Ambivalence in how to address adolescent marijuana use: Implications for counseling

As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed 12 SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health concerns, and their concerns around marijuana. Six themes emerged from the interviews: (1) marijuana use is indicative of underlying mental health issues; (2) normalization of marijuana use; (3) hesitance to endorse marijuana as a medical treatment for youth; (4) risks of marijuana use relative to alcohol use; (5) tension between building trust with adolescent patients and asserting authority; and (6) knowledge and skills gaps that impact counseling. Our findings elucidate key domains to address in order to support providers in their efforts to increase the health and safety of adolescents in states with rapidly expanding legislative and popular acceptance of marijuana.