Drug screens for VA externs/practicum students

[MBellows]

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Um, vascular mechanisms?

I think the choice to use marijuana, to a degree, threatens one's ability to retain a sharp mind over time. This is pretty clear in the lit and I believe its relevant to the topic at hand.

Are you referring to the choice to use it once or the choice to use it once, then use it again at a 'chronic' level?

 

[JeyRo]

Um, vascular mechanisms?

Have these mechanisms been identified in animal models, laboratory studies (e.g., particularly as they relate to "neurotoxicity" - which again, I have a sense is an inappropriate use of the term when it comes to a substance that so overwhelmingly benign from a straightforward toxicological perspective)?

I'm not willing to hang my hat on retrospective studies, for reasons I've already mentioned.

I think the choice to use marijuana, to a degree, threatens one's ability to retain a sharp mind over time. This is pretty clear in the lit and I believe its relevant to the topic at hand.

I'm willing to believe that heavy cannabis smoking in children can lead potentially to lifetime decrements in cognitive function (typically indexed by IQ in the studies I just skimmed), but that's a far cry from the proposition that moderate cannabis use in adults leads to the same.

The choice to engage in all sorts of behaviors potentially can affect the sharpness of a person (or psychologists) mind, anyways, not just cannabis use.

This whole thread originally started with me objecting to the idea that a conception of professional ethics should have anything to do with how a psychologist chooses to recreate in their off-time. Pragma initially objected that psychologists have a special duty to follow the law simply because, well, it's the law - irrespective of how harmful cannabis smoking may or may not be. I objected to that on a philosophical basis. This six-degrees of separation literature review stuff in terms of cannabis and it's health effects, IMHO, is not relevant to the issues of professional ethics, morality, and the law that were brought up in this thread.

 

[Pragma]

This six-degrees of separation literature review stuff in terms of cannabis and it's health effects, IMHO, is not relevant to the issues of professional ethics, morality, and the law that were brought up in this thread.

Yeah, this whole conversation is getting as tangental as a bunch of stoners ripping bong hits in a dorm room 🙂

Politics, crystal balls....we just need some blacklights

 

[MBellows]

Yeah, this whole conversation is getting as tangental as a bunch of stoners ripping bong hits in a dorm room 🙂

Politics, crystal balls....we just need some blacklights

Uh.Tis.Uh.Tis.Uh.Tis....

 

[Qwerk]

I think the choice to use marijuana, to a degree, threatens one's ability to retain a sharp mind over time. This is pretty clear in the lit and I believe its relevant to the topic at hand.

This aspect of marijuana use has been brought up plenty of times in this thread, but -- again -- are we applying the same standards to other things that could slightly alter our mental acuity? Is it unethical to go to work if you haven't had enough sleep? How about having one too many cups of coffee? Not eating breakfast? Taking pain medication? Having a bad fight with your spouse? All of these things could put a damper on cognition more than occasional, moderate marijuana use could.

 

[MBellows]

This aspect of marijuana use has been brought up plenty of times in this thread, but are we applying the same standards to other things that could slightly alter our mental acuity? Is it unethical to go to work if you've only slept for six hours? How about having one too many cups of coffee? Not eating breakfast? Taking pain medication? Having a bad fight with your spouse? All of these things could put a damper on cognition more than occasional, moderate marijuana use could.

And could we be excused of these infractions if we allow a supervisor to slap us in the face?
http://en.wikipedia.org/wiki/MythBusters_(2010_season)#Slap_Some_Sense

 

[Therapist4Chnge]

I haven't gotten a chance to check out the above links yet, though it was my understanding that even regular heavy marijuana users were able to return to baseline functioning during a period of abstinence, so maintaining a "sharp mind over time" may be a moot point.

 

[Qwerk]

I haven't gotten a chance to check out the above links yet, though it was my understanding that even regular heavy marijuana users were able to return to baseline functioning during a period of abstinence, so maintaining a "sharp mind over time" may be a moot point.

Plus, most marijuana users (and I assume most functional professionals who are also marijuana users) aren't the heavy, chronic kind that these studies typically address.

 

[JeyRo]

Plus, most marijuana users (and I assume most functional professionals who are also marijuana users) aren't the heavy, chronic kind that these studies typically address.

I would imagine that in the typical market niches and cultural ethea most of us tend to function in it would be generally quite challenging to maintain something that resembles a professional psychologist practice as a several-times-a-day toker, irrespective of the putative cognitive or health effects.

Perhaps some psychologist has got this kind of lifestyle, tucked away in some hippie commune somewhere, channelling Timothy Leary maybe.... if so, God bless 'em, I say. To each his or her own.

 

[ela]

I would imagine that in the typical market niches and cultural ethea most of us tend to function in it would be generally quite challenging to maintain something that resembles a professional psychologist practice as a several-times-a-day toker, irrespective of the putative cognitive or health effects.

Perhaps some psychologist has got this kind of lifestyle, tucked away in some hippie commune somewhere, channelling Timothy Leary maybe.... if so, God bless 'em, I say. To each his or her own.

"Shrink" starring Kevin Spacey - anyone see this?

http://www.youtube.com/watch?v=B4yHZ4hVnBg&feature=fvwrel

 

[Pragma]

I haven't gotten a chance to check out the above links yet, though it was my understanding that even regular heavy marijuana users were able to return to baseline functioning during a period of abstinence, so maintaining a "sharp mind over time" may be a moot point.

I would imagine that in the typical market niches and cultural ethea most of us tend to function in it would be generally quite challenging to maintain something that resembles a professional psychologist practice as a several-times-a-day toker, irrespective of the putative cognitive or health effects.

I think it would be a moot point in the case of someone who has remained abstinent. But I would be concerned about someone who used daily, as JeyRo alluded to earlier in the thread. Either way, at least my primary disagreement here is that I think it represents stupidity and poor judgment on the part of the psychologist.

Personally, I find the comparison of marijuana to other substances that are more harmful amusing. I think it is very pertinent to the debate about whether marijuana should be legalized, but I don't think it has anything to do with the primary topic in this thread.

 

[JeyRo]

But I would be concerned about someone who used daily, as JeyRo alluded to earlier in the thread.

Although just to add a wrinkle to things further, I'm not sure I'd be particularly concerned about someone, psychologist or otherwise, having a glass of wine or two with their meal before turning in on a typical evening, and I'd venture a very large proportion, if not most North Americans probably tend to feel the same way (and if you go to Britain or Australia I'd bet an even wider majority would feel the same way). I don't know why if cannabis was used instead of alcohol in this manner it would be any different - alcohol being a confirmed, known, as-far-as-I'm-concerned verified neurotoxic agent, cannabis being pretty much theoretical at this point (and with a superior safety profile to alcohol on a number of important domains).

Interesting that once the substance in question happens to be cannabis that an otherwise responsible person involves in their evening routine, it's suddenly a different matter, and the reaction is almost visceral. I can't help but think there's some sort of cognitive bias / stereotype / heuristic at play here and it has something to do with how we make social judgments (illegal vs. legal, in-groups vs. out-groups, etc).

 

[JeyRo]

"Shrink" starring Kevin Spacey - anyone see this?

http://www.youtube.com/watch?v=B4yHZ4hVnBg&feature=fvwrel

I keep saying I'll get around to watching this one....

 

[JeyRo]

I think it is very pertinent to the debate about whether marijuana should be legalized, but I don't think it has anything to do with the primary topic in this thread.

For my part, I should say that the safety of marijuana vs. other substances seems utterly irrelevant as to whether prohibition is a good idea or not.

And politically, I think full decriminalization (of all drugs) is a far better solution to the problem of prohibition than legalization anyways, but that's my wacky classical liberal politics at play. Absolutely a better topic for the Wolf's Den, I would guess.

 

[Pragma]

Although just to add a wrinkle to things further, I'm not sure I'd be particularly concerned about someone, psychologist or otherwise, having a glass of wine or two with their meal before turning in on a typical evening, and I'd venture a very large proportion, if not most North Americans probably tend to feel the same way (and if you go to Britain or Australia I'd bet an even wider majority would feel the same way). I don't know why if cannabis was used instead of alcohol in this manner it would be any different - alcohol being a confirmed, known, as-far-as-I'm-concerned verified neurotoxic agent, cannabis being pretty much theoretical at this point (and with a superior safety profile to alcohol on a number of important domains).

Interesting that once the substance in question happens to be cannabis that an otherwise responsible person involves in their evening routine, it's suddenly a different matter, and the reaction is almost visceral. I can't help but think there's some sort of cognitive bias / stereotype / heuristic at play here and it has something to do with how we make social judgments (illegal vs. legal, in-groups vs. out-groups, etc).

I am concerned about people who drink daily as well. This isn't the topic of conversation. You keep bringing it back here...I am not biased in that sense. Also - at least from my personal experience, I wouldn't equate one or two glasses of wine (or whatever) with smokin' a bowl. Apples to oranges, there, although I suppose it depends on what you are smoking. What makes an apple an orange, in my mind, is that someone chooses to engage in illegal behavior, knowingly.

 

[Pragma]

For my part, I should say that the safety of marijuana vs. other substances seems utterly irrelevant as to whether prohibition is a good idea or not.

And politically, I think full decriminalization (of all drugs) is a far better solution to the problem of prohibition than legalization anyways, but that's my wacky classical liberal politics at play. Absolutely a better topic for the Wolf's Den, I would guess.

Fair enough. I am not all that engaged in that sense.

I'll confess that I know a LOT of people in recovery, most from 12-step programs but some who follow harm reduction methods. Pretty cool what happens when someone decides not to smoke pot anymore, or drink alcohol, or any other drug for that matter. I think that period of someone's life is a lot more interesting than most other peoples' lives. But that is perhaps just me 🙂

 

[JeyRo]

I am concerned about people who drink daily as well. This isn't the topic of conversation. You keep bringing it back here...I am not biased in that sense.

Why shouldn't it be a topic? It still relates potentially to professional standards of behavior, which relates to ethics in an ancillary sense, at least in how you formulated it (e.g., relating to a professional's off-duty behavior). You've emphasized illegality vs. legality, I've emphasized substance use in general and how people's standards for others' behavior seem, well, subjective at times.

Some people are concerned about moderate daily alcohol use, and honestly, many people really aren't. I was merely making the point that I don't think it's a widespread view that people are concerned about this in an otherwise responsible individual simply because it takes place in a ritualized manner (say, some red wine with a meal in the evening as an established practice), although I think from what I've read about this culturally there's more concern expressed about such a practice in North America (perhaps because of our experience with alcohol prohibition and more puritanical roots in general), much less so across the pond (Spain, Italy, France, Australia, Britain).

Also - at least from my personal experience, I wouldn't equate one or two glasses of wine (or whatever) with smokin' a bowl. Apples to oranges, there, although I suppose it depends on what you are smoking. What makes an apple an orange, in my mind, is that someone chooses to engage in illegal behavior, knowingly.

Exactly my point!

 

[JeyRo]

Fair enough. I am not all that engaged in that sense.

I'll confess that I know a LOT of people in recovery, most from 12-step programs but some who follow harm reduction methods. Pretty cool what happens when someone decides not to smoke pot anymore, or drink alcohol, or any other drug for that matter. I think that period of someone's life is a lot more interesting than most other peoples' lives. But that is perhaps just me 🙂

It's cool when someone freely chooses to do what makes them happy, and that includes not ingesting particular plants or substances.

I can imagine a situation where it's much less worth celebrating that a person chooses sobriety - when they're behind bars for previously choosing otherwise, as an example.

 

[Pragma]

Why shouldn't it be a topic? It still relates potentially to professional standards of behavior, which relates to ethics in an ancillary sense, at least in how you formulated it (e.g., relating to a professional's off-duty behavior). You've emphasized illegality vs. legality, I've emphasized substance use in general and how people's standards for others' behavior seem, well, subjective at times.

Some people are concerned about moderate daily alcohol use, and honestly, many people really aren't. I was merely making the point that I don't think it's a widespread view that people are concerned about this in an otherwise responsible individual simply because it takes place in a ritualized manner (say, some red wine with a meal in the evening as an established practice), although I think from what I've read about this culturally there's more concern expressed about such a practice in North America (perhaps because of our experience with alcohol prohibition and more puritanical roots in general), much less so across the pond (Spain, Italy, France, Australia, Britain).

It's fine with me if it is a topic - it just wasn't the thread topic. Or I suppose it isn't what we've been talking about (alcohol could show up on a drug screen too).

 

[Pragma]

It's cool when someone freely chooses to do what makes them happy, and that includes not ingesting particular plants or substances.

I can imagine a situation where it's much less worth celebrating that a person chooses sobriety - when they're behind bars for previously choosing otherwise, as an example.

I admit my bias, since I know a lot of folks in recovery. But they probably would think "freely chooses to do what makes them happy" as a very minimizing statement about drug addiction.

By the way, drug use is pretty rampant behind bars - another topic.

 

[Pragma]

It's cool when someone freely chooses to do what makes them happy, and that includes not ingesting particular plants or substances.

Since you brought up choice, I can't resist but note the great debate about addiction in general. I like this bioethics article, personally.

http://www.tandfonline.com/doi/abs/10.1080/15265160601063969

The "choice" to get clean is basically the alternative to death in the eyes of many folks. It isn't your garden variety 'I think I want to paint my room taupe" choice. Neurotransmitters are out of wack, HPA axis is not responding properly, behaviors are out of control, and people basically relearn how to do everything in their lives.

It's a tough choice, full of suffering and, hopefully, things to celebrate as time goes by.

 

[JeyRo]

Since you brought up choice, I can't resist but note the great debate about addiction in general. I like this bioethics article, personally.

http://www.tandfonline.com/doi/abs/10.1080/15265160601063969

The "choice" to get clean is basically the alternative to death in the eyes of many folks. It isn't your garden variety 'I think I want to paint my room taupe" choice. Neurotransmitters are out of wack, HPA axis is not responding properly, behaviors are out of control, and people basically relearn how to do everything in their lives.

It's a tough choice, full of suffering and, hopefully, things to celebrate as time goes by.

I'll read the article later when I'm back at work, looks interesting. Although I'm guessing I'll probably disagree somewhat with the philosophical underpinnings of it, looks like.

 

[Pragma]

I'll read the article later when I'm back at work, looks interesting. Although I'm guessing I'll probably disagree somewhat with the philosophical underpinnings of it, looks like.

They basically suggest that we still need to hold people accountable for their behavior, but that some of the neurobiological changes that occur with drug use do make certain choices a lot more difficult to make for people with addiction issues.

I am personally interested in that early abstinence period - hypodopaminergic state, hyporesponsive HPA axis - relapse makes a lot of sense under some of those circumstances.

One of those "gray" areas I suppose - and I am sure marijuana doesn't hijack the reward system as effectively as some other substances do.

 

[anotherconstruc]

Slightly off-topic, but hey I can't see how that's possible in this thread.

For people who claim to obtain mental relief from marijuana but don't want to break the law or get high, I thought this was interesting. There is a company called Dixie X Products that ships CBD legally.Their extracts are derived from hemp and have levels of THC too low to be illegal. They list research for several psychiatric conditions on their site. Their prices are too high for psychologists but everybody knows we're a bunch of heavy drinkers anyway.

 

[JeyRo]

I admit my bias, since I know a lot of folks in recovery. But they probably would think "freely chooses to do what makes them happy" as a very minimizing statement about drug addiction.

I'm curious, does "knowing folks in recovery" necessarily means that one would have to have your particular flavor of bias (for example, reacting negatively, e.g., calling it "minimizing" when the words "choice" are used in the context of addictive behavior)?

I've always taken the position that just because a choice is difficult, e.g., choosing not to use when one is addicted, doesn't mean choice doesn't exist in this case, and sometimes the most important choices people can make are the most difficult ones. So I don't think recognizing the role of choice in that context is minimizing the experience of an addict. But that's my bias.

I apologize for taking this thread so drastically and hugely away from the original topic but I started reading Thomas Szasz in college and I think I just live and breathe his stuff as a matter of course these days......

 

[MBellows]

Slightly off-topic, but hey I can't see how that's possible in this thread.

For people who claim to obtain mental relief from marijuana but don't want to break the law or get high, I thought this was interesting. There is a company called Dixie X Products that ships CBD legally.Their extracts are derived from hemp and have levels of THC too low to be illegal. They list research for several psychiatric conditions on their site. Their prices are too high for psychologists but everybody knows we're a bunch of heavy drinkers anyway.

As a cannibinoid, does it not run the risk of falling under the drug analog laws?

 

[anotherconstruc]

As a cannibinoid, does it not run the risk of falling under the drug analog laws?

I had the same question. I don't know if the analog laws apply to naturally occuring substances. On the FAQ section of their site, they claim that CBD derived from hemp is legal while the same compound derived from marijuana is illegal. Go figure.

 

[anotherconstruc]

As a cannibinoid, does it not run the risk of falling under the drug analog laws?

I had the same question. I don't know if the analog laws apply to naturally occuring substances. On the FAQ section of their site, they claim that CBD derived from hemp is legal while the same compound derived from marijuana is illegal. Go figure.

 

[Pragma]

I'm curious, does "knowing folks in recovery" necessarily means that one would have to have your particular flavor of bias (for example, reacting negatively, e.g., calling it "minimizing" when the words "choice" are used in the context of addictive behavior)?

I think I am biased in that I am sensitive to what I hear psychologists say about people struggling wtih addiction. It's an area that I don't think most psychologists are adequately trained to deal with, and I think that the common forms of recovery are also not always well understood. I've heard other psychologists in training say and do some awful things with clients in recovery before (e.g., make them promise not to relapse while they are in therapy).

Personally, I go to 12-step meetings at least a couple of times a year to support people I know for big anniversaries, etc, but also to promote my own understanding of what the programs are about. It is a highly stigmatized group of people, but also a pretty amazing group in my mind. With such a tendency to separate substance use from other mental health issues in our profession, I get disappointed when I hear psychologists make statements that don't seem to reflect the current science behind what is happening in the field of addictions.

I am sure many folks feel the same way about other populations that they might work with - I think it is a consequence of all of the generalist training and how our licensure structure is set up - one can't be an expert on everything right away, in my mind.

I agree with you it is still a choice that people make. But I wouldn't liken it to many of the other choices that we associate with liberty.