Table 1: The CRAFFT Questionnaire24
Each “yes” answer scores 1 point; a total of 2 or higher indicates a need for additional assessment
. Have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs?
. Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
. Do you ever use alcohol or drugs while you are by yourself, alone?
. Do you ever forget things you did while using alcohol or drugs?
. Do your family or friends ever tell you that you should cut down on your drinking or drug use?
. Have you ever gotten into trouble while you were using alcohol or drugs?
Table 2: Severity of Dependence Scale for Cannabis25
During the past 3 months…
. Did you ever think your use of marijuana was out of control?
. Did the prospect of missing smoking or inhaling it make you anxious or worried?
. Did you worry about your use of marijuana?
. Did you wish you could stop?
. How difficult would you find it to stop or go without?
Table 3: Distinguishing Features Characteristic of Cannabis-Induced Psychosis26
|· Close in time to last cannabis ingestion |
. Possible recent sudden increase in cannabis potency or frequency
. Transient positive symptoms (paranoia, grandiosity, perceptual alterations)
. Mood symptoms (lability, anxiety)
. Cognitive deficits
. Fewer negative symptoms than schizophrenia
. Social phobia
. Insight into condition
Table 4: Working With Adolescent Cannabis Users4
Strategy Specific Tips Therapeutic relationship · Establish rapport
. Clarify confidentiality
. Encourage self-efficacy by asking about the adolescent’s goals, thoughts, and motivation for change
. Highlight the adolescent’s strengths and previous successes
. Do not lecture or judge
. Ask permission to address subject another time if the patient is not ready to change
Provide education about cannabis (examples of talking points) · Smoking marijuana may affect your sports performance
. Marijuana directly affects your brain and can hurt your school performance and your future
. Marijuana use can cause lifelong problems for some people
. Don’t ever get into a car with someone who has been drinking or using drugs
. Don’t drive a car after using marijuana, even if you don’t feel high
Set specific goals (examples) · This month: no more than 1 joint per weekend day, and up to 1 additional joint in social situations
. Next month: only 1 joint per weekend and up to 1 additional joint in social situations
Address barriers/triggers · Avoid high-risk situations/individuals
. Find substance-free ways to cope with stress (eg, recreational activities, exercise, talking with nonusing friends, finding a sponsor)
Minimize withdrawal symptoms · Taper use slowly
. Consider a detox facility for severe symptoms
. Consider use of oral cannabinoids
Follow-up · Providing ongoing monitoring/support
. Encourage patients who relapse to re-engage with treatment
. Emphasize that relapse is common and does not preclude long-term recovery
. Refer to addiction medicine specialists or facilities if necessary