504- How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents

Carol Fleck
Welcome to the Attention Deficit Disorder Expert podcast series by Attitude magazine.

Hello, everyone. Thanks for joining us. I'm Carol Fleck, and on behalf of the attitude team, I'm pleased to welcome you to today's ADHD experts presentation titled how Cannabis use affects ADHD symptoms and sleep in adolescents. Leading today's presentation is Doctor Marilee Hernandez. Doctor Hernandez is a clinical psychologist and postdoctoral research fellow at Columbia University Irving Medical center, where she specializes in substance use disorders.

Before earning her doctorate in clinical psychology, she spent seven years researching mood disorders. She now focuses on ADHD and substance use. In addition to her fellowship, Doctor Hernandez runs a private practice guiding adults with ADHD. In today's webinar, we'll discuss cannabis use and what it is not approved to treat. Many people with ADHD say that cannabis helps them manage anxiety, calms their thoughts, and even helps them to fall asleep.

But here's what you might not know. Cannabis can be harmful to developing brains, especially for teens with ADHD. They're at higher risk for becoming dependent on cannabis, and with excessive use, they may experience sleep disturbances and mood changes. Addressing cannabis use early on is important to prevent substance use in individuals later in life. Doctor Hernandez will discuss why many teens with ADHD turn to cannabis and the interventions that can help kids reduce or stop using altogether.

So without further ado, I'm so pleased to welcome Doctor Marilee Hernandez. Thank you so much for joining us today and leading this discussion. Hi. Thank you. Thank you for the lovely introduction.

Marilee Hernandez
I'm doctor Marieli Hernandez at Columbia University Medical center. These are my disclosures. I always say that I'm open to more disclosures and in terms of conflicts of interest. So I'm a federally funded postdoctoral research fellow, and I'm also part of another of a CBT for ADHD study run by doctor Mary Cilantro, Doctor Tony Rossin, and Doctor Sarah O'Neill. So, to get started, what is cannabis?

Cannabis is a plant with over 400 compounds. The psychoactive compound, which is what kind of affects your perception, is tetrahydrocannabinol, which is THC. The products that are high in THC, those are what produce the stereotypical effects of marijuana, of a high that we associate with marijuana, which can vary, but it's sort of giggly, like more sort of heightened sensory experiences, sort of this silliness. And so maybe some mood altering effects and maybe some sedating effects. Cannabidiol, or CBD, is also one of the other compounds in cannabis, and it doesn't have any psychoactive effects.

You do see that there's people putting CBD in everything. So I wanted to at least mention it, but it. But it's not going to be the focus of sort of what I'm talking about today. I'm going to focus on product high in THC that produce that stereotypical high, which is often what people are looking for. To date, there's only been four federally approved cannabis products in terms of what is the approved medical use for cannabis.

At the federal level, there's epidiolex, which is a CBD derived medication to treat severe epilepsy. In terms of THC formulations, there's marinol syndrome, Sesamet. They contain synthetic THC such as nabalone or jonabinol. And it's approved to treat nausea and vomiting related to chemotherapy.

Cannabis is not approved for depression, anxiety, ADhd, insomnia, pain, PTSD. At the federal level, on a state level, you may be able to get a medical marijuana license for any of these conditions. And because of that, there may be people can conflate the two. So in terms of even though these are not, cannabis isn't approved to treat these conditions, a lot of people still use it to try to treat these conditions. And some of those people, I think the people may be potentially at greater risk are young adults, and young adults are at risk for cannabis use disorder in general.

These are some. The next few slides are going to refer to these charts from an epidemiological survey, national epidemiological Survey on Substance use and Mental Health. And these are the results from the 20 2022 survey, and the findings were recently released. In terms of past year illicit drug use or past year marijuana use, the chart kind of shows that for past year marijuana use, 38.2% of people aged 18 to 25 use cannabis like in the past year. And that's sort of the highest group represented.

The next highest group is people age 26 or older, which is like 20.6% of people. Now that age between like 18 and 25, is typically around college age, and it's a normative time. At least it's been normalized in terms of experimentation, increased drinking, increased drug use now. But if the use of either of these, any of these drugs starts to cause problems like you drink more than intended, you have negative health or relational consequences, but you continue to use it can lead to a substance use disorder. And so some of these data also show that 18, that 16 and a half percent of 18 to 25 year olds who used marijuana in the past year met criteria for marijuana use disorder in the past year.

And they were like this, 16.5% is higher than all the other age groups. The next highest percentage is 6.7%. And the category is those who are twelve or older. But really it's the 26 and older, which is 5.4%. So that's 10% difference.

This is sort of a group that's really kind of at risk for problematic use and negative consequences related to cannabis use. The survey also did this thing where they. They wanted to see whether from how many of the people who were characterized as having a substance use disorder and then needed treatment, actually got treatment. So this is sort of whoever met criteria for use disorder. Again, 18 to 25 year olds have the highest percentage of people who are recognized as needing substance use treatment, which is 2029.3.

And then they were also the ones who, in the past year, were least likely to receive it. One thing that's important to note is that for a substance use disorder, you may only need, like, two symptoms, two to three symptoms, and that is a mild disorder. So mild shouldn't mean that it's not important, right? Or it's not impairing, but it's just the number of symptoms. And so it can be relatively easy, then, to meet criteria for a mild disorder.

And so I think a large percentage of those 18 to 25 year olds, I think probably, like over 50%, had a mild disorder. And so if you only have a couple of problems, you may not feel motivated enough to seek treatment. So it doesn't make sense that if you have mild disorder, you may think, well, I can deal with it on my own, I don't necessarily need any kind of treatment. Cannabis is a little bit different, though, and the risk is also related to the perception that it's not that big of a deal.

So I think, in general, all substance use is in the past, like, 1020 years, is kind of going down. But there is a rise in cannabis use and risk of cannabis use disorder. And what's underlying this risk is that now that it's been increasingly decriminalized and legalized, you have more and more diversity of products and different ways of using it, and also way stronger marijuana than like, in previous years. And if you have a more potent drug, the risk for addiction is greater. And so, first of all, there's more availability.

You can't. I know, you can't walk down the street in New York without, like, smelling weed. There's, like, one or two sort of smoke shops or, like, recreational dispensaries almost on every block, and so it's always around. And then if you're. You have greater access to it.

And not just that, but the ones that you have have, like, wild amounts of, like, THC. You know, they're like, oh, you know, 500 milligram candies. And so there's a greater potency. And then people think that, oh, this is not, like, that big of a deal. And that is also kind of a little bit misguided.

Those with ADHD are at greater risk than those without ADHD. I started saying that young adults are at risk for cannabis use disorder and use with ADHD. And I want to start earlier, like younger. So teenagers, they're at really great risk. One, because people with ADHD tend to start or experiment with drugs earlier than neurotypical children and teens.

And then once they do try a drug or something, they're more likely to progress to regular use. So they start using more regularly, faster than their peers. Not only that, but once they do use, even if they drink the same amount, or if they use the same amount or have similar patterns, they tend to get into more trouble or have worse consequences following use. And these consequences basically underlie a problematic use or a use disorder. There's ADHD symptoms of sort of impulsivity, sleep disturbances, sensation seeking.

All of these things could be even motives for substance use. And so some of the more heartbreaking things that I've noticed or that I've read are studies that talk about, like, what are the motivations for those with ADHD to use substances or cannabis, for some boredom, sensation seeking, but also to try to feel normal, to try to fit in, to quiet the thoughts, to calm the hyperactivity. Some claim it helps them focus or to fall asleep. And so sometimes I think the underlying motive for why people use are really important to not discount, but it is a little bit misguided in terms of reaching for cannabis or other drugs of abuse before finding better ways to kind of treat those things. And I do want to say that it's not lost on me that it can be very prohibitive to find a psychologist or psychiatrist that can help with treatment and compared to how easy you can access these drugs on the street and how quickly you can do that.

So it's sort of a losing battle if we don't try to identify this risk and do something about it earlier. The other thing I wanted to say, why I think it's really important to try to talk about this or get a handle of it before the teens kind of go to college or reach that. You know, the higher risk age of 18 to 25 is that once you turn 18, a lot of these experimental things are kind of, you know, mistakes or problems or consequences from youth become crimes. Right. I think when you're under 18, there is a level of protection while you kind of figure some of these things out.

And so I think sort of the earlier the better that you can try to engage your teens or youth in treatment. Talk to them about substance use and some of these risks. And so what are some of these risks? You know, what are the adverse effects of cannabis use? Acute basically means, like, a short term.

Like, once you smoke or take an edible, like, what happens? Right. So you experience short term memory impairment, especially with words. It's hard to find the right word. You can feel sedation or reduced, which means sort of reduced reaction time.

Like, it's. You're kind of in slow mo, reduced inhibitory control, reduced verbal fluency, and shortened attention span. And so those are kind of what you. What we associate with, like, someone who just smoked or is high. In terms of chronic use, though I think that there is less research available on that, because people, there's so many different varieties and strengths of cannabis use.

But for those who use chronically, which is daily or near daily use, there are studies that show that it can change your brain, and it changes your brain, especially if you start as a teenager. Any kind of substance or habit that you start as a teen is extremely difficult to break. And there's really important neural development happening as a teenager. If you introduce any of these sort of toxic substances or, like, these drugs, they can alter your brain circuitry, brain chemistry, that can have some lasting effects. The structural changes to the hippocampal volume.

There's kind of one study that showed that even 28 years after stopping, those changes were present. The hippocampus is a brain structure related, like, that consolidates a short term memory into long term memory. So I think if you have some structural changes, like reduced volume usually means that there is some memory impairment or some issues with the memory. Also, cannabis use, like chronic cannabis use, it can zap motivation and can lead to depression, anxiety. And part of that is, like, it just whenever there is, like, a addiction, like an addiction, any kind of drug, it rewires your brain in the service of the addiction.

But a cannabis specifically, it kind of alters functional connectivity in the reward centers of your brain so that things, like, the only thing that you may find rewarding is the drug, and probably, like, not as rewarding as you would have liked it to be. So other things just don't seem as important, or it's hard to get motivated to do anything else outside of that drug use. And with cannabis, that happens very insidiously and kind of slowly or maybe slowly to the person who's using, while others, maybe parents or loved ones, can notice these changes perhaps a little bit faster. I also think that was any drug, not just cannabis. Like, if you say that cannabis can, like getting high can provide this shield, this barrier between you and the rest of the world.

And so some people want that, right? They want to or get some distance from their feelings, from their situation. But what happens is that then you just learn how to create that distance. You don't learn more adaptive ways of dealing with stress or anxiety, and you kind of stay stuck in the bad situation for longer. I know, like for teens, it may feel like or, you know, for anyone that they can't actually change their situation.

So they might as well use something to tolerate being in that situation. But with drug use and substance use, and especially cannabis use and those with adhd, if you have something that delivers quick relief like that, it's going to be at the forefront of your strategies to deal with something. But it is definitely the least effective because it doesn't change your situation. It can cause some more problems, and it doesn't teach you anything about what you should do the next time that you're in that situation. And then lastly, there's executive function deficits.

So that's sort of with chronic use, difficulties with planning and organizing, etcetera. Shout out to Claritin for supporting this episode and providing us with samples. Spring has sprung. Our household calendar is filling with baseball games and barbecues and picnics and graduation ceremonies, all of them outside, where my allergies interfere every time. Red, itchy eyes, plugged nose, and headaches have a way of ruining a glorious spring day.

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Claritin, clear use as directed. Now, with research studies on cannabis users, there is a paradoxical effect of chronic use, where chronic users, some may not show those executive function effects. So Doctor Yasmin, her head had at Mount Sinai, she was telling me that it's an inverted u shape, right? So if you use drugs, in terms of impairment, the higher is the problems with cognition and attention or whatever. And so the more you use, you kind of get up to here, but then if you become dependent, you almost need the drug to get back to some kind of baseline.

Marilee Hernandez
It's a paradoxical effect. So with the physiological dependence, sort of, you function only when you have the drug, and that's a concern. So, in terms of the research, we may not be finding these executive function deficits, partly because we may not be measuring them in the right way. There's still a lot more research that we need to do.

The next. The next two kind of slides I wanted to talk about when I talked about, I presented some of these slides at an ADHD conference earlier this year, and Doctor Greg Mattingly also presented for the same symposium. And these data that he presented from different research teams was really eye opening and alarming some people, you know, you have questions about how to convince somebody that they might have a problem with cannabis use. And one of the challenges is that cannabis use affects your judgment, and I think it can affect it over time, because maybe it's hard to notice how you accommodate, how you change your life to fit the drug use. So you do less of other things and more of the drug seeking, getting high, and recovering.

But in this sense, this study, what they did is, Mark Cotton and colleagues, is that they had people smoke or use cannabis, and then they measured, I think, like a driving. They had them do some kind of driving simulation and then asked them how they felt, how impaired they felt, or do they think that they can drive? And so maybe for an hour and a half, while those who smoked, who use cannabis had these effects of feeling high, they're like, no, I'm not. I'm not okay to drive. But then if you see it, like an hour and a half, their driving score was still pretty bad, but maybe they weren't feeling high anymore, or maybe they're like, you know, no, I'll be good.

I can drive. So they thought that they were less impaired, that they were much better than they actually were. And this is, to me, I mean, dangerous, right? Like, yes, driving is, like, okay. You think, oh, I'm okay to drive.

But no, you're not. Even if you're not feeling high, the effects of cannabis on cognition, inhibitory control, and, like, you know, response is, it can last for up to, like, 12 hours. So even it can affect, it can impair the concentration, even when you're not feeling high anymore. And so you're not really making good judgments about your capacity and what you're able to do when you're under the influence, even if you don't feel the effects. And the other alarming.

Alarming. And, like, I think there's a lot of questions about cannabis and psychosis, and so what the data has shown is that if you're particularly male and have a risk of psychosis or schizophrenia, family history, you should definitely avoid marijuana because it can potentially, like, trigger or result in a psychotic episode or in some psychosis, you're more vulnerable to those effects. And that's definitely. That can be true. So this other study by Yesen and colleagues is a danish study, and this is data in over, like, 6 million people.

I recommend, like, taking a look at some of the articles, but it was basically those, they looked at those who had a cannabis use disorder diagnosis over time. And those who had cannabis use disorder were exponentially more likely to develop bipolar disorder, unipolar depression, with or without psychotic features as they age. And this is, like, even five years, like, from the five to ten years after the diagnosis. And if you see these graphs, like, compared to people who don't, who didn't have a cannabis use disorder, like, the fact that chronic cannabis use exponentially, like, increases your risk of having depression or bipolar disorder or psychotic symptoms and is a really important consideration and something that, you know, is worth telling people about. Now, like, a fat chance you can convince a teenager, like, you know, in, like, 30 years, you might have a mood disorder, like, or ten years, you may have a greater chance of a mood disorder, like, I don't.

These may not be very salient motivators for young people, you know, and one of the best ways to engage anybody in any conversation about substances is to start asking them, what do they like about it? Why are they using, or what draws them to that thing? So, in terms the research has shown, you know, why do young people with ADHD use cannabis? So, to relieve boredom, mood altering effects, improve sleep, reduce symptoms of ADHD, like hyperactivity, cope with negative affect. So, like, you know, to cope if they're feeling down or something.

Socialization motives are trying to fit in pain, especially for women. Pelvic pain are related to, or, you know, for menstruating people related to cramps or some people claim that it helps them focus. Others, which I thought was interesting, is that some people use cannabis to reduce the side effects of ADHD medication. So if the stimulants don't let them sleep, they may use cannabis to try to get to sleep, or to deal with irritability, or to stimulate their appetite. I thought that was sort of an interesting caveat there.

So I wanted to focus on sleep motives, because we have to sleep every day, and so sleep motives may be a driver of daily use, as opposed to more infrequent use related, tied to socializing with friends. But honestly, any of the motives could be a daily use motive. But in terms of sleep, ADHD, cannabis, and young adults, this also goes for teens, who are notoriously poor sleepers, in terms of it's really hard for them to get enough sleep. Sleep disturbances are prevalent in ADHD and in use, and there's a bidirectional relationship between sleep and drug use. The other reason why I wanted to focus on sleep is that if you don't get enough sleep, you have fewer cognitive resources at your disposal to resist cravings, to make better choices, to be less impulsive.

The other thing is that sleep is an intervention target. We could identify modifiable behaviors related to sleep health that we can try to employ and use to help improve sleep and see if other things get better as well. Well, the other thing is that a behavioral sleep intervention, you can probably. You can start right away, you can do it even while the person is still using. May not be the best, but it's something that you don't have to wait.

Cause it's behavioral, it's not necessarily like a medication.

Sleep disturbances, they are common in ADHD. I feel like maybe I don't have to tell you, but the research absolutely supports it. And it's across all ages, so those with ADHD are more likely to have an evening preference. So in more severe cases, they may have like a delayed phase, delayed sleep phase disorder, basically that, you know, feeling sleepy, like up to like 2 hours later than those who are neurotypical. And it wouldn't be such a problem if society didn't, you know, want every, you know, kind of, if the norm weren't like nine to five or earlier mornings.

Because if you can't get to sleep on time, you have to get up super early, like for school. You're just going to be sleep deprived. It's much more difficult than to try to get to bed on time, especially without any skills or any plan. And not to mention that for those with ADHD, even if you do get to sleep, they're more likely to have fragments of sleep, worse sleep quality.

And it's really prevalent, like any kind of these sleep disturbances in ADHD ranges from like 43 to even up to 80%. And this is including a lot of people with ADHD, also may have sleep apnea, obstructive sleep apnea. So there's behavioral and some biological sleep issues that are kind of overrepresented in ADHD populations, I wanted to say. So this I realize, I want to make sure I have enough time to get to what you should do for teens and young people. But cannabis is a sleep aid.

There's some research that shows, sure, it can help you fall asleep in the short term, it can help with insomnia, but the problem is that the studies aren't long enough. Because, yeah, if you use for short term, it can help you fall asleep, but because it is a drug of abuse, and not one out of abuse, but it's a drug compared to like a medicine, you build up a tolerance, and so you're going to need more and more cannabis to get the same effect. And what happens is this paradoxical effect, again, if you use it every day or daily use, or very frequent or daily use, you actually get less sleep and less worse quality of sleep. There is a study by Gonzalez and company and a colleague who showed that for frequent users, it affects your sleep in different ways, depending what age, because if you sleep too long or sleep to have too short of a sleep duration, it can have adverse health effects. And for young people, they can have short or long sleep duration.

But both of them are. Both of those are associated with, like, metabolic issues and attentional issues. If you don't have ADHD and you get, and you don't get enough sleep, you will start to look like ADHD. So when you don't get enough sleep, the ADHD symptoms just become worse. If you already have that vulnerability, I mentioned before, that if you don't get enough sleep, you may not have enough executive function or, I don't know, it's harder to withstand cravings.

And so this has also been shown in the research that if you have sleep problems, the following sleep problems, the following day, you have your cravings for alcohol and cannabis are higher, you crave it more and maybe more likely to use.

My idea, I guess, was in terms of improving sleep and substance uses, it may help reduce substance use and increase treatment adherence. One of those things is because with cannabis, if you stop using cannabis, one of the withdrawal effects is insomnia, and that can last for up to three weeks. So Doctor Haney, Meghanian and others have shown this in a lab, that you just get really bad insomnia. But also cannabis suppresses REM sleep. So you don't really dream if you fall asleep after, you know, using cannabis, but then when you stop using, you get this rebound of like, REM sleep, so you can have very, very vivid dreams.

So not only is it harder to fall asleep, but once you're asleep, it's. It may not be a very pleasant experience. You have these very vivid dreams.

The. There's consequences of poor sleep health, which I mentioned already, including greater risk of cardiovascular disease and metabolic problems. These would not be necessarily salient for young people, but I did want to mention them here and alongside the multidimensional sleep health framework, which is looking at these different elements of sleep, which would get an overall picture of what the sleep quality is and then identify where the problem is and what kind of behavioral treatments you can do to help. So there's regularity. Sleep regularity.

Are you going to bed and waking up around the same time every day? Satisfaction. Alertness. Satisfaction is, do you feel well rested? Alertness is, are you alert during the day?

Are you, are you tired and need a nap? And are you still distracted? And then the timing matters and sleep efficiency. Are you spending most of the time in bed actually sleeping? As well as the duration of sleep?

And some of the sleep interventions that can address one or more of the multidimensional sleep health elements is a sleep hygiene education. Sometimes just telling people what they should do to get better sleep is enough. There's CBT for insomnia, cognitive behavioral therapy, and there's even free apps. There's the trans diagnostic intervention for sleep and circadian dysfunction, trans C, I think, developed by Alison Harvey, and that has been shown to help teens. They have done study in teenagers as well.

Steven Becker does also a lot of sleep interventions with teens. So what we don't know is whether young people are like, even interested in sleep and what is their preferred way of learning about this? Like, will they hear it from us? Will they hear it from a video? Would they hear it from a, hear, what is their preferred way of getting this information out?

And then whether we don't know whether improving sleep and those with ADHD who use cannabis would improve ADHD symptoms we don't know about their use patterns or the motives. And again, is sleep a big enough motivator to engage youth in treatment?

I wanted to cover some of these slides because I think they will also potentially answer some people's questions. But I'm going to do my best to give you as much information as possible in terms of how to engage use in treatment. A lot of clinicians have said if they want to treat their patients, the patients get very, very defensive about, oh, you want to take my weed away? That's the only thing that helps me, etcetera. And so one, apart from asking them, what are you getting out of it?

You know, I wonder what you like about it, and then say, what are things that are not so good about it? That's one way to start. The other is that a lot of people have never actually tried to quit using cannabis. So that's one. Even if it's one of the questions on, like, you have a substance use disorder and people don't know because they've never actually tried to quit, or they are not even sure what the withdrawal would look like from cannabis.

So even. Even if somebody's resistant to quitting, you can say, okay, well, look, let's just see. You know, if you think it doesn't affect you, maybe you don't use it for one or for a couple of days or for a week. See what it's like to go without it for a short period of time, like a challenge, you know, and they may start seeing a difference. Now, the good thing is, I know I've said if you already start smoking or using as a teen, your brain gets wired from all these things, but it's not like all is lost.

Even if you're a chronic smoker, even 24 hours of abstinence can repopulate some of the receptors or can normalize some of the CB one receptors or cannabinoid receptors in your brain and lead to some improvements. For those with ADHD who already have a compromised executive function, cannabis makes that part worse. So even abstaining for a few days or a week would make a difference in improved memory and attentional faculties. A lot of people with teens with ADHD may think, well, my memory is not good anyway, so why should I even bother? But it can get so much worse.

You know, that's not a good enough reason to kind of not, you know, not salvage whatever you have. So, again, I would just suggest maybe they can go a day or two or weeks, or even if they can't do that, just delay the first use of the day. Many may deny that their use is problematic, which is fine, but you can challenge them to see what they're like with or without it.

They other, the other thing is that if you're working with someone who has ADHD, sometimes just a minor inconvenience could be a big enough obstacle. I know for me that's the case. So, like, if people are having trouble quitting because there are some patients who actually are interested in reducing their use, maybe not quitting altogether, but they're really struggling. And so the struggle may be like, if they have it around, they're just going to smoke it. So one of the things that could be helpful is just to let them run out, just make it more inconvenient.

There's this thing called the ksafe that you can get, and you can set a timer for like days, clear plastic box, you can put it for your phone or whatever and set a timer, and there's nothing you can do to open it until that timer runs out. So say that, you know, the goal is recreational use. Maybe you only want to use it like on the weekends. Then you put things on the cave safe and you set it for like five days, or if you just want to not do it for a few hours. So there's, where there's a lack of, like, willpower use, externalize as much as you can, you know, in terms of accountability or to recruit and as much help as possible to try to meet these goals.

But probably the most important thing is to treat, is to treat the underlying cause, right? So Doctor Paul Glasser is at the university like Washington, St. Louis, and St. Louis, Missouri, and he's a psychiatrist. And what he does with teens is that he asks, what is it that they're treating?

A lot of times, depression or anxiety and the ADHD, so you can treat even while they're using. But I'm not a psychiatrist, so I would want he could, this is what he kind of told me. It's possible people don't want to because it may be risky, but the fact is that once you improve the anxiety, the depression, some of these other things that are causing the problems, with better, more effective, less addictive medications, you're helping them, and they may not be as motivated to use. I was listening to, I think, the hidden brain podcast, and I forgot who it was who said this, but basically, addiction kicks you when you're down. If you're already kind of deprived of the good things and you're already feeling bad, the substances are much more salient and using them more regularly seems like it's more likely, it's more likely that you would be drawn to those if you're already not feeling great.

And so treating whatever is causing the situation or the symptoms can be really effective way of creating distance between the substance and the person and having more meaningful engagement in treatment. I talked about motivational interviewing in terms of what are the perceived benefits. I think that if someone's a heavy user and they quit and they're having trouble with sleep, then you can add something that the psychiatrist can help, can prescribe something to help with sleep. Also, another symptom of cannabis withdrawal is irritability. And I know this can be a challenge for parents because teens can be kind of psychopathic.

Like, they're very, they're so averse to feeling shame. They can be so mean and irritable and grumpy with the parents, and it's hard not to take it personally because they get very, very personal. And so what I would recommend is to consider, you know, they're being nasty. It's because they feel bad. And so if you can kind of just take a deep breath in and either offer like, a hug or something, just say, you know, you know, recognize that they're in pain or they're hurting, and you're not going to be able to reason with them when they're feeling that way, but offering support and being able to kind of listen.

Key. And also with teens especially, I'm giving a lot of advice, but these have to be in conversation with your teen because they should also be part of the solution and because then they'd be more invested in it. In terms of addictions in general, like I had said that, well, in terms of addictions in general, and this is, you know, I was doing work with gambling disorder. The treatment is to increase positive social interactions. You know, drug use and gambling addictions are very isolating.

You kind of do it in secret, you do it alone. But creating more positive social interactions, especially for teenagers who really the most important thing is their friends. This can be challenging for teens that their friends are also using. So if there's a way to collaborate with the parents so that they're all kind of reducing youth, I know that can be really hard. That might be helpful.

And then also one thing I thought is like, well, if these ADHD kids like to do, like, kind of thrill seeker kind of stuff, these adventurous things, those require sobriety. So you can use that, these types of activities that require, like, coordination, and you can't really be intoxicated? Like, four. That might be a good enough motivator for a teenager or a young person, and also building more self efficacy. If they're already down, what are some opportunities for them to get some small wins and kind of build that self esteem back up outside of the drug using context I shared with the organizers, but the child mind institute, they have an Instagram and they have on their webpage, they have really great strategies for how to talk to teens about substance use.

No.

Well, one of the things. We can hear you. You can hear me. Okay. Yes.

One of the things that they said is that you should set a limit, like, be transparent, because the teens do need to know what those boundaries are. And they have some other great strategies, like conditional amnesty, like if, you know you'll always pick them up or give them access to the uber if they ever want to leave an unsafe situation or if they're intoxicated, no questions asked. You're not going to yell at them, whatever. You let them sleep it off, and then you'll talk about it another time so they're not off the hook. We can talk about it in the morning, but they could always come to you if they're not feeling safe or if something happens related to drug use.

So I do recommend checking that webpage out because I think anything that promotes more communication between the people, parents, and the teens can be helpful in creating a collaborative solutions to some of these problems so that they're better equipped to kind of, you know, employ them on their own if they go off to college or when the parents are not around. And I think that concludes my talk. I apologize for it being a little long. Hopefully I have enough time for questions. This is my.

I have the same handle at Doctor Marieli h on Twitter TikTok and Instagram. So you can find me there. And now I'm happy to. Oh, these are my references. Sorry they're so tiny, but I'm happy to take any questions.

Any comments? Well, thank you for such an informative presentation. We appreciate that. Before we start the Q and A, I'd like to share the final results from today's poll. Question.

Carol Fleck
If your team uses cannabis, have you observed changes in their mood or behavior? And what might those changes be? Here's what you said. 29% said it reduces motivation to do tasks or homework, 22% said it worsens attention and focus, 18% said it reduces motivation for social activities, and 17% said it disrupts sleep. No surprise there.

Now to your questions. How does cannabis interact with ADHD meds, including stimulants and non stimulants. Right. So I'm not a psychiatrist, but the can. The way that the areas of the brain the cannabis affects, like, the.

Marilee Hernandez
That are involved in memory concentration are the same areas you're trying to treat with stimulants, with meds. So it does make the meds, like, kind of less effective. I don't think that, like, I don't think it's advisable to tell someone, oh, you know, if they need ADHD meds, that they have to stop smoking first. It can happen together because, you know, it may be that maybe they start using cannabis. The ADHD medic want to go up in the dose after smoking every day, because then it just makes the medication maybe not work as effectively.

So there. It just has to be a conversation. It's either they don't increase the use or they start decreasing the cannabis use before you start increasing the ADHD medication, because they're both trying to work on the same kind of brain areas or similar skills or, you know, capacities, and they're kind of working against each other. And so I know that I don't think that there's plenty of psychiatrists that just won't treat, won't give ADHD meds that they're using cannabis. But again, it's, why are they using the cannabis?

Like, you have to start there? Is it because they're not sleeping well? Let's give them something to help them sleep and then assess for whether they need to increase their ADHD meds. It's like understanding why they're using is probably the most important in terms of guiding how the treatment should go. But by all means, you should treat, because if you don't treat the ADHD, they won't even remember the skills that they learned, or you make more impulsive decisions.

The cost of not treating ADHD, I think, is greater than any, like, reservations you might have about treating both. I think people just need to feel empowered with the knowledge and, you know, these are great questions and assess on a case by case basis in terms of safety. Okay. Another question is, do you believe that any amount of cannabis use is. Is not problematic, or is there, like, a threshold?

No. So we don't know. I can't even say that. Right. But the research I think that I presented in terms of these negative consequences is daily use.

So, one, there's two things that, in terms of harm reduction that I think teens may be open to that parents can communicate, is if you can't delay, just delay. Like, try it after you're 18. The brain development during the teens and the lasting changes is not really worth it, right? So if you can just delay, then you can have probably make better decisions. And then the other thing is just then reduce the frequency.

If you just. Anything that's not every day, it could even be every other day. But try to increase the time between use and not that, like, any kind of use is going to be good or bad, but I think it gives you more space to notice. Do you even really like the effects? You know, when you use less frequency, you kind of have more perspective.

Some people, and I know someone who notice, actually, when I do, you know, when I do smoke, I'm pretty paranoid and I'm not having a good time. And even just that awareness is motivating enough to discontinue use. But you do need space to create that perspective. You need distance to notice how you are on and off the drug and then make an informed decision. Teens may not be able to do that, so you may have to gauge with your teen, in terms of as a parent, what boundaries you're going to set for the behavior until they can kind of do that for themselves.

Carol Fleck
Someone asks, is there a difference in the effects on brain development when a teen smokes marijuana versus taking edibles?

Marilee Hernandez
I don't know if we know that yet, but edibles are pretty potent and so they do affect similar brain areas. I don't know about how it's digested, but there's the issue with edibles and ADHD is that edibles take time to hit. And then people with ADHD don't have patients, so it's much more likely that they may accidentally poison themselves. I know there's been a rise in adolescent admissions to the ER related to cannabis use in edibles. It's really easy to just have a negative reaction.

These high doses can also cause a psychosis, like, in the moment, especially if you're kind of slim. Doctor Napoleon Higgins was telling me that he's concerned with dabbing. So you need, like a Bunsen burner, and you burn this th. Like this THC, that kind of rock, and so it gives you this big dose of THC. THC binds to fat.

If you don't have a lot of fat left, that's not, you know, any receptors. It goes straight to your brain, apparently, and can cause psychosis. And people don't know that. Young people don't know that. They're not making great decisions.

They want the highest impact of the drug and not even thinking, not even knowing that they can have these really horrendous outcomes until it's too late. So I do think that the risk of accidental poisoning or bad physiological effects are probably greater with the edibles because they have a delay onset, and they tend to be much more potent. Okay. Is there a connection between cannabis use in adolescents and erratic and aggressive behavior? Well, I don't know, actually, that's a good question.

We need more research.

Carol Fleck
Someone else asked, if an ADHD adolescent abuses cannabis and suffers sleep deprivation for a year, can this change his brain chemistry or personality? Okay, if I don't sleep for a year, it will absolutely change my personality. I don't know about the brain chemistry. I do think that, like, you know, it's different that if you're just suffering, you're not doing anything, you know, versus you're trying a bunch of stuff and trying to narrow down what the issue is. You know, I do think that teenagers have a hard time falling asleep because they're.

Marilee Hernandez
They don't want to disengage from social life, but they need this sleep. It's really, really important. And whatever motivator for the sleep you can have, the better. I don't know. Of course, I think there's so many changes happening in the brain during adolescence.

I don't know what study, if there's a study that would show what's attributed to what, but I can't imagine it's going to have sort of, like, a great effect. What it would do is maybe change, like, probably cause some depression, anxiety, and maybe apathy, change what actually gets people excited or what they find rewarding, but it is possible to come back from that. So I don't want people to feel faultless.

Carol Fleck
That sort of leads to the next question. Can the brain regenerate after time, such as the hippocampus and executive functioning?

Marilee Hernandez
So this is a great question. There are some. Some areas of the, there are some parts of the brain that can develop, like, create new neurons. I think that the, the study that they did, 28 years later, you still found those deficits. That's kind of old.

We have much more sophisticated scientific instruments, ways of measuring things. So we'll have to see what the research shows. I think the brain is very plastic. It can adapt to even these changes in structure. That doesn't always mean there's a change in function.

But that said, I think that you would have to do a lot of behavioral work and maybe some meds to help reverse some of those negative things. And this is just from research on depression and some other areas, but we just don't have enough information in terms of how cannabis affects the brain, the cannabis that we're using these days, how that affects the brain long term, because there hasn't been enough time yet to kind of observe those changes. Well, unfortunately, that has to be our last question because we're out of time. But Doctor Hernandez, thank you so much for joining us today and for sharing your expertise with our ADHD community. We appreciate you.

Yeah, thank you so much. This was a pleasure and thank you to today's listeners. If you would like to access the event resources, visit attitudemag.com and search podcast 504. The slides and recording are posted a few hours after each live webinar. If you're listening in replay mode, simply click on the episode description.

Carol Fleck
Please know that our full library of attitude webinars is available as a podcast. It's called the ADHD Experts podcast and it's available on all streaming platforms. Make sure you don't miss future attitude webinars articles or research updates by signing up to receive our free email newsletters@attitudemag.com. newsletters thanks everyone. Have a great day.

For more attitude podcasts and information on living well with attention deficit, visit attitudemag.com. that's a D Dash dash Dash Dash a G.com.

Claritin
With everything you have on your plate. Earning your degree online seems impossible, but at Grand Canyon University, we specialize in helping you fit a master's degree in education into your busy day. Your graduation team, led by your own GCU counselor, provides you with the personal support you need to succeed. Achieve your goals with the plan and team behind you. Find your purpose at Grand Canyon University.

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504- How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents

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1: Introduction and Expert Background

2: The Science of Cannabis

3: Cannabis Use Among Adolescents

4: Addressing Misconceptions and Risks

5: Alternative Treatments and Strategies

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