Ask About Marijuana Use in Young Adult Smokers

by Danielle Ramo, PhD

Dr. Ramo is a Clinical Psychologist specializing in substance abuse treatment research and a Postdoctoral Scholar at the University of California, San Francisco.

Marijuana use among young adult smokers is an increasingly prevalent problem, and clinicians who work with smokers need to find ways to incorporate multiple substance use into their patients’ treatment plans. In a recent study published online by Addiction Science and Clinical Practice, my colleague Judith Prochaska, PhD, MPH and I used social media—including Facebook, Craigslist, and a survey sampling company—to recruit young adult smokers throughout the US between the ages of 18 and 25 to complete an anonymous online survey about tobacco and marijuana use.

Our survey results indicated that over half (53%) of young people who smoked cigarettes had also used marijuana in the past month, and among those who did, use occurred on more than half of days (median, 18 days). These findings indicated greater marijuana use than has been reported in epidemiological surveys using face-to-face interviews.     

The findings highlight the importance of incorporating marijuana counseling into clinical visits with patients with pulmonary disorders. In addition to using the 5 A’s for smoking (ask about smoking, advise their patients to quit, assess readiness to quit, offer assistance, and arrange follow-up with cessation efforts), we recommend that physicians treating young smokers do the following:

• Ask about marijuana use (many smokers are also smoking marijuana and may not feel comfortable admitting this unless directly asked).
• Assess thoughts about marijuana use (many people feel differently about their tobacco and marijuana use, and may be more motivated to quit one substance than the other). Ask about desire to quit, expected difficulty of quitting, and whether these thoughts differ between tobacco and marijuana.
• For smokers who are ready to quit tobacco, identify whether marijuana use serves as a high risk for relapse. If so, incorporate reducing/quitting marijuana into the treatment plan and help patients take steps to do so, including referral to another form of treatment (eg, addiction counseling).
  

Young adults may be more susceptible to intervention for smoking cessation if it is delivered in an online, social media format. Advantages include ease of access, ability to remain relatively anonymous, and access to additional sources of social support.

The next phase of our research will adapt cognitive behavioral and motivational interviewing counseling techniques to Facebook. Participants will be able to contact not only the clinicians for support, but also other smokers within the online community. Motivational Facebook messages and formal moderated groups online also will be integrated into treatment. As social media outlets are increasingly integrated into the lives of young people, they can serve as a useful adjunct to physician counseling and nicotine replacement therapy for smoking cessation.