Leader says California marijuana law puts clinicians in more comfortable position

An atmosphere of uncertainty lingers over California as the state begins a challenging implementation of its recreational marijuana law. In looking at how the law that took effect Jan. 1 might affect clinical care for addictions, however, a prominent treatment leader in the state does see one clear positive impact.

“It's really great to see us moving away from counselors being correctional officers and more toward them being helpers and healers,” Pete Nielsen, CEO of the California Consortium of Addiction Programs and Professionals (CCAPP), tells Addiction Professional.

Clinicians in the substance use field generally feel more comfortable talking about addiction as a disease than in defining substance use in legal or moral terms. That doesn't necessarily mean that the transition in thinking regarding marijuana in California will be a totally smooth one, either for counselors or their patients.

Nielsen believes some individuals in recovery might struggle with a greater temptation to use marijuana, now that part of the legal risk is off the table and also because the public will be inundated with advertising from marijuana businesses. Clinicians might need to adjust to new realities as well, he says. It is conceivable, for example, that the counselor's next patient might work in the burgeoning legal pot industry as a legal seller.

Nielsen says that when he worked in private practice, several of his patients used marijuana and varied in the degree to which they were committed to quitting. Oriented mainly to motivational interviewing and cognitive-behavioral therapy as a clinician, Nielsen says he generally worked with these patients in the context of Stages of Change theory. Often their motivation to address their marijuana use came not from legal considerations, but from a spouse's distaste for the patient's smoking at home, or from the patient's own concern that a boss might find out about his/her use and that consequences would result.

Is the state ready?

Nielsen suggests there is little sense that California is fully prepared to take on the policy changes and implementation challenges to come with legalized marijuana. “They're still trying to figure it out,” he says of state officials.

Another potential hurdle surfaced on Thursday with the U.S. Justice Department's move to rescind an Obama administration policy that discouraged federal prosecution of most marijuana offenses in states that have decriminalized marijuana for recreational use. It remains unclear as to which entities or individuals could end up being targeted most from this shift, a move that addiction field advocates say was largely expected.

Nielsen believes that the revenue picture from regulated marijuana, as it pertains to treatment, will be clearer than what has been the case in states such as Colorado, where revenues have gone into the general fund and the treatment community has had to vie for consideration. Treatment leaders in California, prior to the November 2016 voter initiative, had direct involvement in writing into the ballot measure provisions for funding for substance use services.

Nielsen says it remains to be seen how the treatment and prevention communities specifically will fare when funds are distributed. Treatment advocates are focused on the main area they would like to see helped, he says.

“We want to see the building of a youth treatment system that doesn't currently exist,” Nielsen says. “We send the vast majority of our young patients to other states.”