Handling Marijuana Use or Intoxication

Before beginning treatment, the client should be told to refrain from using any substances. This should be communicated in a nonpunitive way, with the counselor explaining that the client can benefit most from the sessions if he or she is not under the influence of marijuana or other substances. Clients also might receive a handout with this expectation highlighted.

If a client comes to a session intoxicated, the counselor can proceed in several ways. The counselor should determine during the check-in what the client’s use pattern has been since the last session and make a clinical judgment about whether the session should be rescheduled. For example, if the client appears to be intoxicated (e.g., has difficulty concentrating on the content of the session, seems unusually tangential in speech pattern), the counselor should suggest that they reschedule. If the counselor reschedules because of the client’s appearing intoxicated, the treatment program should find alternative transportation home so that the client does not drive.

Anyone asked to leave a session is encouraged to return to the next session abstinent and to continue in treatment. If the client smoked marijuana shortly before the appointment, but the counselor determines that the client can participate meaningfully in the session, the session can proceed as planned.

The client should be given specific guidelines for handling the immediate aftermath of a using episode. He or she should be advised to get rid of the marijuana, leave the setting in which the using occurred, and call someone for help (a spouse, a friend, or the supporter identified in session 2). The client should be cautioned about the feelings of guilt and self-blame that often accompany a slip and warned not to allow such reactions to prompt further drug use. Sessions 4, 5, 6, and 7 and elective skill topic 1 provide specific guidelines on preventing and handling slips.

Marijuana Withdrawal

Some clients report withdrawal symptoms such as flulike symptoms, increased anxiety, or difficulty sleeping after they stop using marijuana. These symptoms usually are not severe, start 12 to 24 hours after the last use, and last less than 2 weeks. In most cases, withdrawal symptoms are manageable without medical intervention. Clients can be encouraged to use behavioral strategies such as relaxation techniques for anxiety or to decrease caffeine intake for insomnia. However, if a client either reports having severe withdrawal symptoms or anticipates having a difficult time based on previous experience, the counselor can suggest that the client see a physician for assistance and request permission to discuss the problem with the client’s primary care physician.

In some cases, the client may show more severe problems with anxiety, depression, or cognitive functioning than normally expected from a withdrawal syndrome. In these circumstances, the counselor can suggest that the client see a psychiatrist for an assessment and possible assistance during and after the withdrawal period.