Posts by Jeremy Wachter, ICADC

About Jeremy Wachter, ICADC

Jeremy is a Internationally Certified Alcohol & Drug Counselor who counseled teens and young adults for five years with various drug and alcohol treatment programs around the country. His journey to recovery began at the age in 2009 at the age of 23, and he developed an interest in helping young people and their families his first couple of years in recovery.

A residential substance abuse treatment group holding hands in a meeting.

9 Benefits of Residential Substance Abuse Treatment

By on July 1st, 2022 in Addiction, Alcoholism

Though other levels of care have their benefits, there are distinct advantages to residential substance abuse treatment when a client’s substance abuse problem is severe enough.

Residential substance abuse treatment provides the distinct advantage of being a much more closely monitored around-the-clock substance abuse treatment solution. Residential substance abuse treatment program benefits include more counseling hours, more 12-step meetings, and more accountability. Residential treatment also offers substance users the chance to attain sobriety in a safe, sober environment where they are free to focus solely on recovery, with very few distractions.

Residential treatment is particularly appropriate for those who have shown that they have a tough time staying sober in their home environment, or those whose substance use disorder or post-acute withdrawal symptoms are severe enough to warrant around-the-clock supervision.

1. The Residential Treatment Environment is Safe and Monitored

It’s not uncommon for drug and alcohol users to be approached by using peers in early recovery, or to discover a secret stash they had forgotten about while in a blackout. Additionally, family dynamics in early recovery can present many challenges before either side has had much of a chance to sort out their resentments, guilt, and fears individually. The early recovery process is a major life transition, and it’s not easy.

Residential treatment programs offer the benefit of 24-hour monitoring by trained staff, technicians, or counselors. Additionally, they are surrounded by peers whose goals are the same – to sober up. 24 hours a day, there will be someone who is capable of providing love, support, and objective feedback on a client’s struggles and progress. Family relationships improve as loved ones receive counseling, and self-esteem improves as the resident gains more confidence and time sober.

2. Residential treatment provides a distraction-free environment

Aside from the obvious live-in element of residential substance abuse rehabilitation programs, most require residents to give up electronics capable of outside communication, such as texting, social media, and phone calls. Residents are usually allowed communication with family members, supportive loved ones, and peers in recovery (such as 12-step sponsors), but that’s about it.

Some of the most common risk factors for relapse are contact with using peers, exposure to pro-drug social media communities, and even pro-drug music or movies. For a time, residential treatment centers completely eliminates these potential triggers.

Though this can be a big hurdle for some individuals who enter residential treatment, it provides a few unique benefits:

  • It allows residents to have some objectivity as they sort through which peers in their lives are helpful, and which ones are not.
  • It allows residents to make progress in treatment without undoing their treatment progress in the evening times.
  • It helps residents determine whether they are truly committed to the recovery process before they enter treatment.

3. Residential treatment provides appropriate separation of family members

We often observe in our substance abuse treatment programs that family members and substance users are usually at odds with each other when the treatment process begins. Though the substance user is usually the one that family members initially feel is “the problem,” family members are often surprised after a few weeks when they discover that they have fears, guilt, and resentments of their own.

Residential treatment programs allow for substance users to focus on recovery and mental health issues in an environment away from their family members, while family members seek counseling or support for issues they discover they have.

This allows the family to come back together in a cohesive way as the treatment program progresses. When the newly recovered substance user returns home and begins their IOP or PHP program, the entire family finds they have tools to respond to the new dynamics in the family.

4. Residential treatment programs provide a singular focus on recovery

Participants in outpatient or intensive outpatient treatment programs are in a unique position. They must learn to manage early recovery while also juggling family relationships, home environments, and resisting the classic temptations associated with early recovery. If the individual is also juggling work or school, then a number of other layers are present, each with their own unique temptations.

For some individuals, this is simply too much to deal with.

A benefit of residential substance abuse programs is that they eliminate the need to focus on anything other than just sobering up. Meals are provided, transportation is provided, and events are planned out. For 30, 60, or even 90 days in some cases, clients’ sole focus is to process emotions, learn the basics of the 12 steps, and develop strong bonds with peers in recovery. These early days in residential treatment often prove invaluable.

5. Community and positive peer relationships are formed in residential treatment centers

We know that connection to a community of positive peers is one of the most important factors in recovery. This is one of the fundamental principles behind programs like Alcoholics Anonymous or Celebrate Recovery.

We also know that one of the most common ways to derail a newcomer’s recovery is through regular contact with negative using peers (or sometimes well-intentioned peers who don’t understand recovery).

Is it necessary to only spend time with peers in recovery forever? Of course not – but in the beginning it’s extremely valuable. Residential drug addiction treatment approaches allow for a period of time in the newcomer’s life where all of their social interactions and emotional support come from peers in recovery who understand what they’re going through.

6. Residential treatment centers offer more counseling and more meetings

When comparing levels of care in drug treatment, it’s immediately apparent that residential and inpatient rehab options have the advantage of a much higher intensity of counseling and 12-step support than outpatient or even partial hospitalization programs. Residents often receive up to 6 hours per day of counseling or therapy, in addition to daily 12-step meetings, process groups, and more.

7. Self-sabotage is much tougher in a residential treatment environment

Substance users are masters of self-sabotage, and this often takes the form of “undoing” their progress in treatment as the process unfolds. Recovering from drug or alcohol addiction is a massive step, and there are many uncomfortable challenges along the way. Substance users will often have an important breakthrough in a treatment session, only to drive by their dealer’s house on the way home or pick a fight with a family member later that evening.

Newly sober substance users also are often faced with challenges such as driving by an old liquor store or ex’s house on the way to and from work, IOP, or school day after day.

Residential substance abuse treatment eliminates all those variables for a while, which makes self-sabotage much harder. This allows residential clients to make progress more quickly in the early stages of their recovery.

8. Residential treatment programs provide thorough aftercare planning and goal setting

It’s important to remember that residential substance abuse treatment is just the beginning – it can take anywhere from 18-24 months for newly sober individuals to fully integrate into their new life as a sober individual. This process involves patience, diligence, and many ups and downs.

Residential programs will all have some sort of “hand off” process into the next phase of recovery. Typically, this involves some sort of IOP program, but will sometimes include a PHP program as well. Ideally, every program would culminate with a thorough Aftercare plan that involves check-ins with counseling staff and sober peers, 12-step meetings, and social activities.

Residential programs allow newly sober individuals the space and time to think through every step of this process, including developing specific plans and tools to respond to situations that arise at work, school, home, social time, and time spent alone.

9. Residential substance abuse treatment is a great beginning to the recovery journey

As stated above, residential programs represent a beginning. They are a chance for substance abusers to begin recovery in a safe, sober, and supportive environment. However, it’s important to remember that recovery is an ongoing process and that a robust Aftercare program is of critical importance.

If you or a loved one has been struggling with addiction or substance abuse problems alone, please reach out to a professional. We’d be more than happy to answer any questions you have and help you develop a plan to start your recovery journey today!

A college-age young adult in a rehab setting.

Young Adult Rehab vs Traditional Drug Treatment

By on March 25th, 2022 in Addiction, Adolescent and Young Adult Substance Use

Why Young Adults Need Age Specific Substance Abuse Treatment

The young adult, or 18-25 year old, is often forgotten in the greater drug / alcohol treatment world. They aren’t teenagers, they have some freedom, and society expects them to act like adults. However, they aren’t truly adults yet, either.

Parents and young people alike often report attempt after attempt at sobriety or treatment. Upon further investigation, we often find that these individuals have been in and out of adult treatment centers. Sometimes these programs work well for young adults, but more often than not they fall flat. While we do not wish to disparage adult treatment programs, they don’t tend to meet the 18-25 year-old’s needs very well.

Why is this? We hope to examine the reasons in this post, as well as offer a few viable solutions for parents, young adults, or mental health professionals seeking guidance on working with college-age individuals in a rehab or treatment setting.

Young Adults vs Adults in a Rehab Setting

Much has been written and said about the adult alcoholic or drug addict. For obvious reasons, the treatment and recovery world is designed around the older adult alcoholic. This typically refers to a 45-55 year old individual who has experienced serious consequences – divorces, DUI’s, legal battles, with serious career-related implications.

These individuals may enter treatment on their own or at the behest of a loved one, but they are almost always seeking to alleviate consequences. The classic 30-45 day rehab program is very much designed to serve this type of individual, and the “young adult”, or college-age drug user is often lumped into this group.

It’s important to understand that young adults aren’t in treatment for the same reasons as an adult. They haven’t endured 15-20 years of hard drinking, they haven’t lost businesses, they haven’t been through divorces. They aren’t “fed up” with getting high, even if their lives have been miserable for a few years.

These individuals are over 18, but they haven’t totally started their lives yet. Their brains aren’t fully developed, they are almost always single, and in many ways they think and act like adolescents (more on that later). Their experience is somewhere in between the adolescent and the adult.

They’ve often lived on their own, had jobs, or rented apartments. They may have owned (or wrecked) a car or three. They may have even experienced consequences, such as a DUI, a serious breakup, or expulsion from a college or university program. In many ways their “drug using careers” are just getting started.

Rehab for Young Adults vs Teens

Similarly, much has been written and talked about where adolescents and drug abuse is concerned. We all generally understand that an individual under 18 is a different animal than an adult alcoholic or drug addict. They are (typically) still under the guardianship of a parent, parents, or family members. They are required to go to school, and their drug and alcohol use is almost always motivated by a desire to have fun and obtain peer acceptance. They often haven’t totally crossed the “invisible line” into true addiction or alcoholism, and there are numerous treatment approaches tailored directly to the teen drug user.

Young adults can’t be treated as if they are teenagers, because they are in a different phase of life. Legally, they are adults. Parents don’t have the same leverage over their young adult that they would have over a teen.

Additionally, young adults’ have usually progressed further into their substance use disorders than teens have. They have often been using drugs for more than just a couple years. They’ve progressed into harder drugs and often experience withdrawal symptoms upon cessation of use. When presented with facts about addiction, they usually nod their heads in agreement, rather than glaze over like an adolescent would.

Considerations for Young Adult Specific Drug Treatment

Because young adults often get lumped in with adults, they end up in treatment programs that aren’t designed for them. They usually don’t feel that they relate to their peers in treatment, and upon discharge, they are handed off into various 12-step programs where they continue to struggle to relate.

Consider a few generalizations about the 18-25 year old phase of life:

Young adults have a high social need

Being single and young means these individuals still have a high social need – programs need to incorporate fun, opportunities for social connection with a new peer group, and a clean hand-off into a high quality long-term Aftercare program.

Delayed emotional growth still applies

Parents are often frustrated as to why their 23 year old acts and responds like a 16 year old. We often think of delayed emotional growth with teens, but this applies to young adults as well. Young adults who used drugs through high school and college haven’t experienced the emotional lessons during these years. They often present as “23 going on 16,” and retain the black-and-white logic of a teenager.

Parental involvement is important for this age group

They are often still financially and emotionally intertwined with their parents. It is important that parents of this age group have support as their young person goes through the young adult addiction treatment process.

Parents and young people alike benefit from the parents having tools to manage the high emotions involved in the early recovery process. Parents of young adult drug users often also need family therapy, coaching, and support as they decide when and how to financially disconnect from their young adult.

They feel that they are behind in life

Being college-age means these individuals will be thinking about starting their lives after they sober up. Young adult programs need to consider helping individuals sort through what their goals are, and what steps they can take towards the lives they want to create.

Young adults have also likely gotten in more legal trouble than teens, and may need some coaching and support through the process of cleaning up their past.

A 12-step program with depth is usually necessary

Young adults often have crossed the “invisible line” into being dependent on alcohol or drugs. A strong personal 12-step program will be necessary earlier in the recovery process than it will be for teens.

Is there hope for a young adult alcoholic or drug addict?

Absolutely, yes. We see young adults sober up all the time. They are some of the most fun-loving, smart, funny, and energetic individuals we get to work with.

Though we often say there are no guarantees in the substance use disorder treatment world, we believe that seeking age-appropriate young adult rehab programming is just as important for young adults as it is for teens. Their odds of success improve dramatically when the treatment is age-appropriate, their social needs are met through support groups, and their parents are involved.

If you have any questions about the treatment process for young adults, or would like to inquire regarding a substance abuse evaluation, please reach out to us. We are always happy to answer any questions and assist in developing a plan of action for your family or your young adult.

A girl holding a marijuana joint.

Is Marijuana A Gateway Drug?

By on November 19th, 2021 in Addiction, Adolescent and Young Adult Substance Use, Marijuana

Obviously, the landscape of attitudes toward the use of marijuana has changed dramatically in recent years. One of the pieces of conventional wisdom in the drug world was always that marijuana was the most common “gateway” drug. With the widespread acceptance of THC and CBD products for medicinal and recreational use in various portions of the country, this has become a point of contention in recent years.

Those who argue against the so-called “gateway” theory of marijuana point out that there are no documented marijuana-specific properties that “cause” an individual to use other drugs down the road. While this claim is only partially true (we’ll briefly examine the science later in this post), the argument is fundamentally missing the point.

As an aside, in a recent survey of our patient charts, we found that marijuana is the most common “first drug” used by teens with substance use disorders.

To illustrate what we mean:

We surveyed our opiate users about marijuana use

Our (adolescent and young adult specific) substance abuse program did a year-long quick survey of all the opiate and heroin addicts who went through treatment in our facility.

We asked a simple question – did you start with opiates? The answer, a resounding no. Then we asked the obvious follow up question – which drug did you use first? Almost every response was … marijuana.

Surprised? Neither were we.

Rather than getting into the weeds (pun intended) about the clinical properties of marijuana, we prefer a common sense approach to the question. Is it true that marijuana is often the drug that opens the door to further drug use down the road, and if so, why?

A personal anecdote about marijuana

In other portions of this website, we’ve presented some stories about the teenage experience with drug use. I’ll add a portion of my own story:

As a young teenager, I was decidedly anti-drug. My family did a great job of discouraging me from using drugs as well as providing me with suitable alternatives such as hobbies and sports. Not only that, I went through the now defunct D.A.R.E. program as a kid.

I remember the D.A.R.E. officer talking about how people who used marijuana would inevitably experience serious consequences. Despite having some drug-using friends at school, I stayed clean, mostly because I didn’t want to compromise athletics. Then a curious thing happened:

One summer, I smoked weed for the first time. I took a few puffs of a joint at a concert and enjoyed the light, heady feeling I got from it. I didn’t get very high, but the experiment went so well that I decided to do it again – this time I would make sure to get good and high!

A week or two later, I smoked weed from a bong for the first time with some friends and … I had a great time! That’s right – I didn’t commit any crimes, steal from my grandma, join a gang, or try to jump from a high window. That was the day I realized:

Adults are jerks.

They had lied to me.

Drugs were awesome.

My whole attitude toward drug use changed in an instant. I had believed that doing drugs was stupid, but at that point I “realized” that the joke was on me. Within a few weeks, I repeated the experiment with prescription painkillers, cocaine, and over-the-counter cough medications. I began stashing drugs in my room and I quickly fell in love with getting high.

Unsurprisingly, things did get really dark for me. A few years later I was strung out on heroin, homeless, and on the verge of losing ties to my family.

Turns out the joke was on me. I went through the process of getting sober kicking and screaming. But here’s the point:

It all started at that concert, with those first few puffs of marijuana. An “innocent” moment in time where I went from being a capable, athletic, suburban kid to someone open to the idea of doing drugs.

Lowering the barrier to drug useA teenager vaping marijuana from a wax pen.

The 2020 Arizona Youth Survey points out some telling facts about youth substance abuse:

  • 41.3% of students surveyed have used marijuana by the time they are in the 12th grade.
  • 35.8% of students have used marijuana concentrates by the 12th grade.
  • 28.0% have taken marijuana edibles by 12th grade.

The number of 18 year olds who have used marijuana is approaching half.

We also know from this 2014 study that 44.7% of individuals with lifetime cannabis use progressed to other drugs later in life.

Why is this? Is it something “special” about marijuana? Doubtful – we could likely make the same argument about alcohol or vaping. We think it has more to do with perception of risk. 

Luckily, the AYS gives us data on this topic as well:

Perception of Risk for Marijuana Use Among Youth

The Arizona Youth Survey goes on to say:

  • Only 23.3% of 12th graders perceive trying marijuana once or twice to be a moderate or great risk.
  • 87.3% of 12th graders perceive trying illegal drugs other than marijuana to be a moderate or great risk.

There’s two conflicting facts here: while almost all students perceive trying other illegal drugs to be a great risk, almost half of marijuana users go on to use other drugs. That should tell us something – once someone tries their first drug, their perception of the risks of other drug use often gets lowered by default.

Some Common Sense Facts About Marijuana Use

We believe (and see in our drug abuse program every day) that the gateway effect is not referring to a scientific phenomenon – it’s referring to behavioral and social factors that open the door to drug use in general. Consider the following:

  • A teenager having fun using one drug is more likely to hear from another teenager that another drug is also fun.
  • As noted above, most teens view other illegal drugs as risky at first. Having a good time using one drug makes other, harder drugs seem less scary to try.
  • Starting to use drugs plugs teenagers into a social network of drug-using peers, some of whom have access to drugs other than marijuana.
  • Taking one drug regularly leads to tolerance. This leads to a natural inclination to try other drugs as time goes on.

An overview of the science on marijuana

Earlier we noted that the claim that marijuana doesn’t directly lead to other drug use is only partially true. Here’s an overview of what the science says:

Marijuana’s association with other drug use

  • This 2014 study found that 44.7% of individuals with lifetime cannabis use progressed to other drugs later in life.
  • The National Survey on Drug Use and Health found that marijuana users are three times more likely to become addicted to heroin.
  • A 2018 study found that cannabis use was associated with non-medical opioid use in adults.
  • This 2004 study found that early cannabis use is strongly associated with use, abuse, and dependence on other illicit drugs later in life.

Cross sensitization, or the “priming” effect

Early-use marijuana has been shown to “prime” the brain, setting the person up for substance use disorders later in life. The term cross-sensitization is used to describe the effect of exposure to one drug leading to hypersensitivity to another drug. It has been shown that marijuana use early in life does lead to cross-sensitization for other drugs, which may help explain the high number of users who switch to other drugs later on.

  • In their article on cross-sensitization, the Addiction Policy Forum had this to say: “Marijuana is an undeniably powerful drug, like alcohol and tobacco, changing the brain and accelerating drug-reward learning.”
  • This study from 2004 found that an enduring change to the dopamine system takes place in those who use cannabis early in life. This adaptation led to a long-lasting cross tolerance for drugs like cocaine, morphine, and amphetamine.
  • A more recent study from 2020 performed on rats found that exposure to marijuana during adolescence led to cross-sensitization for cocaine, but adulthood exposure did not. They also reversed the experiment, finding that cocaine use did not lead to cross-sensitization for marijuana.

What about Alcohol and Tobacco?

As compelling as all of this may seem, it turns out that other drugs may have the same effect. For instance, the cross sensitization effect has also been shown in the literature to take place in those who use alcohol or nicotine.

It appears that it may not matter which drug a person does first. As we’ve already stated, it’s likely just the simple fact that someone tries a drug that helps predispose them to other illicit drug use later in life. In their resource on the “gateway effect” of marijuana, the National Institute on Drug Abuse had the following to say:

“An alternative to the gateway-drug hypothesis is that people who are more vulnerable to drug-taking are simply more likely to start with readily available substances such as marijuana, tobacco, or alcohol, and their subsequent social interactions with others who use drugs increases their chances of trying other drugs.”

So … is marijuana a gateway drug?

Hopefully this article has painted a clear enough picture. As stated in the beginning, we’ve hardly ever met a drug abuser who didn’t start with marijuana. We believe practical experience speaks louder than words.

There is massive pressure to be dismissive of some of the common sense wisdom concerning marijuana use. The fact remains that marijuana is almost always the first drug kids try.

Even if it weren’t for the well documented physical health and mental health risks of marijuana, it would still be true that using marijuana early in life sets in motion the social, behavioral, and emotional wheels in motion for other drug use later in life.

A graphic with a marijuana leaf and a graph.

Marijuana Potency Testing Shows the THC Percentage in Weed Has Gone Up

By on November 4th, 2021 in Adolescent and Young Adult Substance Use, Marijuana

Many parents (and even grandparents) we work with assume that marijuana is the same as it ever was – weed is weed, right? Not so fast. If you assume that the marijuana your child has access to is the same weed you and your peers had access to back in high school, think again.

The federal government has been testing marijuana potency since around 1972 in something called the Potency Monitoring Program (due to technological constraints in cannabis testing labs, it wasn’t possible to test marijuana potency prior to the 60’s). It has shown a definite increase in the strength of marijuana over the decades.

While the Potency Monitoring Program has admitted its own limitations in testing methods from decades past (outdated testing methods, small sample sizes, and sampling of months-old samples likely limited the accuracy of potency figures through the 70’s and 80’s), it is true that marijuana potency has increased.

This is especially true in the past 20-25 years, as testing techniques have improved and sample sizes have reached into the 1000’s per year.

Marijuana potency testing shows we have the highest THC Weed in history

A two-decades long study (1995-2014) of the potency of samples confiscated by the DEA showed a clear trend upward from the mid-90’s. This study includes over 38,000 samples of marijuana plants over the two decades. We’ll let the study’s results speak for themselves:

  • The potency of illicit cannabis plant materials has risen consistently since 1995.
  • THC content in 1995 was approximately 4%, whereas by 2014 it had risen to around 12%.
  • CBD content in cannabis plants has fallen on average. The THC to CBD ratio has therefore gone from 14 times in 1995 to 80 times in 2014.

Alternatively, here is the included graph from the Potency Monitoring Program’s quarterly report #146.

A graph of marijuana potency over the last 20 years.

You can see that THC levels have continued to climb since 2014, reaching into the 14-15% range.

Why is this happening? Especially since the onset of the medical marijuana movement and the push for recreational legalization, growers have been working to make higher and higher THC content strains in order to compete with one another.

A simple Google search for “highest THC content ever recorded” returns page after page of articles claiming that strains with names like “Bruce Banner” or “Ghost Train Haze” are the strongest in the world, with concentrations ranging form 27-44%!

High Potency THC Concentrates

The other elephant in the room in the marijuana game right now is the popularity of new cannabis products known as THC concentrates. Nicknamed, oil, shatter, wax, or dabs, these are generally different forms of the same thing: THC that has been extracted from the marijuana plant through various methods. In many ways, this is a new class of marijuana which draws more parallels to some of the traditional “hard” narcotics.

But how strong are they actually?

The National Institute on Drug Abuse compiled some data on this topic. They report that solvent-based marijuana concentrates can have an average THC level of about 54-69%, whereas non-solvent-based concentrates have a lower average of 39-60%. They even report that some of the samples can have upwards of 80% THC content.

Why it matters

In our experience, this has led to a new wave of marijuana related consequences for young adults and teens:

High THC cannabis is now the norm. New conditions such as marijuana hyperemesis and marijuana induced renal failure (kidney failure) have appeared on the horizon. Anecdotally, a higher percentage of our adolescent and young adult substance abuse program’s intakes have included complications from marijuana-induced psychosis.

Marijuana used to have the reputation as the drug that wouldn’t make you overdose. In 2021, this is no longer the case. This scholarly review on marijuana poisoning discusses that deaths have begun to pop up in relation to eating food products containing concentrated THC butter.

For young people, this new world of marijuana is opening doors to potential health, mental health, and social risks that weren’t present in the past. According to one 2019 study, 33% of 8th-, 10th-, and 12th-graders reported lifetime cannabis use and 24% reported lifetime concentrate use.

Ironically, many cannabis users debate whether marijuana potency testing is even a good measure of a marijuana strain. Some claim that super-high THC cannabis strains don’t get the user more “high” than low-THC strains. This begs the question – are the individuals who use these products needlessly opening themselves up to potential consequences without even knowing it?

In Conclusion

In short, the THC percentage in weed has gone up, with new high THC strains coming out each year. Perceived harm among young people has gone down, and legalization efforts have lowered the barrier to obtaining medical-grade marijuana for youth. Additionally, marijuana is decisively the most commonly used drug by teens. Elizabeth Stuyt, MD, an addiction psychiatrist, puts it perfectly in a 2018 article in Missouri Medicine:

“There is absolutely no research that indicates this level of THC is beneficial for any medical condition. The purpose of these products is to produce a high, and the increased potency makes them potentially more dangerous and more likely to result in addiction.”

We couldn’t have said it better.

Two individuals experiencing the symptoms of bipolar.

Marijuana and Mental Health Risks

By on October 4th, 2021 in Adolescent and Young Adult Substance Use, Marijuana

As we’ve seen in our recent posts about marijuana-induced psychotic disorder, cannabinoid hyperemesis, and the physical effects of marijuana, it’s possible that recreational marijuana isn’t quite as harmless as we’ve been led to believe. In this post, we’d like to explore some of the literature relating to marijuana and mental health. As professional drug and alcohol counselors who work with young people every day, we see much of this first-hand.

Marijuana is a complex drug. Some people feel happy and relaxed when they smoke marijuana, and others feel anxious and paranoid. Still others develop more and more paranoia or feelings of anxiety in the long-term, leading to mood swings or manic symptoms.

This article is not intended to tell you what you should or shouldn’t do. We simply want you to be informed on some of the possible outcomes of marijuana use so you can make a decision on your own. We hope this information is helpful, as marijuana is decisively the drug most frequently abused by teenagers and young people.

Marijuana and bipolar disorder

Bipolar disorder, formerly called “manic depressive disorder”, is a mental health condition in which an individual has alternating periods of elation and depression. As mentioned above, one of the main effects of marijuana is the feeling of relaxation and happiness it provides under ideal circumstances. So, is there a link between marijuana and bipolar disorder?

There is actually a decent amount of literature on this topic. In particular, this 2015 study performed a systematic review and meta-analysis of six studies covering 2391 patients with bipolar disorder or manic episodes. The results of the study showed an association between cannabis use and “exacerbation of manic symptoms in those previously diagnosed with bipolar disorder.” Additionally, two studies from the analysis suggested that the risk of developing new manic symptoms is approximately three times higher among people with bipolar disorder who remain undiagnosed.

Marijuana and anxiety disorder

There is some debate in the industry and among the public as to whether marijuana causes anxiety disorder. In fact, the literature is conflicting on this topic at times. Some studies point out that anxiety symptoms get triggered by cannabis use, and others show that it can be beneficial in treating symptoms.

This 2014 systematic review noted in the “Adverse Effects” section that anxiety, psychosis, and dysphoria were all associated with higher concentrations of THC.

Marijuana and suicidal ideation, attempt, and self-harm

A 2021 study by the National Institute on Drug Abuse examined over 280,000 adult participants from the National Surveys on Drug Use and Health. They found that past-year cannabis use disorder, daily cannabis use, and nondaily cannabis use were associated with higher instances of past-year suicidal ideation, plans, and attempts across both sexes. They found that the associations were stronger in women.

Another 2021 study on over 204,000 adolescents found an association between adolescent cannabis use and self-harm among youth with mood disorders. The study states that, “Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders.”

Studies point out the need for more research in this area. It is unclear whether marijuana use causes suicidal ideation or whether individuals with depression are simply more likely to use marijuana to cope with an underlying mental illness.

Marijuana and Depression

One of the current areas of study is that of marijuana’s potential positive effects on depression. However, there is also evidence to suggest it may make things worse. The Mayo Clinic reports that marijuana users are diagnosed with depression more often than non-marijuana users. However, as stated above, there is a problem of determining causation.

The real trouble is that while marijuana use may provide temporary relief, there is also a good chance it will make symptoms worse. This 2018 study found that users of marijuana experienced stress, anxiety, and depression relief with as little as two puffs of marijuana. However, they noted that baseline symptoms of depression ended up being worse over time. This seems to fall in line with conventional wisdom on drug abuse in general – drugs provide temporary relief at the cost of more pain later.

What’s the Verdict?

From the resources linked above, it would appear that marijuana and mental illness go hand in hand. However, many of the sources repeat the same problem with determining causation. It is as of yet unclear whether marijuana increases risk of anxiety disorders, suicidal ideations, depressive episodes, etc, or whether individuals with mental health issues are simply more likely to use marijuana.

In our view, the question isn’t really about whether or not marijuana can cause mental health problems. The question is, how can we help address mental health issues in individuals so they don’t have to use marijuana to cope?

That seems like a worthwhile approach, while also conveniently side-stepping marijuana’s other inherent risks, and the documented negative effects of marijuana use on brain development in adolescents.

A model of the lungs.

Physical Health Effects of Marijuana: Lungs, Brain, and Heart

By on September 15th, 2021 in Marijuana

Marijuana’s health risks are hotly debated, and almost all sources point out that more research is needed to understand them fully. However, in addition to the documented mental health effects of marijuana, there are numerous physical health effects of marijuana. These include side effects of marijuana on the lungs, brain, and heart. While some of the occurrences detailed below are quite rare (such as cannabis-induced stroke), others are not (such as marijuana’s adverse effects on brain development in young people). Is marijuana harmless? You decide:

Marijuana’s effect on the Lungs

Smoking marijuana is associated with greater risks of COPD and damage to lung tissues and damage to blood vessels. In fact, there are quite a few parallels between smoking marijuana and tobacco. Though marijuana smoke contains less compounds than tobacco, a marijuana smoker’s lungs can expect similar results as those found in tobacco smokers:

Decreased lung capacity

  • This study broke 339 participants into four groups: cannabis only, tobacco only, combined cannabis and tobacco, and non-smokers. They found that one cannabis joint’s effect on the lungs was similar to 2.5-5 tobacco cigarettes. They also noted that cannabis smoking was associated with decreased lung capacity.

Coughing, wheezing, and sputum production

  • This study, defining “frequent” cannabis use as 52 times in the previous year found that cannabis use was associated with morning cough, sputum production, and wheezing. They also found that reducing or quitting cannabis use was associated in reductions in those same symptoms. They found that reducing cannabis use often led to a resolution of symptoms, similar to those seen in non-users.

Increased risk of chronic obstructive pulmonary disease (COPD)

  • This study found that marijuana smoke is associated with increased risk of COPD, and the risk is greatest among people who combine marijuana smoking with cigarette smoking.
  • This study followed 299 participants over a mean of 9.8 years and found that continuing to smoke marijuana (or tobacco) had a “significantly increased likelihood” of having chronic bronchitis at follow-up.

Marijuana and its Effects on the Brain

Marijuana affects the brain by attaching to molecules on neurons called cannabinoid receptors in the brain, which influence pleasure, coordination, memory, and concentration among other things. It is well known that marijuana’s effects on the brain include impaired brain development in children and adolescents. As a substance abuse treatment program for adolescents and young people, we encourage you to take a look at our post on how drugs affect the brain of a teenager. Some of the research on the topic shows:

Potential for marijuana brain damage and impaired functioning

Some of these studies on marijuana effects on the brain appropriately point out that the evidence, in most cases, is open to more than one interpretation. Therefore, a call has been made for more longitudinal study in humans. Currently, the National Institute on Drug Abuse is conducting a large-scale study to learn more about the role marijuana plays in adolescent brain development in the long-term.

Marijuana’s effects on the heart & cardiovascular system

Though it has been noted that likelihood of heart complications in otherwise healthy individuals who use marijuana are low, marijuana use increases risk of heart-related problems in those with a history of heart disease or atrial fibrillation / arrhythmia. Marijuana has a dose-dependent effect on heart rate and creates high blood pressure immediately after use. Several suggestions about the cardiovascular effects of marijuana have been made, including increased risk of stroke and impaired cardiovascular system efficiency:

Cannabis-induced stroke

  • This article examines the available research and discussed multiple studies where cannabis use is shown to be associated with risks of stroke, especially in the first hour after use due to blood pressure spikes.
  • This research review further describes the incidence of cannabis-induced stroke as well as discusses cases of other cardiovascular problems such as cannabis-induced myocardial infarction (permanent damage to the heart muscle) and cannabis-arteritis (a rare peripheral necrosis of the lower limbs).

Complications with Arrhythmia

Increased Risk of Heart Attack

  • This study found that the risk of heart attack is around five times higher in the hour after using marijuana.
  • The American Heart Association has even gone so far as to release a statement asserting that cannabis use shows “substantial risks and no benefits for cardiovascular health.”

Impaired cardiovascular functioning

  • This study found that one minute of exposure to marijuana second hand smoke impairs the function of the membrane that lines the inside of the heart and blood vessels in rats for up to 90 minutes. The study had the following to say: “Lack of evidence for marijuana SHS causing acute cardiovascular harm is frequently mistaken for evidence that it is harmless, despite chemical and physical similarity between marijuana and tobacco smoke.”

In Conclusion

In short, we would agree with Wolff et al’s assessment in their research review, stating, “In light of this review, cannabis has to be considered as harmful and the cerebrovascular risk when cannabis is consumed is probably underestimated.” Though almost all sources point out that more research is needed, it is undeniable that the physical effects of marijuana on the heart, lungs, and brain are real.

Marijuana use has been shown to be associated with increased risk of all sorts of heart and lung problems, as well as morphological changes in the brain and problems with development in adolescents and children.

If you or a loved one is struggling with marijuana use or any other type of substance abuse, we recommend you seek a consultation with a professional in your area. You are welcome to contact our substance abuse program for teens and young adults with any questions or to request a consult.

 

Marijuana in a teenager's hands.

Is Marijuana Addictive?

By on September 10th, 2021 in Addiction, Marijuana

With the proliferation of medical marijuana rolling into the movement for recreational marijuana, this seems to be one of the questions of the day – is marijuana addictive? As a general blanket statement, the answer is yes, at around the same rate that alcohol is addictive. The CDC’s report on the health effects of marijuana states that around one in 10 marijuana users will develop addiction, but points out that the number is much higher among users who are under 18 (details below). Long-term marijuana use is one of the fastest growing forms of drug addiction in the United States.

What constitutes a marijuana addiction

Many people point out that marijuana abuse doesn’t have the same severity of withdrawal symptoms as substances such as heroin or alcohol. However, this doesn’t mean that marijuana isn’t addictive. We would like to point out that many “addictive” substances and behaviors don’t necessarily leave the user in cold sweats like heroin does. Take gambling, shopping, or eating for example. Alternatively, most experts would refer to an addiction as the inability to stop engaging in a destructive behavior even though it is causing some kind of physical or psychological harm to the user.

On a clinical level, the diagnosis “cannabis use disorder” is used. This term is taken directly from the Diagnostic and Statistical Manual of Mental Disorders, Vol 5 (DSM-5). The manual states that a cannabis use disorder is a mental health disorder constituted by use of cannabis for at least a one-year period, with the presence of two or more symptoms. These symptoms can include tolerance for the drug, withdrawal from the drug, or failed efforts to cut back / quit, among others. Withdrawal from cannabis typically includes:

Marijuana withdrawal symptoms

  • Decreased appetite
  • Irritability
  • Sweating or chills
  • Mood swings or feelings of depression / isolation
  • Cravings for marijuana
  • Inability to focus
  • Insomnia

Yes, marijuana is addictive. With the recent surge in marijuana use in the United States, cases of marijuana / cannabis use disorder are on the rise. However, it appears that the rate at which individuals become addicted to marijuana is not increasing – simply the number of users has gone up.

What the research says about marijuana addiction

Let’s take a deeper look into some of the research and data available on the topic of marijuana addiction:

  • A 10 year study face-to-face interviews conducted in surveys reported that among marijuana users, almost 3 in 10 developed symptoms of cannabis use disorder.
  • Data from 7,389 past-year cannabis users showed that the odds of transitioning from recreational use to dependence was just under 1 in 10. This is a similar rate that we expect alcohol users to transition to dependence.
  • This study broke down the likelihood of developing cannabis use disorder by age and found that past-year cannabis users are 4 to 7 times more likely to develop dependence if they are under the age of 18.
  • The National Institute on Drug Abuse’s Monitoring the Future survey noted that around 2019, there was a sudden increase in marijuana use among the younger grades, and that teens’ perceptions of the risks of marijuana use has declined in recent years.

Marijuana addiction symptoms & signs

In our drug and alcohol treatment programs for youth, we often describe how marijuana / THC users will “scrape the bottom,” rather than “hitting a bottom” in the traditional sense. We also observe that marijuana is the most popular drug used by teens, by far. Whereas users of other illicit drugs such as heroin or methamphetamine will often experience hard consequences very quickly, marijuana users tend to slowly let their lives slip, such that they themselves are unaware of the effects it’s having on them. Some of the clear marijuana addiction symptoms are:

  • Unsuccessful attempts to stop using the drug or cut back on marijuana or THC use.
  • Incrementally giving up activities, hobbies, or endeavors, likely due to a marijuana-induced amotivational syndrome.
  • Continuing to use marijuana after developing awareness of the destructive consequences. This is one of the most classic signs of addiction.
  • Tolerance for the drug, or needing to use more and more to get high over time.
  • Problems with memory and trouble learning.

Treatment options for marijuana addiction and next steps

If you or a loved one are struggling with marijuana use, we recommend that you start with a consultation with a professional. This doesn’t necessarily mean a trip to rehab – it’s simply to get an objective perspective on the level of use, as well as some next steps. Good places to start would be with a healthcare professional trained in addiction, an addiction counselor, or a drug and alcohol treatment program such as our teen and young adult drug treatment programs in Tempe, AZ and Sacramento, CA. As always, feel free to call our program or contact us if you have questions or would like to request an evaluation.

Marijuana leafs and a bottle of high potency cannabis oil.

Marijuana-Induced Psychosis – What You Need to Know

By on September 5th, 2021 in Marijuana

As drug and alcohol counselors, we often witness the effects of chronic marijuana use on young people in the form of cannabis or “weed” psychosis. It is unfortunate to see these consequences take place in individuals who previously would have regarded marijuana use to be relatively risk-free. Marijuana-induced psychosis is one of the unfortunate side effects of marijuana use in some individuals. Substance-induced psychotic disorders are recognized by the DSM-5 on the schizophrenia spectrum.

What is Psychosis?

Psychosis is a term used to describe when an individual perceives reality in a way that others around them do not. This can include perceiving visual or auditory stimuli that are not actually there, such as seeing things / people or hearing voices or sounds. Psychosis can also come in the form of extremely disorganized thinking, believing one has special powers, or being irrationally paranoid about being watched or sent special messages through the radio or internet. People experiencing psychosis can come across as distracted or confused, and they will often pause before responding to statements made to them.

Is there a link between marijuana use and occurrence of psychosis?

The truth is that there is quite a lot of study on marijuana use being a risk factor for psychotic episodes, going back to the 1970’s up until recent years. What follows is a selection of studies linking marijuana use with occurrence of psychosis. For a deeper dive on what the studies show, we recommend you check out the following research reviews:

An overview of some of the research:

  • A 2019 study of over 900 patients with first-episode psychosis found that users of cannabis were more likely to experience a psychotic disorder than those who did not use cannabis. It was found that the odds increased among daily users, who were around five times more likely to experience a psychotic disorder.
  • One 2012 study by Di Forti et al found that people who carry a specific variant of the AKT1 gene who use marijuana are at an increased risk of developing psychosis.
  • This 2011 study of 2000 teenagers found that teenagers who smoke marijuana five times weekly are twice as likely to develop psychosis over a 10 year period.
  • A longitudinal study of 45,570 Swedish conscripts showed that those who had used marijuana more than 50 times in their lifetime were six times more likely to develop schizophrenia over a 15 year period.

How Long Does Cannabis-Induced Psychosis Last?

Cannabis-induced psychosis can take three distinct forms: acute psychosis during intoxication, acute psychosis after the intoxicative effects of the drug have worn off, and long-term persistent psychosis. While some psychotic effects are somewhat common during intoxication (hearing or seeing things), some users will continue to experience bouts of psychosis after the drug has worn off. These symptoms tend to resolve within a month or so. However, this poses an obvious problem for chronic or regular users of marijuana, especially high-potency marijuana.

Where long-term persistent psychosis is concerned, it has been found that cannabis use is not sufficient to cause a long-term psychotic disorder. In cases where this occurs, it is more likely that cannabis use is simply one of a number of factors causing acute symptoms. As discussed above, there may be other genetic factors at play.

Unsurprisingly, then, an obvious course of action for someone experiencing psychotic symptoms is to discontinue use of marijuana and seek the guidance of a healthcare professional.

Marijuana-Induced Psychosis Symptoms and Next Steps

The debate continues as to whether marijuana causes schizophrenia, bipolar disorder, or other mental health conditions in otherwise healthy individuals. However, as discussed above, there is a large body of evidence demonstrating a clear link between the two. As a substance abuse program working with cannabis / marijuana use disorder, we have seen a noticeable uptick in cases among the youth and young adult populations we work with over the past few years. The most common symptoms include:

  • Auditory hallucinations
  • Persistent paranoid feelings of being persecuted
  • Grandiosity
  • Depersonalization & derealization (feelings of observing oneself from outside one’s body or being disconnected from reality)
  • Persistent confusion and inability to put thoughts into words

These symptoms are unpleasant for the user and scary for a family. As noted above, we recommend that if you or a family member are experiencing an episode of psychosis or any of the symptoms above in combination with marijuana use, that you discontinue use and seek professional help. If you are anywhere near the Phoenix or Sacramento areas, call us to set up a consultation. If not, seek the guidance of a healthcare professional or treatment program in your area.

A cannabis user with hyperemesis syndrome.

What is Cannabinoid Hyperemesis Syndrome, or Marijuana Hyperemesis?

By on September 1st, 2021 in Marijuana

There is a trend in our society to view marijuana use as harmless. While there is a large body of research documenting marijuana’s harmful effects on the developing teenage brain, we would also like to highlight some of the lesser-known and under-recognized adverse effects of using marijuana.

Research dating back as early as 2012 has recognized a clinical condition known as cannabinoid hyperemesis syndrome (CHS), or marijuana hyperemesis. It is characterized by cyclic bouts of persistent nausea and vomiting which can last 24-48 hours and lead to dangerous levels of dehydration or death (in extreme cases).

To many, the occurrence of this condition is counter-intuitive because of the well-documented anti-emetic (anti-nausea) effects of marijuana. However, due to the recent trend of widespread acceptance of pro-recreational marijuana use in the United States, there are more chronic marijuana users in our society than ever before.

This, combined with the massive increase in THC concentration levels in marijuana and marijuana concentrates is believed to be causing the uptick in cases.

As a newly named condition, many medical professionals won’t issue a diagnosis of CHS because they aren’t aware that it exists. This can sometimes lead patients with CHS through an expensive testing process for their “mysterious” cyclical vomiting. The mechanism by which people develop CHS is unclear. What is known is the most direct way to respond to this condition is through cessation of cannabis use (details below).

Cannabinoid hyperemesis syndrome symptoms

Symptoms of CHS are extremely unpleasant and are typically characterized by severe cyclic nausea and vomiting that lasts around 24-48 hours. However, one 2012 case series on 98 patients noted that less severe symptoms can persist for several months. This cyclic vomiting is accompanied with abdominal pain and most people report that hot showers and hot water bathing eases their symptoms. The symptoms of this condition share similarities with cyclic vomiting syndrome, and the two are often confused by medical professionals. Often the onset of symptoms occurs for no apparent reason, with the only known stimulus being chronic cannabis use. It has been noted that more research will be required to learn the exact mechanism by which this condition occurs.

Cessation of cannabis use will cause symptoms to subside, but in many cases this is accompanied by an emergency room visit for extreme dehydration. This dehydration can lead to kidney failure (known in clinical practice as cannabinoid hyperemesis acute renal failure) and has resulted in death in severe cases.

How common is cannabinoid hyperemesis syndrome?

It’s easy to assume that marijuana hyperemesis only occurs in multiple-times-a-day chronic users, or long term users. However, this assumption would be wrong. A 2016 systematic review compiled data from 170 studies and peer-reviewed articles on cannabinoid hyperemesis syndrome. What they found:

  • 4% of CHS cases reported less than weekly use.
  • 4% of CHS cases reported weekly use.
  • 9% of CHS cases reported daily use.
  • 7% of CHS cases reported greater than daily use.

What’s clear from these results is that the majority of people with CHS are from daily use or greater. However, over 1 in 5 cases reported weekly use or less.

Cannabinoid hyperemesis syndrome treatment

As noted other places in this article, cessation of use is the most direct way to treat the symptoms of nausea, vomiting, and abdominal pain. This is confirmed by the systematic review mentioned above, which mentions that several studies included in the review demonstrated this effect. When it comes to responding to the symptoms of marijuana hyperemesis, a number of solutions were attempted, ranging from dopamine antagonists to capsaicin cream. However, the evidence for these types of treatments is limited as of this writing. We recommend that you contact a healthcare professional for the most effective treatment options. The one conclusive piece of evidence across all the studies reviewed was that if someone presents with cannabinoid hyperemesis syndrome, they should stop smoking pot.

Teenagers in an alternative peer group hanging out with each other outside a shop.

Do Alternative Peer Groups Work? What the APG Recovery Research Says

By on August 23rd, 2021 in Alternative Peer Groups

One of the rising concepts in the teen and young adult drug and alcohol recovery world is the alternative peer group (APG) recovery approach as an effective follow-up approach to treatment for substance use disorder. The alternative peer group model for youth recovery is currently in use by programs around the country and has been presented as a more effective alternative to traditional approaches for young people. In this article, we will seek to present the available literature on the topic of APGs in order to present a clearer picture of what elements are present in the model, as well as its overall effectiveness in treating substance use disorders in young people.

What is the Alternative Peer Group Model for Youth Recovery?

Alternative peer groups are a term used for long-term aftercare or school programs that create a youth-specific approach to encouraging continued recovery from substance use disorders. This is in contrast to most adolescent programs, which tend to be modified variations of time-proven adult approaches to recovery. It has been noted that these programs have extremely high attrition rates and relapse rates when applied to young people. Nash et al submitted the following possible reasons for this in their 2016 paper The Alternative Peer Groups: A Developmentally Appropriate Recovery Support Model for Adolescents.

  • Adolescents are more vulnerable to a rapid progression from substance use to dependence.
  • Adolescents tend to be less motivated to seek recovery than adults.
  • Adolescents are more likely than adults to relapse due to social pressures.
  • Adolescents tend to show modest changes in substance use during treatment, but their progress in treatment fades extremely quickly once they leave the treatment environment.

A 2020 article published in the Substance Abuse: Research and Treatment Journal had the following to say about current outcomes for young people:

“Recovery and long-term remission are the goals of treatment for substance use disorders, yet the majority of treated adolescents never stop using or resume using substances quickly after treatment. Thus, continuing care or recovery support services are common post-treatment recommendations for this group. Almost half of people who resolved significant substance use problems did so through participation in 12-step programs like Alcoholics Anonymous or Narcotics Anonymous. These recovery support programs are available online and in communities around the world. Yet <2% of these programs’ members are under 21 years old.”

The alternative peer group is an approach to encouraging continued recovery in young people after treatment. The terminology was first presented by John Cates, MA, LCDC of Lifeway International in Houston, TX. John has over 40 years of experience in working with adolescents and young adults with drug problems. John first utilized this approach in his own efforts to help young people find and maintain a positive, sober way of life, but has since founded the Association of Alternative Peer Groups (AAPG) in order to allow other programs with similar approaches to utilize the model.

Elements of APGs and the theory behind them

While the elements of APGs are clearly presented on AAPG’s website, this 2011 paper by Collier et al. sought to understand the elements that make up the alternative peer group model. They discussed that the foundation of the approach is the social component and presented the elements as follows:

Six elements of an alternative peer group

  • Youth must be present as participants in the program.
  • Social functions such as afterschool hangouts, sober social weekend activities, and retreats.
  • 12-step meetings for young people, since 12-step meetings are traditionally not well-attended by youth.
  • Counseling for the individual, family, and group.
  • Family Support
  • Psychosocial Education for youth and parents.

The paper further goes on to discuss the clinical theory present in this unique approach:

Theoretical underpinnings of alternative peer groups

  • 12-step principles, using modified language to be more inclusive of young people.
  • Social influence theory, noting that adolescents have a higher rate of relapse due to peer pressure than adults, and that it has been shown that social influence has a positive effect on all sorts of risk behaviors in adolescents.
  • Recovery capital, or increasing the presence of internal and external resources to initiate and maintain recovery.

Do APGs work? Quantitative data on the APG recovery model

To our knowledge, only one quantitative study has been done on alternative peer groups. In 2011, Rochat et al did a study comparing relapse rates in APGs to the national average. The study specifically mentions positive social influence and asks, “Can the same relationships that initiate and support use and dependence prove effective in facilitating recovery?”

What they found

  • 50-90% relapse rate is typical for recovery programs.
  • In January, 2008: 90% of clients who had completed IOP in 2006 were sober.
  • In January, 2009: 89% were sober since 2007.
  • In January, 2010: 92% were sober since 2008.
  • Students enrolled in an APG high school had an 87% rate of staying sober the entire school year.
  • APG high school students also had 89% school attendance, 96% graduation rate (for seniors), 79% student retention, and 96% of them went on to attend college.

The study goes on to report:

  • Young people in APGs had significantly better perceptions of their inter-peer relationships than the control group.
  • Parental satisfaction with APGs was overwhelmingly positive. Parents responded favorably to subjective questions about the APG’s role in helping them set effective boundaries, support their child’s recovery, and improve family relationships.

These results seem very compelling in favor of APGs as a viable method of approaching youth recovery. Note that this is just one study; we hope to see more quantitative data in the future.

Qualitative data on APGs

Upon investigation, two peer-reviewed qualitative studies were found regarding the efficacy of APGs:

Study #1: Exploring recovery capital among adolescents in an alternative peer group (2019)

“Recovery capital” is the term used to quantify how many tools and resources (both internal and external) a recovering substance user has available to them. This qualitative study utilized secondary analysis of interview data collected from APG participants.

What they found

Social Recovery Capital – Most participants reported having very few real friends before joining an APG. They also largely described their friends as being negative influences. Participants described developing very close bonds with their peers in APGs and described them as helpful. Also of note is that many participants described improvements in their family relationships. In particular, participants discussed that parents who got involved in recovery family groups had an easier time with this.

Community Recovery Capital – Participants largely reported that the APG’s atmosphere of fun and acceptance led to very good connections with peers in the APG who valued recovery. Also, 67% of the students reported attending a local recovery high school. They reported that the influence of positive peers helped them get past their initial objections to recovery.

Financial Recovery Capital – Participants primarily discussed parents’ or caregivers’ resources when speaking of financial resources which provided access to recovery options. One consistent theme that emerged was a lack of an existing youth agency in providing access to resources. Another subtheme was that some participants reported insurance restrictions as a barrier to recovery.

Human Recovery Capital – This category mainly refers to personal characteristics and internal assets, such as motivation, dedication to recovery, and a sense of accomplishment. Most participants initially reported low motivation, but that their motivation improved as they spent more time in the APG. They described a dedication to staying sober and a sense of accomplishment at staying sober or returning to recovery after a relapse.

Read the full article here.

Study #2: The Good, the Bad, and Recovery: Adolescents Describe the Advantages and Disadvantages of Alternative Peer Groups (2020)

In this study, researchers completed a secondary analysis of transcripts from interviews with adolescent APG participants collected from a prior study. The researchers analyzed recurring themes and attempt to determine that adolescents’ attitudes towards their experience in APGs.

What they found:

The results of the study expanded on four common themes among participants: belonging, meaning, structure, and ambivalence (with many subthemes). The results report:

APG factors that support recovery:

  • Belonging – One of the most common themes was a sense of Participants described feeling welcomed, accepted, understood, loved, and more.
  • Fun – A common subtheme mentioned by participants.
  • Service – Participants reported receiving satisfaction and support for their own recovery by participating in the APG’s culture of giving back to the newer members of the group.
  • Meaning – Most participants reported their APG experience was meaningful.
  • Improved family dynamics – A common subtheme.
  • Stories – Participants reported meaningful stories with positive peers.
  • Structure – Almost all participants cited structure as one of the APG’s greatest benefits. The culture of scheduled meetings, social functions, and accountability was found to be a clear positive effect of APG participation.
  • Positive recovery role models – Multiple participants discussed that the APG’s staff and support groups contained positive recovery role models who were helpful in peer mentoring staying sober.

Potential barriers to recovery:

  • “Unhealthy groups” – A few participants mentioned feeling excluded, stigmatized, or disconnected within their respective APG’s if they were part of an unhealthy group.
  • Alcohol / drug use – At least two of the study participants discussed that APG’s sometimes exposed adolescents to drugs they hadn’t done before, or exposed them to new drug-seeking peers.
  • Hard work – At least two participants mentioned that being in an APG is “hard work.”
  • Time consuming – At least two participants mentioned that being in an APG is very time consuming. One went into specific detail about struggling to juggle school, home life, and 5 nights per week of APG participation.
  • Mandated attendance – One participant discussed that they would experience consequences if they didn’t attend all of the APG’s activities.
  • Ambivalence – Four participants discussed conflicting or mixed feelings towards sobriety or recovery.
  • Resistance to recovery – This was commonly expressed as a desire to get high, while also experiencing the benefits of their APGs.
  • Not working the program – A few participants discussed not working the program because it was “hard work.” Multiple participants noted that over time, their resistance to working the program changed as they began to perceive the 12-steps as helpful.

Read the full article here.

In conclusion

At the core of the philosophy is something near and dear to our hearts as a program: the idea that (in general) young people need to be shown a better, more fun way of life before they are willing to let go of a drug or alcohol habit.

Whether you are a parent attempting to learn about treatment or recovery support systems available in your area or a clinician just trying to learn about the APG recovery approach generally, we hope this article has been helpful. While the elements of the approach go back to the 1970’s, the terminology is new enough that the body of evidence isn’t very large at this time. We hope to see more research come out in the coming years on the topic.

At the Pathway Program, we have been observing the positive effect of providing fun, engaging, and meaningful peer relationships to young people with drug problems has been having for many years. Feel free to take a look at The Pathway Program’s success rate or contact us if you have any questions. We will make efforts to keep this article up to date as new research is completed.