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East Bay residents are enrolling in twelve-step-like classes that use cannabis to quit heroin, pills, cigarettes, alcohol, and other addictive substances, defying decades of Narcotics Anonymous and Alcoholics Anonymous tradition.
Even though NA and AA both mandate abstinence from all illegal drugs, that one-size fits all approach doesn't work for all addicts, says Harm Reduction Clinical Consultant Jennifer Janichek. For the last six weeks, Janichek, along with two other clinicians, have been running pro-cannabis mental health and addiction services for a handful of people out of the Harborside Health Center in Oakland. The free mental health services paid for by the area's largest cannabis dispensary explain the safest way to smoke pot — which is not physically addictive — and use it to combat depression, anxiety, and addiction.
For years, there've been anecdotal reports about people using cannabis to quit harder drugs. The process is called “substitution”, and it's a tactic that's beginning to be endorsed by the “harm reduction” philosophy of mental health. Janichek says the philosophy of harm reduction is most popularly associated with needle exchanges, condom disbursement, ecstasy pill testing, and seat belt laws. Harm reduction accepts that some people will engage in risky behavior, and therefore clinicians should seek to reduce the harms associated with such risks. That might include endorsing a little pot over a lot of OxyContin.
“A lot of these folks go to NA or AA and can't talk about their medical cannabis use because it's frowned upon," Janichek says. "NA and AA wouldn't view users as being sober. I've talked to folks who've had a really good experience in NA except they couldn't share that piece of their life.”
So Harborside crafted a program that's similar to traditional twelve-step programs, but ignores the pot smoking. This concept of substitution is cutting edge, with new research just coming out. According to a poll of medical cannabis users by UC Berkeley's Dr. Amanda Reinman, published in the Harm Reduction Journal of December 2009:
“Forty percent [of those polled] have used cannabis as a substitute for alcohol, 26% as a substitute for illicit drugs and 66% as a substitute for prescription drugs. The most common reasons given for substituting were: less adverse side effects (65%), better symptom management (57%), and less withdrawal potential (34%) with cannabis.”
With that reality in mind, Janichek designed a Substance Use & Misuse Clinical Services Program at Harborside Health Center that is currently at capacity. The program includes information sharing sessions, depression forums, social skills groups, online support groups, and one-on-one counseling. She says most of the clients who sign up report depression, anxiety, and mostly a lot of questions.
“These are people that are functioning for the most part in most areas of their life, they're just trying to work on some things,” she says. “People are looking for more information about different substances. A lot of folks are DARE generation at this point and they haven't been given honest information on the basics of different drugs and what they do to your body.”
Kids want to know if it's okay to break up Adderall and snort it, or which is healthier: smoking out of a bong or hitting a joint, she says. She consults the literature and tells them.
Janichek would never order someone with a problem to simply quit smoking pot. Harm reduction inverts the AA model where users must admit their powerlessness. Addicts aren't powerless, they're smart enough to make their own choices, she says.
“I would have the person reflect on the risks and limitations of their use and help them come to an understanding of 'do I want to change?' We really believe in building off the positive rather than being powerless.”
Janichek is tracking the outcomes of Harborside's free, cannabis-positive mental health services, with the goal of extrapolating the data into guidelines and replicating the services in other dispensaries.
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