The Great Migration ended in 1970 as manufacturing was replaced with electronic goods. Wages stagnated, and income inequality increased rapidly. This led to a new Gilded Age. Nixon replaced Lyndon Johnson’s War on Poverty with his War on Drugs. Blacks were opposed to Nixon’s Vietnam War, and he penalized them by incarcerating them. This, helped by state laws and President Reagan, led to mass incarceration – which became known as the New Jim Crow. Public education was reserved for suburban whites, while urban Blacks were in prison or attended underfunded schools. The Flint, Michigan, water crisis demonstrates the difficulty of urban Blacks as jobs and urban facilities disappeared. President Obama was the first Black president, elected in the financial crisis of 2008. The Supreme Court nullified the 1965 Voting Act as it had done with amendments in the 1880s. Obamacare was the most enduring achievements of Obama’s presidency.

Clinicians who hope to modify patients’ unhealthy use of marijuana face potential frustration and difficulty trying to engage people in meaningful dialogue. The stages of change outlined by Prochaska and Di Clemente provide a useful guide for understanding how to initiate conversation with someone addicted to marijuana, whether they are in the precontemplation, contemplation, preparation (for change), action or maintenance stage. Utilizing the stages of change to guide the approach to promoting behavioral change introduces clinicians to one of the most essential principles of motivational interviewing (MI), often described as “meeting patients where they are”. Developed by Miller and Rollnick, MI shifts the focus away from resistance and denial in order to focus instead on ambivalence and moves clinicians away from confrontation and toward a more collaborative approach that is less likely to stimulate a patient’s defenses. Engagement through empathy for patients’ suffering enables clinicians to increase the cognitive dissonance between their behavior and their goals. Ultimately, the practice of motivational interviewing is an art, and not merely a set of techniques, that requires clinicians to explore their fundamental attitudes toward addiction.