Ask the Expert: Saul Selby of Minnesota Adult and Teen Challenge

Saul Selby / Photo provided by Minnesota Adult & Teen Challenge

We feature an expert in the mental health and substance use disorder field to answer questions. This issue we talk to Saul Selby of Minnesota Adult and Teen Challenge about using cannabis in treatment.

Q: How did you get into the behavioral health field?

I received treatment for drug and alcohol addiction at the age of 27 at Hazelden in Center City. My recovery radically improved my life. AA’s Twelve Steps challenged me to seek a relationship with God and I asked God “What do you want me to do for a career?” I believe He said: “Help others find recovery.”  That led me to train as a counselor at Hazelden and I worked there for eighteen years. My last position at Hazelden was the Clinical Director of services at the Center City campus. Over the course of my career, I trained other professionals nationally, authored publications and videos, and twelve years ago started working at Minnesota Adult and Teen Challenge.

Q: Can you share a bit about your experience and work as Senior Vice President of Clinical Services at Minnesota Adult and Teen Challenge (MnTC)?

MnTC is a unique Christian program.  We offer residential addiction treatment services from one month to two years – depending on the needs of our clients. I was recruited to MnTC in 2012 to help improve our clinical services. Since then, we have integrated addiction medicine, withdrawal services, nursing, mental health counseling and psychiatric care at MnTC. These clinical best practices, layered on top of existing long term spiritual services, make MnTC very effective. We are regularly recognized by Newsweek as one of Minnesota’s best Treatment Programs. We have grown to twelve licensed residential programs, over 1000 beds, and we continue to grow. In 2024 we added four new residential facilities. Additionally, we provide robust outpatient addiction and mental health treatment. Our outpatient counseling and mental health program is called RockBridge. We recently opened a residential treatment program for working adults, also called RockBridge.

Q: You mention in your practice that there is an increase in the number of clients requesting to use medical cannabis in their treatment. Why do you think we are seeing this trend?

Medical cannabis and dispensaries are relatively new. Minnesota legalized medical marijuana in 2014 and launched sales in 2015. Over time clients have become increasingly familiar with how to access medical marijuana. Minnesota law makes it easy to have a medical professional substantiate a medical or mental health condition that is approved for cannabis treatment. Once approved clients have easy access to a variety of cannabis products in the dispensaries (vapes, edibles, leaf, concentrates etc.). These products are very powerful, and there are few restrictions on how much and how frequently clients can use them. Unlike a prescription for an antibiotic that you take for a short period of time and quit, approval gives the client extensive access to these very powerful mood-altering products with little oversight.

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Because our clients have a history of addiction, it’s understandable many of them desire legal access to an extremely addictive drug. Since the cannabis is designed to treat a medical condition, they presume it should be permitted in treatment. Consequently, more and more clients come to our program asking to use their medical marijuana while going through treatment.

Q: How are you handling requests for medical cannabis/marijuana in treatment? What alternative approaches are you considering or implementing?

While MnTC assesses each applicant separately, we discourage the use of medical marijuana in our programs. Most of our clients who apply to MnTC with medical marijuana are being treated for PTSD. Since there are numerous non-addictive clinical interventions for PTSD, we view the use of cannabis as contra-indicated for a client with a destructive history of substance dependence. Theoretically MnTC could allow a client to use medical marijuana for medical conditions if that was the only reasonable medical intervention and its administration did not adversely affect other clients.

Q: What are you observing in the field regarding the use of medical cannabis and its role in treatment for substance use and mental health disorders? What are the potential side effects of administering medical cannabis to individuals in recovery?

I am not intimately familiar with the practice of different treatment programs. However, my impression is that some welcome medical marijuana, some tolerate it, and some discourage it.

As medical marijuana becomes increasingly acceptable within the treatment industry, I believe it creates major obstacles for clients. It provides permission to use a very powerful and destructive drug by “professionals” – nurturing denial and restricting access to meaningful recovery.

Medical marijuana allegedly helps treat mental health conditions, but research suggests it increases anxiety, depression, and psychosis not to mention it diminishes cognitive function that is essential to recovery. Here is a list of significant problems associated with the use of medical marijuana in substance dependence treatment:

  • Regular cannabis use lowers IQ by about eight points. Persistent cannabis users show neuropsychological decline from childhood to midlifeProc Natl Acad Sci USA 2012: E-pub 2012 Aug 27.
  • Lower cognitive function will prevent clients from learning key recovery concepts reducing the likelihood of recovery.
  • Regular cannabis use is associated with mental health problems including, psychosis, increased anxiety increased depression and bi-polar symptoms. What You Need To Know About Marijuana and Mental HealthPsychology Today 8/17/23.
  • Due to cognitive impairment, mental health clinical interventions are often ineffective. What You Need To Know About Marijuana and Mental HealthPsychology Today 8/17/23.
  • Treatment programs that lean on a therapeutic community culture are devastated by clients being permitted to use cannabis within that community.
  • Brain SPECT scans of regular marijuana users clearly illustrate reduced blood flow to the brain adversely impacting cognition, mood, and emotional regulation. The ABCs of CBD, THC, Medical Marijuana, and More – Amen Clinic September 2021.

Q: There are various professional groups that do not support the use of medical cannabis. Do you agree with their position?

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It’s interesting to note that while medical marijuana is legal in MN, major professionals and medical associations discourage its use in general, and particularly with vulnerable populations like recovering addicts. Here is a list of groups that are concerned:

  • The American Psychiatric Association
  • The American Medical Association
  • National Institute of Drug Abuse
  • The Federal Drug Administration
  • The American Society of Addiction Medicine
  • National Association of Alcohol and Drug Abuse Counselors

Most people recognize that there may be potential benefits to medical marijuana. Cannabis plants have a variety of drugs that need to be better researched to understand their safe and therapeutic use. However, in my opinion, medical tetrahydrocannabinol  (THC) is rarely indicated for clients with a history of substance abuse. There may be medical benefits of cannabis, but there is far too little research to support the way it is being administered now. We have a lot to learn, but I think we already know that THC is not a great treatment option for individuals with substance dependence.

Q: Do you have any additional insights or resources that people can refer to in order to learn more about medical cannabis and its use in treatment and recovery?

Addiction is devastating to individuals, family members and our society. However, treatment and recovery can be life-changing events that can transform individual lives and families. Medical marijuana in treatment creates major barriers to individual recovery and the recovery culture critical to success. I hope and pray that professionals and recovering individuals recognize that whatever minor benefits medical marijuana provide, it is significantly outweighed by the immense harm it creates for those whose lives have been destroyed by addiction.


Saul Selby MA LADC has been working in the addiction and mental health field for over 40 years.  Previously the Clinical Director at Hazelden Betty Ford, he is currently the Senior Vice President of Clinical Services at Minnesota Adult and Teen Challenge. Saul is a national speaker and author, and he has developed products utilized for addiction treatment. His publications include A Look at Cross Addiction, Chemical Dependency and Acceptable Disease, and Twelve Step Christianity. Saul is the creator of the puppet Slick, “The Voice of Addiction.” utilized in recovery videos for addiction treatment and referenced twice on CBS 60 minutes. Slick videos are available free on YouTube.

Last Updated on January 13, 2025

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