Cannabis and DBT skills can sit in a complicated relationship. For many clients, cannabis is not just a substance. It is a protected coping tool.
It is April 20. And now it is 4:20 PM.
For many of my clients, cannabis is either on their mind or already in their system. So this feels like a good moment to talk about it.
For some clients, cannabis becomes the one coping tool we are not supposed to question. We can work on sleep, emotional processing, behavioral activation, DBT skills, executive functioning, and even exposures. However, cannabis often sits in a different category.
And I get why.
For many people, it is the one thing that reliably takes the edge off.
Cannabis and DBT Skills
Early on, I often take a dialectical stance.
I might say, “I want you to track it on your diary card, but you do not have to commit to trying to reduce or eliminate it.”
That stance matters.
If I move too quickly into change, clients may feel judged, misunderstood, or controlled. If I ignore the behavior completely, we may miss something important.
So we start with curiosity.
How often are you using? When are you using? What happens before? What happens after? What does cannabis help you avoid, reduce, tolerate, or delay?
When Cannabis Becomes the Fastest Skill
If progress stalls, we get more curious.
If we are not seeing a meaningful increase in DBT skills, emotional processing, exposure practice, sleep consistency, or behavioral activation, then we look at the role cannabis may be playing in the plateau.
I might say something like this:
As long as a fast, easy, highly effective option is on the table, skills will struggle to compete.
It is like eating a handful of gummy clusters, my favorite candy, and then taking a bite of watermelon, my favorite fruit.
The watermelon will not taste as sweet after the candy.
In the same way, mindfulness, distress tolerance, opposite action, exposure, and behavioral activation may not feel very rewarding when cannabis is still available as the faster option.
Why Skills Need a Chance to Work
This does not mean cannabis is “bad” in every situation.
It also does not mean shame helps.
However, it does mean we need to be honest about learning. Skills need repetition. They need friction. They need enough discomfort for the brain to learn that something new can work.
If cannabis removes the discomfort too quickly, the client may get short-term relief without building long-term confidence.
That can keep people stuck.
Sometimes I will say: “If you are serious about learning and strengthening these other skills, we may need to take cannabis off the table for a while so the skills have a chance to work.”
Because my skills cannot compete with how fast, effective, and easy your drugs are in the short term.
Tracking Cannabis Without Shame
Tracking cannabis use can be a useful first step.
The goal is not to shame the client. Instead, the goal is to understand the pattern.
A diary card can help identify links between cannabis use, sleep, anxiety, depression, avoidance, conflict, urges, executive functioning, and skill use.
That information gives us options.
Sometimes the next step is reduction. Sometimes it is a planned break. Sometimes it is building skills before changing use. Sometimes it is a referral for more specific substance use support.
The important thing is that we stop treating cannabis as untouchable.
Cannabis, Mental Health, and Honest Curiosity
Cannabis can feel helpful in the moment. At the same time, it may affect mood, motivation, sleep, anxiety, attention, and emotional learning for some people.
The National Institute on Drug Abuse has information about cannabis and health effects here: https://nida.nih.gov/research-topics/cannabis-marijuana
SAMHSA also has information about marijuana risks here: https://www.samhsa.gov/substance-use/learn/marijuana/risks
Good treatment does not require panic or moralizing.
It does require honest curiosity.
What is cannabis doing for you? What is it costing you? What skills are not getting practiced because cannabis is doing the job faster? And what would your life look like if you had more than one way to take the edge off?
At YFI, we support youth, young adults, adults, and families navigating cannabis use, anxiety, depression, OCD, PTSD, ADHD, emotion dysregulation, avoidance, self-harm, suicide risk, family stress, and difficulty using skills consistently. Our team provides comprehensive DBT, parent coaching, skills training, phone coaching, and coordinated care when clients and families need more support. Learn more about our DBT services here: https://youthandfamilyinstitute.com/dbt/
For families in Venice, Mar Vista, and Playa Vista, YFI provides evidence-based care with warmth, clarity, and respect through our West LA location. To learn more or connect with our team, please visit our contact page: https://youthandfamilyinstitute.com/contact/
