The Marijuana Risk for Teens, with Dr. Larry Walker
The cultural environment around marijuana is changing rapidly, and there is much that parents and students may not understand about the effects of cannabis on young people’s brains and their mental health.
In this episode of The Mayo Lab podcast, Dr. Larry Walker and David talk about the importance of understanding that, as David puts it, this is not your parents’ or grandparents’ mild marijuana. Marijuana is exponentially more powerful—and often more dangerous and, in fact, addictive—now than it was in recent decades.
“I really think we need to sound this alarm more broadly in schools … The perception that it’s safe and been approved for medical purposes makes (teens) feel like there are no consequences to it … We know enough that drugs of abuse in young people change the way their brains develop.”
- Dr. Larry Walker
Dr. Larry Walker is the interim director of the National Center for Cannabis Research and Education (NCCRE) at the School of Pharmacy at the University of Mississippi and director emeritus of the National Center for Natural Products Research at the University.
Larry earned his B.A. in Biology at Oglethorpe University, his BS in Pharmacy at Mercer University, and his Ph.D. in Pharmacology at Vanderbilt University.
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David Magee: I am David Magee, and this is The Mayo Podcast. Welcome to The Mayo Podcast. Thanks for joining us once again, and as always, a welcome to Alexis Lee.
Alexis Lee: Hello.
Magee: Hey, Alexis. I think this is one of my favorite subjects and I'll tell you why. Because as I speak in schools around the country over the past year or two, when I start talking about how marijuana has changed, it's not your grandmother's marijuana, it's not your parents' marijuana even, students really begin to perk up because their lives have been so impacted by it. We dig in on that conversation today.
Lee: We do. One of our very own at the University of Mississippi Medical Center, Dr. Larry Walker, who's the Interim Director of the National Center for Cannabis Research and Education and is Director Emeritus of the National Center for Natural Products Research at the University of Mississippi, which means David, he spent most of his career in the cannabis area and researching about this stuff.
Magee: He is an expert like no other. I'm telling you, for every single parent listening today, you need to go tell 10 others about this episode because so much has changed. Look, the marijuana conversation is a complicated one. The only thing to do... We know there's a lot of medical benefits, but for young developing minds there are a lot of challenges. The only thing to do is dig in deep with an expert and that's where we're going right now. Dr. Larry Walker, welcome to The Mayo Podcast.
Dr. Larry Walker: Thank you so much, David. It's good to see you again.
Magee: Always good to see you. I like a lot of things about you, but what really fascinates me in this moment, the most that I think will interest so many parents and educators and others, is I consider you really a foremost expert in cannabis. You have years of research that has related around natural products including marijuana. Here we are in an era of where we have legality of medical marijuana and just straight up legal in the same way, say, alcohol would be in so many states. It's just a changing environment and really students I think are such at a critical juncture because there's so much information I think that they don't know. What I always say is most ivory drug that comes to the marketplace legally came for good reason in some medical proven benefits, right?
Dr. Walker: Yes.
Magee: I think marijuana clearly has some, but I think there is also so many facts that young people don't know that get lost in the message of perhaps impact on the brain. Tell us first a little bit about how you came to get involved in marijuana research.
Dr. Walker: All right. Thank you, David. Yeah. I went to pharmacy school way back in the ancient era. I really loved pharmacy school. When I finished I was encouraged by some really great professors that I had to go to graduate school. I did that and launched a research career, I guess you would say in pharmacology, which is a study of drugs and how they work. After I finished my graduate work in a short stint, doing some post-doctoral things, I came to Ole Miss. Just by virtue of the environment at Ole Miss, began to develop interest in natural products. They had a lot of research programs there with an emphasis on natural products. At first, it was more how to understand these plant-derived drugs, and how they work, and can we find new ways they work or new compounds there and understand how they work. At first, it was not primarily a cannabis focus, but they had a big marijuana program there. Gradually, over the years, I began to get involved with those researchers.
After many years, I became administrator of the National Center for National Products Research at Ole Miss, which houses that marijuana program. At that time, although I wasn't directly involved in the research, I was following closely what others were doing, and all of the policy, and regulatory, and public, what would you say, media hype that has exploded about cannabis over the years. I've been observing all of that and trying to align that against what we know, research-wise, what we know about potential benefits, potential harms. As you said, there's a wealth of information out there, some of it good, some of it bad. A lot of our young people don't pick up on some of the things probably they should hear about, at least in my assessment. They hear a lot from sources maybe that are not so reliable.
Magee: I think even for parents, it's a bit confusing because in this march to legality, often when I speak in schools, I had a student tap me not too long ago, they said, "I like that. You're not telling me don't do this." I say, "That's your choice, what you do." But I say, "Let's not get confused in a march to legality for young minds." I tell a young people like, "Okay. Well, alcohol is legal, but if I drank a fifth a day, how functional do you think I would be?"
Dr. Walker: Exactly.
Magee: One thing that's really interesting, Larry, that has struck me because the University of Mississippi has been a leader in cannabis research, what I understand is that data has been collected over the years in testing of potency of street marijuana, THC, and that there is an arc that shows that it is much stronger today than, say, it was back in 1995.
Dr. Walker: Yes, absolutely. That's one of the slides I do have if we want to look at that, and I can try to share that. But the idea really is that we have, since the early 90s when we've been tracking it, the potency running from three or 4% up now approaching 20%. That's average potency. That means you have a lot of samples that are much, much higher than that. We've got almost a tenfold increase in the potency of marijuana, not to mention other changes that may be going on as we're breeding the plants and selecting them. Other things are changing as well. It's not just THC.
Magee: Yeah, that's so interesting.
Dr. Walker: Sorry, let me add one thing to that, David. Reaching on back, we know that going back in the 70s, for example, that this was before they began to breed cannabis to high potency. Probably, it was running 2% for wild cannabis. That was back in the days of the marijuana craze, and the Cheech & Chong, and so forth. In those days, that was potent marijuana, but it's nothing compared to what we have now.
Magee: Parents, I tell a lot of them, "This isn't your marijuana." When I speak in schools, and for some reason, I don't know if studies bear this out, but anecdotally, Larry, when I speak in schools, let's say I speak to a student body of 1,000 students and I talk about this, I say, "Hey, folks. What you got to understand is this isn't your grandmother's marijuana. It's not even your mother and father's marijuana. It's going to have a different impact on you because it's so potent." What I find often after I give that talk is if students are lining up to talk to me, often it's male students.
Seems to be more male students, anecdotally, that are impacted by what I would term as... Who are coming up to me and saying, "Wow, I feel so much better now that you've said that, because I thought something was wrong with me. I thought marijuana was not addictive. I thought it was mild, and it's ruined my life. I can't get off of it. I keep saying I'll quit. I don't." Two question, well, really one question. Is there is any evidence that young males or males are maybe a little more predisposed to marijuana addiction?
Dr. Walker: I think that's right, David. I don't have statistics about that, but certainly that's the impression I get when I'm speaking. When I talk with people who are working in the addiction field, I think the problems are much more common with young males. I don't know the reasons for that. I don't know if there's a genetic, some type of metabolism basis, but it definitely seems to be a bit more prevalent in males.
Magee: I'm certainly hearing that in schools. I also was at a school just recently. I'm talking to a nurse practitioner after I've given a talk, and to just emphasize your point about this stronger THC, the nurse practitioner says, "We drug test in our school and we have for years." I've been here for years. I think she said some 15 years. She said, "Just recently, in the past year or two, something strange happened where our test our... When we're testing, have a student testing positive from marijuana, the results came back so high suddenly that we contacted the maker of the drug test and we told them their test was broken, because we'd never seen anything like it." We are not even at the end of that tail where it's getting stronger every day. Also, Larry, how that marijuana is used, as you mentioned, we'll go back to this phrase, back in the tea Cheech & Chong days, it was primarily smoked, I think. Now, however, there's so many other means where they're extracting more potency even from that stronger marijuana.
Dr. Walker: Yes, absolutely. A lot of the dealers and experimenters have gotten very creative with ways to concentrate THC. For example, in the plant material, you might have getting up to 30% THC, which is exceedingly potent plant material. But often. They will distill this, extract it, process it so that you may have an oil that's 90 plus percent THC or 95% THC, so that just a toothpick dipped in, it gives you a pretty whopping dose, a pretty hefty dose of THC.
Lee: Wow.
Dr. Walker: Often, they're finding ways, "Okay, how do we deliver that concentrate by inhalation? How do we vaporize it, somehow volatilize it so we can inhale it quickly?" By that route, you get a very rapid distribution to the brain. People who want to abuse it, who want to use it for that reason, can get a quick buzz from that. Very importantly, a naive person who doesn't know what he's doing tries to take it that way. He may have very bad reactions to it because he's not accustomed to that.
Lee: Dr. Walker, let me ask you this. We're here to educate people. In the space of mental health, how does using cannabis marijuana affect different age ranges in their mental health-wise? Is there studies that show that affects teens more than adults, or in what's the risks of mental health in this space?
Dr. Walker: Yeah, absolutely. Very important point in the rush that we have to legalization, medical or otherwise. Most states have tried to limit exposure to young people and with good reason because teenagers, adolescents, maybe even into early 20s, experts debate about this. When does the brain actually mature? But definitely, young people are much more susceptible to following addiction and mental health problems after chronic marijuana use. This has actually been well studied. Many, many different studies around the world. It's very well known, and it's true for almost any kind of addictive drug that you start early, you really set a pattern that can be devastating.
Magee: You said a word there, addicted. I literally almost fell out of my chair not too long ago when a physician friend of mine, a fantastic doctor, a fantastic enlightened person, told me that marijuana is not addictive. I think, culturally, that's part of where we are. Again, it's not about legal or not legal. I tell everybody. When I'm in schools, talking to parents, whatever, I say, "I'm completely for legal or not legal. Whatever the research shows is the healthiest and the best way to go. That's what I'm for." Alcohol is legal, but it doesn't change this fact of that, when misused, there can be health benefits. It doesn't change the fact that it can, particularly, for some people, be addictive.
Dr. Walker: Yes, absolutely. Any of your addiction clinics nowadays that are seeing patients, they'll verify this. There may be some differences in the propensity of populations to become addicted, but particularly in young people, that percentage is quite high, that they're susceptible to this. It maybe doesn't have the dramatic withdrawal that a full-blown heroin or crack addict might have, but you still have serious withdrawal symptoms. You still have this inability on the part of the people who get to that point, inability to shake that without some professional help.
Magee: My son, William, who, it's well-known, died of an accidental drug overdose not long after college graduation, when he began using marijuana in high school, middle school, and high school. I tried to just talk him out of it, and I tried to punish him out of it, and it didn't really work. He would just kind of come back to me with a line, "This is what everybody's doing." But it's interesting that when he passed away, he'd been in treatment for many months and finding some success, and he kept a journal. In that journal he wrote about how he had learned that a marijuana was addictive. It was even more, I think, than what you're talking about.
It may, for some, not have the physical withdrawals. But for him, he emotionally wrote about not being able to separate it from him. Because for him, it had become a ritual that he began when he woke up, he continued midday, and he didn't know how to go to sleep without it. To be honest, that's what I encounter with a lot of young students I talk to in middle schools, and high schools, and colleges, and universities. It becomes this daily part of their life that they feel is harmless, but that harmless thing kind of grows to where, over time, it takes them over.
Dr. Walker: Yeah. Can't escape it. Yes.
Magee: Hi, I'm David Magee. Now, more than ever before, parents need better information about the challenges facing their children, what sorts of issues to expect and when, and the warning signs to look for. From anxiety and depression to addiction, eating disorder and loneliness, students and their families are facing a mental health and substance misuse epidemic that requires new guidance. My new book, Things Have Changed: What Every Parent (and Educator) Should Know About the Student Mental Health and Substance Misuse Crisis, offers a clear roadmap for helping students find the joy they want and deserve. Head over to themayolab.com to sign up for our newsletter and find a link to pre-order my new book. Everyone who signs up for our newsletter and pre-orders a copy of Things Have Changed will receive a digital copy of my expanded student toolbox. Visit themayolab.com today.
Lee: You are listening to The Mayo Podcast with David Magee. Now, back to the episode.
Magee: What is a high dose of cannabis? I mean, I understand it's probably different for different people. I mean, what are some of the things that it does to a mind, particularly a developing brain? I mean, what happens when that THC hits that brain? What are some of the results?
Dr. Walker: All right. Well, so often this depends on the user, whether they're experienced or not, the route that they're taking it in, the dose that they're taking. Let me talk about those a little bit separate buckets, if you will. Number one, when an experienced user smokes even a low potency marijuana cigarette, 2%, if they smoke that cigarette like we did back in the day, not me, but my generation did-
Magee: Yeah. I get it.
Dr. Walker: ... if he or she smokes that cigarette in that fashion, within 15 to 30 seconds, they'll feel a buzz. Now, this is with low potency, mind you. They'll feel a buzz, and typically, they will titrate that buzz. A little bit of a euphoria, a little bit of a chill, a little bit of maybe relaxation in their minds, maybe stress relief in their minds. They'll titrate that cigarette to keep that buzz for several minutes, and then it'll persist for an hour or so. It gradually come back down. With the high potency cigarettes, experienced users will typically take just a little puff, and they may pass it around. Now, you're getting maybe 5, 6, 8 times, 10 times more THC in a puff. They do it much more controlled, but the endpoint is the same. They try to get a little buzz, sustain it for a while, and then it will gradually come back down.
If you took that same amount of THC orally, you won't feel anything for maybe an hour. In fact, you might not feel anything with that amount of THC, but if you took 10 times more, you still might not feel anything for an hour. But after an hour, it begins to hit your system much more gradually, much more subtly, you might say. The danger is, with that route, that a young person inexperienced might say, "Well, I didn't feel anything with that. Let me take two more." Then an hour or two later, now they're really stoned or they really are beginning to feel the impacts. Typically, chronic marijuana users don't like to take it orally because they don't feel that immediate buzz, that immediate gratification, immediate high that comes with smoking or inhalation. But even given orally, THC is a really potent drug. Let's think about the prescription drug that's on the market, THC, which cancer patients can get from their doctor when they're doing chemo.
They might take a five milligram capsule four times a day, so 20 milligrams a day. If they go above that, they'll have a lot of side effects, a lot of dizziness, maybe stumbling, maybe a fall, maybe a fall risk. You'll begin to feel side effects. Well so, a lot of times, if you go out and buy a brownie out in the "medical marijuana market", you've got 40, 50 milligrams of THC in there. You've got a high dose of THC compared to what's there in the medical prescription marketplace. Whenever people talk about, "Oh, it does this," or, "It doesn't do that," when our medical marijuana folks we're coming, legalization folks were trying to visit with us and talk about the need for this, we just asked a simple question, "What dose? What route of administration?" But they hadn't really thought about that. They just, well, just marijuana. But it's quite different depending on how you use it, in what form, what dose, what purity, how has it been prepared. There are many complexities about this.
Magee: That's why in many states, so far, the research, it's early. It's early in the process. But some of the research I've seen so far suggests that in states where there's some legalization, street marijuana is still predominant. I think you just spoke to, we can just quickly assume why, there's a difference probably in potency that's substantial. I talked to a young man a couple of weeks ago. He said, "I don't like marijuana. I'm tired of it. It's been in my life too long. I've gone up as potent as I can get it. When I use it, now all I'm getting is a little tingly. It's not even doing the same thing that it once did, but I don't know how to stop." But the potency, it keeps going up. But for some users, that have been in it years and years, they're still hitting their wall.
Dr. Walker: That's exactly right. It varies from one person to another where that wall is, and that probably has to do with the biology that's associated with the response to cannabis. That may vary in some people depending on genetics, or other drugs they're taking, or other conditions they may have.
Magee: When we talk about medical marijuana, there are some proven benefits for some people. It may be like, say, a late stage cancer patient might get some help with nausea. I think that's one perhaps. I mean, what are some bonafide medical benefits that people might find in medical marijuana?
Dr. Walker: Well, so on the prescription drug front, what has been approved so far, or for chemotherapy-induced nausea and vomiting, for wasting syndrome in patients with AIDS, so it stimulates your appetite. That's a legitimate approved medical use. In other countries around the world, there are THC products approved for multiple sclerosis to help improve, relieve spasticity and pain with multiple sclerosis. There are a number of potentially legitimate medical uses, but in most of the other cases, we don't have this worked out about what doses does it take, how does it work with other drugs the patient might be on. In the medical marijuana world, you have a completely different ballgame, because typically, states will approve maybe 50 or more different uses, or maybe used for anything you want to use it for. I firmly believe that there are, one day, we'll have legitimate ways to use cannabis-derived drugs for some of those conditions, not all of them.
In the herbal medicine world, a lot of people, they'll have their favorite herbal product, and it's good for everything. It's good. It cures this, and it helps that. Well, drugs don't work like that. They're not good for everything, and marijuana's not good for everything, but there are probably some legitimate uses. We just need to understand, what are we doing in medical marijuana programs? Do we have good medical or health professional oversight? Do we know what we're dosing? Do we know what we're giving the patients? Are we monitoring the outcomes? Are we monitoring if this is improving, or if there are side effects, or abuse problems, or addiction problems? Are we monitoring those?
Well, in most cases, the answer is no. It's a business, and medical marijuana programs are set up for cannabis companies to make money. A lot of times, the medical oversight is fairly limited. It is there, but it's fairly limited, and the range of products is very wide and very variable. Some states have better programs than others. I will say that in the Mississippi program, one strength that they do have is that they do require really rigorous testing so that you have to label what's there, and you have to have an independent verification that that's what's there. That is a plus, but there's still very little guidance about dosing and management of patients with this condition or that condition.
One of the things we're trying to do is see if we can set up a program to voluntarily have patients allow outcomes to be monitored so we can understand, "Did you get improvement with what preparation, with what dose? Did you have some side effects, some problem? What was it that caused that?" If we can match that to the label and know what they were taking, maybe we can begin to sort out some of these benefits and risks. But for most programs, medical marijuana programs, it's really hard to do that. For ours, it's hard to do it, but we're hoping to get some info on it.
Lee: Wow. Dr. Walker, I know there's a study in the slides that you sent about marijuana dependence and the disorders that come with that. Can you talk about specific disorders and what that looks like versus the general population?
Dr. Walker: Yeah. A number of studies have shown now that especially with teens who are chronic marijuana users, that the incidence of all kinds of mental health and mood disorders are exaggerated. Two, threefold, maybe sometimes more. These may range from depression, addiction problems, aggression, other types of mood disorders. There's even good evidence now that marijuana use is associated with schizophrenia. The frequency of schizophrenia is much higher with chronic use. This has been debated a lot, whether that's causal or whether it goes along somehow with the propensity to use marijuana. But some recent studies are suggesting that it may actually, with early users, early chronic users, it may actually exaggerate problems with schizophrenia down the road.
I'm not a mental health expert in any fashion, but these studies have come from well-run, well-designed studies from the different institutes with the federal government and other countries around the world. One interesting study in New Zealand has been going on for 50 years, I guess, where they are just monitoring multiple lifestyle issues, including marijuana and alcohol use, but monitoring it from childhood in a huge number of, well, adults now, but when they started, they were children or adolescents. Just monitoring how did they progress in their social life, in their education, in their economic progress, in their mental health. How did they progress if they were heavy marijuana users versus not?
It's really quite striking that the heavy users, especially if they started young, they make less money. They have more family problems, they have more addiction problems, they have more societal adjustment problems, the all kinds of things that are difficult to quantify if you don't have a study. I mean, you wouldn't pick it up in one or two people that you might know, but if you quantify this, measure this over a period of time in large numbers of people, you can see these things. Even IQ tests, the ones that were users performed worse on IQ tests. This is very intriguing studies and alarming studies, I think, that particularly point us toward caution with young people.
Magee: Right, exactly. What you just talked about, and he's not going to mind me sharing this, but I have the anecdotal study of that New Zealand one. My son Hudson, who's now more than a decade sober, he allows me to share his story. He began using marijuana regularly in late in middle school and continued through high school on a habitual basis. It's interesting that when he decided to stop in college, two things happened. One, we began to get to know him in a way we never knew him before. We used to joke that he matured in dog years before our eyes because maybe that maturation processes put on hold in emotional and development in some ways, and then particularly around money. He wasn't good with money before. Now he's great with it. Almost overnight, he became great with it.
He was hungrier to make it, he held onto it, and managed it better. I've seen that anecdotal study and I've actually heard him counsel other student, young people about that because he experienced it. Also, I've seen it, real time. But also, Larry, it's interesting when you talk about there are some medical benefits, but there's just a lot of misinformation. For example, one is, and I encounter this with a lot of parents, and they'll say to me, "I don't like it that my teen is habitually using marijuana, but they suffer from anxiety and I know it's good for anxiety, so I just look the other way instead of going to get them treatment." However, I've seen studies that show that for some people, depending on personality type and depending on the strain of cannabis they're using, that for probably 50% of the people, it not only doesn't reduce their anxiety, it may exacerbate it greatly. A, have you heard that? And B, if that's true, what do we do to get that word to parents?
Dr. Walker: Yeah, it's absolutely true. I don't know what the numbers are, but there are a lot of people that have, when they first exposed to cannabis, they may have actually an anxiety reaction that is... Their reaction is negative. They say, "I don't like it." A lot of people, you may have heard people like this, "I don't like marijuana," because they had that kind of anxiogenic reaction when they first smoked it. It could have been dose, it could have been their genetics. There may be other factors, but it's definitely true. Actually, the data on THC for treating anxiety is not very good. It's better for some other things than it is for treating anxiety. However, there are many who swear by it that that's their go-to Valium, I guess, you might say.
Magee: If you had a room full of parents you were speaking to, in essence, we do on The Mayo Podcast, and some parent raises their hand and go, "I don't really know what to do." But for a teenager, would you recommend, knowing what you know, Larry, if I'm a parent and I'm asking you for advice, is it okay for my teen to use marijuana or not? Not that I have full control, but I might get them into counseling more quickly or maybe even treatment if I really understood. Is marijuana for a young person something you would recommend, or no?
Dr. Walker: Absolutely not. In fact, I really think we need to sound this alarm more broadly in schools. I know you can't always stop what teenagers are going to do, but they don't need the message coming from adults that, "Oh, this is going to be okay." I don't know if I shared this story with you before, but in Colorado, when they first legalized medical marijuana, it was on a doctor to patient basis. In other words, the doctor would say, "I want you to use this strength or whatever, and go to this clinic and you can get it." It was just a doctor patient thing, and they left alone the public marketing, you might say. It did pretty well. It was actually a well-received program, I think, without a lot of negative impact, at least that was easily observed.
But then they went to opening the dispensary, so you could go and buy what you wanted to on every corner. Well, then the problems in the schools begin to rise and the ER admissions begin to rise with young people, because the perception is, "Well, it's legal. It's there on the corner. I can buy it easier than I can buy alcohol. It must be okay. What's the harm?" My point is, that was long-winded, but my point is that perception drives young people, drives usage up in young people. The perception that, "It's safe, it can't be that bad. It's been approved for medical purposes. I got a card," it makes them feel like that there are no consequences to it. In our public campaigns, we don't need to lie. We don't need to over dramatize about the dangers, but we need to educate, parents, teachers, our organizations that are promoting health and wellness. We need to advertise it, I think.
That I'm not recommending it for anyone, but especially for young people, there are dangers that we may be... Actually, again, I don't want to overhype this, but in some animal studies, you treat young animals with cannabis, with THC, you permanently change their brain. I mean, permanently. It will not recover. Now, a lot of times, those are high doses and we don't know exactly how to translate this into humans, but I think there's enough of signal there. Excuse me. We enough that drugs of abuse in young people change the way your brain develops. This is just too risky for us to play with for some modest potential medical benefit in young people, or just for, "All my friends are doing it."
Magee: That's great stuff. Dr. Larry Walker, thank you for joining us on The Mayo Podcast. Such important information about a topic that, I think, most every family of young people will face, either with their children or their friends, at one time or another. Just wonderful information, and I appreciate you joining us so much.
Dr. Walker: Thank you, David, and thank you all for all your work. Very commendable and much needed.
Magee: Thank you. Thank you so much.
Lee: Thank you for joining us on this episode of The Mayo Podcast. The Mayo Podcast is produced by Dr. Natasha Jeter, Dr. Meagan Rosenthal, David Magee, Alexis Lee, and Slade Lewis. This podcast was recorded at Broadcast Studio in Oxford, Miss. The show was mixed and mastered by Clay Jones, and our original music was composed by Slade Lewis. The Mayo Podcast is brought to you by The William McGee Institute for Student Wellbeing. For more information on The Mayo, head over to thenayolab.com, and follow us on social media, @themayolab. If you enjoyed listening to The Mayo Podcast with David Magee, we need your help. Tell others about it. We'd love for you to subscribe, rate, and give us a review on iTunes, Spotify, or wherever you are listening to this podcast. This podcast represents the opinions of David Magee and guests of the show. This podcast is not intended to be a substitute for the medical advice of a licensed counselor or a physician. The listener should consult with their mental health professional in any matters relating to his or her health, or the health of a child.