Days Of Nonuse Research Articles

A daily diary investigation of cannabis use and its diet and exercise correlates.

The increasing availability of legal-market cannabis products has raised many questions about potential harms and benefits of increased use. In particular, concerns have been raised about the possible negative impact of cannabis use on behavioral determinants of obesity and chronic disease, including diet and exercise. However, previous research is mixed and has largely relied on cross-sectional survey data and coarse measurements of cannabis use, underscoring the need for more rigorous research designs. The present study utilized longitudinal daily diary data to assess whether exercise and diet patterns differed between cannabis users and non-users and, within cannabis users, whether legal-market cannabis use, diet, and exercise covaried within individuals across time and based on cannabinoid content. A sample of 98 participants (77 cannabis users, 21 non-users) completed a baseline appointment and a 30-day daily diary study assessing their daily cannabis use, diet, and exercise. Cannabis users were quasi-randomly assigned to use either a THC-dominant flower product (n = 36) or a CBD-containing flower product (n = 41) ad libitum over the course of the daily diary study. Participants were between the ages of 21 and 41 (M = 29.28) and were majority male (61.2%). At baseline, there were no differences in BMI or exercise behavior between users and non-users. Likelihood of exercising and exercise minutes per day over the 30-day period also did not differ between users and non-users, nor did these outcomes differ on cannabis use vs. non-use days among cannabis using participants. In contrast, there was some evidence for a relationship between cannabis use and dietary measures. At baseline, non-users scored higher on the Healthy Eating Index than users. Daily data also indicated that users consumed marginally more salty snacks and fast food per day relative to non-users, and users consumed more fruits/vegetables and marginally more salty snacks on cannabis use days vs. non-use days. Interestingly, among users, no associations were dependent on the cannabinoid content of their assigned product. Findings suggest little association between cannabis use and exercise but underscore the need for further research on how cannabis use may impact dietary patterns. Future research should examine the impact of cannabis on non-behavioral pathways to obesity and chronic disease (e.g., metabolism).

Cannabis use and sleep quality in daily life: An electronic daily diary study of adults starting cannabis for health concerns

BackgroundReal world patterns of cannabis use for health concerns are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with electronic daily diaries that capture person-specific patterns of cannabis use and health symptoms may help clarify risks and benefits. MethodsAs part of a larger, randomized trial (NCT03224468), adults (N = 181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms. ResultsCompletion rates of daily surveys were moderate to high (median completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Among the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms. ConclusionCannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Daily web-based assessments of cannabis appear valid and feasible in adults seeking cannabis for health concerns, providing a flexible, complementary method for future real-world effectiveness studies with expanded and objective measures.

Forgoing plans for alcohol and cannabis use in daily life: Examining reasons for nonuse when use was planned in a predominantly white college student sample.

The reasons for college students to abstain from alcohol and cannabis use on a given day can inform efforts to prevent or intervene in those behaviors. Research on reasons for alcohol nonuse remains in its nascent stages and no study to date has examined reasons for cannabis nonuse on a given day. Here we examine reasons for nonuse among college students after they planned to use alcohol and/or cannabis. College students (N=341; Mage =19.79; 53% women; 74% White) from 3 universities completed 54days of data collection across which approximately 50% were nonuse days. Each morning, participants indicated whether they planned to use that day; nonuse reasons were assessed the next morning, if applicable. Generalized linear mixed-effects models were used to disentangle within- and between-person effects. On a given nonuse day (at the within-person level), "work" and "school" were reasons associated with having no plan to use alcohol and "to feel in control" was linked to having no plan to use cannabis. "Did not want to get high" was related to forgoing plans (did not use when originally planned) for alcohol use at the within-person level. At the between-person level, "no desire" was associated with no plans for alcohol or cannabis use and "did not want to get high" was related to no plans for cannabis use. "School" and "could not get" were related to forgoing plans for alcohol and cannabis use, respectively, at the between-person level. An examination of earlier intentions for alcohol and/or cannabis use on nonuse days yielded novel findings on the intention-behavior gap. Reasons for nonuse can inform intervention and prevention strategies (e.g., those involving social norms or just-in-time adaptive efforts) for alcohol and cannabis use on college campuses.

A longitudinal examination of daily patterns of cannabis and alcohol co-use among medicinal and recreational veteran cannabis users

BackgroundPrompted by the ongoing debate regarding whether cannabis serves as a complement to or substitute for alcohol, this study uses prospective data to examine daily associations between medicinal versus recreational cannabis and alcohol use in veterans. MethodsThree semi-annual waves of Timeline Followback Interview data were collected from a sample of veterans who reported co-using alcohol and cannabis on at least one day (N = 115; 56% medicinal users; 93% male; 62,100 observations). Linear mixed effects models were used to examine the association between daily cannabis use and number of drinks consumed across time for both medicinal and recreational users and to examine the frequency medicinal cannabis used to substitute for alcohol. ResultsCompared to medicinal users, recreational users were more likely to drink more on cannabis use days relative to non-use days. Among medicinal users, those endorsing more frequent use of cannabis as a substitute for alcohol reported fewer number of drinks consumed on days when cannabis was used relative to non-use days. ConclusionsAmong veterans, recreational users are at greater risk for increased drinking when co-using cannabis at the daily level, an association that is stable over time. Medicinal users may be at lower risk for increased drinking on days when cannabis is also used, especially those who endorse using cannabis to substitute for alcohol. Findings help clarify the debate on cannabis-alcohol substitution or complementary associations in a sample of veterans and suggests that alcohol interventions should address cannabis use as a risk factor, especially for recreational users.

Daily Patterns of Marijuana and Alcohol Co-Use Among Individuals with Alcohol and Cannabis Use Disorders.

The study aims were to examine daily associations between marijuana and alcohol use and the extent to which the association differs as a function of cannabis use disorder (CUD) and/or alcohol use disorder (AUD) diagnosis. Timeline Followback interview data was collected in a study of veterans (N=127) recruited from a Veterans Affairs hospital who reported at least 1day of co-use of marijuana and alcohol in the past 180days (22,860 observations). Participants reported 40% marijuana use days, 28% drinking days, with 37% meeting DSM-5 criteria for CUD, 40% for AUD, and 15% for both. Use of marijuana on a given day was used to predict a 3-level gender-adjusted drinking variable (heavy: ≥5 (men)/4 (women) drinks; moderate: 1 to 4/3 drinks; or none: 0 drinks). A categorical 4-level variable (no diagnosis, AUD, CUD, or both) was tested as a moderator of the marijuana-alcohol relationship. Multilevel modeling analyses demonstrated that participants were more likely to drink heavily compared to moderately (OR=2.34) and moderately compared to not drinking (OR=1.61) on marijuana use days relative to nonuse days. On marijuana use days, those with AUD and those with AUD+CUD were more likely to drink heavily (OR=1.91; OR=2.51, respectively), but those with CUD were less likely to drink heavily (OR=0.32) compared to moderately, nonsignificant differences between any versus moderate drinking in interaction models. Heavy drinking occurs on days when marijuana is also used. This association is particularly evident in individuals diagnosed with both AUD and CUD and AUDs alone but not in those with only CUDs. Findings suggest that alcohol interventions may need to specifically address marijuana use as a risk factor for heavy drinking and AUD.

Topiramate in the treatment of cocaine use disorder.

The literature on topiramate use in cocaine-dependent patients was reviewed. Six randomized, double-blind, controlled clinical trials evaluating the use of topiramate in patients who were cocaine dependent were analyzed. The results from the studies indicated that topiramate, when used in combination with cognitive behavioral therapy, may be effective in reducing short-term cocaine use and should be considered as a possible treatment option. Other trials suggested that topiramate was not effective in patients with a dual diagnosis of opioid and cocaine dependence. Two trials suggested that short-term abstinence assisted by pharmacotherapy is a predictor of longer-term (6 months and 1 year, respectively) abstinence. Cocaine use is dependent on multiple factors; therefore, a reduction in use or craving is not definitively associated with abstinence. However, decreased use reduces potential patient harm and the amount of money spent on illicit cocaine. The findings of this literature review should be used to encourage the completion of more trials that are appropriately designed. Topiramate was shown to be effective for increasing cocaine abstinence, the proportion of cocaine nonuse days, and the proportion of patients to attain 3 consecutive weeks of cocaine abstinence and decreasing the abuse liability of cocaine. Conflicting results in clinical trials do not provide a definitive answer regarding topiramate's efficacy in managing cocaine dependence. Available research neither validates nor invalidates the hypothesis that topiramate is efficacious in attaining abstinence in cocaine-dependent patients.

Antecedents and consequences of cannabis use among racially diverse cannabis users: An analysis from Ecological Momentary Assessment

BackgroundCannabis remains the most commonly used illicit substance and use rates are rising. Notably, the prevalence of cannabis use disorders (CUD) nearly equals that of other illicit substance use disorders combined. Thus, the present study aimed to identify cognitive, affective, and situational predictors and consequences of ad-lib cannabis use in a racially diverse sample. MethodsThe sample consisted of 93 current cannabis users (34.4% female; 57.1% non-Hispanic Caucasian), 87.1% of whom evinced a current CUD. Ecological Momentary Assessment was used to collect frequent ratings of cannabis withdrawal, craving, affect, cannabis use motives, and peer cannabis use over two weeks. Mixed effects linear models examined within- and between-day correlates and consequences of cannabis use. ResultsWithdrawal and craving were higher on cannabis use days than non-use days. Withdrawal, craving, and positive and negative affect were higher immediately prior to cannabis use compared to non-use episodes. Withdrawal and craving were higher among those who subsequently used cannabis than those who did not. Cannabis use resulted in less subsequent withdrawal, craving, and negative affect. Enhancement and coping motives were the most common reasons cited for use. Withdrawal and negative affect were related to using cannabis for coping motives and social motives. Participants were most likely to use cannabis if others were using, and withdrawal and craving were greater in social situations when others were using. ConclusionsData support the contention that cannabis withdrawal and craving and affect and peer use play important roles in the maintenance of cannabis use.

Seizure Drug Shows Promise As Cocaine-Addiction Treatment

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSeizure Drug Shows Promise As Cocaine-Addiction TreatmentJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:18 Dec 2013https://doi.org/10.1176/appi.pn.2013.12a1AbstractEvery few years, a promising medication to treat cocaine dependence emerges, only to fizzle. Is the latest one—topiramate—the longed-for treatment or will it too disappoint?Despite decades of zealous scientific effort, an effective medication to treat cocaine addiction remains elusive. Hope for such a treatment is growing, however, based on results of a study published online October 16 in JAMA Psychiatry.The medication topiramate—already approved by the Food and Drug Administration (FDA) to treat seizures and prevent migraines and also used off label to treat alcohol dependence—is now looking promising as a treatment for cocaine dependence as well.The study was headed by Bankole Johnson, M.D., D.Sc., chair of psychiatry at the University of Maryland.Animal research has shown that an intact GABA neurotransmitter system in the nucleus accumbens, corpus striatum, and several other brain structures is critical for cocaine to exert its effects. Animal research has also indicated that medications that enhance GABA function can reduce cocaine’s effects. Thus Johnson and his colleagues hypothesized that topiramate, a medication known to enhance GABA function, might be effective in treating cocaine dependence. They then launched a clinical trial to test this hypothesis.A total of 142 cocaine-dependent adults were recruited to take part in their study. Half were randomized to receive topiramate, and half were randomized to receive a placebo over a 12-week period. The primary outcome variable was the weekly difference from baseline in the proportion of cocaine nonuse days during weeks 6 to 12, the period when subjects’ topiramate doses should have been optimal. Cocaine use was monitored by self-report and urine tests three times a week.Bankole Johnson, M.D., D.Sc.: “A large effectiveness study is being planned to generalize the findings to an even wider population of cocaine addicts.”Bankole Johnson, M.D., D.Sc.The second outcome variable was cocaine craving as measured by two craving scales that had been well validated in previous pharmacotherapy trials for cocaine dependence—the Cocaine Selective Severity Assessment Scale and the Brief Substance Craving Scale.Finally, global functioning was evaluated by a clinician or nurse practitioner using the Clinical Global Impression-Observer Scale and by the subjects themselves using the Clinical Global Impression–Self Scale.Topiramate was significantly more efficacious than placebo in increasing cocaine-nonuse days and urinary cocaine-free weeks, in reducing the frequency and intensity of cocaine craving, and in improving both observer-rated and self-rated global functioning.In short, “We have some great news regarding a treatment for cocaine dependence,” Johnson told Psychiatric News. As he and his colleagues asserted in their report, “Taken together, it is reasonable to propose that topiramate treatment was associated with a clinically meaningful improvement in the severity of cocaine dependence.”They did acknowledge that they could not compare topiramate’s impact with that of any other medication, since no medication has been approved by the FDA to treat cocaine dependence. “Finding a safe and effective medication (or vaccine) for the treatment of cocaine use disorder has been the holy grail of our field for decades,” Petros Levounis, M.D., chair of psychiatry at Rutgers New Jersey Medical School and an addiction psychiatrist, said during an interview. “Every few years, an exciting possibility appears on the pharmacotherapy scene, only to fizzle out a little later. For a long time, topiramate has been thought of as one of the more promising medications for the treatment of cocaine addiction, and the present study supports this notion. We hope that our current optimism for the success of topiramate is not short-lived as was the case for some other drugs. Had the study been longer than 12 weeks, our confidence in the reported encouraging results would be considerably higher.”Indeed, the next step, Johnson and his team explained, will be to undertake a trial of six months or longer to try to replicate and extend their current findings. The study was funded by the National Institutes of Health and the Agency for Healthcare Research and Quality. ■ An abstract of “Topiramate for the Treatment of Cocaine Addiction: A Randomized Clinical Trial” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=1756816. ISSUES NewArchived

Topiramate for the Treatment of Cocaine Addiction

No medication has been established as an efficacious treatment for cocaine dependence. We hypothesized that dual modulation of the mesocorticolimbic dopamine system by topiramate-a glutamate receptor antagonist and γ-aminobutyric acid receptor agonist-would result in efficacious treatment for cocaine dependence compared with placebo. To determine the efficacy of topiramate vs placebo as a treatment for cocaine dependence. Double-blind, randomized, placebo-controlled, 12-week trial of 142 cocaine-dependent adults in clinical research facilities at the University of Virginia between November 22, 2005, and July 25, 2011. Topiramate (n = 71) or placebo (n = 71) in escalating doses from 50 mg/d to the target maintenance dose of 300 mg/d in weeks 6 to 12, combined with weekly cognitive-behavioral treatment. For the efficacy period, weeks 6 to 12, the primary outcome was the weekly difference from baseline in the proportion of cocaine nonuse days; the secondary outcome was urinary cocaine-free weeks, and exploratory outcomes included craving and self- and observer-rated global functioning on the Clinical Global Impression scales. Using an intent-to-treat analysis, topiramate was more efficacious than placebo at increasing the weekly proportion of cocaine nonuse days, irrespective of whether missing data were not or were imputed conservatively to the baseline value (13.3% vs 5.3%, 95% CI for the estimated mean difference, 1.4%-14.6%, P = .02 or 8.9% vs 3.7%, 95% CI for the estimated mean difference, 0.2%-10.1%, P = .04, respectively). Topiramate also was associated, significantly more than placebo, with increasing the likelihood of urinary cocaine-free weeks (16.6% vs 5.8%; odds ratio, 3.21; 95% CI, 1.24-8.32; P = .02), as well as decreasing craving and improving observer-rated global functioning (all P < .05). Topiramate is more efficacious than placebo at increasing the mean weekly proportion of cocaine nonuse days and associated measures of clinical improvement among cocaine-dependent individuals.

Modafinil for the treatment of cocaine dependence

Aim Modafinil was tested for efficacy in facilitating abstinence in cocaine-dependent patients, compared to placebo. Methods This was a double-blind placebo-controlled study, with 12 weeks of treatment and a 4-week follow-up. Six outpatient substance abuse treatment clinics participated in the study. There were 210 treatment-seekers randomized, having a diagnosis of cocaine dependence; 72 participants were randomized to placebo, 69 to modafinil 200 mg, and 69 to modafinil 400 mg, taken once daily on awakening. Participants came to the clinic three times per week for assessments and urine drug screens, and had one hour of individual psychotherapy weekly. The primary outcome measure was the weekly percentage of cocaine non-use days. Results The GEE regression analysis showed that for the total sample, there was no significant difference between either modafinil group and placebo in the change in average weekly percent of cocaine non-use days over the 12-week treatment period ( p > 0.79). However, two secondary outcomes showed significant effects by modafinil 200 mg: the maximum number of consecutive non-use days for cocaine ( p = 0.02), and a reduction in craving ( p = 0.04). Also, a post hoc analysis showed a significant effect of modafinil that increased the weekly percentage of non-use days in the subgroup of those cocaine patients who did not have a history of alcohol dependence ( p < 0.02). Conclusions These data suggest that modafinil, in combination with individual behavioral therapy, was effective for increasing cocaine non-use days in participants without co-morbid alcohol dependence, and in reducing cocaine craving.

A preliminary randomized, double-blind, placebo-controlled study of the safety and efficacy of ondansetron in the treatment of cocaine dependence

Prior studies have demonstrated inefficacy among dopamine receptor antagonists for treating cocaine dependence. An alternative approach would be to investigate the ability of indirect inhibitors of cortico-mesolimbic dopamine release, such as the 5-HT 3 receptor antagonist ondansetron, to reduce cocaine's reinforcing effects. We hypothesized that ondansetron might be more efficacious than placebo at reducing cocaine intake and promoting abstinence in cocaine-dependent individuals. In a pilot randomized, double-blind, 10-week controlled trial, 63 treatment-seeking, cocaine-dependent men and women received ondansetron (0.25 mg, 1.0 mg, or 4.0 mg twice daily) or placebo. Up to three times per week, participants were assessed on several measures of cocaine use, including urine benzoylecgonine. Cognitive behavioral therapy was administered weekly. Ondansetron was well tolerated, causing no serious adverse events. The ondansetron 4.0 mg group had the lowest dropout rate among all treatment groups and a greater rate of improvement in percentage of participants with a cocaine-free week compared with the placebo group ( p = 0.02), whereas the ondansetron 1.0 mg group had a lower rate of improvement in percentage of weekly mean non-use days than did placebo recipients ( p = 0.04). These results suggest the possibility of a non-linear dose–response function, with evidence supporting efficacy for the 4.0 mg group.

Factors That Influence Skill Decay and Retention: A Quantitative Review and Analysis

This article presents a review of the skill retention and skill decay literature that focuses on factors that influence the loss of trained skills or knowledge over extended periods of nonuse. Meta-analytic techniques were applied to a total of 189 independent data points extracted from 53 articles. Results indicate that there is substantial skill loss with nonpractice or nonuse, with the amount of skill loss ranging from an effect size (d) of -0.01 immediately after training to a d of -1.4 after more than 365 days of nonuse. Most of the study's hypotheses for moderators were supported. Physical, natural, and speed-based tasks were less susceptible to skill loss than cognitive, artificial, and accuracy-based tasks. Additionally, certain methodological variables, such as using recognition tests, using similar conditions of retrieval at retention, and using behavioral evaluation criteria, resulted in less skill loss over time. Implications of the results for training and future research are discussed.

Psychological correlates of marijuana use: an exploratory study.

The study was concerned with social and emotional correlates of marijuana use. 85 undergraduate students were given a structured diary to fill out nightly for 1 wk. 24 Ss reporting use of marijuana during this period were compared in terms of (1) the days they used and did not use the drug and (2) with the group of 61 nonusers. While most comparisons showed only a small difference, there was a tendency for marijuana users to more frequently report sex desire on use days than nonuse days and to smoke cigarettes more often than the nonuse group.