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Chapter One: The Little Green Book


Michael Stratton

Manipulating Consciousness

BY THE END OF THIS PARAGRAPH, you’ll know if this book is for you. I’m a mental health therapist practicing in the areas of substance abuse and recovery; I’ve also been in recovery more than two decades due to problems with smoking pot and drinking. And so, what I’m about to say may surprise you: I think marijuana (1) should be legalized, regulated and taxed; (2) is an appropriate medication of choice for many conditions; (3) is used responsibly by millions of people in ways that enhances their enjoyment of life; and (4) presents serious problems in an estimated 9% of users (according to the National Institute of Drug Abuse, NIDA).
Still with me? I often lose audiences the second I mention legalization. They’re so anti-marijuana that they’ll do anything to keep it illegal. On the other hand, some marijuana advocates can’t tolerate the mere suggestion that weed might be harmful.

This is a book about marijuana, but it’s not like any other book about marijuana. It’s not a scientific book, though there is some science in it. It’s not a preachy, here’s-what-you-oughta’-do kind of book, though there are some assessments and considerations for users to help them determine if there might be a different pathway they’d like to take. And it’s not a quick-fix book, though it does offer effective, creative strategies for therapists and clients to adopt collaboratively. Finally, this book isn’t exactly a memoir, though there are bits of that as well—vignettes from my own life that “tell it like it is (or was)” throughout my own journey through marijuana use and recovery. Mostly, though, The Little Green Book is written for the ever-growing population of cannabis users who are examining their own marijuana use, who are beginning to wonder if it might be affecting their lives in a less than positive way. Maybe, even, negatively. And it’s for the people who care about them: family members, partners, friends, colleagues. And it’s also for the people who are helping them in some fashion: therapists, doctors, counselors, attorneys, teachers, nurses, clergy, etc.

This book is specifically for that someone who is kind of “stuck” in life—and is using marijuana on a regular basis. As it turns out, though, you (if you are such a person) may not have connected the dots between this immobilization and your cannabis use.
Now we have available to us a set of tools that can help you make that connection. Here are evidence-based practices that have helped many users take a break from their marijuana habit or to stop using completely. 
We have in our toolbox new, better and more-effective methods to help people make better decisions about their use without employing harsh confrontation or scare tactics. 
Marijuana users who’ve developed a strong relationship with the drug do so because it was initially a solution. But where it once enhanced their life, it then became dulling. I know from first-hand experience how the soft fuzziness of a marijuana buzz eventually evolves into an ever-present cognitive fog. 
The Little Green Book is meant to help you cut through that fog.

But, first, a few qualifiers:
I am not anti-weed. I sincerely believe that marijuana should be legalized, regulated, and taxed. It just makes too much sense not to. For starters, it’s proven itself to have multiple benefits for a lot of people: it can soothe any one of numerous physical complaints, particularly seizures; and for some people, marijuana is the safest and most effective way to address pain or neural conditions. 
I have a lot of experience with cannabis. I LOVE marijuana! Or loved it. I loved the feeling of being high and all of the associations that went along with it. I’d be doing it today if I could have learned to use it like a normal person. But I couldn’t. Instead, I became hooked. Throughout this book, I’ll document my personal experiences with marijuana—a toke-by-toke account of my 17-year love affair with pot. Finally, I knew, I had to quit. And then, I did.
I’m a therapist—a Federally Certified Trainer—licensed to both work with marijuana users and to help train therapists who are doing the same. I’ve treated countless marijuana users who range from folks who are completely content with their use, to those who feel tortured and want to quit and, then, really struggle to do so. IF you are a therapist who works with people who are struggling with their marijuana use, this book will help you. This book will be helpful for your clients to read as well. 

Why now?
People’s opinions on marijuana are changing, and the laws are changing, too. National Institute of Drug Abuse (NIDA) conducted a survey in 2010 and found that over 17 million people had used marijuana in the past month. A lot of those people were teens and young adults. Marijuana is becoming de-mythologized and it’s gaining wider acceptance. 
I believe marijuana is less destructive than most drugs. I preferred it to alcohol. It’s certainly less deadly than nicotine. 
Not everyone who uses marijuana will develop a problem with it. In fact, the majority will use it responsibly.
Dr. Sanjay Gupta, who was President Obama’s first choice for Surgeon General, recently came out and apologized for his opposition towards marijuana. But he still maintains (as does NIDA) that 9% of those who use marijuana will become addicted. And we know that cannabis is especially harmful for teens. That 9% equates to nearly 2 million marijuana addicts in the USA alone. 
Among the many myths about marijuana (for instance, that it’s a gateway drug) one of the most destructive is that marijuana isn’t addictive. In fact, it is.

Who am I? And Why am I so interested in Marijuana?

I’m a psychotherapist who, once, was enormously enthusiastic about marijuana. In fact, I was so enthusiastic that I smoked it morning, noon and night. I had an affair with pot. We went to bed together, woke up together, ate together. I didn’t want to go anywhere without her. But then she started to take over my life. Make my decisions for me. We would break up, only to get back together again. Finally, we got a divorce. 
A few years later I found myself working with others who had the same kind of relationship with weed. Eventually I became a cog in a large study conducted by the Substance Abuse & Mental Health Administration (SAMHSA) whose aim was to discover who was likely to develop problems with marijuana and what treatment techniques tended to be most useful in helping those individuals stop. I became a Federally Certified trainer in those techniques. 
I also write. And I love music and all sorts of creativity. I’ve hosted a jazz radio show for over two decades at a local community college. Finding creative outlets goes hand-in-hand with finding creative and effective pathways for treating marijuana users who discover harmful patterns of use and want to effect positive change in their lives. 
Seeing how attitudes and laws around marijuana were changing and continue to change, I became concerned that there will likely be a significant increase in people smoking marijuana, and a percentage of those using will develop the kind of relationship with cannabis that I had. I wanted to do what I could to get the word out. As such, I developed a tele-seminar that reached a national audience and really made a difference to some marijuana users, but I realized I could do even more.
That’s why I wrote this book. 

Disturbing trends, changing attitudes
The old myths of “Reefer Madness,” an anti-marijuana film from the 1930s, were ridiculed from the 1960s on, often at midnight movies filled with pot-laced audiences. Dope heads viewed the claim that marijuana was as serious as heroin or cocaine as nothing more than scare tactics. 
But new myths arose: that marijuana is harmless, and that it is a cure all. Some studies, which I’ll review in the next chapter, are indicating some profound problems with chronic marijuana use. There appear to be links between pot and mental health issues, including depression, anxiety and, in some cases, schizophrenia. There is also a link between use and life satisfaction and income level—even a decrease in IQ. It’s clear that marijuana brings about changes in the brain.
Even though it’s anecdotal, many of us know someone, maybe a high school or college friend or acquaintance, who became a heavy marijuana user and just seemed to lose their way. You may even know a number of very functional users, but this book is intended to help you, or help you help the ones who are lost. 
There has been a shift in how marijuana is perceived, and also in how it’s been used. If you’re reading magazines, newspapers, watching television, searching on line, chances are you’ve been hearing about new legislation, or calls for new legislation, to decriminalize, legalize, regulate and tax marijuana. It started with Colorado and Washington, and by the time you read this, my hunch is there may be several other states that have joined them. 
I write this within a mile of Michigan State University, with a population of some 50,000 students. Contrasting surveys related that in the year 2000, 15% of the students reported using marijuana within the past month. That number rose to 20.3% in 2014. 
As the number of users rise, so will the numbers of those who will struggle with their cannabis use. “Now” hardly seems soon enough.

Maureen Dowd, op-ed writer for The New York Times, had a rough experience with edibles when she visited Colorado in 2014. She was doing some ‘research’ for reporting on the new change of laws in the Rocky Mountain state, and decided to try one of the chocolate edibles that were now legally sold in stores. She took just a bite, then another. Nothing seemed to happen for the first hour. The ensuing paranoia and (what sounds like) panic attack which lasted for several hours highlighted the problem with unregulated weed. If alcohol was as unregulated as marijuana, you can imagine the difference between drinking 6 oz. of wine vs. 6 oz. of tequila, or flat-out grain alcohol. 
Pot pioneers are experimenting with synthetic cannabis. Some users will confuse their belief that marijuana can’t be harmful with the stronger strains currently being developed.

The perpetual question: Is marijuana a gateway drug?
Like many paradoxes, the answer is simple and complex. Is marijuana a gateway drug? No. Unless it is. 
That is, many marijuana users never go on to anything heavier. But many heavy drug users describe marijuana as a step on their path to deep addiction. Cigarettes are actually more often described as the first drug that addicts tend to experiment with. Their first experience with addiction.
One of the reasons I mentioned dabs is that some marijuana users will experience something called “tolerance.” Tolerance to any substance—prescription drugs, over-the-counter medications, marijuana—means that the body is getting used to, or becoming more efficient at metabolizing that substance. A marijuana user, for example, may find they need to use more or stronger marijuana, or need to use it longer, to achieve similar effects than was obtained when they first started using.
Tolerance is one of the symptoms of abuse and possibly dependency. 

In my own story I found that initially I would feel profoundly changed from just a little bit of marijuana. Eventually I got used to feeling high, and, some days, I smoked around the clock. I existed in kind of a cloud. 
I remember going to party with some old college friends, guys who loved to get high. I’d rolled up an entire ounce of weed into joints, and had them ready to burn. We smoked the first one sitting around a table and I dug into my plastic bag for another one. Just as I was ready to light it, my buddy, an inveterate pothead, reached out his arm and put his hand on mine. “Don’t you think we’ll enjoy that more, five minutes from now?” he said. An early warning that I was using compulsively. 
I went on to experiment with a number of other drugs, almost anything you can imagine short of heroin and crack cocaine. (I had my standards!) But, for me, using marijuana lightly was a gateway to using it heavily.
And, interestingly, it was also my gateway to alcohol abuse. More about that later. 

Can marijuana be addictive?
According to the NIDA, the answer is a resounding “yes;” some 9% of users do become addicted.
According to many users I see in my practice: an equally resounding, “no.”
I recommend sidestepping the argument altogether.
There was an old Monty Python (an English comedy group) skit about a man who went to see another man and paid to have an argument. It went something like this:
“Is this the right room for an argument?”
“I’ve told you once.”
“No, you didn’t.”
“Yes, I did.”
And so on. Like a ping-pong match. If you get into these types of exchanges with someone defending their marijuana use, you’re the one who’s lost.
I’ll usually just lay out that we find, via research (which I’m happy to discuss if the client wants). But it’s tricky because marijuana addiction is so much more subtle than other addictions. Sometimes so subtle it barely registers on the addictions meter.
Consider the severe withdrawal symptoms associated with coming off heroin: sweating, vomiting, chills, aches, among others; or, alcohol: uncontrollable shaking and trembling possible life-threatening seizures. And marijuana withdrawal symptoms? Some anxiety, depression, irritability, cravings, insomnia.
My preferred way to talk around the phenomena of addiction is to describe the relationship to marijuana. It is amazing how much more receptive and open pot smokers are to discussing their use by using this metaphor. 
For instance: Is marijuana a stranger? Once it was. 
Is she an acquaintance, someone you just see now and then? 
How about a friend? A good friend? Someone you really enjoy seeing and hanging out with. Someone who makes you happy. Someone you look forward to seeing so much, you want to see them every day.
Is marijuana your best friend? Someone you seek out in most circumstances, a friend with whom you share your joys and troubles. 
Is she your lover? Someone you would sneak out to see, even briefly. You go to sleep with her and wake up with her. Even at work or school you can’t stop thinking about when you can see her again.
I’ve developed a questionnaire, an assessment tool that I use in my practice that can helpful in giving someone an idea about where they are in their relationship with marijuana. give someone an idea of where they are in their relationship with marijuana. 

Where are YOU?
A tool for assessment:
20 questions that define your relationship with marijuana

How often do you use marijuana?
Never = 0
Monthly or less than monthly = 1
Weekly = 2
Daily or almost daily = 3
Multiple times a day = 4
Did you lie or want to lie about the question above?
No = 0
Yes = 1
Has a close friend or a girl- / boyfriend complained about your use?
No = 0
Yes = 2
Do your friends joke that you’re a “burnout” or a “stoner”?
No = 0
Yes = 3
Most of my friends get high.
No = 0
Some, but not all = 1
Most, but not all = 2
Yes, all of them = 4

My performance in school has worsened since I started using.
No = 0
Yes = 1

I don’t do activities that I used to enjoy since I started using.
No = 0
Yes = 1

My grades aren’t what I expect them to be.
No = 0
Yes = 1

There have been legal consequences due to my use or possession
No = 0
I’ve been ticketed = 1
I’ve been arrested = 2
I’ve been arrested multiple times = 4
I own more than 3 items of marijuana paraphernalia (i.e. rolling papers, clips, bowls, bongs, vaporizers, etc.)

No = 0
Yes = 2
I’ve attempted to cut down or quit, successfully or unsuccessfully.

No = 0
No, but I feel like I should = 1
No, but others feel like I should = 1
Yes = 2

I’ve been treated by a therapist, counselor or doctor for substance abuse issues.
No = 0
Yes = 4

I spend too much money on drugs and/or alcohol.
No = 0
Yes = 2

My memory isn’t as good as it used to be.
No = 0
Yes = 1
I get nervous when I’m out of marijuana, or am about to run out.
No = 0
Yes = 1
My goals have changed since I started using; or, I can’t get any traction toward my goals.

No = 0
Yes = 1
I have a hard time picturing life without marijuana.
No = 0
Yes = 3

When I’ve quit or cut down, I find myself drinking or using other drugs more.
No = 0
Yes = 2
I started using at age 15 or younger.
No = 0
Yes = 3

I’ve done things I’m ashamed of to continue to use (i.e. lying, cheating, stealing)
No = 0
Yes = 2

What’s your relationship with marijuana? Add up your points, and check it out …

Your Score
Your Relationship with Marijuana

0-5 points Stranger
6-9 points Casual Acquaintance
10-12 points Distant Friend
13-16 points Inside Circle
17-20 points Best Friend
21 points or more Lover

If marijuana is becoming more important to you than you want or had realized, you may be hooked—or getting there. And chances are, you’ve already begun to alter the course of your life that’s resulting from this relationship. You may be giving up friends, or goals, or a chance at the happiness that might be within your reach. You may want to reconsider this relationship with marijuana.

The Diagnostic and Statistical Manual of Mental Disorders includes criteria for Cannabis Use Disorder. They look for a problematic pattern of marijuana use that would include at least 2 of the following symptoms within a 12-month period:
Cannabis is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.
Craving, or a strong desire or urge to use cannabis.
Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
Important social, occupational, or recreational activities are given up or reduced because of cannabis use.
Recurrent cannabis use in situations in which it is physically hazardous.
Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
Tolerance, as defined by either a (1) need for markedly increased cannabis to achieve intoxication or desired effect or (2) markedly diminished effect with continued use of the same amount of the substance.
Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms

The DSM goes on to suggest that problems with marijuana might be mild, moderate or severe, dependent on the number of symptoms associated with the individual using.

The Nature of Consciousness: A deeper look
“All men’s miseries derive from not being able to sit in a quiet room alone.” 
~ Blaise Pascal

So far, we’ve been sweeping the shallows; all is quite clear, transparent and
measurable. But there is something else going on here, at all sorts of levels.
Humans are fairly unique creatures. Consider our ability to think and act beyond instinct. And the tampering of that ability is something we’ve been capable of for at least a couple of millenniums. But never more so than today. And tomorrow. 
Changing our minds. It’s our prerogative, no? A matter of choice, of course, is one thing. But the altering of the very structure and functioning of our brains seems something else entirely, does it not? 
And that’s what we’re talking about when we ingest a chemical that alters our moods and abilities to think and feel. 
We are a restless species, filled with the capacity for love and compassion, yet at the same time we have the traits of aggression and greed. 
It seems to be in our nature to attempt to change. 
The Greek philosopher Heraclitus felt that change was the basic nature of reality, and that it was impossible to step into the same river twice. If that’s true, why do we need to alter anything? It’s always altered already. Yet so many people perceive their surroundings to be in a sort of unbearable stasis, to the extent that they need to change where they are, what they are doing, and with whom. 
Aldous Huxley suggested that drugs could open the “doors of perception,” writing a book by that title, equating usage to epiphanies artistic and spiritual. 
Again, there seem to be those voyagers who can partake and seem to be capable of going there and coming back with minimal negative effects. Others are less fortunate.
70% of America is on prescription drugs, the top three being antibiotics, antidepressants and pain killing opioids. We seem to need to get better, feel better, or numb pain (and emotions!).

Buddhists speak of The Hungry Ghost, a being with a distended belly and a thin neck, always hungry and never satisfied. It’s a metaphor for addictions as well as other compulsive behavior or obsessive thought. 
Consider the Ghost: for one thing, forever haunted. Hanging around in a place that once held some special meaning that has now shifted, even though the Ghost is still searching. The Ghost hungers. Due to its thin neck, it cannot even receive that which it hungers for. And the stomach cannot digest it. 
Do you remember being in love? How would you describe that feeling to someone who had never experienced love? It transcends language, yet encompasses the realms that are sensual, emotional and psychological. It feels like magic. I think most marijuanics are searching for magic. They hunger for it … and more … and more. 
In my own experience with marijuana, I found that initially it satisfied so many needs. It enhanced all of my senses. Music sounded better. Food tasted better. Even sex was better! 
In the end, marijuana dulled my senses. I used to feel like I was putting on what I called my “stupid helmet” every time I smoked. I could feel my IQ dropping. I couldn’t remember the page I’d just read, couldn’t remember what I’d just said, couldn’t remember why I had come into a room.
I was a hungry ghost. No matter how much I used, I always wanted more.
“My drug of choice is more.” My first sponsor. 

That insatiable hunger is what we are talking about. That’s what we’re up against.
And the defense of the need to feed that hunger is one of the things we must become very skilled in working with. Not against. With. That word is very deliberate. It’s a dance, not a confrontation. And we have to learn to invite the ghost to dance with us. If we don’t meet the ghost, we’re doomed to fail.
So, this book has been and will continue to be a mix of science and metaphor, philosophy and fable, highbrow and lowbrow. The solution must contain paradox, as the plight of the hungry ghost is paradoxical.
The DBT (Dialectical Behavioral Therapy) therapist and trainer Josh Smith says they are trying to “Instead of finding the contradiction within wisdom, find the wisdom within contradiction.  So finding construction within destruction, accuracy within distortion, function within dysfunction first, then moving towards wisdom.” Paradox. Evolution both contains and transcends what came before, so the solution must contain the seed of the problem as well.

The client’s dilemma
When someone comes to me in therapy, and they’ve been smoking a lot of marijuana, one of my jobs is to get a sense of where they are in their relationship with pot; another conversation is whether they want to do anything about it. I’ll be discussing this in detail in Chapter 4. 
But, for argument’s sake, let’s say someone has decided to quit, and they’ve come to realize that they need help with it. Where do they turn?
I’ve had clients say that they’ve attended AA (Alcoholics Anonymous) meetings, only to feel out of place because their problem isn’t really alcohol. 
Clients describe going to NA (Narcotics Anonymous) meetings, only to feel like their problems are minor compared to the heroin and crack addicts surrounding them.
There is MA (Marijuana Anonymous), but those meetings are rare unless you live in a larger metropolitan area.
Simply put: a client with an issue with marijuana is more likely to have to rely on a good therapist who is skilled with working with this issue.

The therapist’s dilemma
Here’s a dilemma that many marijuana users express: “What’s the harm?” As subtle as the drug itself: a nearly unconscious collusion with the Hungry Ghost. 
Again, I’m not suggesting that all marijuana use is bad, but allow yourself to explore the relationship your client has with the substance, and notice the pull or resistance against doing so. That relationship is likely to be strongly protected. 
And what if you find that marijuana is your client’s best friend, or even more? And the client is unmotivated to change that relationship? 
I’ve heard therapists suggest that until a client decides to quit using they wouldn’t work with them.
I disagree. I think—in fact, I know, because I’ve done it, a lot—that you can work with someone who is still using and has little to no inclination to quit. And I’ve seen them change their minds. Sometimes gradually, sometimes more dramatically. 
Whether you are an avid user of cannabis, or someone on the fence about your use, or someone in the helping profession who feels helpless in working with this population, my promise is to arm you with facts, information and a process whereby you can shift the relationship with weed. A roadmap for dropping pot. Before we go another step, here’s my story.


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