'Not Your Parents' Pot'

PHOENIX – Discussion about substance abuse on college campuses generally doesn’t center on marijuana, which makes fewer headlines these days than prescription drugs or, of course, booze.

But dozens of health educators who gathered here last week at the American College Health Association’s annual conference made it clear that this drug – which is students’ illegal substance of choice, and ranks only behind alcohol and tobacco in overall popularity, according to the National Survey on Drug Use and Health – is one that they need to address.

“People like to play down the consequences of marijuana use, I think because in the picture of a college campus, people who smoke marijuana aren’t getting into the same level of trouble – like disciplinary problems – that people with alcohol do,” said Lisa Laitman, director of alcohol and drug services at Rutgers University at New Brunswick, who presented at ACHA along with Diane Fedorchak of the University of Massachusetts Amherst’s Center for Alcohol and other Drug Abuse Prevention. “I’m very involved, so I like to think people are becoming more attuned to it, but my guess is that they might not be.”

Part of the problem, ACHA attendees agreed, is a lack of conclusive research, both about the health effects of marijuana and about effective treatment methods for those who abuse it.

One of the biggest arguments from students who smoke pot, they said, is that "It’s only weed; what’s the big deal?" But as the drug continues to gain potency – in the U.S., the tetrahydrocannabinol content of some strains has risen from 2 percent in 1980 to 8.5 percent in 2006 – it is linked to ever more neurological problems. To be successful changing students' behavior, health educators must be able to engage students in a neutral conversation about the dangers of marijuana, they said. “[Students] expect to be Charlie,” Fedorchak said, pointing to a cartoon of the Peanuts comic strip character as “doctor” Lucy lectures him about his psyche. “We want to set a different stage with them because we have a different goal…. A lot of what we’re doing is creating this non-judgmental, non-confrontational environment to plant the seeds and help students make changes in their substance use.”

Research has found that student rates of use are highest among white males, particularly in fraternities, in the Northeast and in rural or small towns. The larger the institution, the higher the use, with private colleges just edging out public ones. According to the University of Michigan’s Monitoring the Future survey, while the percentage of students who have ever used marijuana is declining (and currently hovers a little below 50 percent), about 5 percent are daily users, and that number is on the rise. (Just under 20 percent reported using in the past month; that number has been stable for several years.)

Despite a largely dismissive cultural attitude about marijuana – perhaps explained in part by adults’ nostalgia for the less-potent pot of their day – according to research cited at the conference, long-term, heavy use of the drug has been linked to panic disorder, psychosis and depression (the latter is not necessarily a result of smoking, but can be worsened by it). Marijuana has also been shown to prompt anxiety disorders, which are becoming more prevalent annually and are the most-reported psychological problems among college students.

However, that research is often a point of contention. Mitch Earleywine, a psychology professor at the State University of New York at Albany who has researched and written about marijuana, said it's true that students shouldn't think they can study or attend class while high, because they won't remember anything. The respiratory effects are real, too. But there aren't any "real data" on long-term IQ or memory damage, or structural brain changes, he said. His own research has also found that smokers exhibit fewer depressive symptoms than non-smokers. "I feel like a lot of my colleagues ... don't understand that, and tend to just do this kind of, 'Marijuana's evil so let's throw the book at them.' And we're losing students in alienating them in ways that are really unnecessary, given the potential harm related to the plant," Earleywine said. "The data that are counter from the original stereotypes are hard to absorb. It's hard to change perceptions."

In terms of negative consequences, alcohol is far worse, he said: "Nobody's going to smoke so much pot that they pass out and die," he said, adding that nobody would get high and start a massive fight in a fraternity house, either -- although that's probably not why college officials don't talk about marijuana. "If you say, 'By the way, only 15 percent of the campus smokes pot,' because that's completely illegal, administration freaks out," Earleywine said. "So they don't do those preventative efforts in part because it would be confessing to illegal activity on campus."

There’s not yet proof that it is effective, but to reach students who are struggling with marijuana abuse, Fedorchak and others advocate the “motivational interviewing” technique that has been proven effective in addressing alcohol abuse. The goal is not to eliminate use completely, but more realistically, to reduce risk for the individual to the greatest possible degree. For instance, one might encourage a daily smoker to smoke only two or three times a week. “It’s about how not to have the negative consequences from marijuana,” she said.

“When [students] have days when they’re not using, and they start to piece together two or three of those days, they start to feel a change,” Laitman said. “Reducing use is a goal that most of the students we see are willing to do. When we start talking to them about quitting, we often lose them.”

In motivational interviewing, the student and clinician together discuss the ways a substance affects the user's life. Having the student identify how many hours he spends smoking per week, or times when the drug has kept him from class or harmed a relationship, can encourage him to cut back in ways that lecturing can’t, Fedorchak said. (Resources like basicsfeedback.com and echeckuptogo.com provide worksheets to give students.)

It’s a method that Jenny Haubenreiser, director of health promotion at Montana State University, uses on her campus. There, effective treatment is more important than ever: since the state legalized medical marijuana in 2004, the number of cardholders has skyrocketed, and student use has increased accordingly, as evidenced by data from the National College Health Assessment and AlcoholEdu, as well as campus incident reports. It’s become so much of an issue that marijuana has displaced alcohol as enemy number one in the eyes of many administrators, she said. “Systems respond to whatever is perceived as new and scary. Marijuana hasn’t been scary,” she said. “Pot’s always been there…. But suddenly, you’re in a state where access has increased dramatically.” (One of Earleywine's studies of teens in states where medical use became legal found no change in use rates following legalization.)

Haubenreiser said that while nobody should think that alcohol is suddenly not a problem anymore, it’s not surprising that the panic has shifted. It’s an issue of prevalence; marijuana hasn’t been as hot a topic on campus because it’s harder to obtain than alcohol or prescription drugs. (Montana State students now say it’s easier to get marijuana than alcohol, she said, but colleges in states that have legalized it can still bar the drug from campus under the federal Drug-Free Schools and Communities Act.) “Students will use whatever substance is available. That’s just a feature of this population,” she said. “And from a prevention standpoint, access, cost – all of these environmental issues have a great deal to do with how much it is used.” Now that many students are coupling marijuana with alcohol, prevention becomes even more difficult.

But one of those substances is far more dangerous than the other, said Mason Tvert, executive director of SAFER, or Safer Alternative for Enjoyable Recreation, which argues that marijuana is less harmful than alcohol and should be treated as such. "I'd rather a student smoke marijuana and sit in their room and play video games than have a student get drunk and go out and hurt themselves or others," he said. "It's unfortunate that college campuses or administrators have been, for quite some time, punishing students more harshly for marijuana than alcohol, sending a very dangerous message that alcohol use is more acceptable. As marijuana use is becoming more acceptable in the mainstream, is it really fair for them to be steering students from one drug to another?" (Tvert and Earleywine were not at the ACHA meeting, but spoke in an interview.)

Tvert said the research cited in the conference presentation is "the same misinformation and propaganda that they've been spreading for years, and it's unfortunate that it's coming from institutions of higher education." Earleywine agreed that many irrational fears about the effects of marijuana linger from the "Reefer Madness" anti-pot craze.

Nevertheless, over her 30 years in the substance abuse field, Laitman has seen more and more students volunteering themselves for treatment. And she finds one reason to be hopeful: after three months of marijuana abstention, adolescents’ neurocognitive problems in attention spans, memory and learning have largely remitted. However, she noted, that indicates the need for longer treatment. “This isn’t your parents’ pot,” she said. “[These are] very much the issues we see with students with addictions, where they like to live on the edge. Even on the edge of their mental health – they’re still on the edge.”