Alcohol and Substance Abuse - Cannabis and Opioid Specific Concerns

Cannabis

• Since marijuana may be one of many drugs abused, total abstinence from all psychoactive substances should be the goal of therapy. Periodic urine testing should be used to monitor abstinence. Cannabinoids can be detected in the urine up to 21 days after abstinence in chronic abusers due to fat redistribution; however, one to five days is the normal urine positive period. Thus, beginning drug monitoring needs to be interpreted accordingly.
  
  
• If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital. Life-style changes such as avoiding people, places, and things related to cannabis use should be encouraged. Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of cannabis abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans. Drug urine tests should be used to ensure compliance.
  
  
• It is likely that some heavy cannabis users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy and psychiatric medications.
  
  
• Psychotherapy is useful when it focuses on the reasons for the patient's drug abuse. The drug abuse itself - past, present, and future consequences - must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial. In the adolescent, cannabis dependence often hides poor self-esteem, depression, severe family problems, and learning disorders. These issues must be addressed in therapy. Generally, a nonjudgmental, honest, steady, and firm approach is needed with adolescents.
  
  

Opioids

As described for previous drugs, with one important additional note:

• Like all addictions, opioid addiction is difficult to kick. In some cases, it is recommended that patients addicted to opioids get on to a Methadone or LAAM maintenance program via a maintenance clinic. Patients on such maintenance programs go to the clinic each day and receive medication in the form of Methadone or LAAM. These medicines are themselves opioids, and so keep the opioid addicted patient from experiencing withdrawal symptoms so long as they continue to use the Methadone or LAAM. The advantages of having patients on Methadone (versus Heroin) are many: Methadone can be given in one daily dose and provides a long lasting effect without any spiked-'high' states. This allows the addicted person to have the rest of their day free to pursue more socially useful endeavors than simply finding the next fix. It can be administered orally, and is thus much safer than IV injected Heroin. Although it is not easier for people to come off of Methadone than it is to come off of heroin, the process can be done very gradually in measured doses, so that it is safe and more likely to actually work than any cold-turkey complete abstinence approach.