Counseling Today, Online Exclusives

Legalized marijuana’s impact on counseling up for debate

By Bethany Bray February 12, 2014

Marijuana leaf

Recreational marijuana recently became legal in Colorado, and several other states may soon follow suit. It remains to be seen what impact this decision ultimately will have on counselors working with clients in school, addictions, mental health and other settings.

Catherine Iliff, a licensed professional counselor in Pueblo, Colo., says the legalization of recreational marijuana has been a much-discussed topic and cause for concern among her colleagues, especially those who treat clients with addictions. She predicts legalization will lower people’s inhibitions about trying the drug, likely leading to an increase in marijuana use. In some cases, she says, users will experience increased levels of anxiety or depression.

“[Marijuana use] will increase the potential problems in people’s lives, [and] more will seek help for their problems,” Iliff says. “As a counselor, it will affect how I see the problems of these individuals. I screen for marijuana use so that I can determine those people who may be affected by it. I will need to assess in session whether an individual’s decision-making and judgment are affected by marijuana use.”

In Colorado, stores began selling marijuana for recreational use on Jan. 1. Washington state, which has also legalized marijuana, is in the process of licensing retailers. Petitions or ballot measures to legalize pot are also gaining momentum in Alaska, Oregon, Arizona, California, Maine, Massachusetts, Montana and Nevada, among others.

In addition, medical marijuana is legal in 20 states and the District of Columbia.

Keith Morgen, assistant professor of counseling and psychology at Centenary College in New Jersey and president of the International Association of Addictions and Offender Counselors, a division of the American Counseling Association, says the challenge for counselors will be the discrepancy of legality between states. Federally, possession of marijuana remains illegal.

“Clients who present with marijuana use can be more resistant to making any changes in their behaviors because they see how … they would not be in counseling for engaging in the exact same substance use behavior” in a state such as Colorado, Morgen explains. “I’m already seeing that phenomenon in the work I do with adolescents in an outpatient program. Also, imagine if a client used to live in a state where marijuana is legal but moves to a state where recreational use is illegal. Obviously, that is a context prime for problems and confusion.”

“Legalization in some states also comes at a time of great change in how we diagnose substance use disorders via the DSM-5,” Morgen continues. “So there are plenty of new issues and concepts that are still being worked out.”

Colorado counselor Briana Mahoney says she is “not terribly concerned” about her state’s recent decision to legalize marijuana. “In my experience, my clients who use marijuana frequently certainly did so before it became legal, and I’m not sure I’ll see a big spike in usage just because it’s legal,” she says.

Mahoney recently finished her master’s degree and works with transgender clients in private practice at Pride Counseling Center in Denver. “I think legalization has a minimal impact on my work,” says Mahoney. “When I’m discussing pot use with clients, I would certainly have mentioned the legal issues that come with using an illegal substance, but the bulk of my work would center around what the drug ‘does’ for my client: Does it allow them to feel more social? Is it being used to numb uncomfortable feelings? Does it relieve physical pain? Is it being enjoyed and appreciated like one would a glass of fine wine? Legality is a small part of the overall effect of the drug on a client’s life.”

Counselors who may see legalization come to their state could prepare with additional training, says Iliff.

“Counselors will need training on the effects of marijuana and what to expect in people’s behaviors,” Iliff says. “It is important to be able to identify the negative effects as well as be prepared for how people believe it helps them, and to have some information about the research so that as a counselor, an objective view can be presented in educating the client. As a counselor, I would also like more training [because] I don’t believe I am well enough informed to persuade clients that it may be harmful.”

According to the National Institute on Drug Abuse, marijuana use can worsen schizophrenia and has been linked to depression, anxiety, suicidal thoughts in adolescents and personality disturbances.

Michele Engle, a Colorado Springs resident and graduate student at Adams State University, acknowledges Colorado’s decision to legalize recreational marijuana has made her rethink her approach with clients. “I live in Colorado, so it is going to impact my practice,” she says. “I have to sort through my old thoughts and ideas and see what needs to be changed so that I might ‘see through the eyes’ of my clients when assessing their needs and values.”

“I am a graduate intern in my last semester, and I have recently had two new [young] clients who are both using pot recreationally,” Engle says. “I am looking at my own ideas and values in respect to this, and I look forward to talking with others who are facing the same questions.”

Morgen thinks the counseling profession will remain largely unchanged by the legalization of marijuana.

“I don’t think there is anything specific a counselor would need to do if marijuana became legal in their state,” he says. “Counselors work every day with clients who are addicted to legal substances such as alcohol and nicotine. Many people smoke a pack of cigarettes per day and don’t care. They don’t seek counseling. Some want to quit smoking cigarettes, so they are the ones who seek counseling. Clients are mandated to counseling for addiction and behavioral problems due to alcohol. So, I think the work [of counselor]) would continue relatively unchanged. If the use of a legal substance leads to impairment in someone’s life, counseling would be warranted and/or possibly mandated.”




Links of interest


Map, via USA Today, showing which states have legalized marijuana (recreational and medical):


Denver Post special section on marijuana:


Washington Post article on Colorado’s legalization of marijuana, and other states progression toward legalization:




Bethany Bray is a staff writer at Counseling Today. Contact her at

Follow Counseling Today on twitter @ACA_CTonline



  1. Grizwald Grim

    Marijuana’s tendency to temporarily dissolve belief structures (that’s how it allows people to be paranoid for a while) is very useful in personal reflection and development. Are their any counselors actively seeking to incorporate its use into their practice?

    1. Angela Brown

      I just graduated with my masters in social work and have a dream of having a private practice of group cannabis counseling. I believe that the first stage of a group (Forming stage) would be short lived because of the calming effect of cannabis. The steps are as easy as Ganja Yoga (look it up), everyone indulges in their cannabis and becomes more comfortable with one another. The community already has something in common besides having crises, they found that cannabis relaxes them and calms their excited/anxious minds. As everyone relaxes, the group facilitator introduces the subject to the group and each member has the increased focus and openness to offer dialogue. The holistic unity of the group members would/could be extraordinary.

  2. Joshua Francis

    It seems that the counseling profession is primed to provide objective and evidence-based research and interventions on the growing and evolving marijuana issue. I believe professional counselors possess the unique training and ability to interact effectively with this complex issue and meet the growing needs it is going to create. Whether we like it or not, the issue is upon us, and we need to meet it with unbiased expertise.

  3. Courtney

    The last two sentences are how I feel, “So, I think the work [of counselor]) would continue relatively unchanged. If the use of a legal substance leads to impairment in someone’s life, counseling would be warranted and/or possibly mandated.” I also agreed with the counselor who talked about assessing what cannabis does for the client. Is it being used like some people unwind with a glass of wine or is it used to “escape” from problems going on in their life.

  4. Donna Wolter

    I am a retired educator in addiction. Why is no one talking about the dangers and the research out there. Counseling is the same as any other substance use/abuse and that is what are the consequences to ones life. Physical, psychological, Pot has some very disturbing results especially to the brain and the short term memory. Why are we not addressing these issues. Once again greed and money win out over the consequences, especially to our youth.

  5. Marlboro

    I agreed with the counselor who talked about assessing what cannabis does for the client. Is it being used like some people unwind with a glass of wine or is it used to “escape” from problems

  6. Cas Young

    I’ll quote this to begin. “As a counselor, I would also like more training [because] I don’t believe I am well enough informed to persuade clients that it may be harmful.” You should know that smoking anything can be harmful. Hydrocarbons are cancer causing agents. There is evidence that smoking marijuana can have beneficial effects and that’s why some states have medical marijuana. However it is a drug and any levels of impairment depends on how much is used on a daily basis. Then there is a tolerance effect that may minimalize how much one is impaired. Now to the hype about marijuana. It is put forth by federal standards that pot use can cause addiction, which is possible in extreme cases but not for everyone. Cigarettes are way more addictive than pot yet is legal. So is alcohol. I’ve done enough research that indicates the use of pot is far less dangerous than any other drug. Be careful where you get your information from because it’s all about politics when it comes to pot use. I am in my second year as a registered drug counselor and I saw right off the bat that the information I was giving to clients was highly exaggerated and political in nature. There is also a double-standard. A lot of rehab centers allow cigarette smoking as socially acceptable. We allow clients to smoke cigarettes which we know are highly addictive. However if you have medical marijuana rights, you can’t be smoking it in rehabs but we’ll allow you to take norco’s. The reason we can’t allow pot use in rehabs is because it’s a “trigger” for others. So even if it does become legal I don’t think it will be allowed. This all comes down to the “chief complaint”. If a client ( who has medical marijuana rights) comes in wanting to quit drinking, we treat that. But they still can’t smoke marijuana. Usually we request a change of prescription to something like Ultram (a non-narcotic). This creates another issue regarding “ethics”. We are counselors, not doctors. In no way do I find it ethical to make someone change their prescription when I am not a doctor and obvious;y don’t have enough knowledge about why pot was prescribed to begin with. Information protected by HIPPA makes it so I can’t really ask. My opinion? If cigarettes are legal, why can’t pot be? I also agree that the counseling profession will remain largely unchanged by the legalization of marijuana.

  7. R. Woolley

    It is without question that an individual can walk into a CVS today and purchase a bottle of vodka big enough to drink ones self to death. Let alone the possibility of injury or death as a result from the intoxication/black out. Tolerance obviously plays a factor as every individual is effected differently. Same with opioids bought legally from a pharmacy. Marijuana can be administered without smoking through oils and tinctures and edibles.
    If Marijuana can become a managed therapy for alcoholics and opioid addicts, administered with the oversight of a professional, it is possibly a less dangerous alternative to alcohol and opioid consumption like methadone is for the heroin addict. I know this is a broad stroke. However, I have never seen anyone overdose or succumb to heart failure due to marijuana consumption. The side affects from marijuana withdraw are far less harmful that that of alcohol or methadone or opioids. An alcoholic or opioid/heroin addict will do whatever it takes to get their drug of choice. There needs to be a willingness and or spiritual shift in the individual that truly wants to change their circumstances regardless of the mode of therapy chosen to manage the addiction. Only then can marijuana be taken out of trigger category and be assimilated to a therapeutic solution for those in need.
    Two Cents!

  8. Amanda Peterson

    >She predicts legalization will lower people’s inhibitions about trying the drug, likely leading to an increase in marijuana use.

    Hasn’t it already been shown in countries where marijuana is legal that this isn’t the case?

  9. Angela Brown

    Marijuana is a natural herb, non-toxic (LESS TOXIC than AN ASPIRIN!) medicine given to us by our Creator. He also gives us our endocannibinoid system for a reason. Yes, this is about science and politics, I know. Sadly. But all we need is more evidence-based WRITTEN research so we can actually prove to the critics that it is on this earth for good purpose. RESCHEDULE CANNABIS!!!

    1. Lara

      Wow!Wow! This is the problem I see often in our profession. (I have been a Substance Abuse Counselor for 30 yrs). There are counselors that are not trained and have not had experience in marijuana addiction and don’t realize that something being “natural” is not the issue here. Parsley is natural and we don’t smoke that! LOL! As a substance abuse counselor, we need to treat marijuana just like any other mind-altering substance. Alcohol is legal and we treat people who are addicted to it. We don’t need to treat someone that enjoys a glass of wine with dinner and never has any consequences. It is the same with marijuana. We need to be clear on this and explain to our clients that there is a difference between addictive use and recreational use. Like I say to my clients, if you are a recreational user you do not use it all day long and you don’t use it as a crutch to deal with negative emotions. You use it occasionally to enjoy a relaxed feeling or to unwind. The issue for counselors is to be unbiased and educate themselves on the damaging effects of using ANY substance excessively, in spite of adverse consequences. Also, take a look at the brain scans of using ANY addictive substance excessively- Marijuana included. Google Images has pictures of these, including excessive cigarette and caffeine use. The issue here is that it disrupts proper blood flow to the brain. Also, when you smoke ANYTHING, you are breathing in toxins which is very damaging to the lungs and these travel in our circulatory system and affect every part of our brain and body. I tell my clients that if someone’s heart has stopped and you do CPR on them but they didn’t have blood flow to the brain for 4 or 5 minutes or more, the brain does not recover. You may get their heart going but the brain is damaged beyond repair. That is how important it is to breathe OXYGEN in and out constantly. When you are breathing in toxins you are cutting the oxygen supply to the brain. That is what causes the areas on the brain scan to look like holes. These are areas that are not able to function efficiently, hence the memory issues with marijuana, a-motivational syndrome, etc. And if someone starts using marijuana too young, before the brain is fully developed, there are more serious consequences. I have chronic marijuana users that are 40 and still living with their parents, don’t work, spend their days playing video games like teenagers, with no motivation for anything. So as counselors we need to be unbiased and educate ourselves on this issue. Also, years of experience in counseling the addicted population, will help deal with this issue more appropriately.

Leave a Reply

Your email address will not be published.