Day-level associations of craving and anxiety with self-reported attention and concentration problems in young adults who use cannabis: A key role for anxiety

Abstract

Aim: Acute effects of cannabis use on cognitive functions such as attention and concentration are well studied. Less is known about how subjective states such as craving and anxiety, both of which can occur during cannabis withdrawal, impact cognitive functioning in daily life. This smartphone survey study examined the extent to which day-level cannabis craving and anxiety were associated with self-reported attention and concentration problems, accounting for trait anxiety and cannabis withdrawal. Study findings have implications for understanding how cannabis-related subjective states impact aspects of cognitive functioning in daily life. Methods: Young adults (ages 18-25), who reported using cannabis at least twice per week, were recruited (2017-2019) using Craigslist and research registry to participate in a smartphone daily survey study for up to 30 days in Pittsburgh, PA. Participants completed a baseline lab assessment (cannabis withdrawal scale, State-Trait Anxiety Inventory). Phone surveys were delivered 3 times/day: morning, afternoon, evening. Participants also self-initiated reports of cannabis use. Phone survey items (rated: 0- none to 10- a lot) queried cannabis craving, “How are you feeling now?” (e.g., anxious), and in the evening: “Today, how much difficulty did you have with…” “keeping your attention on an activity for long”; and “concentrating and thinking clearly”. On days with a completed evening survey, cannabis use was coded 0=none and 1=any use. Multilevel models tested associations of day-level attention and concentration (separate outcomes) with daily cannabis craving and anxiety, accounting for day-level cannabis use, and baseline trait anxiety and cannabis withdrawal. Results: Young adults (N=57; 60% female; mean age=19.8 [SD=1.7]; 78.9% White, 10.5% Black, 10.6% Other race/ethnicity) reported cannabis use on 390 out of 558 days. At baseline, average trait anxiety was 20.6 (SD=5.9, range=11-33/40 maximum) and withdrawal severity was 6.3 (SD=6.6, range=0-29/68 maximum). Average daily craving was 3.3 (SD=3.0) and momentary anxiety was 2.0 (SD=2.6). Participants reported low average daily attention (2.5+2.5) and concentration (2.3+2.4) problems. In a multilevel model using trait anxiety, craving, state anxiety, and day-level cannabis use to predict daily attention problems, craving and state anxiety were significant predictors (p<.05). In predicting daily concentration problems using the same set of variables, craving, state and trait anxiety were unique predictors (p<.05). Using withdrawal severity at baseline (instead of trait anxiety), and the same set of variables to predict daily attention and concentration problems (separate models), craving and state anxiety were statistically significant (p<.05). In a final model including both withdrawal and trait anxiety, with craving, state anxiety, and day-level cannabis use to predict daily attention and concentration problems (separate models), only state anxiety was significant (p<.05). Notably, day-level cannabis use was not uniquely associated with self-reported attention or concentration problems. Conclusion: Results suggest the unique contribution of momentary anxiety, over and above trait anxiety, cannabis withdrawal, momentary craving, and day-level cannabis use, on self-reported daily mild attention and concentration problems. The temporal ordering of anxiety in relation to cannabis use and its effects on attention and concentration remain unclear, but suggest the potential for mindfulness training to reduce anxiety and increase attentional focus.