Just this month, an article appeared in the Journal of Neuropsychology entitled “Early Onset Marijuana Use is Associated with Learning Inefficiencies.” Young adults reporting early onset marijuana use have learning weaknesses, which accounted for the association between early onset marijuana use and delayed recall.
Results replicated a long line of prior research demonstrating poor delayed recall with marijuana use (Becker et al, 2014; Crane, Schuster, Mermelsteine, & Gonzales, 2015; Dougherty, et al, 2013; Gonzales et al, 2012; Hansan, et al, 2010; Harvey, Sellman, Pater, and Framptom, 200; Schuster, Crane, Mermelstein, & Gonzales, 2015; Solow et al, 2011).
Poor learning among early onset marijuana users may reflect a primary weakness in executive functioning. Executive functioning weaknesses have been documented among adolescent marijuana users, particularly among those who initiate use early. Early marijuana use may impede learning via disruption in brain regions, viz, prefrontal and parietal cortices that are neurologically implicated in the memory network (Dickerson and Eichenbau, 2010; Uncepher and Wagner, 2009). This hypothesis is supported by dense localization of CB1 receptors and anandamide, the endogenous cannabinoid in the prefrontal cortex, as well as frontal gray matter (Bhattacharyya et al, 2009; Bossong et al, 2012) and white matter disruptions in marijuana using adolescents (Aslor et al, 2011; Chorchrell, Lopez, Carson, and Yurgelin-Todd, 2010; Medina, Nagel, and Tapert, 2000; Yocel et at, 2010).
Learning weaknesses only in early onset marijuana users support early adolescence as a time of vulnerability to exogenous cannabinoids due to continued development of brain networks that mediate higher order cognitive capacities (Goglay et al, 2004; Tamnes et al, 2010).
Neuroimaging studies have found earlier age of marijuana use onset associated with abnormalities in cerebral gray and white matter (Batatha, et al, 2013; Lorensetti, Sulowj, Feranto, Loranzo, & Yucel, 2014) e.g., atypicial morphometry and neuropsychological correlates in the hippocampus (media, Scheinsburg, Cohen-Zion, Magel, and Tapent, 2007), prefrontal cortex (Media et al, 2009), as well as disruption in white matter integrity on frontal-temporal and the frontal-parietal pathways (Bera, et al, 2009; Brea & Tapert, 2010; Jacobos et al, 2009; Jacobos, Squeaglia, Bara, & Tapert, 2013). This research does not suggest that marijuana use later in adolescence is “safe,” due to its impact on other cognitive capacities, mental health, and psychosocial functioning which still need to be fully understood.
Non-users and late onset marijuana users scored in the normative range (average-high average) on the CLVT-II. Weaknesses (possibly fragility of memory as well as deficits in cognitive processing) fell on the low end of the normative average range and were approximately 1/3 standard deviation from controls in late onset marijuana users. This does not constitute clinical impairments. Although the early onset sample was comprised of high functioning individuals, a critical question is that, given the relative weaknesses demonstrated by the data in learning, is marijuana keeping these young adults from achieving at a higher potential (MIQ=112).
Research findings of these investigations along with other studies shows a reduction in capabilities and intelligence across time (cognitive decline) (Mecer et al, 2012).
Adolescents using marijuana were found to have more difficulty learning new information and thus may not perform optimally (Lynskey and Hall, 2000), have lower grades (Medina, Hanson, et. al. 2007) and may need to work harder to achieve at grade level (Topert, et. al. 2007). These results suggest marijuana is detrimental to cognitive reserve.
The aforementioned study demonstrated that early onset marijuana use is associated with the acquisition of information into memory directly.
DSM-V defines cannabis-use disorder and the other cannabis-related disorders which includes problems associated with substances derived from the cannabis plant and chemically synthetic compounds.
The cannabinoids have diverse effects on the brain. Most significant is actions in CB1 and CB2 cannabinoid receptors found throughout the central nervous system. Individuals who regularly use cannabis can develop all of the symptoms of a substance abuse disorder. Cannabis use disorder (CUD) is not reflective of an isolated, benign item. CUD is commonly observed concurrently with other types of substance use disorders (i.e., alcohol, cocaine, opioids). Tolerance develops in individuals who use cannabis on a regular basis.
Abrupt cessation of daily or almost daily cannabis use results in development of cannabis withdrawal syndrome. Common symptoms of withdrawal include irritability, anger, anxiety, depressed mood, sleep difficulty and decreased appetite and weight loss. Periodic cannabis use and intoxication can negatively affect behavior and cognitive functioning and interfere with optimal performance at work or school or place the individual at increased physical risk when preforming activities that would be physically hazardous, such as driving a motor vehicle, playing certain sports, preforming manual work activities. Arguments with spouses or parents and the use of cannabis in the home, and using in the presence of children, can negatively impact family functioning and are common features of those with CUD.
Is cannabis an effective means to cope with mood, sleep, pain and other physiological and psychological problems? Comprehensive assessment typically reveals reports of cannabis use contributing to exacerbation of these very same symptoms as well as other reasons for frequent use, e.g., to experience euphoria, forget problems, in response to anger, and as an enjoyable social activity. Some individuals who use cannabis multiple times daily do not perceive themselves as spending an excessive amount of time under the influence and recovering from the effects of cannabis, despite being intoxicated on cannabis or coming down from its effects. Symptoms of acute and chronic use includes red eyes (conjunctival injection), cannabis odor on clothing, yellowing of finger tips (from smoking joints), chronic cough, burning of incense (to hide the odor) and marked craving and impulse for specific foods.
In terms of development and course, the DSM-V notes that recent acceptance of by some of the use and availability of “medical marijuana” may increase the rate of onset of CUD among older adults. In terms of functional consequences of CUD, many areas of psychosocial cognitive or health functioning may be compromised in relation to CUD. Contrary to what individuals state such as “it helps me think clearly,” cognitive function, in particular, higher executive functions, appears to be compromised in cannabis users. The relationship appears to be dose dependent acutely and clinically.
This in turn is conducive to problems at school and work. Cannabis use has been related to reduction in pro-social goal-directed ability, which some have labeled amotivational syndrome manifested in poor social performance and employment problems. Moreover, cannabis-related problems with social relationships are reported in these with CUD. Accidents due to involvement in potentially dangerous behaviors while under the influence (driving, recreational, sport activities) are also of concern. Cannabis smoke contains high levels of carcinogenic compounds and place chronic users at risk for respiratory illnesses similar to tobacco smokers. Thus, the trend of control of tobacco products and legalization of cannabis products places the public at risk for health and cognitive and psychological disorders.
Chronic cannabis use may contribute to onset of exacerbation of many other mental disorders. In particular, concern has been raised about cannabis use as a causal factor in schizophrenia and other psychotic disorders. Cannabis use can contribute to onset of an acute psychotic episode, can exacerbate some symptoms and can inherently affect treatment of a major psychotic illness. This author has observed many cases of “marijuana psychosis.” It is a very real phenomenon. There is a subset of the population in which there are psychiatric disorders in relation to marijuana use.
Cannabis has been commonly thought as a “gateway” drug. This is due to the thought that individuals who frequently use cannabis have a significantly greater lifetime probability than non-users of using more dangerous substances, e.g., opioids and cocaine. It is difficult to understand why marijuana is used for pain management when Cognitive Behavioral Therapy is the Gold Standard and non-pharmacologic pain management as well as pain management groups and biofeedback. As someone said on NFL Today, “Why are people talking about use of marijuana for pain when there is an opioid epidemic in this country.” The goal should be for the patient to be in control of their care and not to become dependent on substances that are carcinogenic.
Co-occurring mental conditions are common in CUD. Cannabis use has been associated with poorer quality of life, increases in mental health treatment and hospitalization as well as higher rates of depression, anxiety disorder, suicide attempts, and conduct disorder. Individuals with past year or lifetime CUD have high rates of alcohol use disorder (>50%) and tobacco use disorder (53%). Among those seeking treatment for a CUD, 74% report problematic use of a secondary or ternary substance: alcohol (40%), cocaine (12%) methamphetamine (6%) and heroin and other opiates (2%). In those younger than 18, the rates are significantly higher.
Individuals with past year or lifetime diagnosis of CUD also exhibit higher rates of concurrent mental disorder: Major Depressive Disorder (11%), anxiety disorder (24%), bipolar disorder (13%) are quite common among individuals with a past year diagnosis of CUD as are antisocial (30%) obsessive-compulsive (19%), paranoid (18%) personality disorders.
The most significant health effects of cannabis involve the respiratory system. Chronic cannabis users exhibit high rates of respiratory systems of bronchitis, sputum production, shortness of breath and wheezing.
The evidence for the severe adverse health and psychological effects of marijuana is supplied by a large body of research and replicated studies. Legalization of marijuana may be explicable in light of deleterious effects when one considers the profit motive of cities and individuals.
As with any other product, let the buyer beware! Stay strong! Fight On!
Many patients struggle with anxiety. As with ADHD, this tends to be an often over diagnosed/misdiagnosed term. Thus, a diagnosis of anxiety disorders and panic disorder should always take into account differential diagnoses. Some examples are as follows:
Neurological disorder: Patients who present with apprehension and tremulousness may be suffering from Benign Essential Tremor (BET). This is a neurological disorder that can result in tremulousness. This is a familial tremor that causes a rhythmic trembling of the hands, voice, legs, or trunk. BET is often confused with Parkinson’s. It can be treated by a neurologist with medicines to address the condition.
Agoraphobia: The author has treated patients for phobias affecting driving on the freeway. Often, these patients suppress (consciously or unconsciously) intense emotions, e.g. anger. This results in tremulousness. Being assisted with expressing emotion and feelings can be very helpful with this problem.
Social Anxiety: Patients may have social avoidance due to being sheltered most of their life. They are made to feel as though they are “china dolls” and thus are fearful to try new things. Disorganized and ambivalent attachment bonds may produce patients who have difficulty forming close, intimate attachments with others. Frequently, these patients need support or Behavioral Techniques such as successive approximation to gradually approach feared goals.
Patients are advised to query their health care practitioners on differential diagnoses and insist on objective psychological testing to investigate diagnoses.
Stay Strong! Fight On!
Check this out!
Psychologist Julian Rotter developed the concept of locus of control. Individuals with internal locus of control believe that they influence outcomes in their lives, e.g. (internal)-“I received an A on this test because I worked hard, applied myself, and mastered concepts.” Individuals with external locus of control believe that outcomes in their lives are due to forces or events outside of themselves, e.g., “I did not get an A because the teacher was not fair,” “I was having a bad day,” etc. You may ask, “What are the implications for me?”
Individuals with internal locus of control take responsibility for their actions, are less influenced by the opinions of other people, have a strong sense of self-sufficiency, and tend to work hard to achieve their goals. These individuals tend to be physically healthier, report being happier, and more independent, and often achieve greater success in the workplace. An example of this is a young man who was set to play football for the Michigan Wolverines. He was paralyzed from the waist down in a car accident. He was given a “1%” chance to walk. He had been involved in an intensive rehab program. His insurance ran out. He was then challenged by the Michigan strength and conditioning coach. He had planned on getting married and wanted to walk to the altar. He eventually did go to the altar albeit on wobbly legs and participated in the morning ceremony. He also walked across the University of Michigan football field grasping two canes to high five the “big blue” banner.
Individuals with an external locus of control blame outside forces for their circumstances, often credit luck or chance to success, don’t believe they can change their situation through their own efforts, feel hopeless and powerless in trials, and are more prone to experiencing learned helplessness.
It is important to remember that internal does not always mean “good” and external does not always mean “bad.” If a person is trying hard at something, but does not know the limits of their competence, they may become depressed. For example, if a person is not good at sports, they may feel depressed or anxious about their performance.
What is your locus of control? It can be a game changer. If you are always looking to “luck” or external forces to change your life, you will be seriously disappointed. If you persist and pick yourself up when you fall, you will succeed and be a better person. Stay Strong! Fight On!
Does the availability of weapons lead to violence? Citizens certainly have a right to bear arms and defend themselves. However, what does the science say about this area?
Harvard Injury Control Research Center conducted a comprehensive review of the literature. Hepburn and Hemenway (2004) found a broad array of evidence that indicates that gun availability is a risk factor for homicide. Case-control studies, ecological time-series, and cross-sectional studies indicate that in regions in the US where there are more guns, both men and women are at a higher risk for homicide, particularly firearm homicide.
Hemenway and Miller (2000) investigated the relationship between homicide rates and firearm availability across 26 high income countries. States with higher levels of household gun ownership had higher rates of firearm homicide and overall homicide. This relationship held for both genders and all race groups, after accounting for rates of aggravated assaults, robbery, unemployment, urbanization, alcohol consumption, and resource deprivation (e.g. parenting). There was no association between gun prevalence and non-firearm homicide. One cannot draw a causal relationship between gun prevalence and homicide.
Many individuals in mass shootings are disaffected individuals with poor social skills who somehow feel victimized in some fashion by society. Some are disaffected workers, such as in the case of the TV reporter and technician being shot on live TV. The station manager went into a rant as to how the state should provide more mental health services. However, one wonders why the station apparently had no Employee Assistance Program (EAP) to which the perpetrator could have been referred for employee-mandated counseling. This would have addressed the problem early in the process.
This author firmly believes in the constitutional rights of citizens to bear arms and defend themselves. Focusing on “Gun Control” seems to be where our primary focus should not be. The effects of society to reduce homicide should be focused on management of domestic violence, substance abuse, and community mental health services as well as parenting. Children growing up without “Tough Love” and/or consequences end up victimizing others. Enabling parents encourage the “victim mentality” and entitlement enables these types of individuals.
We live in a society which is becoming more and more dependent on cellphones and other devices. This leads to parents buying “things” for their kids and not spending time with them. This in turn leads to kids being loners and isolated from others. In the school shooting in Connecticut, the mother of the perpetrator had apparently home schooled him, thus depriving him of necessary socialization. To compound matters, she reportedly taught him to use high powered firearms at a range. Individuals such as this have more difficulty expressing their feelings. On the surface, they are affable and engaging, yet under the surface they pent up their feelings. When feelings are suppressed, they accumulate. Then there is explosive discharge.
This author has seen, in cases of matricide, individuals severely depressed who believe they had found a “better place” and take others with them via homicide, matricide, as well as mass casualty events. This relates to the phenomena of dissociation, viz, thoughts and experiences dissociated from consciousness and awareness and immersion in an altered mental state. As a protective mechanism against pain, the mind splits off from immediate consciousness and an individual dissociates into another mental state removed from the immediate conscious mental state.
It is the author’s opinion that a contributor to the escalating trend with violence was the era of “Reagonomics” wherein the mental health system of California was systematically dismantled. Gone were the comprehensive mental health services in psychiatric hospitals and community mental health centers. There is a robust relationship between violence and mental illness. It is ironic that Reagan was shot by a mentally deranged individual. In violence risk assessment, mental illness and substance abuse are risk factors for violence. These areas are where our focus should be. It all starts in our homes and functions with us. Parents are well advised to keep lines of communication open between their kids and themselves. The teaching and example by parents of forgiveness and humility is a great starting point. Professional sports teams need to hold individuals accountable, e.g. Grey Hardy, of the Cowboys (no discipline yet physically confronted special teams coach), as parents need to keep their children accountable. Children who truly feel loved and who are encouraged to use their God-given gifts to help others are far less likely to resort to firearms and violence. It all starts with each one of us- together, we can make our society safer. We have more potential to save lives and turn others from their destructive ways.
Several years ago, a sophmore psychology student came to my office seeking an unpaid internship. SHe became my first assistant in my clinical and forensic practice. She went on to organize everything and create office systems that were badly needed. She went on to graduate from CSUF and currently is a graduate student at Chapman University. An assistant who came after her, appeared in the waiting room in a state of excitement stating "I want to be a forensic psychologist!" This student went on to write a great paper on suggestive police interviewing. This student is now in a doctoral program in psychology. Another current assistant just graduated from Chapman University and competes in international figure skating. My current office manager just graduated from Chapman University and presented a paper with me at the American College of Forensic Psychology. Another current assistant of mine graduated from UC Irvine and is currently attending a crime scene investigation program at UC Riverside. He will be presenting a paper with me next year at the American College of Forensic Psychology.
All of the assistants particiapted as a research team on a chapter I wrote in a textbook that was published this year. Team building is done regularly with an annual Christmas Party as well as several dinners wherein students are rewarded for achievements. We are blessed to be in such a great profession and to have had the opportunity to have obtained a great education. We need to be mentors and share our knowledge with the students. They are the future of forensic psychology. Professional organizations would be well advised to recruit students as they are the future of the profession. The students offer great insights on forensic cases, do bookkeeping, interface with legal and healthcare professionals. It is important for forensic experts to contribute to the development of student's careers. Did we not need support and guidance when we were in school? Being blessed to have a great education and careers, we need to give back. How about you? Stay strong! Fight on!
I have written a chapter on a methodology primer for conducting bonding studies in child custody evaluations in the Handbook of Child Custody. This chapter provides a comprehensive protocol for conducting bonding studies in custody evaluations, performing develomentally specific tasks for parent and child, scoring systems, as well as data collection methods. These systems are evidence based and grounded in research literature. The author's experience of over 20 years in conducting bonding studies in a variety of settings is applied to bonding protocols in child custody evaluations. The work of this chapter is provided in response to the inquiries of many psychologists for a standardized, objective approach to bonding studies. This information will be published soon!
Caveat emptor–Let the Buyer Beware!
There has been a significant change in the "marketing" of psychology programs. Private schools are now pushing programs for students to be a "forensic psychologist." There are generally Psy.D. programs which are gutted out PhD. programs. Students are on a fast track! The all too often result of this are poorly trained "forensic psychologists" with little education in research, scientific method, statistics, psychological testing and the biological sciences. Student should look to scientist-practicioner programs such as UCLA and USC where research foundations and psychological testing are taught. The best forensic psychologists are researchers first and receive a PhD. in clinical psychology. They then have the evaluation skills and apply them to logical problems. Recently, students prevailed in litigation against misrepresentation in doctoral programs. Stay focused an traditional PhD. programs at solid universities such as USC and UCLA. Do not settle for second best. Your career and life deserve the best! Fight on!
Things in this world have come full circle from the horrific events of last year when a promising Chapman University student was beaten to death in front of a club in Santa Ana. Fast forward to last week when Matt Barnes, of the LA Clippers, Aunt was fatally stabbed on a sidewalk in Sacramento. She was trying to say "M" (first letter of his name) before she died. Matt and turned to his fans for help. Actress Gabrielle Union retweeted Matt's Tweet to over a million people. It worked! A tip was generated and the suspected killer was apprehended by police.
This chain of circumstances illustrates how victims can pull together and assist victims and families of violence. Group dynamics of this situation illustrate that many people do want to get "involved" and intervene for victims. A reason to celebrate humanity. Stay strong! Fight on!