Cannabis and Psychotherapy? They're Working on It

Imagine a therapy session where you either step into your therapist’s office — or more likely sign into your teletherapy session — smoke or vape up the cannabis product of your choice, and conduct the session as you would any other session. While it’s not necessarily available everywhere, a devoted assortment of mental health innovators, taking their cue in large part from the explosion in psychedelic-assisted therapy, are creating their own cannabis-assisted psychotherapy model, educating practitioners, and treating patients in medical and legal states. They assert that cannabis should also be seen as a psychedelic plant medicine and that it can account for the same breakthroughs seen in studies involving psilocybin, MDMA and ketamine. And while it’s early days for such treatments, a recent paper suggests its effects are significant enough to merit further study.

The movement towards integrating cannabis use into therapy has its roots, like many of cannabis’s most interesting developments, in Colorado. Bearing an MA in Transpersonal Counseling Psychology from Naropa University, Daniel McQueen began working with cannabis in therapy after its adult-use legalization in 2014. He founded the Center for Medicinal Mindfulness two years earlier, and through the Center provides individual and group therapy sessions along with his wife Alison. Mental health professionals can become credentialed in both Cannabis-Assisted Psychedelic Therapy and Cannabis-Assisted Somatic Psychotherapy through the Center. In the Medicinal Mindfulness protocol, patients are served a high-potency blend of cannabis which attempts to counteract the effects of THC with the anti-anxiolytic effects of CBD and CBG, along with CBN, which according to McQueen can serve as a muscle relaxant. Alongside music, breathwork and “somatic awareness,” McQueen maintains that cannabis, at suitably high doses, can trigger the same subjective effects as ayahuasca, MDMA or psilocybin and can treat the same traumas, from PTSD to depression, that these medicines are being explored for. On lower dosages, cannabis can be psycholytic, meaning it can stimulate insight and conversation. Because cannabis is legal in most states, and cannabis gives people more personal agency than psychedelics, McQueen argues for its adoption by clinicians who may otherwise wait for a few more years for MDMA or psilocybin to be rescheduled.

COVID, of course, has complicated this protocol, since practitioners like Dr. Mark Braunstein, who once worked as Medicinal Mindfulness’s Medical Director, cannot necessarily account for the regional variability of cannabis wherever their patients may live. Speaking to the Plant Medicine Podcast, Braunstein chooses a slow and cautious approach for this reason. It will start off with a consultation where Braunstein assesses the patient’s psychoactive medication history, which digs into everything from caffeine and nicotine to prescription medications, recreational drugs and psychedelics. “You get as much information as you can about the patient and you come up with a dosage recommendation,” he says. Sometimes, practitioners will integrate cannabis in with other medications as well. Braunstein will occasionally use cannabis in a multi-day schedule which also includes ketamine. Becca Williams, a licensed dietitian/nutritionist, uses cannabis alongside meditation and microdosing psilocybin (which the patient has to acquire on her own) and guide her clients during the course of a self-help seminar that helps her clients towards the ultimate goal of Emotional Liberation, a spiritual conception she’s borrowed from kundalini yoga teacher GuruMeher.

Indeed, much of the work surrounding cannabis-assisted psychotherapy borrows as much from New Age mysticism as it does from psychedelic clinical research. The Center of Medicinal Mindfulness defines its program thusly: “In our context, Psychedelic Therapy… includes not just psychotherapeutic techniques, somatic approaches, and assessments with trained psychotherapists, but also mindfulness practices, ceremony & ritual, and spiritual exploration within an energetic/transpersonal paradigm.” As for what the science says, very little research has been done on what are for now the field’s largely anecdotal claims. One recent paper co-written by longtime cannabis researcher Dr. Mitch Earleywine surveyed 852 people about their encounters with particularly high-potency cannabis. Previous landmark papers have theorized that therapeutic breakthroughs are likelier to occur during a “mystical” psychedelic experience, such as one where one felt a feeling of “oceanic boundlessness.” Respondents in Earleywine’s study were polled about their high-potency cannabis experiences using a portion of the questionnaire used in these psychedelic studies to measure this oceanic boundlessness. Earleywine determined that 17-19% of those polled experienced this feeling — not as much as the 59% of those who had used psilocybin, but enough to justify a future study where these medicines could be compared.

Just like psychedelics, the sort of cannabis use proposed for cannabis-assisted psychotherapy would be used only a handful of times and then discontinued, which may not be what devoted consumers had in mind. That’s because the focus is on the therapy, rather than the substance, and the possibility that the process to mental healing can be accelerated through the combination of substance with a skilled practitioner. “The contrast I see with traditional psychotherapy is the transformation I see with these medications,” says Braunstein. “The difference of seeing people every week for a decade or two to help them really transcend their issues in a shorter number of sessions — I love it and they love it.”