Problematic Cannabis Use Research Articles

Attention Problems in Childhood and Adult Substance Use

To assess the link between childhood attention problems (AP) and substance use 18 years later. This cohort study was conducted in a community sample of 1103 French youths followed from 1991 to 2009. Exposures and covariates were childhood behavioral problems (based on parental report at baseline), early substance use, school difficulties, and family adversity. Outcome measures were regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use (based on youth reports at follow-up). Individuals with high levels of childhood AP had higher rates of substance use (regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use). However, when taking into account other childhood behavioral problems, early substance use, school difficulties, and family adversity, childhood AP were related only to regular tobacco smoking and lifetime cocaine use. Early cannabis exposure was the strongest risk factor for all substance use problems. This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood AP and substance use is confounded by a range of early risk factors. Early cannabis exposure plays a central role in later substance use.

Childhood conduct disorder trajectories, prior risk factors and cannabis use at age 16: birth cohort study

AimsTo investigate the prevalence of cannabis use and problem use in boys and girls at age 16 years, and to investigate the role of adversity in early life and of conduct disorder between the ages of 4 and 13 years as risk factors for these outcomes.DesignBirth cohort study.SettingEngland.ParticipantsA total of 4159 (2393 girls) participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort providing information on cannabis use at age 16.MeasurementsCannabis use and problem cannabis use at age 16 were assessed by postal questionnaire. Material adversity, maternal substance use, maternal mental health and child conduct disorder were all assessed by maternal report.FindingsCannabis use was more common among girls than boys (21.4% versus 18.3%, P = 0.005). Problem cannabis use was more common in boys than girls (3.6% versus 2.8%, P = 0.007). Early-onset persistent conduct problems were associated strongly with problem cannabis use [odds ratio (OR) = 6.46, 95% confidence interval (CI) = 4.06–10.28]. Residence in subsidized housing (OR = 3.10, 95% CI = 1.95, 4.92); maternal cannabis use (OR 8.84, 95% CI 5.64–13.9) and any maternal smoking in the postnatal period (OR = 2.69, 95% CI = 1.90–3.81) all predicted problem cannabis use. Attributable risks for adolescent problem cannabis use associated with the above factors were 25, 13, 17 and 24%, respectively.ConclusionsMaternal smoking and cannabis use, early material disadvantage and early-onset persistent conduct problems are important risk factors for adolescent problem cannabis use. This may have implications for prevention.

Sleep Quality Moderates the Relation between Depression Symptoms and Problematic Cannabis Use among Medical Cannabis Users

Objectives: This study sought to extend research on the relation between depression symptoms and problematic cannabis use by evaluating the potential moderating role of perceived sleep quality among medical cannabis users. Methods: This employed a cross-sectional design. The sample consisted of 162 adults (mean age = 42.05 years, SD = 14.8; 22% female), with current recommendations from a doctor for medical cannabis, recruited from a medical cannabis dispensary. Results: Consistent with previous research, individuals with heightened depression symptoms had greater problematic cannabis use. In addition, perceived sleep quality moderated this relation, such that depression symptoms differentially related to problematic cannabis use as a function of perceived quality of sleep (ΔR2 = .03, p = .02). Participants with higher levels of depression and good perceived sleep quality had the greatest rates of problematic cannabis use. Conclusions: These results suggest that individuals with heightened depression may have higher rates of problematic cannabis use, in part, because of the beneficial effects of cannabis in terms of perceived sleep quality.

Patterns of alcohol, tobacco and cannabis use and related harm in city, regional and remote areas of Australia

BackgroundPrevalence of substance use and related harms differs across geographic locations, with prevalence increasing with remoteness. This paper builds on previous research, investigating patterns of problematic use by remoteness. MethodsAnalysis of the National Drug Strategy Household Survey (NDSHS) data from 2007 by geographic location (in accordance with the Australian Standard Geographical Classification (ASGC) remoteness index). ResultsProblematic cannabis use was predicted by demographics; older males with less education were more likely to report problematic cannabis use regardless of location. Younger, less educated males in inner regional and remote areas were more likely to report risky alcohol consumption for short term harms, while older, less educated males in outer regional and remote areas were more likely to report daily drinking. People from remote areas were significantly more likely to report driving under the influence of alcohol. ConclusionsIt is clear that men with lower levels of education were significantly more likely to report problematic alcohol and cannabis use patterns. An additional level of risk is associated with living in inner regional and remote areas, particularly in relation to risky drinking. Findings suggest a complex relationship between remoteness and substance use which requires further investigation.

Optimal scaling of the CAST and of SDS Scale in a national sample of adolescents

PurposePsychometric and screening properties of the Cannabis Abuse Screening Test (CAST) and of the Severity Dependence Scale (SDS) were investigated using DSM-IV diagnoses of cannabis dependence (CD) as external criteria. Performance of the SDS and of the CAST were compared. MethodsCross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) was carried out in Italy in 2009. The sample consisted of 5787 Italian adolescents aged 15–19 who reported cannabis last year use. Uni-dimensionality, internal reliability, external validity, and optimal scaling of the 6 items for CAST and 5 items for SDS were performed. The Munich Composite International Diagnostic Interview (M-CIDI) was used as a gold standard for DSM-IV diagnoses, and all outputs were assessed by 10-fold cross validation procedure. ResultsBoth scales were uni-dimensional and Cronbach's α was 0.74 for SDS and 0.78 for CAST. High and comparable area under curve (AUC) values indicate a good ability of both scales to discriminate between individuals with and without dependence diagnosis. Based on balanced sensitivity and specificity, the optimal cut-off scores for problematic use disorders were 7 for CAST MCA and 4 for SDS MCA. Both CAST and SDS overestimated CD prevalence. ConclusionsThe CAST and SDS are equally useful for screening for problematic cannabis use disorders. Both clinical and research applications of the scales are possible.

The interactive effects of emotional clarity and cognitive reappraisal on problematic cannabis use among medical cannabis users

This study examined whether emotional clarity (i.e., the extent to which one can identify and understand the type and source of emotions one experiences) and cognitive reappraisal (i.e., altering how potentially emotion-eliciting situations are construed to change their emotional impact) would individually or jointly be associated with problematic cannabis use among individuals receiving cannabis for medical reasons (n=153). Findings indicated that problematic cannabis use was predicted by the interaction between emotional clarity and cognitive reappraisal. In particular, low levels of emotional clarity combined with high levels of cognitive reappraisal predicted problematic cannabis use. The current study is the first to demonstrate the interactive effects of emotional clarity and the use of cognitive reappraisal in predicting substance use disorder outcomes. Such findings are important given the lack of empirical data demonstrating for whom and for which conditions cannabis is either beneficial or detrimental.

Cannabis-related impairment and social anxiety: The roles of gender and cannabis use motives

Social anxiety appears to be especially related to cannabis-related problems, yet the nature of this association remains unclear. Some data suggest that socially anxious men may be especially vulnerable to problematic cannabis use. The current study examined the relations between social anxiety, cannabis use and use-related problems, and motives for cannabis use by gender among 174 (42.5% female) current (past-month) cannabis users. Among men, social anxiety was significantly, positively related to the number of cannabis-related problems and coping and conformity motives. Coping and conformity motives mediated the relation between social anxiety and cannabis-related problems. Among women, social anxiety was significantly related only to social motives, and was unrelated to cannabis-related problems. These findings suggest that socially anxious men may be especially vulnerable to using cannabis as a means of avoidance coping (avoiding scrutiny and negative affect), which may contribute to the high rates of cannabis-related problems among socially anxious individuals.

Effekte einer einmaligen Chat-Intervention auf problematischen Substanzkonsum

Ziel: Überprüfung der Effektivität einer auf Motivational Interviewing (MI) basierenden Intervention im Online-Chat unter jungen Alkohol- und Cannabiskonsumenten mit ambivalenter Änderungsmotivation. Methodik: Randomisiert-kontrollierte Online-Studie mit Nachbefragungen nach einem und nach drei Monaten. Die Rekrutierung erfolgte über die Selbsttests auf der Website drugcom.de und schloss nur Personen mit problematischem Alkohol- oder Cannabiskonsum ein. Teilnehmer der Interventionsgruppe nahmen am privaten MI-Chat teil. Mitglieder der Kontrollgruppe erhielten im Chat lediglich Sachinformationen über den zuvor genutzten Selbsttest. Ergebnisse: 302 Personen wurden randomisiert und in die ITT-Auswertung einbezogen. Es zeigten sich keine Gruppenunterschiede im Konsum von Alkohol (p ≥ 0.224), Cannabis (p = 0.537) oder in der Änderungsmotivation nach RCQ (p = 0.469). Beide Gruppen senkten ihren Alkoholkonsum im Studienverlauf signifikant und zeigten Verbesserungen der Änderungsbereitschaft. Schlussfolgerungen: Die beschriebene Chat-Intervention erzielt keine Verhaltensänderung bei ambivalent eingestellten Konsumenten. Online-Interventionen für diese Zielgruppe sollten womöglich länger und verbindlicher gestaltet werden.

Screening of cannabis-related problems among youth: the CPQ-A-S and CAST questionnaires

BackgroundCannabis use among young people is a significant problem, making particularly necessary validated screening instruments that permit secondary prevention. The purpose of this study was to analyze and compare the psychometric properties of the CAST and CPQ-A-S questionnaires, two screening instruments specifically addressing the youth population.MethodsInformation was obtained on sociodemographics, frequency of substance use, psychopathological symptoms and cannabis-use problems, and the CPQ-A-S and CAST were applied, as well as an infrequency scale for discarding responses made randomly. The sample was made up of 144 young people aged 16 to 20 that had used cannabis in the last month, of which 71.5% were boys. Mean age of the sample was 17.38 years (SD = 1.16).ResultsThe results show that from the psychometric point of view both the CAST and the CPQ-A-S are good screening instruments.ConclusionsThe CAST is shorter and presents slightly better internal consistency than the CPQ-A-S. Both instruments show high sensitivity and specificity in the detection of young people dependent on cannabis according to the DSM IV-TR criteria. The CPQ-A-S appears to show greater capacity for detecting psychopathological distress associated with use. Both questionnaires yield significant odds ratios as predictors of frequent cannabis use and of the DSM IV-TR abuse and dependence criteria. In general, the CPQ-A-S emerges as a better predictor than the CAST.

Patients with Nonaffective Psychosis Are at Increased Risk for Heroin Use Disorders

Background/Aim: It is well-established knowledge that persons with nonaffective psychotic disorders often have problematic use of alcohol, cannabis and stimulants, but heroin use is usually not included. Our aim was to investigate the prevalence of heroin use disorders in patients with nonaffective psychosis. Methods: As the combination of heroin use and nonaffective psychosis is infrequent, epidemiological studies have to include large populations. The present study is acase count study using information from all psychiatric and social services in Oslo. Prevalence was calculated for four possible scenarios of minimum and maximum case counts and prevalences of nonaffective psychosis. Odds ratios were calculated for the resulting prevalences compared to the minimum and maximum prevalence of heroin use disorder in the general population. Results: We found between 39 and 56 subjects with nonaffective psychoses and comorbid heroin use disorder. The number of individuals with nonaffective psychosis was estimated to be between 692 and 1,730. This corresponds to a prevalence of heroin use disorder of between 2.3 and 8.1%. The odds ratio compared to the general population will range from 1.83 with a prevalence of heroin use disorder in the general population of 1.2% to 9.43 with a prevalence of 0.9%. Conclusion: Individuals with nonaffective psychosis are at increased risk of heroin use.

Gene-environment interaction in problematic substance use: interaction betweenDRD4and insecure attachments

To investigate the combined effect of an exon III variable number tandem repeat in the dopamine receptor gene (DRD4) and insecure attachment style on risk for tobacco, cannabis and alcohol use problems in young adulthood. It was hypothesized that (1) individuals with 5, 6, 7 or 8 repeats (labelled 7R+) would be at increased risk for problematic drug use, and (2) risk for drug use would be further increased in individuals with 7R+ repeats who also have a history of insecure parent-child attachment relations. Data were drawn from the Victorian Adolescent Health Cohort Study, an eight-wave longitudinal study of adolescent and young adult development. DRD4 genotypes were available for 839 participants. Risk attributable to the combined effects of 7R+ genotype and insecure attachments was evaluated within a sufficient causes framework under the assumptions of additive interaction using a two-by-four table format with a common reference group. 7R+ alleles were associated with higher tobacco, cannabis and alcohol use (binging). Insecure attachments were associated with higher tobacco and cannabis use but lower alcohol use. For tobacco, there was evidence of interaction for anxious but not avoidant attachments. For cannabis, there was evidence of interaction for both anxious and avoidant attachments, although the interaction for anxious attachments was more substantial. There is no evidence of interaction for binge drinking. Results are consistent with a generic reward deficit hypothesis of drug addiction for which the 7R+ disposition may play a role. Interaction between 7R+ alleles and attachment insecurity may intensify risk for problematic tobacco and cannabis use.

Tobacco, alcohol, cannabis and other illegal drug use among young adults: The socioeconomic context

BackgroundLow socioeconomic position predicts risk of substance abuse, yet few studies tested the role of preexisting familial and individual characteristics. MethodsData come from the TEMPO (Trajectoires Epidémiologiques en Population) study (community sample in France, 1991–2009, n=1103, 22–35 years in 2009) set up among offspring of participants of an epidemiological study (GAZEL). Past 12-month substance use was assessed in 2009 by self-completed mail survey: regular tobacco smoking, alcohol abuse (AUDIT), cannabis use, problematic cannabis use (CAST), other illegal drug use. Socioeconomic position was defined by educational attainment, occupational grade, employment stability and unemployment. Covariates included demographics (age, sex, relationship status, parenthood), family background (parental income, parental tobacco smoking, parental alcohol use), and juvenile characteristics (psychological problems, academic difficulties) measured longitudinally. Results35.8% of study participants were regular smokers, 14.3% abused alcohol, 22.6% used cannabis (6.3% had problematic cannabis use) and 4.1% used other illegal drugs. Except for alcohol abuse, substance use rates were systematically higher in individuals with low, rather than intermediate/high, socioeconomic position (age and sex-adjusted ORs from 1.75 for cannabis use to 2.11 for tobacco smoking and 2.44 for problematic cannabis use). In multivariate analyses these socioeconomic disparities were decreased, but remained statistically significant (except for illegal drugs other than cannabis). ConclusionsTobacco smoking, alcohol, cannabis and polysubstance use are common behaviors among young adults, particularly those experiencing socioeconomic disadvantage. Interventions aiming to decrease substance abuse and reduce socioeconomic inequalities in this area should be implemented early in life.

Diagnostic characteristics of inpatients in a Western African psychiatric hospital

Little is known about psychiatric patients and psychiatric service delivery in non-Western developing countries. Therefore, this naturalistic pilot study aimed at analysing and describing the patient population treated in the Tanka Tanka Psychiatric Hospital, the mental health inpatient facility of The Gambia. Most patients were male and exhibited a wide age range of over 40 years. There were also indicators that the hospital population consisted of two distinguished groups: a large group of chronically ill patients and a smaller group of psychiatric patients with very acute symptoms. Psychotic/mood disorders and substance dependence/abuse were the most common diagnoses. In many patients problematic cannabis use was prevalent. Such research can contribute to better understand the needs of psychiatric patients, and help to develop continuously improved service delivery and optimise therapeutic options.

Reward sensitivity and outcome expectancies as predictors of ecstasy use in young adults

Extending recent studies showing that sensitivity to reward and outcome expectancies are associated with problematic alcohol and cannabis use, we undertook to determine if similar relationships would hold for ecstasy. One hundred and twenty five males and females aged between 18 and 35 years were recruited from RMIT University and through snowball sampling. Participants completed a questionnaire package measuring frequency, amount and first age of ecstasy use, sensitivity to reward and punishment as well as outcome expectancies relating to ecstasy use. Frequency of ecstasy use was significantly related to reward sensitivity (p < .05) and positive outcome expectancies (p < .01). Regression analysis revealed significant prediction of ecstasy use by study variables, with expectations of increased confidence making the largest individual contribution. Multiple intervention points are suggested by the results of this study, within a largely cognitive-based framework.

A postal intervention for dependent cannabis users

INTRODUCTION AND AIMS. In Australia, many would-be treatment seekers for problematic cannabis use live in rural and remote areas, thereby limiting their access to face-to-face treatments. In order to address this gap in treatment availability, the present study aimed to assess the feasibility of a mail-based intervention for regular cannabis users. Treatment was based upon cognitive-behavioural and motivational interviewing principles, and consisted of six treatment modules posted fortnightly to participants. In addition to the standardised modules, participants received personalised feedback at four points, based upon their mailed-in responses to the modules. Participants were recruited via advertisements in rural newspapers and a Google advertisement. A total of 268 people expressed interest in this study and 36 participants went on to complete treatment. Treatment completers demonstrated a significant reduction in cannabis use at the 1 month follow-up. Transposing face-to-face treatments into a mailed format has shown some promise and future research is warranted to determine the efficacy of such treatments in a controlled study.

Motives for cannabis use in high-risk adolescent users.

The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use.

An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R)

Background Cannabis is widely used and significant problems are associated with heavier consumption. When a cannabis misuse screening tool, the CUDIT, was originally published it was noted that although it performed well there was concern about individual items. Methods 144 patients enrolled in a clinical trial for concurrent depression and substance misuse were administered an expanded CUDIT, containing the original 10 items and 11 candidate replacement items. All patients were assessed for a current cannabis use disorder with the SCID. Results A revised CUDIT-R was developed containing 8 items, two each from the domains of consumption, cannabis problems (abuse), dependence, and psychological features. Although the psychometric adequacy of the original CUDIT was confirmed, the CUDIT-R was shorter and had equivalent or superior psychometric properties. High sensitivity (91%) and specificity (90%) were achieved. Conclusions The 8-item CUDIT-R has improved performance over the original scale and appears well suited to the task of screening for problematic cannabis use. It may also have potential as a brief routine outcome measure.

Genetic and environmental influences on cannabis use initiation and problematic use: a meta‐analysis of twin studies

Because cannabis use is associated with social, physical and psychological problems, it is important to know what causes some individuals to initiate cannabis use and a subset of those to become problematic users. Previous twin studies found evidence for both genetic and environmental influences on vulnerability, but due to considerable variation in the results it is difficult to draw clear conclusions regarding the relative magnitude of these influences. A systematic literature search identified 28 twin studies on cannabis use initiation and 24 studies on problematic cannabis use. The proportion of total variance accounted for by genes (A), shared environment (C) and unshared environment (E) in (i) initiation of cannabis use and (ii) problematic cannabis use was calculated by averaging corresponding A, C and E estimates across studies from independent cohorts and weighting by sample size. For cannabis use initiation, A, C and E estimates were 48%, 25% and 27% in males and 40%, 39% and 21% in females. For problematic cannabis use A, C and E estimates were 51%, 20% and 29% for males and 59%, 15% and 26% for females. Confidence intervals of these estimates are considerably narrower than those in the source studies. Our results indicate that vulnerability to both cannabis use initiation and problematic use was influenced significantly by A, C and E. There was a trend for a greater C and lesser A component for cannabis use initiation compared to problematic use for females.

Verbreitung und Einflussfaktoren cannabis-bezogener Probleme bei Jugendlichen. Ergebnisse der Europäischen Schülerstudie zu Alkohol und anderen Drogen (ESPAD) in Deutschland

AIM: Aim of the present analysis is to describe the prevalence of cannabis-related problems in adolescents as well as their factors of influence. METHODS: Data from 1 933 recent cannabis users participating in the European School Survey Project on Alcohol and other Drugs (ESPAD) were analysed. Cannabis-related problems were assessed using the Cannabis Abuse Screening Test (CAST). RESULTS: The most frequently reported problems were reproaches from family or friends and memory problems. High risk consumption was identified in 9.3% of recent cannabis users. Significant predictors were gender, cigarette consumption, other problem behaviour and friends using cannabis. CONCLUSION: The identification of persons with problematic cannabis use is important in order to offer targeted early interventions.

Le cannabis chez l’adolescent : prise en charge par les familles

Cannabis is the most frequently used illegal drug in France. In 2007, the average age for a first use was 15.1 years. Most teenagers will limit their use to a few experiences or controlled use. However, for those who do become dependent, the lapse between the first use and dependence is brief (approximately 18 months) with an average of 28 months compared to tobacco (3–5 years) and alcohol (5–9 years). In light of this brief delay, it is crucial to quickly recognize adolescents who have problem cannabis use and to educate parents to warning signs and to teach them how to efficiently discuss the subject with their teenager. Multidimensional Family Therapy, Cognitive and Behavioral Family Therapy and Brief Strategic Family Therapy have shown their efficacy in clinical trials. Improving family dynamics represents not only a motivational opportunity to help the adolescent to adhere to drug dependence treatment, but may also facilitate reintegration into a drug-free social environment and maintenance in a drug-free existence. Family interventions have been shown to be even more effective when community family assistance relations (social workers, educational counselors) are optimized. Family therapy should also be combined with personal empowerment and life planning interventions which enable the adolescent to increase his self-esteem through scholastic and professional achievement.