Tag Archives: marijuana

Counseling Connoisseur: Cannabidiol and mental health therapy

By Cheryl Fisher February 4, 2019

Carol presented with concerns related to continuous panic attacks that were jeopardizing her work as a medical professional. “I can’t think straight when they happen and I cannot be this debilitated when I see patients,” she explained. Carol had also been self-medicating with alcohol on the weekends to “ease the stress.” Throughout a year and half of intensive therapy, Carol’s panic disorder began to subside, but her general anxiety continued. One day during therapy Carol announced, “I have not been anxious for two weeks!” Thrilled for her, I asked what had caused such a significant change. She looked sheepishly at me and whispered, “cannabis.” I inquired whether she had shifted to smoking marijuana versus drinking alcohol (which she had recently begun cutting back on). She quickly responded, “Oh no! That would get me fired from my job. I am taking a cannabidiol tincture.”


Geraldine came to therapy having returned from a year deployment to a country that is without sunlight for months at a time and has very limited pharmaceutical access. She had been without her medication for anxiety and depression and was feeling overwhelmed. “I can’t function,” she lamented. She had contacted a psychiatrist, but the only available appointment was a month away. We identified some tools she could use to help ease her symptoms while she waited, but they only worked for short periods of time. As a result, she was constantly anxious and depressed. Three weeks into our work together, Geraldine announced that she was feeling much better and attributed it to the cannabidiol-infused honey that she was using in her morning oatmeal.


Tim presented with depression and insomnia related to chronic pain caused by lupus. He had been taking psychotropic medication for years, but it no longer brought him any relief. Despite taking sleep aids, he was unable to get a good night’s sleep. Tim worked hard in therapy and was able to ease some, but not all, of his symptoms through regular mindfulness meditation. To my surprise, Tim appeared one afternoon smiling in delight. “I slept all night this week!” he exclaimed. Again, the answer to his dilemma was cannabidiol, which he consumed in capsules.




As a counselor, I strive to create the best evidence-based, holistic and individualized treatment plans through collaboration with my clients. In addition to traditional talk therapy, I use a variety of therapeutic approaches, including a wide range of expressive arts and animal and nature-assisted therapies. Recently multiple clients have reported symptom improvement through the use of an over-the-counter supplement that works with the body’s endocannabinoid system (ECS). Approved in the form of an oral solution (Epidiolex) in June 2018 by the U.S Food and Drug Administration (FDA) for the treatment of Lennox-Gastaut syndrome and Dravet syndrome — rare and severe forms of epilepsy — cannabidiol (CBD) has also drawn interest as a therapeutic agent for use on a variety of neuropsychiatric disorders.


What is cannabidiol?

CBD is a naturally derived, non-psychoactive hemp derivative. Proponents describe CBD as a food supplement that provides the therapeutic element of cannabis without tetrahydrocannabinol (THC), which is the component that produces a high. It can be found as a tincture, vapor, infused in honey or creams and is used in food products such as smoothies. Reported side effects include possible positive drug screening results, appetite changes and sleepiness.

How does it work?

CBD affects the ECS, which consists of endogenous cannabinoids, cannabinoid receptors and the enzymes that synthesize and degrade endocannabinoids. As noted in a 2018 article in the journal Frontiers in Molecular Neuroscience, research has found that the ECS plays a significant role modulating physiological functions such as mood, cognition, pain perception and “feeding behavior.” The ECS also interacts with the immune system and moderates inflammatory processes. Animal studies and anecdotal observations have shown that modulating the ECS can have beneficial effects on mood, but the authors note that numerous additional factors, such as the placebo effect, could be influencing these findings.

Research that focuses specifically on targeting the ECS with CBD has also been intriguing. In a 2015 article appearing in the journal Neurotherapeutics, a review of studies on animal and limited human populations concluded that acute doses of CBD can reduce anxiety. The authors call for research on chronic doses and note that because past human studies of CBD were conducted with healthy volunteers, future work should focus on clinical populations.

Overall, current research indicates that CBD has significant potential as a treatment for a number of mood disorders.

What does this mean for counselors?

As counselors, it is important to be informed about supplements clients are using to manage mental and physical disease. While we cannot prescribe medications and should refer clients to their doctors for medical advice around pharmacology and supplements, we do have a duty to provide our clients with psychoeducation and research.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.




EDITOR’S NOTE: Counselors should be aware that according to a U.S. Food and Drug Administration (FDA) statement issued in December 2018, although hemp has been removed from the Controlled Substances Act, it is still illegal to add CBD to consumer food products or to market it as a dietary supplement.

Some jurisdictions, such as the cities of New York and Los Angeles, have begun ordering restaurants to stop selling food containing CBD. The FDA is not currently preventing the manufacture of CBD as a dietary supplement. However, counselors and clients should be aware that like all dietary supplements, those containing CBD are not subject to set standards regarding dose or strength.


Learn more about risk management issues related to client marijuana use (ACA members only): counseling.org/docs/default-source/risk-management/ct-risk-management-july-2018.pdf


FDA statement on CBD cannabis regulation: fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm628988.htm


FDA and marijuana Q+A: fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#enforcement_action





Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.



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):  usat.ly/1eKJehT


Denver Post special section on marijuana: denverpost.com/marijuana


Washington Post article on Colorado’s legalization of marijuana, and other states progression toward legalization:  wapo.st/1dCSGxI




Bethany Bray is a staff writer at Counseling Today. Contact her at bbray@counseling.org.

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