Cannabis Use Disorder Symptoms Research Articles

Persistent increased severity of cannabis use disorder symptoms in adolescents compared to adults: a one-year longitudinal study.

Adolescence is a developmental period characterised by increased vulnerability to cannabis use disorder (CUD). However, previous investigations of this vulnerability have relied on cross-sectional comparisons and lack a detailed assessment of cannabis quantity, a potentially important confounding factor. Here, we aimed to investigate the one-year course of CUD in adolescents compared to adults who currently use cannabis, adjusting for a comprehensive measure of cannabis quantity. Data are from a one-year observational longitudinal study (CannTeen) of adolescents and adults who currently used cannabis regularly with five waves of assessment at 3-monthly intervals, based in London, UK. Participants were n = 70 adults (26-29, 45.7% female), who did not regularly use cannabis when they were under age 18, and n = 76 adolescents (16-17, 50.0% female). The exposure was adolescent (compared to adult) frequent cannabis use. The primary outcome was CUD symptoms measured using the cannabis use disorder identification test revised (CUDIT-R) at five time points. Models were adjusted for cannabis quantity using mean weekly standard THC units (one unit = 5mg THC). Other covariates included gender, and whether each session occurred before or during the COVID-19 pandemic. In models adjusted for pre-registered covariates, adolescents scored 3.7 points higher on the CUDIT-R compared to the adult group across the 5 assessment waves (3.66 95% CIs 1.99, 5.34). There was also evidence of a linear reduction in symptoms over time in both groups (-0.47, 95%CIs -0.67, -0.27). Adolescents had persistently increased CUD symptoms compared to adults across the 12-month period. This association was robust after adjusting for the quantity of cannabis consumed and other covariates.

Expectancies of the Effects of Cannabis Use in Individuals with Social Anxiety Disorder (SAD).

Previous research has indicated that anticipating positive effects from cannabis use may be linked with increased frequency of cannabis consumption, yet these expectancies remain poorly understood in adults with social anxiety disorder (SAD). Thus, our study aimed to investigate the expectancies of the effects of cannabis use in 26 frequently using adults with SAD (age: 27.9 ± 7.3 years; 54% female) and 26 (age: 27.4 ± 6.7 years; 50% female) without. While no between-group differences were observed, both groups reported expecting tension reduction and relaxation (F = 0.001; p = 0.974), cravings, and physical effects (F = 1.10; p = 0.300), but denied global negative effects (F = 0.11; p = 0.744). The trajectory of cannabis use perceptions (further investigated in 12/26 participants/group) also showed no between-group differences. Before the initial use, positive perceptions may have led to initial and continuous cannabis consumption, while the symptoms of cannabis use disorder may have contributed to repeated use. Our data indicate that, regardless of psychiatric history, frequent cannabis-using adults are more likely to report positive expectancies, which are often associated with increased patterns of cannabis consumption. Psychoeducational programs and openly discussing the risks of cannabis may be beneficial in preventing and/or reducing cannabis use in people with SAD.

General and Domain-Specific Perceived Risk Demonstrate Unique Associations with Cannabis Use, Negative Outcomes, and Motivation to Change among Undergraduate Students

College student cannabis use is at an all-time high. Although frequent heavy cannabis use is related to cannabis problems, perceived risk of cannabis use is rapidly decreasing. Yet, it is unknown whether specific domains of risk perceptions (general and domain-specific risk, risk to others and personal risk) are related to more cannabis use or related problems. Thus, among 130 undergraduates who reported past-month cannabis use, the present study conducted secondary analyses to test whether, for both perceived risk to others and perceived personal risk: (1) general perceived risk was associated with cannabis-related outcomes (i.e., use, negative consequences, cannabis use disorder (CUD) symptoms, motivation to change), (2) seven specific domains of perceived risk were related to cannabis outcomes, and (3) domain-specific perceived risk was related to cannabis use frequency. General perceived risk to others was negatively associated with cannabis use frequency whereas general perceived personal risk was positively associated with cannabis-related negative consequences, CUD symptoms, and importance and readiness to change. Greater legal and withdrawal/dependence risks were uniquely related to several outcomes (e.g., CUD symptoms). Participants who used cannabis frequently perceived more personal risk in most risk domains and less general risk to others than those who used infrequently. Findings suggest personal risk is an important component to consider when assessing perceived risk of cannabis use and focusing on both general and domain-specific risks may provide valuable insight for future prevention and intervention efforts.

15 Associations Among Subjective Cognitive Function and Cannabis Use in Older Adults

Objective:Cannabis use in older adults is becoming increasingly common as cannabis becomes both more socially acceptable and legally permissible, whether for medical or recreational purposes. While previous research has found harmful effects of cannabis use on cognition in adolescents and younger adults, few studies have explored cognition and cannabis use in older adults. This study aimed to examine the relationship between lifetime cannabis use patterns and subjective cognitive performance in older adults.Participants and Methods:The sample (N=51) consisted of adults ages 60 and older residing in the United States who endorsed cannabis use within the previous year. Participants completed online questionnaires on demographics, mental health [Geriatric Anxiety Scale (GAS) short form and Geriatric Depression Scale (GDS) short form], and measures of subjective cognitive function [Cognitive Failures Questionnaire (CFQ), the Cognitive Problems and Strategies Assessment (CPSA), and part IV of the Cognitive Self Efficacy Questionnaire (CSEQ)]. The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQCU) and the Cannabis Use Disorder Identification Test (CUDIT) were used to assess cannabis use, and the Alcohol Use Disorders Identification Test Consumption items (AUD-C) were used to assess alcohol use. Partial Pearson’s correlations were used to examine relationships between scores of subjective cognitive functioning and cannabis use patterns while controlling for alcohol consumption.Results:Participants aged 60+ (M=68.06, SD=5.80, 49% women) had 15.39 (SD=2.21, range 12-18) years of education on average. Participants’ race/ethnicity was reported as 90.2% White (n=47), 5.9% Latinx or Hispanic (n=3), 2% Black or African American (n=1), and 1% Other (n=1). Most participants (59%) reported first using cannabis as a child or adolescent (range of ages 7-17 years), while 31% reported first using cannabis as an adult (ages 18-58 years), and only 8% endorsed initial use in older adulthood (62-84 years). On average, this sample reported using cannabis for 19.75 days (SD=11.14) in the last month with n=35 (69%) and having used cannabis for 20 or more years (range 1-60 years). The total CUDIT score was positively correlated with CFQ (rp=.47, p<.001), CPSA problems (rp=.46, p<.001), GAS (rp=.43, p=.002), and GDS (rp=.35, p=.014), and negatively correlated with the CSEQ (rp=-.33, p=.02), all while controlling for alcohol consumption. Days of use in the past month and total years of use were not significantly associated with subjective cognitive function.Conclusions:Among older adult cannabis users, symptoms of Cannabis Use Disorder (CUD) were significantly associated with greater self-reported cognitive failures/problems and worse self-efficacy for cognitive ability, as well as symptoms of anxiety and depression, when controlling for alcohol use. Notably, there was no relationship between subjective cognition and frequency of recent use or lifetime use. For patients who use cannabis, neuropsychologists may find it helpful to focus their clinical interview on CUD symptoms when discussing cognitive complaints rather than other measures of cannabis use. Additional research is needed to examine objective measures of cognitive functioning in older adult cannabis users.

Changes in Cannabis Use From 2014 to 2019 Among Young Adults in Washington State

Understanding changes in cannabis use in the legalized nonmedical cannabis context is critical. Washington State, one the earliest states to implement legalization, presents a unique opportunity to examine how cannabis use and its consequences changed after the implementation of legalization for adults. With a focus on Washington State young adults, this study conducted in 2022-2023 examined changes in (1) cannabis use by sex and age, (2) preferred mode of use, and (3) cannabis use disorder symptoms. Using repeated cross-sectional data on young adults aged 18-25 years in Washington State from 2014 (premarket opening) to 2019 (N=12,945), logistic regression models assessed trends over time in the prevalence of any and frequent (20+ days) past-month cannabis use. Among individuals reporting use, multinomial logistic regressions estimated trends over time in the preferred mode of use and negative binomial regressions examined trends in the count of cannabis use disorder symptoms. From 2014 to 2019, the prevalence of cannabis use converged by sex, with females being equally likely as males to report both any and frequent use by 2019. Among young adults reporting past-month use, smoking as the preferred mode of use decreased relative to other modes. Number of cannabis use disorder symptoms reported increased, which was not accounted for by changes in preferred mode of use. During the 5-year period following the implementation of legalization, patterns of young adult cannabis use shifted, including particularly sharp increases among females and increases in cannabis use disorder symptoms. Future studies should investigate underlying causes for these important changes.

Executive functions and behavioral economic demand for cannabis among young adults: Indirect associations with cannabis consumption and cannabis use disorder.

Behavioral economic demand for cannabis is robustly associated with cannabis consumption and cannabis use disorder (CUD). However, few studies have examined the processes underlying individual differences in the relative valuation of cannabis (i.e., demand). This study examined associations between executive functions and cannabis demand among young adults who use cannabis. We also examined indirect associations of executive functions with cannabis consumption and CUD symptoms through cannabis demand. Young adults (N = 113; 58.4% female; mean age 22 years) completed a Marijuana Purchase Task. Participants also completed cognitive tasks assessing executive functions (set shifting, inhibitory control, working memory) and semistructured interviews assessing past 90-day cannabis consumption (number of grams used) and number of CUD symptoms. Poorer inhibitory control was significantly associated with greater Omax (peak expenditure on cannabis) and greater intensity (cannabis consumption at zero cost). Poorer working memory was significantly associated with lower elasticity (sensitivity of consumption to escalating cost). Lower inhibitory control was indirectly associated with greater cannabis consumption and CUD symptoms through greater Omax and intensity, and poorer working memory was indirectly associated with greater cannabis consumption and CUD symptoms through reduced elasticity. This study provides novel evidence that executive functions are associated with individual differences in cannabis demand. Moreover, these results suggest that cannabis demand could be a mechanism linking poorer executive functioning with heavier cannabis use and CUD, which should be confirmed in future longitudinal studies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Associations Between Cannabis Use Disorder and Measures of Weekly and Within-Day Cannabis Frequency, Quantity, and Potency in College Students.

Background: College student cannabis use has increased significantly in recent years, and individuals aged 18-25 are at elevated risk for development of cannabis use disorder (CUD). While weekly cannabis use frequency is a commonly used measure of cannabis consumption, there is increasing scientific interest in exploring more nuanced measures of cannabis use. Currently, limited research exists examining the clinical utility of cannabis quantity, within-day frequency, and potency variables. Methods: We used cross-sectional survey data from a sample of 617 undergraduate students in the state of Colorado. A two-part model-building approach was leveraged to examine whether within-session cannabis quantity and within-day cannabis use frequency were associated with odds of experiencing any CUD symptoms and total number of CUD symptoms endorsed. We also examined whether cannabis flower potency was associated with odds of experiencing any CUD symptoms and total number of CUD symptoms endorsed among a subset (N=288) of the sample who reported knowledge of the cannabinoid content of their most frequently used products. Results: Weekly flower use frequency (odds ratio [OR]=1.27, p<0.001) and weekly concentrate use frequency (OR=1.10, p=0.044) were positively associated with increased odds of experiencing any CUD symptoms, but cannabis quantity and within-day frequency variables were not. In addition, no association was found between flower potency and odds of endorsing any CUD symptoms. Among individuals endorsing at least one symptom, weekly flower use frequency (incident rate ratio [IRR]=1.06, p<0.001) was positively associated with total symptom count, but weekly concentrate use frequency, cannabis quantity variables, and within-day frequency variables were not. Among individuals endorsing symptoms, a positive association was found between flower potency and total symptom count (IRR=1.01, p=0.008). Conclusion: Current methods of assessing within-session cannabis quantity and within-day cannabis use frequency may lack clinical utility in examining college student CUD symptoms over and above weekly cannabis use frequency. Cannabis flower potency may prove useful in assessment of CUD symptom severity, but further research is warranted.

Evaluation of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Questionnaire and its Relations to Cannabis-Related Problems.

Cannabis use and the prevalence of cannabis use disorder (CUD) among emerging adults are on the rise. Several indicators of cannabis use (e.g., quantity, frequency) as they relate to negative outcomes have been posited in the extant literature. Despite research examining links between indicators and cannabis outcomes, few assessments of cannabis use indicators exist. The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) was developed to assess cannabis use across a range of factors. However, the factor structure of the DFAQ-CU has not been replicated. Further, the DFAQ-CU was modeled using reflective strategies despite formative strategies being conceptually appropriate. The present study utilized principal components analyses (PCA) and principal axis factoring (PAF) to evaluate the structure of the DFAQ-CU. PCA yielded a four-component solution; PAF resulted in a five-factor solution. Linear regression found significant relations between PCA components and PAF factors with CUD symptoms and cannabis-related problems; however, effect sizes were larger for the PAF suggesting possible misdisattenuation. The PCA components demonstrated evidence of discriminant and convergent validity with measures of cannabis and alcohol behavior. The study informs research and clinical work through the refinement of cannabis use assessment and enhancing our understanding of the importance of model selection.

Impact of a brief distress intolerance intervention on acute stress modulation of response inhibition neurophysiology in cannabis use disorder

BackgroundThe prevalence of cannabis use in the US has increased within the past two decades. Moreover, cannabis use disorder (CUD) is associated with significant disability, but the underlying neural mechanisms of CUD are unclear. Distress intolerance (DI), a psychological risk factor for CUD, may confer risk in part via impaired inhibitory control (IC) capacity during acute stress. DI and cannabis use problems have been associated with altered N2 amplitude, an IC-related event-related potential, in prior cross-sectional studies, but whether altered N2 is a state marker of CUD severity, a pathoplastic factor responsive to intervention and predictive of CUD symptom change over time, or an enduring trait-like vulnerability is unclear. In this secondary analysis, we tested the impact of a DI-targeted intervention on acute stress-related modulation of the N2 and whether pre-intervention N2 predicted CUD symptom change through follow-up. MethodSixty participants were randomly assigned to a DI-targeted or control intervention. Participants completed an IC task before and after a stress induction at pre- and post-intervention lab visits while EEG activity was recorded. ResultsThe DI intervention did not alter the N2 compared to a control intervention. Pre-intervention post-stress IC-related N2 was associated with worse CUD severity but did not predict changeover time. ConclusionFindings are consistent with blunted N2 after acute stress acting as a stable marker of CUD severity rather than a pathoplastic factor predictive of CUD trajectory. Future research should investigate whether stress-related blunting of N2 is a consequence of severe CUD or a pre-existing vulnerability.

Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia

BackgroundThailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed.MethodsCannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test.ResultsThe prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40–49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18–19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive.ConclusionsAlthough most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.

Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005-2019.

In the United States, cannabis is increasingly used to manage chronic pain. Veterans Health Administration (VHA) patients are disproportionately affected by pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUDs), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. From VHA electronic health records from 2005 to 2019 (∼4.3-5.6 million patients yearly), we extracted diagnoses of CUD and chronic pain conditions ( International Classification of Diseases [ ICD ]- 9-CM , 2005-2014; ICD-10-CM , 2016-2019). Differential trends in CUD prevalence overall and age-stratified (<35, 35-64, or ≥65) were assessed by any chronic pain and number of pain conditions (0, 1, or ≥2). From 2005 to 2014, the prevalence of CUD among patients with any chronic pain increased significantly more (1.11%-2.56%) than those without pain (0.70%-1.26%). Cannabis use disorder prevalence increased significantly more among patients with chronic pain across all age groups and was highest among those with ≥2 pain conditions. From 2016 to 2019, CUD prevalence among patients age ≥65 with chronic pain increased significantly more (0.63%-1.01%) than those without chronic pain (0.28%-0.47%) and was highest among those with ≥2 pain conditions. Over time, CUD prevalence has increased more among VHA patients with chronic pain than other VHA patients, with the highest increase among those age ≥65. Clinicians should monitor symptoms of CUD among VHA patients and others with chronic pain who use cannabis, and consider noncannabis therapies, particularly because the effectiveness of cannabis for chronic pain management remains inconclusive.

Cannabis Use Disorder Symptoms in Weekly Cannabis Users: A Network Comparison Between Daily Cigarette Users and Nondaily Cigarette Users

Background: Concurrent use (co-use) of cannabis and tobacco is common and associated with worse clinical outcomes compared with cannabis use only. The mechanisms and interactions of cannabis use disorder (CUD) symptoms underlying co-use remain poorly understood. Methods: We examined differences in the symptom presence and symptom network configurations between weekly cannabis users who use tobacco daily (co-users, n=789) or non- or nondaily (nondaily co-users, n=428). Results: First, we identified a range of symptoms (craving, failed reduce or quit attempts, neglected responsibilities, and negative social effects) that are most central to the highly interconnected CUD symptom network. Risky cannabis use was mostly associated with negative social and health effects, and independent of other CUD symptoms. Craving symptoms act as a bridge between different CUD and withdrawal symptoms. Among co-users, (1) craving is more strongly associated with negative psychosocial effects, (2) feelings of depression and negative health effects are more central to the network, and (3) the negative health effects are more strongly associated with failed attempts to reduce or quit attempts compared with nondaily co-users. Discussion: Our results go beyond existing findings focused on the mere increase in CUD symptom presence, and speak to the potential synergistic effects of co-use on dependence and withdrawal symptoms. We outline clinical implications with respect to targeting specific CUD symptoms in co-users, and point to future research to disentangle tobacco and cannabis craving symptoms.

Initial development and validation of a brief assessment of marijuana demand among young adult college students.

Hypothetical purchase tasks assess substance demand, but the length of purchase tasks makes repeated assessment of state-dependent changes in demand difficult, often limiting clinical utility. Although brief assessments of alcohol and cigarette demand exist, brief measures of cannabis demand do not. College students (N = 209, Mage = 19.92, SD = 1.45; 63% female; 56.9% non-Hispanic Caucasian) who reported using cannabis at least 3 days in the past month, completed an online survey including the full-length marijuana purchase task (MPT), a three-item brief assessment of marijuana demand (BAMD) assessing intensity, Omax and breakpoint, and cannabis use outcomes. Convergent and divergent validity were examined. Independent samples t tests compared demand on the BAMD and MPT based on presence or absence of cannabis use disorder (CUD) symptoms, and one-way between-subject analyses of variance compared effects of CUD severity (mild/moderate/severe) on BAMD indices. All indices were significantly correlated across both assessment measures (ps < .01). Similarly, all indices on both demand measures were significantly correlated with craving, CUD severity, and cannabis-related consequences (ps < .01); whereas only intensity and Omax were significantly correlated with cannabis use frequency (ps < .01). Individuals with (vs. without) CUD symptoms reported significantly greater intensity and Omax (ps < .01) and significant differences in CUD severity on BAMD indices were found as well (ps < .05). The BAMD demonstrated convergent and divergent validity with the MPT. Findings suggest that brief cannabis demand can be easily assessed as an indicator for high-risk cannabis use. Thus, the BAMD may be a useful and clinically relevant tool to assess cannabis demand in real-world settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership.

Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.

Pot at the End of the Rainbow: Cannabis Use Among Sexual Minorities.

Introduction: Gay, lesbian, and bisexual individuals (i.e., sexual minorities) use cannabis more frequently than heterosexuals; however, little research has directly compared sexual minorities' patterns of cannabis use (e.g., quantity, age of onset, forms of cannabis used) with heterosexuals. Some research has identified motivations for cannabis use in sexual minorities, but much of this research has been qualitative and/or narrow in scope (e.g., focused on sexual motivations). To the best of our knowledge, no previous research has used a validated measure to examine motives for cannabis use among sexual minorities. Additionally, cannabis use is known to be associated with mental health symptoms, but little research has examined relationships between cannabis use and mental health in this population. Materials and Methods: Data analyses were performed on archival survey data collected from 10 undergraduate psychology subject pools across the United States (N=4,669) as a part of Project ART (Addictions Research Team). Participants indicated their sexual orientation using a 5-point scale, and responses were used to classify participants into three groups: the majority of the sample (n=3,483) were classified into the heterosexual group, about one quarter were classified into the bisexual group (n=1,081), and a small number were classified into the gay group (n=105). Results: The bisexual group was more likely to report using cannabis. They also reported using cannabis more frequently, were more likely to report use of all product types (i.e., flower, concentrates, and edibles), and reported more severe symptoms of cannabis use disorder (CUD) than the heterosexual group. The bisexual group also reported higher levels of coping and enhancement motives for using cannabis and reported higher levels of all measured mental health symptoms (e.g., depression, suicidality, generalized anxiety, and social anxiety) compared with the heterosexual group. Conclusions: Increased frequency of cannabis use, use of a broad range of different products, and use of cannabis to cope with mental health concerns may be placing bisexual individuals at greater risk of CUD. Findings from this study can be used to guide future research and help target mental health interventions among bisexual individuals.

The threshold problem of impairment criteria in psychiatric diagnosis

Dear Editor, Psychiatric diagnoses are made based on careful ascertainment of cluster of signs and symptoms. However, just having symptoms and signs is not sufficient, these need to create problems to the person (or others around him/her) and manifest as distress or functional impairment. For example, a person may have third-person-discussing-type auditory hallucinations for over a month, but he or she may be able to attend to most social occasions and conduct the occupation as an agriculturist diligently. Similarly, individuals may present with symptoms of cannabis use disorder, but not manifest impairment of substance use disorder.[1] We argue that there is considerable heterogeneity in the conceptualization, practical ascertainment, and interpretation of functional impairment. This results in, at least to some degree, nebulousness of determining the threshold of psychiatric disorders.[2] Determining a threshold has implications in adjudicating the prevalence of psychiatric disorder, whether a psychiatric disorder is in remission, and whether a person needs treatment. We envisage three main reasons contributing to the threshold of psychiatric diagnosis. The first is the individual context of the person being interviewed for a diagnosis. A pilot experiencing sleep difficulties due to anxiety and missing a day of flight would be considered to have a diagnosis, whereas a college student missing a class in a month might not be considered passing the diagnosis threshold. The second is the social and cultural context of the person being evaluated. A person from rural parts of Punjab in India being extremely jocular and interrupting the therapist occasionally may be passed off as nonimpairing. A similar presentation of an individual from rural Tamil Nadu may be considered manifesting impairment associated with an affective illness. The third factor is the experience and expectations of the therapist. The therapist decides whether a person crosses the threshold or not. This may have something to do with how they appraise the information and what clinico-therapeutic experiences they may have had in the past. Since there is heterogeneity in determining the threshold of psychiatric diagnoses, there are a few suggestions to address the issue. One is acceptance of the subjectivity of the process of determining the threshold of diagnosis. One could determine kappa values of interrater reliability of impairment criteria. Interrater reliability of diagnoses and functional impairment assessment has been found to be acceptable, though not completely concordant.[3] The second approach could be greater recognition of contextual aspect in determining diagnosis and addition of an explanatory note on how social, educational, economic, political, legal, and other factors might have influenced determining threshold in a particular case. The third approach could be to put a-priori note during diagnostic evaluation process, when the diagnosis is being made and about in what circumstances or degree of functional impairment would the mental health professional not consider a psychiatric diagnosis or the diagnosis to be deemed to be in remission. To conclude, we do proffer that subjectivity exists in determining the lower threshold of impairment of psychiatric disorders, and being cognizant of this may help in rationally labeling an individual as having psychiatric disorder. Financial support and sponsorship The authors disclosed no funding related to this article. Conflicts of interest The authors disclosed no conflicts of interest related to this article.

Gender differences in cannabis use disorder symptoms: A network analysis

BackgroundWhile cannabis use in women is increasing worldwide, research into gender differences in cannabis use disorder (CUD) symptomology is lacking. In response to limited effectiveness of addiction treatment, research focus has been shifting from clinical diagnoses towards interactions between symptoms, as patterns of symptoms and their interactions could be crucial in understanding etiological mechanisms in addiction. The aim of this study was to evaluate the CUD symptom network and assess whether there are gender differences therein. MethodsA total of 1257 Dutch individuals reporting weekly cannabis use, including 745 men and 512 women, completed online questionnaires assessing DSM-5 CUD symptoms and additional items on plans to quit or reduce use, cigarette use, and the presence of psychological diagnoses. Gender differences were assessed for all variables and an Ising model estimation method was used to estimate CUD symptom networks in men and women using network comparison tests to assess differences. ResultsThere were gender differences in the prevalence of 6 of the 11 symptoms, but symptom networks did not differ between men and women. Cigarette use appeared to only be connected to the network through withdrawal, indicating a potential role of cigarette smoking in enhancing cannabis withdrawal symptoms. Furthermore, there were gender differences in the network associations of mood and anxiety disorders with CUD symptoms. ConclusionThe association between smoking and withdrawal as well as gender differences in the role of comorbidities in the CUD network highlight the value of using network models to understand CUD and how symptom interactions might affect treatment.

Cannabis use disorder uniquely predicts educational impairment in college students over and above other mental health disorders

Objective: The impact of cannabis use disorder (CUD) on education functioning and GPA was examined within the context of co-occurring alcohol use disorder (AUD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Participants: Undergraduates (N = 210) who reported using cannabis within the past six months were recruited. Methods: Hierarchical multiple regression analyses were used to determine whether CUD symptom severity and presence of probable CUD diagnosis predicted educational impairment and current GPA, over and above other mental health conditions. Results: CUD symptom severity, but not probable CUD, significantly predicted greater educational impairment, over and above probable PTSD and MDD, which were also significant predictors. CUD symptom severity, but not probable CUD, significantly predicted lower GPA. Conclusion: In addition to other common mental health conditions, CUD may be an important area of assessment and intervention for university counseling centers to foster student academic success.

Smoking Mostly Alone as a Risk Factor for Cannabis Use Disorders and Depressive Symptoms.

The empirically grounded etiological models of cannabis use already include a vast range of psychological factors (within an individual), paving the ground for individualized prevention and intervention programs. However, the interpersonal (among individuals) and relational variables influencing the emergence of excessive cannabis use are less understood. Particularly, the impact of consumption context (i.e., smoking alone or with others) on cannabis use intensity in youth remains to be clarified. We evaluated how smoking mostly alone modulates cannabis use disorders (CUD) and depressive symptoms in college students. A sample of 854 individuals from France (568 women, 286 men) who used cannabis in the last 6months completed self-report questionnaires evaluating cannabis consumption, CUD symptoms, and depressive symptoms. Mostly alone users presented higher current use frequency as well as increased CUD and depressive symptoms compared to mostly social users. Smoking mostly alone remained positively correlated with CUD and depressive symptoms, even when controlling for current use frequency. The association between smoking mostly alone and depressive symptoms was significant before adjustment for symptoms of CUD. The loss of significance of this association after control reflected the mediating effects of symptoms of CUD on the relationship between smoking mostly alone and depressive symptoms. These results suggest that smoking mostly alone constitutes a risk factor for uncontrolled cannabis use and promote the relationship between cannabis use and depressive disorders, potentially through loneliness and social isolation. Longitudinal studies are required to identify the causal mechanisms underlying the links between smoking mostly alone, cannabis use and psychopathological disorders.

Increases in cannabis use and negative emotions during COVID-19 pandemic among college students with cannabis use disorder

ABSTRACT Using cross-sectional baseline measurements from a longitudinal cohort study, we evaluated the perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on cannabis use and emotional well-being among college students meeting cannabis use disorder (CUD) criteria (N = 150). Compared to before the pandemic, participants retrospectively reported an increase in cannabis use during the first phase of the pandemic when stay-at-home orders occurred, which was correlated with a greater number of CUD symptoms and cannabis use-related consequences since the pandemic began. Reporting greater frequency of cannabis use during the pandemic was associated with greater frequency of using amphetamine-type drugs and consumption of cannabis by dabbing since the pandemic began. There were significant differences in cannabis use-related outcomes as a function of negative emotions (e.g., feeling lonely/stressed/anxious/depressed) experienced during the pandemic. The findings elucidate the impact of the pandemic on cannabis use among college students with CUD and can inform prevention/intervention efforts in this population.