It’s Your Choice: What About Marijuana? Journal Helps Clients Reevaluate Their Use

by William R. Miller, PhD, and Denise D. Walker, PhD

What about marijuana? It’s a question on the minds of clients and counselors alike. At one extreme is the idea that cannabis is a harmless drug, far less dangerous than either tobacco or alcohol. At the other extreme is a zero tolerance perspective – no use of any psychoactive drug is acceptable. Most people find themselves somewhere in between.

Public attitudes about marijuana are changing rapidly. As states legalize medical or recreational use, views on cannabis become more similar to alcohol and tobacco.

So what do we say to our clients? That’s the question we had in mind as we developed the Interactive Journal What About Marijuana? as a clinical resource. This Journal is not a universal prevention tool but is designed specifically to give to clients who are already using cannabis, often in combination with other drugs. It can be used as a free-standing intervention or discussed as part of individual or group counseling.

We developed this Interactive Journal from a motivational interviewing perspective, inviting clients to take an honest look at their own marijuana use and make their own decisions. In truth, that freedom of choice cannot be taken away. Telling people “you can’t” is as ineffective as punishment or scare tactics. It is better to tell the truth and recognize that people are going to decide for themselves.

So what is the truth about marijuana? There is a large and growing body of research literature that, unsurprisingly, offers mixed findings. We do our best in this Journal to offer a fair appraisal and help clients weigh their own current motivations for use against the potential risks. We offer a self-assessment with individual feedback, as well as norm correction to counterbalance users’ common overestimation of the prevalence of marijuana use. Clients can compare their own experience with the diagnostic symptoms of a substance use disorder. In terms of potential risks, we included evidence-based sections on the effects of marijuana use on physical health, the brain, sleep, driving, relationships, motivation and mental illness. We include self-evaluation information about tolerance, as well as physical and psychological dependence.

In a final section, we ask readers to rate their importance and confidence for change, offering a menu of self-change strategies from which to choose. Readers are invited to consider the positive effects they hoped to experience with marijuana – and to explore drug-free paths or “new roads” as alternatives.

In the end, clients’ choices are theirs to make. This Journal is an honest-to-science resource, built on an evidence-based clinical method for helping people make healthy choices.

William R. Miller, PhD

William R. Miller is a cofounder of motivational interviewing and has focused on developing and testing more effective treatments for people with alcohol and drug problems. Dr. Miller has published over 400 scientific articles and chapters, and 50 books, including the groundbreaking work for professionals Motivational Interviewing, Third Edition.

Dr. Miller is a recipient of the international Jellinek Memorial Award, two career achievement awards from the American Psychological Association and an Innovators in Combating Substance Abuse Award from the Robert Wood Johnson Foundation. The Institute for Scientific Information has listed him as one of the world’s most highly cited researchers.

Denise D. Walker, PhD

Denise D. Walker is research associate professor at the University of Washington, director of the Innovative Programs Research Group and a licensed clinical psychologist. She is an expert in the development and evaluation of interventions for cannabis use disorders for both adults and adolescents.

Dr. Walker helped develop the Teen Marijuana Check-Up (TMCU), a school-based intervention to elicit self-referral by heavy using adolescents. The TMCU has been the focus of five clinical trials and is identified as an evidence-based intervention by the Substance Abuse Mental Health Services Administration (SAMHSA). Dr. Walker has also adapted the Check-Up model, a motivational interviewing intervention, for other high risk populations.