I find it truly bizarre that in the article and in the discussion there is NO mention of marijuana. A large portion of the young adult population is experimenting or using marijuana. What would a review the literature show on outcomes of first episode psychoses in marijuana using patients who are given a truly supportive environment, real help in being marijuana/substance free ( like mandatory rehab . aimed at eliminating pot long term? (since active psychosis would sort of impair the young person’s ability to recognize that pot may be the root of his psychosis, more than addiction may alone would cloud one’s thinking).) Is it because it is impossible to keep marijuana away from these young adults that we just throw up our hands.. ‘can’t be done.. I won’t address it..I’ll just keep doing talk therapy/ motivational interviewing’ while the kid keeps dumping more and more marijuana on his brain? I find this extremely troubling.. VT is in a mental health crisis. We realize that antipsychotics have major problems and are at least sometimes not helpful/harmful. We also all know that there are now literally hundreds of studies contributing to the literature and creating a consensus that marijuana can cause and worsen psychosis.. WHY is not there a truly drug, marijuana, free area in northern Vermont for these young adults? Do they deserve what so many of us were given, took for granted? Why isn’t there even one truly drug free high school? What would their recovery rate be then? And why is n’t this even discussed? In Minneapolis I understand the state supports at least one truly drug free high school.. it is not an entirely unheard of concept. What would outcomes look like if the VT education department and Vermont Mental Health Department were truly serious about providing at least one drug/pot free environment for these vulnerable folks? Isn’t it at least conceivable that this is a disability which requires that the state address it? If your kid has an allergy to nuts the school must provide a nut free environment. On a public health and systems level if just the Vermont Department of Mental Health and mental health providers were to publicly recognize the value of establishing a truly pot free high school (and university for that matter) wouldn’t this loud public recognition alone send a message to the state and Vermonters, who are now quite confused about the role of marijuana in mental illness? If mental health providers were to lobby for the establishment of just one truly marijuana free high school ( not in name only) would this send the state and Vermonters a message? (Even if the idea is hopeless because there is no money for it? ).. The mere public acknowledgement by leaders in psychiatry and mental health providers of the value, for prevention and treatment of mental illness, of a real marijuana rehab, paid by BCBS and VT Health Connect, and a real marijuana free high school, would carry a lot of weight and would be helpful in educating and in sending a new clear message to lay Vermonters about the reality and danger of marijuana in causing psychosis, contributing to suicide and severe mental illness. I wonder what effect a real enforcement program of this type ( with pee tests) would have on our Church Street homeless psychotic individuals and on the associated violence issues? .. I hear the protest that it would be too difficult and too expensive.. but what if it were actually cost effective.. ? what is happening now is pretty expensive for Burlington. Many psychotic people can not grasp that they need to stop smoking pot long enough to recover. Our environment in Vermont sabotages them before they even start. In this case, almost by definition, withdrawing their marijuana must be very often involuntary? Motivational interviewing (and dialogue) in the face of cheap available pot and a blossoming addiction must be pretty tough to conduct. I wonder if there is data that motivational interviewing works on actively psychotic patients with active developing marijuana dependence? I wonder how many psychologists recognize marijuana as an addictive drug, a treatable addiction? Does BCBSVT insurance and medicaid approve payment for this treatment now? Do we need a systems, societal solution to this problem… or is each isolated family left to treat marijuana addiction alone in an out patient near vacuum as pathetically as they can in a sea of cheap, cool pot? The addiction unrecognized really as a disease by most people, the treatment unpaid for by the insurance companies who gladly pay for unbelievably expensive antipsychotics, and marijuana generally unrecognized by families and friends, even some therapists, as a significant cause of severe mental illness made more expensive to treat by continuing to use..not recognizing on a societal level at all that the main solution may be removing pot…. A solution which it is nearly impossible to implement in the midst of a statewide race to more, cheap, available, and more socially acceptable marijuana.. driven by a powerful corporate, profit hungry, predatory, and destructive industry.