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Our Governor, a physician, announced that marijuana will be legalized in Virginia July 1 of 2021 with retail sales to begin in 2024. No reasons were given except it’s time and this will make it more equitable for all Virginians–more equitable to have access to more drugs??? To me, this defies sensibilities. I don’t see how adding another public health problem is a win for the Commonwealth. Yes, I am a skeptic, but for good reason. This political move is all about money, not the public’s health. Many people will be negatively affected but the tax dollars will roll in.

Given the new attitude towards marijuana, it is now the most commonly used drug after alcohol in the US. And teen use has significantly  increased in part due to vaping THC (the ingredient that produces the high in marijuana) and marijuana edibles.

But despite the casual attitude towards marijuana use, you don’t hear the entire story. Cannabis is an intoxicant that can have detrimental effects on a person’s functioning. Long term use affects brain development. When teens use, they experience impaired memory, impaired thinking and impaired learning functions. These changes can result in loss of IQ points, general knowledge and verbal abilities. Some changes may be permanent.

So let’s take a look at how marijuana impacts a person’s health and mental health.

Physical health: Smoking marijuana irritates the lungs and results in breathing problems-the same as tobacco. This can lead to daily coughing, phlegm and more lung infections. Your heart rate also raises for up to 3 hours after smoking, putting an older person at greater risk for heart attack. During pregnancy, marijuana use can result in lower birth weights and impact the developing brain of the fetus resulting in problems with attention [1], memory and problem-solving [2]. And one side effect you hear little about is something called Cannabinoid Hyperemesis Syndrome, cycles of vomiting, nausea and dehydration related to regular long-term use. In some cases, this can be a medical emergency.

Mental Health: During the pandemic, many mental health problems have increased. Now we are about to add even more problems. Cannabis can make psychiatric disorders such as mood, anxiety and psychosis worse. For example, there is evidence to suggest that regular cannabis use can increase symptoms of mania in those with bipolar disorder; people with anxiety also see an increase in anxiety with daily cannabis use. Those who suffer with PTSD may also see an increase in symptoms using cannabis. And finally, those diagnosed with schizophrenia may see a worsening of their positive symptoms (hallucinations, paranoia). So while people may use cannabis as a way to mellow out, that strategy could back fire and cause more problems [3].

In terms of bringing on mental illness, there is moderate evidence of an increased risk in developing depression, bipolar disorder and social anxiety disorder. In addition, cannabis use may affect the onset of schizophrenia for those at risk for psychosis. And the development of schizophrenia may have an earlier onset. Overall, cannabis can worsen a number of psychiatric diagnoses.

Addiction:The greatest risk of use of course is developing a cannabis use disorder. If you begin using as a teen, your risk of dependence increases. And teens with ADHD and depression are likely to misuse drugs, especially cannabis. Now, with legalization, teens believe regular use of marijuana is less risky [4]. Yet, evidence shows that between 9-30% of those who use may develop the addictive disorder [5]. And using as a teen, ups your odds for addiction.

Signs of addiction typically include: Not completing obligations, engaging in risky behavior, developing tolerance and difficulty in quitting. The number of people I have seen who try to cut back without success is growing. When they do try to cut back, they can experience withdrawal symptoms like irritability, sleep problems, decreased appetite, cravings and restlessness.

And we aren’t sure, but have some indication that early exposure to addictive substances like THC may change how the brain responds to other drugs, making it easier for addiction to take place.

Life Satisfaction:People who use large amounts of  marijuana frequently do notreport that it makes their lives better? They report lower life satisfaction, poorer mental and physical health and more relationship problems. In terms of academic and career success, these is more school drop out, job absences, accidents and injury.

So just because something is legalized or natural doesn’t mean it is good for you. As marijuana use becomes more mainstream, we need to be aware of the fall out of yet another drug added for recreational use. It’s not harmless as so many would lead you to believe. You need to know the risks.

References:

1. Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol.2000;22(3):325-336.
2. Richardson GA, Ryan C, Willford J, Day NL, Goldschmidt L. Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years. Neurotoxicol Teratol.2002;24(3):309-320.
3. Martinez, D. (December 18, 2020)/ Cannabis and Cannabinoids: Weighing the benefits and the risks in psychiatric patients. Medscape.
4. Johnston L, O’Malley P, Miech R, Bachman J, Schulenberg J. Monitoring the Future National Survey Results on Drug Use: 1975-2015: Overview: Key Findings on Adolescent Drug Use.Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2015.
5. Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry.2015;72(12):1235-1242. doi:10.1001/jamapsychiatry.2015.1858.
     

The last time I did a live call-in radio show on the topic of in-laws, the phones rang off the hook. Not everyone has the blessing of good in-laws. But like it or not, the in-laws are part of your life. So having a good relationship with them is vital. After all, these are the people responsible for raising the person you married and important to your spouse. And if you have children, in-laws play a role in instilling values in your children.

Handling in-laws can be tricky for most every couple. Let’s face it, as the in-law, you are an outsider to a family system that already has established rules and dynamics. But to be fair, your spouse has the same challenge with your family. So, working out how to navigate in-law relationships is important to the health of your marriage.

The most common complaints for couples are that in-laws are overbearing, pushy, and don’t respect boundaries. Disrespect is mentioned as well. Intrusiveness and meddling in-laws may have trouble letting go of their parenting role, and the adult child (your spouse) may have trouble establishing independence. In some cases, the other extreme is experienced. There is too much distance. This cut off creates a loss of support, relationship, a lack of caregiving, and limited family participation. Then, couples lose out on what could be an intimate and supportive relationship.

So here are a few tips to make getting long with the in-laws a more positive experience:

1. Identify family differences. Our culture and upbringing play a major role in how we do marriage. Early on, identify differences in the two families who come together in marriage. Each spouse, as a representative of his or her family, has expectations as to how things are supposed to go. Everything from how to deal with finances, stress, pressure, conflict, etc. is learned from the original family.  Most often, the two family systems have different expectations, values and ways of doing things. The bigger the differences, the more potential for conflict. Thus, couples need to identify their differences early on in their relationship. Here is an example: A couple in therapy was struggling with conflict. His expectation was that problems needed to be discussed. Her expectation was that problems needed to be avoided. Both were based on their family of origin upbringing. Until they identified this difference, they could not go forward with a solution as to how to handle conflict.
2. Establish ground rules. Don’t wait for a problem. Ahead of time talk about how you as a couple will handle extended family: For example, should your marital issues be private and not discussed with parents? How much time do you spend with in-laws? If there is a problem, will your spouse confront it?  Then, decide how you will handle times when those differences are front and center. One couple I worked with handled a difference this way. You may disagree with their strategy but in their opinion, this battle was not worth the fight: In her upbringing, the women did all the cooking and cleaning up at mealtimes. So, when they shared a meal with her parents, her husband stayed out of the way. However, when her parents weren’t around, her husband was part of the cooking and cleaning because his dad did this growing up. The couple wanted to be sensitive to the differences of values when in-laws visited. For them, it wasn’t a big deal. They were less concerned about their rights over a small difference that would potentially raise a lot of conflict knowing their families. Now, as a couple, you may not want to accommodate like this and feel strongly about establishing your own ground rules, but you need to decide together how you will handle differences. The point is, there are many ways to deal with differences. Just agree on how to handle each of them.
3. Develop code words and strategies ahead of time. My husband and I had a good relationship with each other’s parents. Even so, there were times when both sets of parents challenged us. When those times occurred, we had code words or certain glances that cued us to a strategy-one we discussed ahead of time.  We remained respectful, but we also knew when we needed to change the conversation, stay quiet or assert ourselves. The point is to know ahead of time what the hot buttons are and how you will handle them.
4. Don’t criticize your spouse’s relationship with his or her parents. If you do, your spouse will only become defensive even if he or she agrees! Instead of being critical, try to understand more about the family system and why people behave the way they do. Dig into their backgrounds and life experiences. More understanding usually tells you a lot about the issues you see and experience. Then, when the in-laws do something hurtful, tell your spouse what it was and how it impacted you. Once you have that conversation, decide if there needs to be action. If so, have your spouse approach his or her parents. You can do this together if you wish but make sure your spouse is in the room and takes the lead. Stay unified as a couple.
5. Spend time with your in-laws. There is no better way to really get to know someone then spending time with them. A lot of hurt can happen because people don’t know or understand each other. So, do activities together and ask what they enjoy. Make an effort to join them in fun things. In the end, you could discover areas of common ground. And you can build some good memories with your children. If things are especially difficult, choose an activity of fun that requires more doing and less talking.
6. Honor your parents and in-laws: This does not mean that you put up with disrespect or constant boundary violations. It also doesn’t mean you do things their way or bite your tongue all the time. Sometimes, honoring means a diplomatic NO or speaking the truth in love. Other times, it might means giving grace to a situation and letting go of offense. The key is how you speak to them and how you draw the line on difficult things. Stand your ground as a couple but do this in a way that keeps the relationship intact. If you need help with this, find a licensed marriage and family therapist (LMFT) trained in this type of interpersonal work. Remember, God will judge you for your response to others–was it loving, forgiving, respectful and honoring? We can’t control what others do, only our reactions.

Another couple I know is calling it quits after 27 years of marriage. The husband announced that he is done and wants to be happy. He’s not happy and believes he needs a different partner to accomplish his happiness.

The news wasn’t surprising in that this couple has struggled for years. The pandemic probably pushed their relationship to the breaking point, But it got me thinking, what does is take to make it through difficult times?

Here are 7 characteristics that help couples stay the course no matter what comes their way:

1. They provide safety in their relationship. Safety is the foundation of a every relationship that allows intimacy to grow. No matter what is raging around them, couples who create a safe space weather storms. This safety is created emotionally and spiritually. It is that feeling that your partner has your back, will listen to your concerns and accept you for who you are-flaws and all. You don’t worry about divorce or not measuring up because you have a deep trust with this person. Because of this, you can relax and let down your guard.
2. They manage their own emotions. In order to let down your guard, you need to know that your partner will manage his or her emotions. They won’t allow their anger to get out of control. Arguments will not lead to threats of divorce. And feelings will be self-regulated.  Then during difficult times, you can turn towards each other without fear or anxiety. This builds trust and safety.
3. They appreciate each other. Couples who have a regular pattern of  pointing out the good, build positive emotions. They appreciate each other and say so often. This frequent verbalization of positives creates a positive relationship. Then, when difficult times come, they don’t turn against each other and become a source of more stress. Rather, they see benefit in the relationship.
4. They take on conflict, but do so collaboratively. Couples who work together often have to sacrifice and compromise. It’s not all about them or ego-centered. They face problems together with the mindset of “we” not “I.” The goal during conflict is not to win, but to find the best outcome for the couple. Conflict is a normal part of the relationship but the focus is on collaborative problem-solving.
5. They put their relationship first. Priorities matter because they tell a person what is truly important. Couples who survive hard times, put their relationship above work, money and children. They know a strong martial bond impacts all other areas of their life. So they give their full  attention to the relationship. They check in with each other and stay attuned to their partners needs.
6. They share a vibrant spiritual life. A strong spiritual life is the anchor to make it through any storm. With shared faith and worldview, couples create the best chance of going the distance. Those who cultivate a spiritual life together, bring God into their every day affairs. They pray, study Scripture, worship and serve others together. This spiritual bond is not easily broken. And it provides amble room for forgiveness and grace.
7. They stay hopeful and know they will hit bumps now and then. Couples who weather storms like we have seen this pat year, stay hopeful. They know, “this too shall pass.” They bend but don’t break under pressure. And they don’t use escape and avoidance to deal with stress. They face problems head on and know they will get through the storm with God’s help. Problems will come, but when they do, there is a commitment to stay by each other’s side no matter what. The end result is a strengthening, not weakening of the relationship.

Depression is often described like being in a dark tunnel. It is a complicated disease affecting more women than men. While you may have heard that depression results from chemical imbalance, it’s not quite that simple. It involves faulty brain regulation that impacts mood, genetic vulnerability, stress and life events, medications and medical problems. In other words, a combination of many factors can lead to depression.

In my experience, people often fail to understand this complexity. For example, one of my patients was told by fellow believers that she was depressed because she lacked faith. Actually, her depression stemmed from cancer treatments and the side effects of the drugs. Another was questioned about demonic oppression. When in fact, this patient had a terrible and rare reaction to a new medication prescribed for a medical condition. Her reaction to the medication looked like someone with psychosis. Avoid a quick move to judgment when you have no full understanding of the person’s life.

That said, not all depression can be traced to biochemical causes either. I have treated depressed Christians whose spiritual and relational lives were not in order.  They opposed good counsel.  They had unrepentant hearts and character problems that needed repair. I think of the Biblical story of Naomi, a woman who suffered personal loss, felt God turned away from her and so turned away from Him. She asked to be called “Mara” (bitter).  Change came when she was reminded of the personal covenant God had with her.

For some, medication is not the answer. New choices, renewed thinking and coping can help. But for others, medication clearly makes a difference. Certain medications can be life saving or lift the darkness enough to work through other issues.

So how should we respond to those who suffer from clinical depression?  Here are 10 things you can do to help someone who might be depressed:

• Acknowledge the depression. Don’t avoid talking about it. You may feel uncomfortable and not know what to say.  Proverbs 12:25 says heaviness in the heart causes depression but a good word makes it glad (paraphrased).  Provide empathy and a listening ear.
• Get them help. Depression is a serious illness that can lead to suicide, especially if there is no treatment. So, refer them to a licensed Christian mental health provider who will address mind, body and spirit. Reassure the person that getting help does not mean failure. It is a step towards healing.
• Talk to the person about their spiritual life. The person may feel like God has abandoned them. Yet, we know, God is ever present. In the middle of difficulty, God doesn’t leave us even though it can feel that way. Also, provide hope. The Bible reassures us there are better things ahead–a plan and a future. However, be careful not to use Scriptures as platitudes. Rather use Scripture to encourage and provide hope for a better day. Pray for the person.
• Support someone who wants to try an antidepressant. It may be just what they need. And remember that many antidepressants take weeks to get at therapeutic dose and be effective.
• Encourage realistic expectations. God does heal, but healing can be progressive. Change may be gradual and not immediate. In the meantime, stay hopeful and try different treatments if need be.
• Provide unconditional love and support. Let the person know that being depressed won’t push you away.  You will pray and support their treatment. You will love and care for them even in dark times.
• Suggest a daily routine even though the person won’t feel like doing anything. Get out of bed, dress and go about the day regardless of how you feel.
• Suggest exercise and positive activities. The benefits are both physical and emotional. Exercise releases important brain chemicals that are mood enhancing. Invite them to a Bible study, dinner or to go for a walk.
• Listen. No one is asking you to be a therapist but people often need to process feelings.  We benefit from talking with a friend. Be a friend and listen.
• Most of all, let the person know they can get better. My mother-in-law used to say, “This too shall pass.” A reminder that in God’s kingdom there is always a way of escape can bring hope for a better day. This present darkness will one day give way to light.

What would happen if we made it more acceptable to talk about depression? After all, so many people struggle with depression in and out of the church. To encourage you to ask someone how they are doing, here is what happened at a Bible study I attended. One woman bravely stated that she needed prayer for depression.  A silence fell over the group. Five minutes passed and no one spoke or responded.  She glanced at the floor.  All I did was offer a word of support and encouragement.  To my surprise, three other women talked about their depression as well.  Others informed the group they were on medication.  Everyone breathed a huge sigh of relief and we got down to some serious prayer. Be ready.  Today may be your day to help encourage a friend in pain.

The pandemic has made the normal celebrations of Easter and Holy Week more challenging this year. During Palm Sunday, I worshipped on-line without my palm branch in hand. Instead, I had my coffee cup! The glorious music came through my computer screen. And while I am glad for the technology, it’s not the same electrically charged atmosphere of a church service, especially during this glorious week. Easter is the most important day of the Christian calendar. Yet the build up this year has been subdued by the pandemic.

Tonight we are immersed in Maundy Thursday. We won’t go to the church and have communion. It will be up to us to recreate this memorable night in our home. Hopefully, this will be the last year of limited gatherings. But as I talk to friends about Holy Week, I am surprised at the number of people who don’t know the significance of this day.

The word, “Maundy” is derived from the Latin word mandatum, meaning commandment. If refers to the commandments Jesus gave His disciples at the Last Supper, the night He was betrayed. He told them to love with humility by serving one another;  to remember His sacrifice through the breaking of bread and wine that was about to be received. It was their Passover meal. Jesus took bread and wine and blessed them. The bread He said represented His body given for us. We  share 21st century bread but we eat it remembering Him. He then took a cup of wine, blessed it and told His disciples that  it represented His blood, poured out for us. Do this also in remembrance  of  Him. This is why tonight, churches that can meet will have a Communion Service, remembering the Last Supper and Jesus’ commands.

For me, it is a night set aside to be reflective and commemorate the life of Christ, His crucifixion and glorious resurrection–to remember the incredible sacrifice our Savior made for us and be thankful. And it is a reminder to love as Christ loved. “Beloved, let us love one another. For love is from God, and whoever loves has been born of God and knows God. Anyone who does not love does not know God, because God is love.” (1 John 4:7-8). We could use a little more love in this world!

Tomorrow is even more solemn as we remember Good Friday. There was a purpose in all that suffering. Jesus, his mission and all it entailed; even so, he was obedient, all the way to his execution. Our sins were nailed to two rough planks of wood with him to cover the cost of our redemption. Without His sacrifice, we could not be justified to God. So he prepared. He prayed and walked out His purpose for our benefit.

So my friends, remember what Christ did for you this Maundy Thursday. Give thanks, love with humility and serve one another.