.
[00:53:10.610]Harold and Kumar Go To White Castle,
[00:53:12.840]literally the entire movie is dedicated to the munchies.
[00:53:15.160]So, Maller's team at the University of Michigan said,
[00:53:17.100]well, you know who hasn't seen those movies, rats.
[00:53:23.700]Some of them had but, oh well.
[00:53:26.240]Maller's team did a fascinating study
[00:53:28.140]where they had different flavored vials of water
[00:53:30.154]and they wanted to see if once they gave the rats
[00:53:32.920]the munchies, en quotes, once they stimulated oxanamide,
[00:53:36.340]were there flavors that they tended to go for like crazy,
[00:53:39.210]or they just went for flavors across the board more crazy.
[00:53:41.800]Right, so they had all these different flavored vials
[00:53:43.590]of water, they had sour, that was super sour and bitter.
[00:53:47.340]They has sweet, which is really, really sugary.
[00:53:49.810]They had salt, which was really salty.
[00:53:51.840]They had my favorite category, meat water.
[00:53:55.082]I think that's fascinating.
[00:53:58.200]What are you drinking, meat water.
[00:54:00.646]It's for my heart.
[00:54:03.950]And the electrolytes.
[00:54:05.720]And then, gave them oxanamide
[00:54:07.660]to see what they'd go crazy for.
[00:54:10.160]What would your predict, was it all of the flavors,
[00:54:12.250]was it one of them?
[00:54:13.083]I can tell you want students predict.
[00:54:15.470]Students predict salty, give me Doritos,
[00:54:17.862]give me tacos, give me all this stuff.
[00:54:20.820]Sweet, sweet stuff seems to taste
[00:54:23.180]way, way, way, way sweeter,
[00:54:25.560]there were not significant differences
[00:54:26.830]on any of the other flavors.
[00:54:29.620]So, in that movie, instead of biting into a cheeseburger
[00:54:32.900]and saying this is the best cheeseburger I've ever had,
[00:54:34.789]it would of been a more scientifically accurate movie
[00:54:36.650]if they had a vanilla shake and said,
[00:54:37.900]this is the best damn vanilla shake I've ever had.
[00:54:40.190]But people that say, oh, I want to eat a bag of Doritos now,
[00:54:43.670]there's an element of expectancy to that,
[00:54:46.320]there's an element it's been portrayed that way culturally,
[00:54:49.130]and that's what people say they should go toward.
[00:54:51.460]If someone says, what's really important to me
[00:54:53.620]is to stay in shape.
[00:54:54.520]What's really important to me is to focus on,
[00:54:56.349]you know, losing weight.
[00:54:58.470]Cannabis use can be in conflict with that
[00:54:59.990]because of the impact on appetite.
[00:55:02.340]We're at lunch, but I'm almost done with this
[00:55:04.096]and we're gonna be at a good stopping point.
[00:55:05.380]Heart health, this is harder research to evaluate
[00:55:09.510]but it's stunning.
[00:55:10.980]I would say this is most relevant to athletes
[00:55:13.150]and if there's a student you are working with
[00:55:14.980]that God forbid has preexisting heart condition.
[00:55:17.550]You made reference to working with some
[00:55:18.640]older clients or patients,
[00:55:19.870]any of you working with an older population,
[00:55:21.639]certainly important to be mindful of too.
[00:55:24.240]No one in this room would disagree,
[00:55:25.800]cocaine is a hardcore stimulant.
[00:55:27.720]Cocaine, on average, increase heart rate 32 beats a minute.
[00:55:31.870]Marijuana slows down almost everything in the body
[00:55:34.800]with a the very paradoxical effect
[00:55:36.130]that it jacks up heart rate.
[00:55:37.780]And believe it or not, only three beats away, on average
[00:55:39.605]from what we see with cocaine.
[00:55:43.480]29 beat increase in resting heart rate,
[00:55:46.640]for some people, the resting hear rate more than doubles.
[00:55:49.950]What's the impact of that?
[00:55:51.040]It can weaken the heart and increases blood pressure,
[00:55:54.430]that'll be relevant with student athletes in just a bit
[00:55:57.070]but this article came out looking at
[00:55:58.810]factors associated within the hour prior to a heart attack.
[00:56:04.060]I should of highlighted this and I did not,
[00:56:06.210]if you look at the third to last line of the abstract,
[00:56:09.344]in the hour following use of marijuana,
[00:56:12.410]heart attack risk goes up 4.8 times.
[00:56:15.460]I love math in a very geeky way, 4.8 times zero is zero.
[00:56:19.579]So if you have no heart attack risk,
[00:56:22.120]4.8 times zero is zero.
[00:56:23.960]But if someone has a family history of heart attack,
[00:56:27.065]or whatever their heart attack risk is
[00:56:29.230]based on diet, ethnicity, family history, sex, you name it,
[00:56:33.460]this becomes noteworthy.
[00:56:35.970]When we look at athletes, I love,
[00:56:38.940]and these will be in your handouts,
[00:56:40.640]this article came out and actually showed
[00:56:44.100]that the more the athletes used marijuana,
[00:56:46.910]the more it decreases their physiological work capacity
[00:56:49.790]and the more it reduces their maximal exercise duration.
[00:56:52.700]What does that mean?
[00:56:53.720]A coach says, you know, do this until you tap out
[00:56:56.760]and can't go anymore.
[00:56:57.980]The more people use marijuana, the sooner they tap out.
[00:57:01.730]If a team is looking for a competitive edge,
[00:57:04.106]and decides as a team, we're all gonna avoid marijuana use,
[00:57:07.510]the science would say, you're making a heck of a call.
[00:57:10.420]Because that, that's going to,
[00:57:12.420]there's not a single, actually, I'm getting ahead of myself,
[00:57:15.060]I'll even show you.
[00:57:16.280]This article in 2013 said, the use of marijuana
[00:57:19.560]by the elite athlete prior to competition
[00:57:22.040]may result in danger to that athlete or others
[00:57:24.003]as results of impairment of response
[00:57:25.960]or inappropriate decision making.
[00:57:27.900]But it was Pesta in 2013 who first outright said,
[00:57:31.510]because of decreased exercise performance,
[00:57:34.560]that was on this slide,
[00:57:36.950]possibly secondary to increases in heart rate
[00:57:39.010]and blood pressure, that was on this slide,
[00:57:44.048]which may alter perceived exertion,
[00:57:45.890]marijuana may be considered and ergolytic agent.
[00:57:48.120]What does ergolytic mean?
[00:57:49.370]Ergogenic, things like steroids,
[00:57:51.060]performance enhancement drugs.
[00:57:52.670]Ergolytic, ones that impair performance.
[00:57:56.320]This came out last month, and in July,
[00:58:00.223]pardon me, that should of said 2018,
[00:58:02.050]I wrote Kennedy in 2017, this Kennedy 2018,
[00:58:04.690]found 15 published studies that looked at effects of THC
[00:58:08.000]and exercise, the number that showed improvement
[00:58:10.450]in aerobic performance, none of them.
[00:58:13.200]I've heard some students that aren't even athletes say
[00:58:14.804]sometimes if I use like before I go on the treadmill,
[00:58:17.520]I feel like I have a better workout,
[00:58:19.200]I feel like I workout better, I exercise better.
[00:58:21.590]Not a single study shows that's the case.
[00:58:23.700]They said there was no evidence of increase strength
[00:58:25.750]or endurance and may impair abilities in extreme situations,
[00:58:28.880]and they even said there's no data to support claims
[00:58:31.130]of analgesic or muscling relaxing properties for athletes.
[00:58:34.390]I'll fix that in the slides you get, to get the year right.
[00:58:37.540]Something we use in the field, desperately need an update
[00:58:40.210]in the scientific literature,
[00:58:41.790]if you're working with an intercollegiate athlete
[00:58:43.920]whose eligibility could be compromised
[00:58:45.590]with a failed drug test, if their only value is
[00:58:48.320]I wanna be an athlete in good standing.
[00:58:50.654]They need to be aware of the fact
[00:58:52.183]a person can reliably test positive
[00:58:54.010]for up to 95 days after marijuana use.
[00:58:57.760]That article was from 2006, I will show you post lunch
[00:59:00.760]that potency is certainly gone up.
[00:59:03.800]So it could be even longer now.
[00:59:05.470]We had a streak, where in our nation,
[00:59:07.260]there were two national championships for football in a row
[00:59:10.090]where players sat out 'cause they failed tests
[00:59:12.650]for marijuana use before that test, before that game.
[00:59:17.220]We're supposed to end at 12:15, we ended at 12:20,
[00:59:19.430]which is okay, I hope.
[00:59:21.159]We're gonna have a 40 minutes break for lunch
[00:59:24.170]'cause we'll resume again at 1:00.
[00:59:25.603]When we come back, we're gonna have
[00:59:27.070]more practice with reflections,
[00:59:28.920]we're gonna have more with pulling it all together
[00:59:30.390]with motivation interviewing and then consistent with agenda
[00:59:33.720]I will talk about some kind of lessons learned
[00:59:36.340]in the state of Washington and what that might mean to you
[00:59:40.090]Before we officially break for lunch
[00:59:41.500]and I have Megan explain what we're doing next,
[00:59:44.390]what final questions or comments do folks have?
[00:59:49.760]Oh, sorry, it's such a, hard to see with all the lights,
[00:59:52.923]Specifically with driving,
[00:59:54.763]the potency that was tested for the...
[01:00:01.570]Well, that's the point, so the five nanograms
[01:00:03.510]is in, it's active THC, so it's not the metabolite,
[01:00:07.440]it's not what you would see in a urine test.
[01:00:09.370]So, obviously, the more a person uses,
[01:00:11.760]the higher potency, the more that's gonna impact that.
[01:00:14.870]In my state, the way it works
[01:00:16.180]because we don't have a breathalyzer for marijuana,
[01:00:18.640]if an officer believes someone is under the influence
[01:00:21.160]of marijuana and it's effected their driving,
[01:00:23.160]their arrested under the influence,
[01:00:25.429]their arrested under suspicion of DUI.
[01:00:28.460]So under suspicion of DUI is now a thing.
[01:00:31.580]They're taking to a hospital for a blood draw
[01:00:34.170]and it's there that they look at that.
[01:00:35.447]So, it's active THC.
[01:00:37.230]So obviously, the more with concentrates,
[01:00:39.218]hash oils, what people use for dabbing,
[01:00:41.410]that's even more potent, so the likelihood greater potency
[01:00:43.920]is gonna be more present there.
[01:00:46.340]They come up with that five, though,
[01:00:47.610]based on the author's of initiative 502
[01:00:49.570]came up with five nanograms based on what was
[01:00:52.250]in the research at the time they wrote the initiative
[01:00:54.202]in terms with its alignment with .08 for alcohol.
[01:00:59.150]Alright, with that, I will tag over to Megan
[01:01:00.780]to tell us what happens next,
[01:01:02.550]and I'll talk to you all at 1:00 back in this room.
[01:01:05.040]Go ahead Megan.
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