30-day Marijuana Use Research Articles

The impact of disruptive behavior disorder on substance use treatment outcome in adolescents

The current study examined the impact of disruptive behavior disorder (DBD) on substance use outcomes in an adolescent sample. Sixty-eight adolescents and their caregivers were randomized to one of two fourteen-week, outpatient treatments: Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)+Parent Management Training+Contingency Management (CM; experimental) and MET/CBT+Parent Drug Education (attention control). This study assessed abstinence, substance use, externalizing behavior, and parenting outcomes over five assessment periods for youth with DBD (DBD+) and without DBD (DBD−). Results showed DBD+/experimental adolescents reported fewer days of marijuana use than DBD+/control adolescents. Results also showed that parents of DBD− adolescents in the experimental condition reported significantly better parenting outcomes compared to DBD−/control. Substance abuse treatment for adolescents with DBD which includes a component such as contingency management and parent training has the potential to contribute to substance use outcomes. Such treatment strategies, however, should include additional support for parents.

Acute Intoxication Caused by a Synthetic Cannabinoid in Two Adolescents

Illicit drug use continues to be a common problem among pediatric patients. Daily marijuana use among high school seniors is currently at a 30-year high. Marijuana use in adults has rarely been associated with cardiovascular adverse effects, including hypertension, tachycardia, arrhythmia, and myocardial infarction. Recently, abuse of synthetic cannabinoids, such as the incense "K2" or "Spice," has been increasingly reported in the lay press and medical literature. Overdose and chronic use of these substances may cause adverse effects including altered mental status, tachycardia, and loss of consciousness. Overdoses in adult patients have been described; however, limited reports in the pediatric population have been documented. A recent case series describes myocardial infarctions in pediatric patients, associated with synthetic cannabinoid use. In this report, we describe two adolescent patients admitted after they inhaled "K2," resulting in loss of consciousness, tachycardia, and diffuse pain.

Response to Grant et al. Letter

Back to table of contents Previous article Next article Communications and UpdatesFull AccessResponse to Grant et al. LetterHerbert D. Kleber, M.D., and Robert L. DuPont, M.D.Herbert D. KleberNew YorkSearch for more papers by this author, M.D., and Robert L. DuPontRockville, Md.Search for more papers by this author, M.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ajp.2012.12060791rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: While we did not mention the Center for Medicinal Cannabis Research at the University of California, ably headed by Dr. Grant for the past decade, we did not suggest that the “evidence for marijuana’s efficacy is anecdotal”—just the large majority of it! We did say that “indications with the most evidence include spasticity secondary to neurological diseases such as multiple sclerosis (and) pain management, especially neuropathic pain.” These in fact are the subject of the references cited by Grant et al. to prove their point about marijuana efficacy. These also are the relatively rare conditions that most applicants claim as the reason they need medical marijuana cards, and less than 3% of applicants claim such conditions.Finally, as we noted in our commentary, in 2011 daily marijuana use among high school seniors reached the highest level in 30 years, according to the Monitoring the Future survey conducted annually by researchers at the Institute for Social Research at the University of Michigan. Researchers found, as we pointed out, that “the rate of marijuana use in youths is inversely related to ‘perceived risk’ and ‘perceived social disapproval.’” Surely Grant et al. are not suggesting that the “medical marijuana” referenda and the dispensaries are unrelated to this increase.We commend Grant et al. for their attempt to evaluate marijuana scientifically and look forward to the day when there will be FDA submissions.New YorkRockville, Md.The authors’ disclosures accompany the original commentary. FiguresReferencesCited byDetailsCited bySSRN Electronic Journal Volume 169Issue 10 October 2012Pages 1120-1120 Metrics PDF download History Accepted 1 July 2012 Published online 1 October 2012 Published in print 1 October 2012

Legalization of medical marijuana and marijuana use among youths

Aim: This study examined the relationship of youth marijuana use and perceived ease of access with the number of medical marijuana cards at the county-level, and marijuana norms as indicated by per cent of voters approving legalization of medical marijuana in 2004.Methods: Survey data from 17,482 youths (aged 13–19) in Montana and county-level archival data, including votes for the legalization of medical marijuana and the number of medical marijuana cards were analysed using hierarchical linear modelling.Findings: Living in a county with more medical marijuana cards was not related to lifetime or 30-day marijuana use. However, voter approval of medical marijuana was positively related to lifetime and 30-day use. Perceived ease of access to marijuana was positively related to medical marijuana cards, but this relation became non-significant when voter approval was controlled. Among marijuana users, marijuana cards and voter approval were positively related to perceived ease of access.Conclusions: The relation between medical marijuana cards and youth use may be related to an overall normative environment that is more tolerant of marijuana use. Interventions to prevent youth marijuana use should focus on adult norms regarding use by and provision of marijuana to youths.

One-year outcomes of a drug abuse prevention program for older teens and emerging adults: Evaluating a motivational interviewing booster component.

The present study tested the efficacy of motivational interviewing-based booster sessions for Project Toward No Drug Abuse (TND), a 12-session school-based curriculum targeting youth at risk for drug abuse. In addition, generalization of effects to risky sexual behavior was assessed. The 1-year outcomes evaluation of the project is presented. A total of 24 schools were randomized to one of three conditions: standard care control (SCC), TND classroom program only (TND-only), and TND plus motivational interviewing booster (TND + MI). A total of 1186 participants completed baseline and 1-year follow-up surveys. Following the classroom program, youth in the TND + MI condition received up to 3 sessions of MI in person or by telephone. Effects were examined on 30-day cigarette, alcohol, marijuana, and hard drug use, as well as measures of risky sexual behavior (number of sex partners, condom use, having sex while using drugs or alcohol). Collapsed across the 2 program conditions, results showed significant reductions in alcohol use, hard drug use, and cigarette smoking relative to controls. These effects held for an overall substance use index. The MI booster component failed to achieve significant incremental effects above and beyond the TND classroom program. No effects were found on risky sexual behavior. While the program effects of previous studies were replicated, the study failed to demonstrate that an adequately implemented MI booster was of incremental value at 1-year follow-up.

Associations Between Community Attachments and Adolescent Substance Use in Nationally Representative Samples

Social capital and social attachment theories of substance use argue that positive bonds to society and the conventional values they promote deter adolescents from substance use. Using nationally representative samples of U.S. high school seniors, we hypothesized that adolescents' community attachments, measured by social trust, social responsibility, and religiosity, would be negatively associated with lifetime and 30-day substance use. We used repeated cross-sectional nationally representative high school senior data from 1976 to 2008 Monitoring the Future Study cohorts (weighted N = 64,246; 51.6% female). Participation rate ranged from 77% to 86% across years. A series of multiple linear and logistic regressions examined unique associations of adolescents' social trust, social responsibility, and religiosity with lifetime and 30-day use of cigarettes, alcohol, marijuana, hallucinogens, cocaine, amphetamines, barbiturates, tranquilizers, and narcotics. Models controlled for gender, race, college aspirations, high school grades, parents' education, and survey year. Social trust, social responsibility, and religiosity showed independent negative associations with use of cigarettes, alcohol, marijuana, and six other types of drugs. After accounting for controls, community attachments related to lower lifetime and past 30-day use. Associations were consistent across measures, except social responsibility was not associated with binge drinking or lifetime illicit drugs besides marijuana. Study strengths included nationally representative samples, diverse substance use measures, and inclusion of controls. We extend theory by suggesting that distinct aspects of adolescents' community attachments uniquely relate to lower substance use. Results suggest potential public health benefits of integrating promotion of community attachments with substance use prevention.

Daily marijuana use and suicidality: The unique impact of social anxiety

Despite a clear relationship between marijuana use and suicidality, little is known about psychological vulnerability factors that may interact with marijuana use to increase suicidality among this high-risk group. The present study examined the moderational impact of social anxiety on the relationship between marijuana use status (current users vs abstainers) and suicidality among 343 community adults. We also examined whether social anxiety moderated the relation between more frequent use (daily vs less frequent) among the 134 current marijuana users. Although social anxiety did not moderate the relation between use status and suicidality, it did moderate the relation between daily use status and suicidality after controlling for a wide range of relevant variables (e.g., demographics, depression, negative affect, and other types of anxiety). The overall model accounted for 59% of the variance in suicidality such that daily marijuana users with elevated social anxiety reported the highest suicidality. Findings highlight the importance of considering social anxiety in efforts to understand and prevent suicidality among this high-risk population.

Identifying subtypes of dual alcohol and marijuana users: A methodological approach using cluster analysis

Alcohol is the most common psychoactive substance used with marijuana. However, little is known about the potential impact of different levels of use of both alcohol and marijuana and their influence on risky behaviors, injuries and psychosocial functioning. A systematic approach to identifying patterns of alcohol and marijuana use associated with increased risks has not yet been identified in the literature. We report on the secondary analysis of data collected from a RCT conducted in a busy urban emergency department. Cluster analysis was performed on the patterns of past 30-day alcohol and marijuana use in two random subsamples N 1 = 210 and N 2 = 217. Four distinct subtypes of those who use both alcohol and marijuana were identified: (1) Daily Marijuana and Weekly Alcohol users; (2) Weekly Alcohol and Weekly Marijuana users; (3) Daily Alcohol and Daily Marijuana users; and (4) Daily Alcohol, Weekly Marijuana users. The four subtypes were replicated in both subsamples and examination of the external validity using ANOVA to determine cluster differences on psychosocial and behavioral variables confirmed the theoretical relevance of different patterns of alcohol and marijuana use. There were significantly different psychosocial negative consequences and related risky behaviors among subtypes. We found that Daily Alcohol and Daily Marijuana users are at the highest risk to experience more negative consequences and engage in a broader spectrum of risky behaviors related to both substances, than the other three types of alcohol and marijuana users.

Exercise and Substance Use Among American Youth, 1991–2009

The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context. This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time. Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009-2010. Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time. There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.

Gender Differences in Adolescent Marijuana Use and Associated Psychosocial Characteristics

Marijuana use in adolescents is associated with many adverse outcomes, including neurobiological and health consequences. Despite this, little is known about gender differences in the correlates of adolescent marijuana use. This study attempted to fill this gap by examining gender differences in the correlates of lifetime and past 30-day marijuana use. Data from a cross-sectional statewide survey of adolescent risk behavior participation in Connecticut were analyzed using χ and hierarchical logistic regression methodologies to examine the demographic, psychosocial, and risk behavior correlates of adolescent marijuana use. Gender-by-trait interactions were tested with hierarchical logistic regression. Of the 4523 participants (51.8% females, 75.8% white), 40.4% endorsed lifetime marijuana use and 24.5% endorsed past 30-day marijuana use. Risk behavior participation, particularly other substance use, had the most robust associations with lifetime and past 30-day adolescent marijuana use; participation in extracurricular activities seemed protective. Gender interactions were observed for African American, Asian, or other race and participation in extracurricular activities; in these 3 cases, males had a greater likelihood of use. They were also observed for having a job (lifetime use only), with females having elevated odds, and past 30-day cigarette smoking (past 30-day use only), with males having elevated odds. Finally, there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in females, when compared with males. These results indicate important gender differences in the correlates of marijuana use in adolescents, and these findings may facilitate the development of gender-informed prevention and early intervention programs for adolescent marijuana use.

Predicting adolescent substance use: The effects of depressed mood and positive expectancies

This study examined whether sixth-graders' depressed mood and positive substance use expectancies predicted increases over the next two years in students' lifetime and 30-day cigarette, alcohol, and marijuana use, and whether sixth graders' positive substance use expectancies moderated the relationship between baseline depressed mood and changes over the next two years in the use of these substances. Study data came from a randomized controlled trial of Project ALERT, a school-based substance use prevention program, in which students from 34 schools completed self-report surveys as sixth (n = 5782), seventh (n = 5065), and eighth graders (n = 4940). Primary analyses were performed using Hierarchical Nonlinear Modeling. Over time, there were significant effects of baseline positive expectancies on each of the six measures of substance use. Baseline depressed mood predicted increases over time only for lifetime use of cigarettes and alcohol, and for 30-day alcohol use. Positive expectancies significantly moderated the effects of adolescent depressed mood only on lifetime marijuana use. Although depressed mood predicted substance use for half of our variables, our results suggest that positive expectancies are a more consistent predictor of adolescent substance use, and that they may moderate the effects of depressed mood on marijuana, but not cigarette or alcohol, use. Substance use prevention programs may benefit from addressing adolescents' perceptions about the positive consequences of drug use.

Depressive Symptoms and Patterns of Drug Use Among Street Youth

Rates of depression among street youth are poorly characterized, particularly as they pertain to concurrent drug use. We sought to assess associations between drug type and degree of depression in this population. Between October 2005 and November 2007, data were collected from a cohort of street-recruited youth aged 14-26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiological Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regression. Logistic regression was also used to assess adjusted odds of CES-D score ≥ 22. Among 447 youth, mean CES-D score was the highest among heroin users (adjusted mean: 22.7; standard deviation [SD]:1.2), followed by crystal methamphetamine users (adjusted mean: 21.8; SD: 1.1), then cocaine and/or crack users (adjusted mean: 19.1; SD: 1.0), and finally, marijuana users (adjusted mean: 18.3; SD: 1.1), resulting in a difference that was significant among groups (p < .001). When compared with daily marijuana users, odds of CES-D score ≥ 22 were higher among heroin users (adjusted odds ratio [AOR]: 2.64; 95% confidence interval [CI]: 1.39-4.99) and crystal methamphetamine users (AOR: 1.88; 95% CI: 1.04-3.42), but not among cocaine/crack users (AOR: 1.41; 95% CI: .79-2.52). To our knowledge, this is the first report of drug use typologies and depression among street youth. Policymakers might heed the apparent vulnerability of heroin and crystal methamphetamine users to even greater degrees of depression than their peers.

Predictors of Depressive Symptomatology Among Rural Stimulant Users

This study examined sociodemographic and drug-related predictors of depressive symptoms among a rural, multistate sample of not-in-treatment stimulant drug users (n = 710). Participants were recruited using respondent-driven sampling in Ohio, Arkansas, and Kentucky. The Patient Health Questionnaire (PHQ-9) was used to measure symptoms of depression. Moderate to severe depressive symptomatology was reported by 43.0% of the sample. Cumulative logistic regression analysis showed that daily and nondaily crack use as well as the daily use of cocaine HCI increased the odds of depressive symptoms. Methamphetamine use had no significant association with depression. The daily use of marijuana, the illicit use of tranquilizers, light/moderate cigarette smoking, and injection drug use also increased the risk of depressive symptoms. Living in Kentucky or Ohio (compared to Arkansas), having unstable living arrangements, and being White, female, and older were related to higher odds of depressive symptoms. These results suggest that a host of drug and nondrug factors need to be considered when addressing depressive symptoms in stimulant users.

Functions of Marijuana Use in College Students

Hierarchical regression analysis was used to test the hypothesis that specific functional factors of marijuana use would predict past 30-day marijuana use in 425 college students more precisely than demographic variables alone. This hypothesis was confirmed. Functional factors of personal/physical enhancement as well as activity enhancement were significant predictors of 30-day marijuana use. Furthermore, this model explained over half of the variance of students' monthly marijuana use. Implications for future research and practice are discussed.

Gender Differences in Body Consciousness and Substance Use Among High-Risk Adolescents

This study explores the association between private and public body consciousness and past 30-day cigarette, alcohol, marijuana, and hard drug use among adolescents. Self-reported data from alterative high school students in California were analyzed (N = 976) using multilevel regression models to account for student clustering within schools. Separate regression analyses were conducted for males and females. Both cross-sectional baseline data and one-year longitudinal prediction models indicated that body consciousness is associated with specific drug use categories differentially by gender. Findings suggest that body consciousness accounts for additional variance in substance use etiology not explained by previously recognized dispositional variables.

A Short-Term, Quasi-Experimental Evaluation of D.A.R.E.'s Revised Elementary School Curriculum

We present the short-term results of a quasi-experimental evaluation of the revised D.A.R.E. (Drug Abuse Resistance Education) curriculum. Study outcomes examined were D.A.R.E.'s effects on three substances, namely students' lifetime and 30-day use of tobacco, alcohol, and marijuana, as well as their school attendance and academic performance. The study comprised students in 17 urban schools, each of which served as its own control; 5th graders in the 2006-2007 school year constituted the comparison group (n = 1490), and those enrolled as 5th graders in the 2007-2008 school year constituted the intervention group (n= 1450). We found no intervention effect on students' substance use for any of the substance use outcomes assessed. We did find that students were more likely to attend school on days they received D.A.R.E. lessons and that students in the intervention group were more likely to have been suspended. Study findings provide little support for the implementation and dissemination of the revised D.A.R.E. curriculum.

The Effects of Project ALERT One Year Past Curriculum Completion

School-based drug prevention curricula constitute the nation's most prevalent strategy to prevent adolescent drug use. We evaluated the effects of one such curriculum, Project ALERT, on adolescent substance use. In particular, we sought to determine if a single effect on 30-day alcohol use, noted shortly following the completion of the 2-year program, could be detected 1 year later. We also looked for delayed effects on other outcomes of interest, namely lifetime alcohol use, and 30-day and lifetime use of cigarettes, marijuana, and inhalants. We employed a randomized controlled trial that used school as the unit of assignment. Thirty-four schools with grades 6-8 from 11 states completed the study. Seventy-one Project ALERT instructors taught 11 core lessons to sixth graders and 3 booster lessons to seventh graders. Students were assessed prior to the onset of the intervention, as sixth graders, after the completion of the 2-year curriculum, as seventh graders, and again 1 year later as eighth graders. This paper examines data from the pretest and final posttest. Using hierarchical nonlinear modeling, we found that our earlier effect on 30-day alcohol use did not persist. Further, we continued to find no effects for lifetime alcohol use and both the lifetime and 30-day use of cigarettes, marijuana, and inhalants. Our findings do not support the long-term effectiveness of Project ALERT, when delivered to sixth graders.

Project SUCCESS' effects on the substance use of alternative high school students

Project SUCCESS is a selective and indicated substance use prevention program that targets high risk students in secondary school settings. We evaluated the effects of Project SUCCESS on adolescents' substance use immediately following program implementation, and again one year later. Two successive cohorts of alternative high schools were randomly assigned to an intervention or control group, yielding seven schools per condition. Main outcomes included 30-day use of alcohol, marijuana, and illegal drugs excluding marijuana, and drinking to intoxication. We conducted exploratory analyses on 30-day cigarette use. Using Hierarchical Linear Modeling, we found that students in the control schools reported significantly less use of illegal drugs excluding marijuana than those in the intervention group at the first posttest; however, this effect did not persist one year later. There were no other outcome effects of even a marginal nature. While results of this study do not provide evidence of Project SUCCESS' effectiveness, students' program exposure was low. It is possible that Project SUCCESS would perform better in schools with higher and more regular rates of attendance.

Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother–daughter program

This study tested a computerized gender-specific, parent-involvement intervention program grounded in family interaction theory and aimed at preventing substance use among adolescent girls. Following program delivery and 1 year later, girls randomly assigned to the intervention arm improved more than girls in a control arm on variables associated with reduced risks for substance use, including communication with their mothers, knowledge of family rules about substance use, awareness of parental monitoring of their discretionary time, non-acceptance of peer substance use, problem-solving skills, and ability to refuse peer pressure to use substances. Relative to control-arm girls, those in the intervention arm also reported less 30-day use of alcohol and marijuana and lower intentions to smoke, drink, and take illicit drugs in the future. Girls' mothers in the intervention arm reported greater improvements after the program and relative to control-arm mothers in their communication with their daughters, establishment of family rules about substance use, and monitoring of their daughters' discretionary time. Study findings lend support to the potential of gender-specific, parent-involvement, and computerized approaches to preventing substance use among adolescent girls.

Adolescents' thoughts about abstinence curb the return of marijuana use during and after treatment.

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents' motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual's average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time.