I’ve been curious to see how inpatient rehabs will respond to people who arrive in treatment expecting to continue smoking pot. So far, the examples I’ve seen have involved patients using medical marijuana for chronic pain or PTSD. Now, with legalization in some states, a whole other group is seeking the same privilege for recreational use.

Inpatient rehabs are a closed system where it doesn’t take much for certain behaviors to spread like a virus. Drug use, of course, but also sexual contact, and even in some cases, violence. If one or two members exhibit such ‘viral’ behaviors, others tend to follow.

Often this occurs in secret because nobody wants to ‘snitch’ on their peers. They expect staff to detect and fix the problem without help. If that doesn’t happen, the usual result is a rash of incidents, including folks signing out against advice.

Most programs seek to prevent this cycle by discharging patients for noncompliance. But clinical staff may argue against that. One psychiatrist insisted that it was unethical to discharge someone for smuggling drugs onto the unit. “Why eject the poor fellow for exhibiting the very behavior that characterizes his illness?” ran the argument.

The counter-argument: drug use in the program undermines the recovery of other patients who are seeking help for the same disorder. And that does seem to occur. People leave prematurely, sometimes in droves. Most will return to drugs within a short while. Exactly who does that benefit?

By the way, the notion that we can clearly distinguish recreational from medicinal pot use is naive. As one NFL player stated: “for (us, meaning athletes), it’s exactly the same thing.” I’ve never had much success explaining to a patient in the first 30 days of recovery that when Bobby smokes dope, it’s medicine, but when Liz lights up, it’s drug abuse.

You get a lot of blank looks.

It’s in the nature and psychology of addiction for certain activities to trigger craving and compulsion —  one example being drug use by others. In the rehab pressure cooker, it quickly becomes a tempest in the teapot.

And nobody gets much work done.