Tough topic that I would appreciate some serious discussion on - Marijuana and social services

This is a big, complicated, and heavy one. I am a Mental Health Counselor and see clients at a community non-profit for mental health. A large percentage of my clients are receiving cash assistance from the state Department of Social and Health Services "Aged Blind and Disabled" program for a mental health disorder. This program provides $197 per month and requires clients receive mental health services (paid for by their Medicaid insurance through the state) and apply for SSD benefits from the Federal government. Now, there's nothing wrong with that program in and of itself, I have had a significant number of clients be able to improve their lives thanks to that tiny portion of income with such successes as obtaining employment, ending homelessness, and resolving their mental health concerns and returning to their regular lives. 

The issue that arises is the marijuana usage. Here in Washington, marijuana is legal and is available on nearly every street corner. There are more dispensaries in this town than Starbucks. I have clients that are using up to a gram of 99% THC marijuana condensate or wax up to 5 times daily and do not consider it drug use or addiction. I have clients that vape marijuana e-juice literally just about every waking moment. The vape box/pen does not leave their hand from when they wake until they go to sleep. I have clients that have housing paid for through other social services, food paid for by EBT/Basic Food, and then spend their ABD money on marijuana every month. They are literally living completely on the public assistance system to spend their entire lives high.

I have been working with my supervisor and employer on this issue as far as the clients go, but I just don't know how to keep working with this population without doing something else. I see people struggling with minimum wage jobs and making smart choices and working their butts off get basically next to no help, and then I have to deal with someone who is only coming to me to ensure that they continue that handout for their drug money. I want to be able to sleep at night and look myself in the mirror, so how do I continue signing their ABD paperwork stating that they are fully participating in resolving their mental health diagnosis when they are not?

Again, I have been getting guidance from my supervisor and such, I guess I am more looking for moral guidance or any suggestions on how to help disrupt the system so it doesn't get soured for those that actually need it?

Thank you,

Javelin

In reply to Javelin :

I’m not gonna pretend to have answers, but I do appreciate your balanced and level headed approach to the problem. 

Man that's a tough one. On one hand, I am fully of the belief that drug use and or abuse should automatically 86 someone from a government assistance program. Where this gets murky is the fact that it's marijuana. At least around me, you can get medical card for an assortment of mental health issues, including ones that could lead to potential disability and government assistance, which puts them directly at odds with each other. 

On the other hand- it's legal. Unless there's a documented addiction issue (which it certainly sounds like it could be) you can't really tell someone what they can and cannot do. 

I guess the real question becomes where your moral compass lies. What do you believe the best service is? Keeping hope they decide to get their E36 M3 together, lay off the weed and move on with life? Failing their program for lack of progress? You have the option to you know- not sign the paperwork. But I assume there's several consequences to that, or you may have never asked us this question. 

I guess I would ask myself- what's the worst thing that could happen if I do exactly what I feel is right, and can I accept that? And work from there. 

What was the counsel from your supervisor?

Does he agree that signing off on their paperwork is essentially fraud, or is he more of the opinion that it’s a necessary evil, and that you are providing a valuable service?

That's a sticky one. Is there a program/ protocol for alcoholism , maybe follow what that policy is. Seems to be a vicious cycle for those that don't have much motivation to do anything  with their lives. Or it is simply their mental health has their priorities all out of whack with what society thinks is  "normal" but the addictive lifestyle they lead is their "normal" and neither one can understand how the other can live that way.

As to the people that manipulate the system that don't deserve the assistance, it amazes me that the people  who really need help either don't know where to ask for help or are to proud to ask yet these guys get ever6hnsed to them. If someone is abusing a priviledge it might be appropriate to notify the agency that is supporting them about the abuse. 

One option if you are in the position to offer the assistance might be to help guide those who are making an effort to places they might qualify for help. Could be a morally better option as you are helping someone and you can feel good about that.  The other way you may feel bad even though you really did the right thing.

Good luck with your decision 

What if they were drinking alcohol instead. Would you have the same moral dilemma? 

To understand heroine and heroine addiction, I replace the word heroine with the word sugar. 

I imagine how nearly impossible it would be for me to quit sugar. It seems that sugar is in everything and is everywhere. 

If you live in the heroine world, heroine seems to be everywhere too. 

So, maybe you can get your head around this dilemma by asking yourself how you handle your customers who live on only Mt Dew and Snickers bars. 

Is your moral dilemma the fact that they are abusing drugs, or that you are enabling them?

Or that the system is broken?  

yupididit said:

What if they were drinking alcohol instead. Would you have the same moral dilemma? 

Marijuana can legitimately be used for mental health disorders. I have to frame it more like someone abusing their prescription medication.

Does what they are doing affect their eligibility for the money they get?

Is the money they get free for them to spend as they see fit?

If the answer to the first question is no, and the answer to the second question is yes, it's none of your business.

Since it is legal, this is no different from buying Hot Wheels Cars or Starbuck's Coffee with the money that gets handed to them.

(full disclosure: I'd prefer it if they were spending their money on something else, but it's also none of my business, either)

In reply to Javelin :

It does sound like you have made up your mind.  To be honest you and your priority's has to come first, so whatever you decide you'll get no criticism from me.  
From my perspective theses people obviously need help no matter what you think that help should be.  

For a long time I wondered how my friend who worked in a housing development could keep on doing it.  Working with addicts and mentally retarded, Down Syndrome, inbred, and some of the real dregs of society. 
 

She said that most of the country discarded these people but in the end they were people who without her help would suffer and probably deeply. 

If you want to cut them free and turn your back to those most in need, you've already done your share.  More than your share.  Look after yourself.  I thank you for all you've done. 

In reply to Brett_Murphy :

To your first question, in some cases yes. Those are the specific ones I'm struggling with. I harbor no resentment towards marijuana users, hell I voted for legalization and have tried it myself. It's the few that are to the point that it is abusing the substance and not participating in what they legally should be doing. I would like to prevent that from happening in others that are teetering on the edge. How can I help reign in that usage from abuse? 

As an aside, the only outpatient substance use treatments available to low/no income people in the area are of the deeply flawed and religious "12-step" programs. 

Javelin said:

yupididit said:

What if they were drinking alcohol instead. Would you have the same moral dilemma? 

Marijuana can legitimately be used for mental health disorders. I have to frame it more like someone abusing their prescription medication.

I'd rather they use weed than anti-depressants, alcohol, or harder drugs.

I'm not saying you can't become addicted to the need for what marijuana offers.  I have friends who escape into weed 24/7 to mask anxiety and PTSD.  Even though it isn't chemically addictive, the escape it can provide to those with anxiety and depression can be addictive.  Heck, I have a friend who had a medical use script and when he lost his job to downsizing (and the financial ability to afford weed) he checked himself into a hospital.  His Dx was schizophrenia and PTSD.  He should have had counseling to help get beyond his need for MJ (as evidenced by the underlying issue that surfaced when he stopped using it) but the fact that he operated as a perfectly normal human in society for that many years is partially a testament to the potential benefits of THC as a treatment for mental health disorders.

However, as far as my moral compass points (enrolled in master's program for clinical counseling, so not a pro, but hope to be one day), marijuana is about as harmless as can be.  At least once they get their lives to a point (with your evidently caring assistance) where they can function more fully and not have the need to cover or dither the brain dysfunction, the weed is easy to quit.  Once the need for the escape disappears, at least they aren't chemically addicted to anti-depressants or heroin.

This is a tough one. I'd say if they're using it constantly, it isn't effective and they need to try a different medication. They're using it as a crutch. A crutch doesn't cure you, it doesn't fix the problem at hand, it just takes the pressure off to actually attack the problem. So are they trying to fix the problem or are they just leaning on the marijuana?

Javelin said:

In reply to Brett_Murphy :

 It's the few that are too the point that it is abusing the substance and not participating in what they legally should be doing.

Copy, I understand what you're saying now.

I think we're also kind of dancing around the morality of THC use.

Disclaimer:  I'm not a THC user.  Maybe once a year I'll take a drag on vacation, but I'm one of those people who takes a hit and I am just useless.  I fall asleep.  My brain chemistry is not a weed smoker type because the downsides outweigh the benefits when I smoke it.  I'm one of those weirdos who can do 4 lines of coke, drink a coffee and still sleep like a baby.

Further disclaiimer:  Even when it was widely considered contraband, I never thought that marijuana use was immoral.  In fact, I think alcohol use is less of a moral choice than smoking weed.  I say that because (when I gave my advice above) I would personally view the MJ with your clients in the exact same way that I might approach food if you had a client with a compulsive eating disorder, or antibacterial soap with someone who is germaphobic/OCD, or theft to a client who has kleptomania.  The substance is their soothing element, but I wouldn't (personally) condemn THC or MJ as anything more than a cheeseburger to the overeater in the first example.

Now, if their soothing element is crack, heroin, or meth, that is truly damaging to the body.  If that were the case, I would be legally bound to report it, but also morally compelled.

TL,DR:  Your hope (I'm inferring) is to unlock and move them through their need for the soothing element; that is to say, move the kleptomaniac to a point where they no longer need to steal.  To move the overeater through whatever is causing them to self-soothe with three racks of ribs.  In those cases, you don't blame the ribs, you recognize that something in that person uses the ribs to soothe.  You don't restrict his/her caloric intake with legal action.  That wouldn't solve the mental health issue.  In the case of THC, I don't view it as any different than cheeseburgers, lysol, or shoplifting.  In the case of crack, sniffing glue, or meth, then their soothing element is physically destructive, not to mention illegal.  In short, if THC were illegal where I was working, I would be legally obligated to report it, but I wouldn't feel a moral obligation to do so.  If it is legal where I am working, I would feel neither obligation.  The only obligation I would focus on is why they need the soothing element, not judging the element itself.

Javelin said:

 I am a Mental Health Counselor and see clients at a community non-profit for mental health. 

This alone right here makes you darn near a saint to me.  Kudos.

You knew the job would be fraught with bureaucratic catch 22's when you accepted it.

Do your job and mind your own business.

If you can't sleep because of this issue, perhaps you should seek counsel or move on to a position that doesn't get your knickers all twisted up.

Sorry to be crass but that is the lay of the land you are a SERVANT designated to administer benefits within tightly and legally framed parameters, that is all.

When you get done cleaning up the mental health system come south and teach these motherberkleying bums how to pick up after themselves.

bentwrench said:

You knew the job would be fraught with bureaucratic catch 22's when you accepted it.

Do your job and mind your own business.

If you can't sleep because of this issue, perhaps you should seek counsel or move on to a position that doesn't get your knickers all twisted up.

Sorry to be crass but that is the lay of the land you are a SERVANT designated to administer benefits within tightly and legally framed parameters, that is all.

When you get done cleaning up the mental health system come south and teach these motherberkleying bums how to pick up after themselves.

Wow. That's an... unexpected response. I am doing my job thank you very much. If I made the world as black and white as you I'd report every one of these addicted clients as non-complient and be done with it. But the world is not black and white and my duty to help the client is supposed to count for something, which is why I came to the hive of knowledge for some perspective from outside of the "system" to see if there were any fresh ideas on what I could do to. Sorry that got your knickers twisted up.

In reply to Curtis :

I really appreciate what you've said here. I think maybe that was the perspective I needed to hear was to address what the clients are soothing from while helping them through their dark times. There are a handful that I believe can make it and I will redouble my efforts in working with them.

That said, there are a few that maybe need more services than I can provide. They are too deep in the self-soothing to be reached at this point. I also wonder about the addictive effects of THC itself and the very real possibilities of other substances being in the e-juices, distillates, and waxes being used. 

In reply to Javelin :

My own personal take? While I wouldn’t be too happy about my tax dollars paying for someone to get high all day, honestly I think it sounds like a better(for them), safer(for all), and cheaper(for taxpayers) solution than the in & out of institutionalization/incarceration cycle I suspect many of them would otherwise go through. 

I'm of the opinion that if they are obviously abusing the system to get cash to stay high, I'd report them and get them booted. 

I would approach it from this perspective. Most government and non-profit agencies have a limited number of people they can help. If someone abusing the system is taking up one of the few spaces, then someone that really needs and wants the help is going without. I would get the dead wood out of the system. 

My 2 cents. Take into consideration I could not and would not do your job for 10 times the money. I am not compassionate enough. 

Is it my understanding that you are counseling these people to become productive members of society? 

I'd be curious what these people are doing to get money to use wax all the time. A quick check of Weedmaps shows around here a gram of concentrate is between $65-90 gram depending on strength, 60-95% THC. Even if you made that last all week, which I seriously doubt they are, you're talking hundreds and hundreds of dollars per month in cash on it. 

Replace MJ with cigarettes and nicotine vapes.  How do you feel now?  It's not much different.  If someone came in smelling like they just smoked a heater, you wouldn't think anything of it.  Society until very recently had us convinced that you get reefer madness, but cigarettes are cool.
 

 Most of us here are old enough that that was the message we received.  DARE officers came to school, told us how weed was a gateway drug, and we watched racecars with cigarettes and other tobacco ads on them while our tv icons all had a marlboro hanging out their mouth.  In reality, weed isn't anywhere near as bad as nicotine, but we're still conditioned that pot is bad.  Nevermind i think sucking anything into your lungs besides air is pretty not smart, but just think about it and how you're conditioned.  
 

people get hooked on everything.  You're addicted to buying cars(me too), some people get hooked on weed, some shoot heroin, some are addicted to food, and some lucky people can practice moderation in every facet of their lives.  
 

I use some plant based medication for pain, but don't use it enough to get high because I do not like altering my mental state.  I don't drink, and it took me until 37 to get over the stigma society forced down my throat about how horribe MJ is to even try a bite of a cookie that my buddy made for me when i was having horrible back pain and refusing to take narcotic pain killers.  I get it, I understand the stigma.