Cannabis use is becoming increasingly common across many client populations. With expanding legalization and shifting cultural attitudes, more individuals are using cannabis for both recreational and perceived therapeutic purposes. As a result, emerging therapists are more likely than ever to encounter clients who use cannabis regularly and who may view it as helpful, neutral, or even essential to their well-being.
This creates a complex clinical landscape.
Cannabis use can be associated with both mental health challenges and perceived benefits, depending on the individual, the pattern of use, and the context. For emerging therapists, the task is not to take a rigid stance for or against cannabis use. The task is to assess, understand, and respond thoughtfully.
Why Cannabis Cannot Be Overlooked in Clinical Work
One of the most common mistakes new clinicians make is minimizing or overlooking cannabis use because it is socially normalized or legally accessible. Clients may also downplay their use, describing it as casual or harmless.
However, cannabis can significantly impact:
- Mood regulation
- Anxiety levels
- Sleep patterns
- Motivation and cognition
- Psychotic symptoms in vulnerable individuals
Research indicates that cannabis use, particularly frequent or high-potency use, is associated with increased risk of anxiety, depression, and psychosis in some individuals (Volkow et al., 2014). This does not mean cannabis is inherently harmful for all clients. It means it must be assessed with the same level of attention as any other substance. Ignoring cannabis use can lead to incomplete case conceptualization.
Cannabis use often intersects with mental health in complex ways. Clients may use cannabis to:
- Reduce anxiety
- Improve sleep
- Cope with trauma-related distress
- Manage mood fluctuations
- Decrease intrusive thoughts
In the short term, cannabis may provide relief. Some individuals report reduced anxiety or improved sleep following use. However, over time, patterns can shift.
For some clients, cannabis use may:
- Increase baseline anxiety
- Contribute to depressive symptoms
- Interfere with emotional processing
- Reduce motivation or engagement in treatment
The relationship is not linear. It varies based on frequency, dosage, individual vulnerability, and co-occurring conditions (Crippa et al., 2009). This complexity requires nuanced clinical thinking.
Recognizing Potential Benefits Without Overgeneralizing
It is important for emerging therapists to avoid an overly pathologizing view of cannabis. Some clients experience meaningful relief from certain symptoms, particularly in areas such as sleep, pain management, and acute anxiety reduction. A growing body of research suggests that cannabinoids may have therapeutic potential in specific contexts, though findings remain mixed and highly individualized (National Academies of Sciences, Engineering, & Medicine, 2017). Dismissing a client’s perceived benefit can damage rapport and shut down honest conversation.
Instead, therapists can explore:
- What does cannabis help with
- When and how it is used
- What changes has the client noticed over time
- What role does it play in their coping system
Understanding function is more clinically useful than making assumptions.
A common clinical misstep is encouraging clients to reduce or stop cannabis use without first helping them build alternative coping strategies. If cannabis is serving a regulatory function, even imperfectly, removing it too quickly can increase distress.
Clients may experience:
- Heightened anxiety
- Sleep disruption
- Increased emotional reactivity
- Difficulty managing stress
Without replacement skills, clients may disengage from therapy or return to use more heavily. Ethical care involves pacing.
Instead of rushing abstinence, therapists can focus on:
- Building emotional regulation skills
- Increasing distress tolerance
- Expanding coping strategies
- Exploring readiness for change
Change is more sustainable when it is supported.
Clinical Assessment: Moving Beyond “Do You Use Cannabis?”
Assessment should move beyond simple yes or no questions. Emerging therapists should explore:
- Frequency and quantity of use
- Method of use (smoking, edibles, etc.)
- Potency and type (THC vs. CBD dominant)
- Context of use (alone, social, before sleep, etc.)
- Perceived benefits and drawbacks
- Impact on functioning
Understanding patterns allows for more accurate case conceptualization and treatment planning.
Not all clients are ready or interested in abstinence. A harm reduction approach can be clinically appropriate in many cases.
Harm reduction may include:
- Reducing frequency or dosage
- Avoiding use in high-risk situations
- Increasing awareness of triggers
- Monitoring impact on mood and functioning
At the same time, therapists must remain attentive to situations where cannabis use is contributing to significant impairment or risk, particularly in cases involving psychosis, severe mood instability, or substance use disorder. Clinical judgment requires flexibility.
Therapist Bias and Self-Awareness
Emerging therapists bring their own beliefs and experiences into the room. Some may view cannabis as relatively harmless, while others may hold more negative or cautionary perspectives.
Unexamined bias can influence assessment and intervention.
Therapists should reflect on:
- Personal beliefs about cannabis use
- Emotional reactions to client use
- Assumptions about motivation or responsibility
Supervision is an important space to explore these dynamics. Reflection Questions for Emerging Therapists:
- How do I currently view cannabis use in relation to mental health
- What assumptions do I make when clients disclose use
- How comfortable am I exploring substance use in detail
- How can I balance validation with clinical responsibility
Final Thoughts
Cannabis use is not a simple clinical issue. It sits at the intersection of culture, biology, coping, and mental health. For emerging therapists, the goal is not to take a fixed stance, but to develop the ability to assess thoughtfully, respond ethically, and work collaboratively with clients.
Do not overlook cannabis use.
Do not assume it is harmless.
Do not assume it must be eliminated immediately.
Stay curious. Stay grounded. Stay client-centered. That is where effective clinical work happens.
Author:
Dr. Steven Glasser, PhD.
References:
Crippa, J. A. S., Zuardi, A. W., Martín-Santos, R., Bhattacharyya, S., Atakan, Z., McGuire, P., & Fusar-Poli, P. (2009). Cannabis and anxiety: A critical review of the evidence. Human Psychopharmacology: Clinical and Experimental, 24(7), 515–523. https://doi.org/10.1002/hup.1048
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. The National Academies Press. https://doi.org/10.17226/24625
Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219–2227. https://doi.org/10.1056/NEJMra1402309
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