Problematic Cannabis Use Research Articles

Cannabis addiction in Tunisia: sociodemographic profile and neuropsychological complications

IntroductionCannabis consumption constitutes a public health problem both because of its serious repercussions and complications and the psychological and social problems it causes.ObjectivesOur objective was to assess the level of cannabis dependence in consumers receiving care at the Sfax detoxification center in Tunisia, to describe the sociodemographic profile of these consumers and the neuropsychological complications that may be caused.MethodsWe conducted a cross-sectional study, over a period of 13 months (September 2020 to October 2021), among cannabis users consulting the Sfax detoxification center in Tunisia. We used the Cannabis Abuse Screening Test (CAST) in order to detect a “problematic” cannabis use, along with a clinical information sheet to collect epidemiological and clinical data. All patients gave their free and informed oral consent to participate in the survey while ensuring anonymity.ResultsWe included 38 patients. The average age was 26 years old with a median age of starting cannabis use at 17 years old. The sex ratio was 8.5 with an over-representation of men. Most of the subjects were single, lived with their family and had a secondary school education. Consumption was daily for the majority of patients (68.5%) with an average quantity of 4 joints/day. According to the CAST scale, 36 users (94.7%) had problematic cannabis use. The factors favouring cannabis consumption were stress and anxiety in 34 patients (89.5%) followed by depression and the festive atmosphere in 14 subjects (36.8%) each. Among the participants, 26.3% had a psychiatric history including depression (5.3%), a psychopathic personality disorder (10.5%) and cannabis-induced psychotic disorder (10.5%). History of psychiatric hospitalization and history of suicide attempt were found in 21.1% and 26.3% of the patients respectively. Concerning the complications caused by cannabis, 68.4% of the patients described a phenomenon of tolerance, while 63.2% reported the sensation of craving. Psychotic symptoms such as delirium and/or hallucinations were found in 6 patients (15.8%) and 8 subjects (21.1%) reported a history of overdose in the form of cannabis psychosis. Chronic complications were an amotivational syndrome (63.2%) and social disintegration (52.6%). Treatment of cannabis dependence was considered effective with total withdrawal in 31.6% of subjects. Weaning was partial in 42.1% of the patients.ConclusionsCannabis use is emerging as one among many interacting factors that can affect psychological and physical health, with an impact on various levels including mood, neurocognition and general health. Although studies have shown functional brain mechanisms underlying the effects of cannabis, the exact mechanisms remain unclear. Overall, treatment for substance use disorders generally prevents these complications and improves prognosis.Disclosure of InterestNone Declared

Cash outs during in-play sports betting: Who, why, and what it reveals

Cashing out is a popular feature of modern ‘in-play’ sports betting that allows sports bettors to withdraw a bet before the sporting event on which the bet was placed is finalized. Previous studies have shown that use of the cash out feature is positively related to problem gambling symptomatology. However, little is known about demographic and psychological characteristics of in-play sports bettors who use the cash out feature, or their motivations for use. To fill this knowledge gap, we recruited 224 adults (18 + years) from Ontario who engaged in in-play sports betting in the past three months. Participants completed self-report measures of psychological and gambling-related variables. Participants also provided qualitative responses for their motivations for using the cash out feature. Approximately half (51.8 %) of the participants reported using the cash out feature. No statistically significant demographic differences were found between participants who used and did not use the cash out feature. Participants who used the feature (compared to those who did not) reported higher problematic alcohol and cannabis use, feelings of depression, anxiety, and stress, and were motivated to gamble to make money. The primary reasons for cashing out were to access money immediately, to cut losses, and because cashing out felt like a less risky option. The current findings shed light on underlying psychological vulnerabilities associated with individuals who use the cash out feature, which can inform initiatives to reduce the harms associated with this popular feature of sports betting.

Emotion Dysregulation Is Associated With Increased Problem Cannabis Use Among Emerging Adults During COVID-19.

Emerging adulthood (18-25 years) is associated with peak prevalence of cannabis use. Although population-based longitudinal studies have found little change in cannabis use among emerging adults during COVID-19, research examining changes among vulnerable subgroups is lacking. The present study examined the association between emotion dysregulation at 23 years and change in cannabis use frequency and problem cannabis use among a large sample of emerging adults, from before to during the COVID-19 pandemic. Longitudinal data were analyzed from 1,226 emerging adults (59% female; n = 738 reported cannabis use) who completed online surveys before the pandemic (2019; age 21) and 1 year into COVID-19 (2021; age 23) as part of the Québec Longitudinal Study of Child Development. There was no significant overall within-person change in cannabis use outcomes during COVID-19 among the emerging adult sample. However, emotional clarity (a dimension of emotion dysregulation) at 23 years significantly moderated change in problem cannabis use during COVID-19. Namely, low emotional clarity at 23 years was associated with increased problem cannabis use (B = 0.79, 95% CI [0.23, 1.34]), whereas high emotional clarity at 23 years was associated with decreased problem cannabis use (B = -0.68, 95% CI [-1.27, -0.09]) during COVID-19, among men only. Findings highlight the need to consider changes in cannabis use during COVID-19 among emerging adults with elevated emotion dysregulation (and particularly, low emotional clarity among men) and reiterate the need for supports and targeted interventions to reduce cannabis use and decrease associated harms as society emerges from COVID-19.

Medicinal cannabis use among young adults during California’s transition from legalized medical use to adult-use: a longitudinal analysis

ABSTRACT Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults. Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021. Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18–26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors – cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups. Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) – low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) – low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) – high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01). Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational – but not medicinal – cannabis use.

Examination of Rumination's Mediating Role in the Relation Between Distal Personality Predictors, Cannabis Coping Motives, and Negative Cannabis-Related Consequences.

Perseverative cognitive processes, such as rumination, may indirectly influence effects of personality traits on cannabis use and related problems. Understanding relations among personality, rumination, and cannabis use motives may lead to better understanding of problematic cannabis use. The present study examined personality traits' influence on negative cannabis-related consequences via rumination and cannabis use coping motives. We tested a sequential path model across two independent samples such that the model was tested in one sample and replicated in the second sample. Participants were U.S. undergraduate students from multiple universities who reported using cannabis at least once in the prior thirty days. Results partially supported hypotheses such negative urgency and distress tolerance were indirectly related to negative cannabis-related consequences via rumination and coping motives. Specifically, higher negative urgency and lower distress tolerance were related to higher rumination. Higher rumination was related to higher coping motives; which in turn was related to more negative cannabis-related consequences. Results indicate that rumination is a risk factor belying associations between personality and cannabis use to cope and negative consequences of use. Implementing techniques that attenuate rumination for individuals high in negative urgency or low in distress tolerance may reduce or prevent problematic cannabis and unintended outcomes.

Distal and proximal risk factors of problematic cannabis use associated with psychotic-like experiences

BackgroundProblematic cannabis use is associated with endorsement of psychotic-like experiences (PLEs) in non-clinical samples. However, little is known in regard to predictors of this relationship, which may be relevant to prevention and intervention. In the present research, we investigate impulsivity and cannabis use motives as potential distal and proximal risk factors for PLEs using conditional process analysis. MethodsUsing an online cross-sectional survey of N = 300 students, we assessed endorsement of PLEs using the Community Assessment of Psychic Experiences (CAPE), problematic cannabis use with the Cannabis Use Disorder Identification Test (CUDIT-R), motivations for using cannabis with the Substance Use Motives Measure, and impulsivity using the Urgency and Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behaviour Scale (UPPS-P). ResultsAll three subscales on the CAPE were associated with significantly higher scores on the CUDIT-R. Before and after covarying for sex, we found that higher CUDIT-R scores mediated the relations between lack of perseverance and negative urgency impulsivity with higher PLE symptoms. Furthermore, the indirect effect of cannabis use on the relationship between lack of perseverance and high negative PLE symptoms was only significant at high and moderate levels of depression-coping, but not at low depression-coping motives. ConclusionImpulsivity and depression-coping motives may be distal and proximal psychological risk factors for negative PLEs in the context of problematic cannabis use. Our findings are in line with the broader substance use and mental health literature and may be informative for cannabis use treatment targets.

Resilience buffers the association between psychotic-like experiences and suicide risk: a prospective study from a non-clinical sample

BackgroundSeveral studies have reported that psychotic-like experiences are associated with low levels of resilience and increased suicide risk. However, it remains unknown as to whether resilience mediates or moderates the association between psychotic-like experiences and suicide risk. Therefore, in this study, we aimed to explore the moderating and mediating effect of resilience in the association between psychotic-like experiences and suicide risk.MethodsA total of 1100 non-clinical, young adults (aged 18 – 35 years) with a negative history of psychiatric treatment were enrolled. Participants were recruited by the snowball sampling methodology through advertisements posted in the online platform. They were followed-up for about 7 months. Variables of interest were recorded using self-reports. Psychopathological assessment was conducted using the Prodromal Questionnaire-16, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Traumatic Experience Checklist, the Childhood Experience of Care and Abuse Questionnaire, the Cannabis Problems Questionnaire, the Connor-Davidson Resilience Scale-10, and the Mini-International Neuropsychiatric Interview. The STROBE statement guidelines were followed.ResultsThe moderation analysis revealed that higher levels of psychotic-like experiences and related distress at baseline were associated with significantly higher suicide risk at the follow-up after adjustment for baseline sociodemographic characteristics, depressive and anxiety symptoms, a history of childhood trauma, and problematic cannabis use. The interaction between follow-up resilience and distress related to baseline psychotic-like experiences was significantly and negatively associated with suicide risk at the follow-up. Specifically, the correlation between the level of distress related to psychotic-like experiences and suicide risk was significant and positive only in participants with lower levels of resilience. This interaction did not reach statistical significance for the baseline level of psychotic-like experiences. No significant mediating effect of the follow-up resilience level in the association between baseline psychotic-like experiences and the follow-up suicide risk was found.ConclusionsFindings from the present study indicate that resilience might protect against suicide risk in people with psychotic-like experiences. These findings could be applied in the formulation of early intervention strategies aimed at mitigating the risk of suicide. Future studies need to explore the effects of interventions targeting resilience for individuals with psychotic-like experiences.

Adverse Childhood Experiences and Problematic Cannabis Use: The Role of Emotion Dysregulation and Affective Impulsivity.

Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use in this population. The present study investigated whether emotion dysregulation mediates the relationship between adverse childhood experiences (ACEs) and problematic cannabis use, and whether affective impulsivity (negative and positive urgency) uniquely moderates this relationship. Participants consisted of current cannabis users (N = 586) recruited from five universities across Canada. Participants completed an online survey containing self-report measures of ACEs, emotion dysregulation, negative and positive urgency, and problematic cannabis use. Among the sample of postsecondary students, 36% (n = 213) met the threshold for problematic cannabis use. Moderated-mediation analyses revealed that ACEs were positively associated with emotion dysregulation and problematic cannabis use. There was also a significant indirect effect of emotion dysregulation on the association between ACEs and problematic cannabis use at moderate and high (but not low) levels of negative urgency, and at moderate and high (but not low) levels of positive urgency. The moderated-mediation models remained significant when controlling for other facets of impulsivity. Results suggest that elevated levels of emotion dysregulation and urgency are important proximal risk factors for problematic cannabis use among postsecondary students with a history of ACEs. While ACEs cannot be modified given their occurrence in the past, interventions that aim to build mindfulness and adaptive emotion regulation skills may be beneficial for reducing the likelihood that these students will engage in impulsive behaviors, such as cannabis use, when experiencing emotional distress.

The Influence of Anxiety and Avoidant Coping on Probable Cannabis Use Disorder.

Individuals with anxiety frequently use cannabis to cope and are at greater risk for developing probable cannabis use disorder (CUD). Previous literature suggests avoidant coping styles are associated with higher anxiety levels and risk for problematic cannabis use, while action-oriented coping is associated with lower anxiety and problematic cannabis use. No studies have examined whether anxiety and action-oriented coping or avoidant coping interact to influence risk for CUD, which was the aim of the present study. College students were recruited as part of a cross-sectional study on cannabis use. Participants (N = 371; 72.2% female) completed the Depression Anxiety and Stress Subscale (DASS-21), Cannabis Use Disorder Identification Test-Revised (CUDIT-R), and the Brief-COPE (B-COPE). The data were analyzed using logistic moderation analysis. After controlling for gender, anxiety was a positive significant predictor of probable CUD, but action-oriented coping and avoidant coping were not. The interaction between anxiety and avoidant coping on probable CUD was significant, indicating that participants with high avoidant coping (regardless of high or low anxiety) and those with high anxiety (even with low avoidant coping) were more likely to have probable CUD than those with both low anxiety and low avoidant coping. No significant interaction was observed with action-oriented coping. Results suggest that avoidant coping, but not action-oriented coping, influences the relationship between anxiety and risk for probable CUD. Findings emphasize the importance of targeting both anxiety and avoidant coping when considering risk for probable CUD.

Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial.

Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. DERR1-10.2196/53094.

Endorsement of psychotic-like experiences and problematic cannabis use associated with worse executive functioning performance in undergraduates

BackgroundEmerging adults who endorse more positive psychotic-like experiences (PLEs; bizarre experiences, delusional ideations) may experience greater cannabis-related impairments in executive function. Negative and depressive PLEs are also associated with cannabis use, however, less is known about their relation to executive functioning. Here, we hypothesize that high positive PLEs and cannabis use are associated with worse performance on computerized versions of the Iowa Gambling Task (IGT) and the Card Sorting Task (CST); exploratory analyses are conducted with negative and depressive PLEs. MethodsWe recruited university students (N = 543) who completed an online study consisting of self-report measures of problematic cannabis use (Cannabis Use Disorder Identification Test; CUDIT-R) and PLEs (Community Assessment of Psychotic Experiences; CAPE). Of these, n=270 completed the CST and n=251 completed the IGT. ResultsProblematic cannabis use and high endorsement of positive PLEs related to significantly worse performance on the IGT and greater perseverative errors on the CST. In addition, people who endorsed high levels of positive PLEs were also significantly more likely to complete the IGT with less money relative to those who endorsed fewer PLEs, regardless of cannabis use. Further analyses based on negative PLEs revealed a similar pattern for perseverative errors on the CST; depressive PLEs were not related to task performance. ConclusionFindings highlight that problematic cannabis use and more frequent and distressing positive PLEs are associated with poorer executive functioning. Thus, executive functioning may have implications for intervention among those high on both attributes, who are at high risk of onset of psychosis.

Relationship quality, COVID stress, and mental health in sexual and gender minority young adults

Sexual and gender minority (SGM) individuals, particularly those assigned female at birth (AFAB), have shown poor mental health outcomes during the COVID-19 pandemic. This issue highlights the importance of identifying factors that may promote SGM-AFAB mental health during the pandemic and protect SGM-AFAB individuals against the negative psychological effects of COVID-related stress. Grounded in previous research and theory suggesting that high quality romantic relationships have promotive (i.e., main) and protective (i.e., stress-buffering) effects on partner’s mental health, we explored associations between relationship quality, COVID-related stress, and mental health among SGM-AFAB individuals. Specifically, we tested whether (1) higher relationship quality, as a promotive factor, was directly associated with fewer mental health problems (depressive and anxiety symptoms, problematic alcohol and cannabis use), and (2) relationship quality, as a protective factor, had a stress-buffering effect, reducing the negative effect of COVID stress on mental health within SGM-AFAB young people. Between May 2020-July 2021, 227 SGM-AFAB individuals (ages 19–35; M = 23.5) in current romantic relationships completed measures of pandemic-related stress, relationship quality, depressive and anxious symptoms, and problematic alcohol and cannabis use. As hypothesized, relationship quality was negatively associated with anxious and depressive symptoms and problematic cannabis use. Relationship quality attenuated the positive association between COVID stress and depression, but not the other mental health outcomes. Findings suggest that high-quality romantic relationships may promote mental health and have a stress-buffering effect for depressive symptoms among SGM-AFAB individuals during major society-wide stressors.

Modelling the effects of the exposome score within the extended psychosis phenotype

It has been reported that cumulative measures of risk factors for psychosis might help to predict its development. However, it remains unknown as to whether these measures are also associated with the extended psychosis phenotype that refers to a continuum of features bridging subclinical symptoms with clinically relevant outcomes. In this study, we aimed to investigate the association of the exposome score (ES) with psychosis risk in a non-clinical population. A total of 1100 non-clinical adults (aged 18–35 years, 51.4% females) with a negative history of psychiatric treatment were recruited. The Prodromal Questionnaire–16 (PQ–16) was used to screen for psychosis risk. Self-reports were used to record environmental exposures. The ES was significantly higher in participants with the positive PQ-16 screening. Specifically, the prevalence of obstetric complications, non–right handedness, all categories of childhood trauma, and problematic cannabis use was significantly higher in this group of participants. A network analysis demonstrated that the ES was directly connected not only to items representing psychotic experiences (“paranoid thoughts”, “a lack of control over own ideas or thoughts”, “thought echo”, and “being distracted by distant sounds”) but also those covering depressive or anxiety symptoms (“uninterested in things used to enjoy” and “feeling anxious when meeting people for the first time”). In conclusion, the ES is associated with the extended psychosis phenotype, suggesting its potential to identify individuals who may benefit from further psychosis risk assessment. The ES appears to contribute to non-specific psychopathology, which may, in some cases, progress to psychosis.

Prevalence and correlates of gambling disorder in Spain: findings from a national survey

ABSTRACT The aim of the study was to estimate the prevalence of gambling disorder (GD) in a sample of Spanish adults and analyze the sociodemographic variables, addictive behaviors (i.e. gambling-related characteristics, substance use, and problematic internet use), and lifetime clinical diagnoses related to the severity of GD. Participants from the 2020 Spanish Survey on Alcohol and Drugs (N = 17,105; 50.52% men; M age = 38.38 ± 13.07) were included. Individuals were classified as gamblers with GD when scored ≥4 points in the DSM-5 criteria. ANOVA and Pearson correlations were carried out to analyze differences in GD scores according to the variables noted above. The results showed that the rate of GD was 0.63% in the total sample and 1.05% in past-year gamblers. Characteristics which showed significantly higher GD scores were as follows: being a man, younger age, unmarried, greater gambling involvement both online and offline, gambling both online and offline, betting on both strategic and non-strategic games or on exclusively strategic games, lower gambling risk perception, greater substance use, higher problematic alcohol, cannabis, or internet use, or a lifetime diagnosis of anxiety, insomnia, or substance use disorder (all p-values ≤.001). The findings may guide future legal regulation policies and promote actions to prevent gambling-related problems.

Co-occurrence of food addiction, obesity, problematic substance use, and parental history of problematic alcohol use.

The present study investigates the rates of co-occurrence among food addiction (FA), problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping), parental history of problematic alcohol use, and obesity as an important step to understanding whether an addictive-like eating phenotype exists. A community sample of 357 U.S. adults (49.7% male, 77.6% White, Mage 40.7) completed the Yale Food Addiction Scale 2.0 (YFAS2.0), the Alcohol Use Disorders Identification Test, the Cannabis Use Disorders Identification Test, the Fagerstrom Test for Nicotine Dependence, the E-Cigarette Dependence Scale, the Family Tree Questionnaire, and demographic/self-report body mass index questions through Amazon Mechanical Turk. Risk ratios (RRs; unadjusted and adjusted for sociodemographic covariates) were calculated using modified Poisson's regression. Risk of FA was higher in participants with problematic alcohol use (RR = 2.13, 99% CI [1.32, 3.45]), smoking (RR = 1.86, 99% CI [0.82, 3.36]), cannabis use (unadjusted; RR = 2.22, 99% CI [1.17, 4.18]), vaping (RR = 2.71, 99% CI [1.75, 4.21]), and parental history of problematic alcohol use (RR = 2.35, 99% CI [1.46, 3.79]). Risk of FA in participants with obesity was only higher in adjusted models (RR = 1.87, 99% CI [1.06, 3.27]). Obesity was not significantly associated with problematic substance use and parental history of problematic alcohol use. FA, but not obesity, co-occurred with problematic substance use and a parental history of problematic alcohol use. Results support the conceptualization of FA as an addictive disorder. The inclusion of FA as an addictive disorder in diagnostic frameworks is an important area of future consideration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users

Background While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. Methods The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). Results Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. Conclusions Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BackgroundMonitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils. MethodsThe data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release. ResultsConfigural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway. ConclusionThe CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Measurement invariance of the Marijuana Motives Measure among men and women using Stop Cannabis App

BackgroundMotives to use cannabis play a central role in the development and maintenance of problematic cannabis use and previous studies stressed sex-related differences on motives to use cannabis. However, motives cannot be validly compared in men and women without first establishing the measurement invariance across sex. Therefore, the aim of the study is to (1) examine for the first time the measurement and structural invariance of the Marijuana Motives Measure (MMM) across sex, and (2) to investigate the motives for cannabis use that best explain problematic use. Methods2951 (41.7% women) users of the “Stop cannabis” smartphone app of which 99.8% reported having used cannabis in the last three months completed an online MMM and ASSIST to assess the severity of their problematic cannabis use. ResultsMultigroup confirmatory factor analyses supported measurement invariance across sex, whereas structural invariance was not confirmed. Indeed, group comparisons indicated that women reported greater coping motives then men whereas men showed greater social motives than women. A multiple linear regression analysis showed that only coping and conformity motives were significantly associated with greater problematic cannabis use, whereas neither sex nor the sex by motives interactions were significantly related to problematic cannabis use. ConclusionsThe MMM appears to function comparably across men and women. Therefore, sex-related comparisons on the questionnaire can be considered valid. Coping and conformity motives may play a central role part in the development of marijuana use problems which may hold implications for intervention development and public policy.

Longitudinal Associations Between Cannabis Use and Cognitive Impairment in a Clinical Sample of Middle-Aged Adults Using Cannabis for Medical Symptoms.

Introduction: Cannabis use to alleviate medical symptoms is increasing in middle-aged and older adults. Cognitive impairment associated with cannabis use may be especially detrimental to these understudied age groups. We hypothesized that among middle-aged and older adults who used cannabis for 12 months, frequent (≥3 days/week) compared with nonfrequent (≤2 days/week) use will be associated with cognitive impairment. Materials and Methods: We performed secondary analysis on data from a clinical trial of cannabis use for medical symptoms. Participants (n=62) were ≥45 years, and completed a baseline and at least one postbaseline visit. Cognitive domains were assessed through the Cambridge Neuropsychological Test Automated Battery. Cannabis use was assessed prospectively through daily smartphone diaries. Frequency of cannabis use was a binary predictor in a mixed-effects logistic regression model predicting cognitive impairment adjusted for baseline cognitive functioning. Results: At baseline, participants were primarily nonfrequent cannabis users; however, in all other time periods, most participants were frequent users (range: 55-58%). Cognitive outcomes did not differ between frequent and nonfrequent cannabis users. However, in sensitivity analyses, respondents with problematic cannabis use scored significantly worse on one cognitive domain compared to those without problematic cannabis use. Conclusions: In a clinical sample of adults aged ≥45 years, no longitudinal associations were found between cannabis use and cognitive functioning. However, a few significant associations were observed between problematic use and cognitive functioning. Further research is needed to assess the impact of cannabis use on adults, particularly those aged ≥65 years, and to investigate potential subtler influences of cannabis use on cognition. ClinicalTrials.gov ID: NCT03224468.

Association of self-reported use of cannabis for the purpose of improving physical, mental, and sleep health with problematic cannabis use risk

BackgroundLittle is known about health-focused cannabis use purposes and their associations with risk for problematic cannabis use. This cross-sectional study examined three broad cannabis use purposes and association with risk for problematic use among young adult cannabis users who report using for > 1 health reasons.MethodsYoung adults completed an electronic survey as part of an ongoing study on substance use and health. Those who self-reported past 6-month use of ≥ 1 cannabis products—smoking, vaping, dabbing, eating, and blunts—were included in the analysis. Their purposes for use were coded into three categories: sleep, mental, and physical health. Problematic cannabis use (PCU) was measured with the three-level structure Cannabis Abuse Screening Test (CAST-3). Adjusted multivariable regression models were used to estimate use purposes associated with with problematic cannabis use at the p < 0.05 level.ResultsParticipants (n = 954) were mostly female (63.94%) and Hispanic (54.93%). Mental health was the most endorsed reason (73.38%) for use among study sample. Among participants, 36.3% were classified as being at severe risk (CAST-3 score ≥ 8). There was a significant association between PCU risk and reporting cannabis use for physical health (p < 0.01), mental health, and sleep health (p < 0.01) purposes. Those who used cannabis for physical heath purposes had about four times the risk (adjusted relative risk ratio (aRRR) = 4.38, 95% CI = 3.06–6.69), those who used for mental health had about three times the risk (aRRR = 2.81, 95% CI = 1.86–4.72), and those who used for sleep health had almost two times the risk (aRRR = 1.83, 95% CI = 1.17–2.63) for severe PCU.ConclusionAll cannabis use purposes examined increased risk of problematic cannabis use. Physical health use purposes was associated with highest PCU risk. This study demonstrates the risk for cannabis use disorder associated with self-medicating with cannabis.