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Chaaban S, Istvan M, Schreck B, Laigo P, Rousselet M, Grall-Bronnec M, Pain S, Victorri-Vigneau C. Cannabis use and dependence among festival attendees: results from the French OCTOPUS survey. BMC Public Health 2024; 24:992. [PMID: 38594675 PMCID: PMC11003156 DOI: 10.1186/s12889-024-18496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Chronic use of cannabis is associated with an increased risk of psychosocial, mental and physical health impairments. Sociohealth institutions reach a very limited proportion of cannabis users in need of treatment. Using data collected from festival attendees, this study aimed to estimate the prevalence of dependent cannabis users and to characterize cannabis dependence. METHODS We used data from the cross-sectional OCTOPUS survey carried out at 13 music events in the French department of Loire-Atlantique between July 2017 and July 2018. 383 participants aged 18 or older underwent a face-to-face interview about their basic sociodemographics, tobacco use, alcohol use and past-year substance use. Using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, we estimated the prevalence of dependent cannabis users and characterized their dependence. RESULTS More than two-thirds of participants reported that they had used cannabis in the past 12 months. Among 194 regular cannabis users (at least monthly), 63.4% were dependent. At least 40% of regular users reported health and/or social consequences of cannabis use. Compared to nondependent cannabis users, dependent cannabis users were more likely to be stimulant users and hallucinogen users. CONCLUSIONS Dependent cannabis use is common among festival attendees, especially among stimulant or hallucinogen users. Festival settings may be important arenas for i) implementing efficient harm reduction measures to prevent dependence and ii) providing information on care structures and promoting the use of care to dependent users. In addition, healthcare professionals should be aware of trends in polysubstance use among dependent cannabis users.
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Affiliation(s)
- Sarah Chaaban
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, F-44000, Nantes, France
| | - Marion Istvan
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
| | - Benoit Schreck
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
- UIC Psychiatrie et Santé Mentale, Nantes Université, CHU Nantes, F-44000, Nantes, France
| | - Pauline Laigo
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, F-44000, Nantes, France
| | - Morgane Rousselet
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, F-44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France.
- UIC Psychiatrie et Santé Mentale, Nantes Université, CHU Nantes, F-44000, Nantes, France.
| | - Marie Grall-Bronnec
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
- UIC Psychiatrie et Santé Mentale, Nantes Université, CHU Nantes, F-44000, Nantes, France
| | - Stéphanie Pain
- Centre d'addictovigilance, Service de Pharmacologie Clinique, CHU de Poitiers, 86000, Poitiers, France
- Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U-1084, Université de Poitiers, 86000, Poitiers, France
| | - Caroline Victorri-Vigneau
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
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Dawson D, Stjepanović D, Lorenzetti V, Cheung C, Hall W, Leung J. The prevalence of cannabis use disorders in people who use medicinal cannabis: A systematic review and meta-analysis. Drug Alcohol Depend 2024; 257:111263. [PMID: 38493566 DOI: 10.1016/j.drugalcdep.2024.111263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The prevalence of cannabis use disorders (CUDs) in people who use cannabis recreationally has been estimated at 22%, yet there is a dearth of literature exploring CUDs among people who use medicinal cannabis. We aimed to systematically review the prevalence of CUDs in people who use medicinal cannabis. METHODS In our systematic review and meta-analysis, we followed PRISMA guidelines and searched three databases (PsychInfo, Embase and PubMed) to identify studies examining the prevalence of CUDs in people who use medicinal cannabis. Meta-analyses were calculated on the prevalence of CUDs. Prevalence estimates were pooled across different prevalence periods using the DSM-IV and DSM-5. RESULTS We conducted a systematic review of 14 eligible publications, assessing the prevalence of CUDs, providing data for 3681 participants from five different countries. The systematic review demonstrated that demographic factors, mental health disorders and the management of chronic pain with medicinal cannabis were associated with an elevated risk of CUDs. Meta-analyses were conducted on the prevalence of CUDs. For individuals using medicinal cannabis in the past 6-12 months, the prevalence of CUDs was 29% (95% CI: 21-38%) as per DSM-5 criteria. Similar prevalence was observed using DSM-IV (24%, CI: 14-38%) for the same period. When including all prevalence periods and using the DSM-5, the prevalence of CUDs in people who use medicinal cannabis was estimated at 25% (CI: 18-33%). CONCLUSIONS The prevalence of CUDs in people who use medicinal cannabis is substantial and comparable to people who use cannabis for recreational reasons, emphasizing the need for ongoing research to monitor the prevalence of CUDs in people who use medicinal cannabis.
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Affiliation(s)
- Danielle Dawson
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia.
| | - Daniel Stjepanović
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Valentina Lorenzetti
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Faculty of Health Science, Australian Catholic University, Daniel Mannix Building, Fitzroy, VIC 3065, Australia
| | - Christy Cheung
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, St Lucia, QLD 4067, Australia
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Petrilli K, Hines L, Adams S, Morgan CJ, Curran HV, Freeman TP. High potency cannabis use, mental health symptoms and cannabis dependence: Triangulating the evidence. Addict Behav 2023; 144:107740. [PMID: 37121087 DOI: 10.1016/j.addbeh.2023.107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Cannabis potency (concentration of Δ-9-Tetrahydrocannabinol) has been associated with risks of adverse mental health outcomes and addiction but no studies have triangulated evidence from self-report and objective measures of cannabis potency. We hypothesised that users of high potency cannabis would have higher levels of (a) anxiety, (b) depression and (c) psychosis-like symptoms (d) cannabis dependence than users of lower potency cannabis. METHODS A cross-sectional study of 410 participants donated a sample of cannabis for analysis of THC concentration and reported their cannabis potency preference. These two exposure measures were investigated for their association with cannabis dependence, depression, anxiety, and psychosis-like symptoms in separate linear/logistic regression models. RESULTS High potency cannabis preference was associated with a slight increased risk of cannabis dependence after adjusting for confounding, with the exception of cannabis use frequency (OR = 1.16, 95% CI 1.04-1.28). No association was found between THC concentration in cannabis and cannabis dependence. There was weak evidence of a small association between cannabis potency and depression and anxiety. There was no association between high potency cannabis preference or THC concentration in cannabis and psychosis-like symptoms. CONCLUSIONS Users of cannabis who preferred high potency types might be at increased risk of problematic cannabis use. This should be considered with caution as we were not able to triangulate these results with an objective measure of cannabis potency. More research is needed to understand the association between high potency cannabis use and depression and anxiety.
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Affiliation(s)
- Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.
| | - Lindsey Hines
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK; Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sally Adams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Celia J Morgan
- Washington Singer Laboratories, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology Department, University College London, London, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Mills L, Dunlop A, Montebello M, Copeland J, Bruno R, Jefferies M, Mcgregor I, Lintzeris N. Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder. Subst Abuse Treat Prev Policy 2022; 17:67. [PMID: 36209081 PMCID: PMC9548192 DOI: 10.1186/s13011-022-00493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION AND AIMS There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes. METHOD Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial. RESULTS Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use; nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout; and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout; greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose; greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose; and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling. DISCUSSIONS AND CONCLUSIONS These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.
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Affiliation(s)
- Llewellyn Mills
- grid.482212.f0000 0004 0495 2383Drug and Alcohol Services, South East Sydney Local Health District, Caringbah, NSW Australia ,grid.1013.30000 0004 1936 834XSpecialty of Addiction Medicine, Faculty Medicine, and Health, University of Sydney, Camperdown, NSW Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW Australia ,grid.416088.30000 0001 0753 1056NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Health, St Leonards, Australia
| | - Adrian Dunlop
- grid.3006.50000 0004 0438 2042Drug and Alcohol Services, Hunter New England Local Health District, New Lambton, NSW Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.482157.d0000 0004 0466 4031Drug and Alcohol Services, Northern Sydney Local Health District, Hornsby, Australia
| | - Mark Montebello
- grid.1013.30000 0004 1936 834XSpecialty of Addiction Medicine, Faculty Medicine, and Health, University of Sydney, Camperdown, NSW Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW Australia ,grid.416088.30000 0001 0753 1056NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Health, St Leonards, Australia ,grid.482157.d0000 0004 0466 4031Drug and Alcohol Services, Northern Sydney Local Health District, Hornsby, Australia
| | - Jan Copeland
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW Australia ,grid.1034.60000 0001 1555 3415Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Sippy Downs, QLD Australia
| | - Raimondo Bruno
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW Australia ,grid.1009.80000 0004 1936 826XUniversity of Tasmania, Hobart, TAS Australia
| | - Meryem Jefferies
- grid.482212.f0000 0004 0495 2383Drug Health, Western Sydney Local Health District, North Parramatta, NSW Australia
| | - Iain Mcgregor
- grid.1013.30000 0004 1936 834XSchool of Psychology, University Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XLambert Initiative Cannabinoid Therapeutics, University Sydney, Camperdown, NSW Australia
| | - Nicholas Lintzeris
- grid.482212.f0000 0004 0495 2383Drug and Alcohol Services, South East Sydney Local Health District, Caringbah, NSW Australia ,grid.1013.30000 0004 1936 834XSpecialty of Addiction Medicine, Faculty Medicine, and Health, University of Sydney, Camperdown, NSW Australia ,grid.3006.50000 0004 0438 2042Drug and Alcohol Services, Hunter New England Local Health District, New Lambton, NSW Australia
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Mauro PM, Gutkind S, Rivera-Aguirre A, Gary D, Cerda M, Santos EC, Castillo-Carniglia A, Martins SS. Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay. Int J Drug Policy 2022; 108:103810. [PMID: 35939947 PMCID: PMC9912990 DOI: 10.1016/j.drugpo.2022.103810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay. METHODS Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country. RESULTS Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only. CONCLUSION Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.
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Affiliation(s)
- Pia M Mauro
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
| | - Sarah Gutkind
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
| | - Dahsan Gary
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Magdalena Cerda
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA
| | - Erica Chavez Santos
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA; University of Washington School of Public Health, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Alvaro Castillo-Carniglia
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Badajoz 130, Room 1306, Las Condes, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
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Sharma R, Tikka SK, Bhute AR, Bastia BK. N-acetyl cysteine in the treatment of cannabis use disorder: A systematic review of clinical trials. Addict Behav 2022; 129:107283. [PMID: 35189496 DOI: 10.1016/j.addbeh.2022.107283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Cannabis is the most consumed illicit drug globally, with a high risk of developing cannabis use disorder (CUD). No approved pharmacological treatment exists for CUD, but N-Acetyl Cysteine (NAC) has shown promising results in different clinical studies. This study aims to conduct a systematic review of NAC clinical trials for the treatment of CUD. METHODS Systematic review of randomized controlled trials (RCTs) was conducted to determine the effect of NAC for the treatment of cannabis dependence/cannabis use disorder (CUD). Articles were electronically searched across different databases using PubMed, Google Scholar, EMBASE, Cochrane Library, Medline and PsycINFO from inception to June 2021. Several study characteristics, including study duration, sample size, study population and age group, intervention, adverse effects, and outcome measure were extracted. A PICO table was used for data extraction. RESULTS We included 08 RCTs in the qualitative analysis. The risk of bias (RoB) was assessed according to Cochrane RoB criteria, and a 5 point grading system according to the Oxford Centre for Evidence-Based Medicine was used to rate the methodological quality (level of evidence) of the included articles. Mild and well-tolerated adverse events were reported in the placebo and NAC group. CONCLUSIONS The studies collectively offer mixed results, although the strength of the evidence available on which to make a recommendation is strong. NAC has shown to be effective in promoting abstinence, medication adherence and reducing cannabis use and craving among cannabis dependent users. This review also suggests recommendations for future research.
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Montebello M, Jefferies M, Mills L, Bruno R, Copeland J, McGregor I, Rivas C, Jackson MA, Silsbury C, Dunlop A, Lintzeris N. Mood, sleep and pain comorbidity outcomes in cannabis dependent patients: Findings from a nabiximols versus placebo randomised controlled trial. Drug Alcohol Depend 2022; 234:109388. [PMID: 35316689 DOI: 10.1016/j.drugalcdep.2022.109388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mood, sleep and pain problems are common comorbidities among treatment-seeking cannabis-dependent patients. There is limited evidence suggesting treatment for cannabis dependence is associated with their improvement. This study explored the impact of cannabis dependence treatment on these comorbidities. METHODS This is a secondary analysis from a 12-week double-blind placebo-controlled trial testing the efficacy of a cannabis agonist (nabiximols) against placebo in reducing illicit cannabis use in 128 cannabis-dependent participants. Outcome measurements including DASS-21 (Depression, Anxiety, and Stress subscales); Insomnia Severity Index (ISI); and Brief Pain Inventory (BPI), were performed at weeks 0, 4, 8, 12 and 24. Each was analysed as continuous outcomes and as binary cases based on validated clinical cut-offs. RESULTS Among those whose DASS and ISI scores were in the moderate to severe range at baseline, after controlling for cannabis use, there was a gradual decrease in severity of symptoms over the course of the trial. BPI decreased significantly until week 12 and then rose again in the post-treatment period during weeks 12-24. Neither pharmacotherapy type (nabiximols vs placebo) nor number of counselling sessions contributed significant explanatory power to any of the models and were excluded from the final analyses for both continuous and categorical outcomes. CONCLUSIONS Participants in this trial who qualified as cases at baseline had elevated comorbidity symptoms. There was no evidence that nabiximols treatment is a barrier to achieving reductions in the comorbid symptoms examined. Cannabis dependence treatment reduced illicit cannabis use and improved comorbidity symptoms, even when complete abstinence was not achieved.
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Affiliation(s)
- Mark Montebello
- Drug and Alcohol Services, Northern Sydney Local Health District, Level 1, 2c Herbert Street, St Leonards, NSW 2065, Australia; Specialty of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, City Road, Camperdown, NSW 2006, Australia; National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia.
| | - Meryem Jefferies
- Drug Health, Western Sydney Local Health District, 5 Fleet St, North Parramatta, NSW 2151, Australia.
| | - Llewellyn Mills
- Specialty of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, City Road, Camperdown, NSW 2006, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Services, South Eastern Sydney Local Health District, The Langton Centre, 591 South Dowling St, Surry Hills, NSW 2010, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; School of Psychological Sciences, University of Tasmania, Private Bag 30, Hobart, Tasmania 7001, Australia.
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Locked Bag 4, Maroochydore BC, QLD 4558, Australia.
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, City Road, Camperdown, NSW 2006, Australia.
| | - Consuelo Rivas
- Drug and Alcohol Services, South Eastern Sydney Local Health District, The Langton Centre, 591 South Dowling St, Surry Hills, NSW 2010, Australia.
| | - Melissa A Jackson
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Level 3, 670 Hunter Street, Newcastle, NSW 2300, Australia; School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia.
| | - Catherine Silsbury
- Drug Health, Western Sydney Local Health District, 5 Fleet St, North Parramatta, NSW 2151, Australia.
| | - Adrian Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Level 3, 670 Hunter Street, Newcastle, NSW 2300, Australia.
| | - Nicholas Lintzeris
- Specialty of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, City Road, Camperdown, NSW 2006, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Services, South Eastern Sydney Local Health District, The Langton Centre, 591 South Dowling St, Surry Hills, NSW 2010, Australia.
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8
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Steeger CM, Hitchcock LN, Bryan AD, Hutchison KE, Hill KG, Bidwell LC. Associations between self-reported cannabis use frequency, potency, and cannabis/health metrics. Int J Drug Policy 2021; 97:103278. [PMID: 34062287 PMCID: PMC8585676 DOI: 10.1016/j.drugpo.2021.103278] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research shows that cannabis use frequency is associated with cannabis dependence and health metrics. However, much less is known about how self-reported cannabis potency (THC and CBD) may be associated with the same metrics, and whether any associations exist after accounting for frequency of cannabis use. Moreover, even less is known about how these relations may differ across cannabis product forms. This exploratory study examined 1) associations between cannabis frequency, potency, and cannabis/health metrics, and 2) whether associations between potency and cannabis/health metrics remained after controlling for frequency of use. METHODS Using a sample of adult recreational cannabis users in Colorado (N = 300), we tested the relationship between self-reported cannabis use metrics of frequency and potency of flower, edible, and concentrate products with separate measures of problematic cannabis use (i.e., dependence, withdrawal, craving), depression, anxiety, and general perceived health. RESULTS Greater frequency of flower and concentrate (but not edible) use were associated with greater problematic cannabis use, and greater concentrate use frequency was also associated with more mental health problems. Partial correlations controlling for average frequency of use across all product forms and CBD potency per product showed that one significant association between THC potency and cannabis/health metrics remained (i.e., higher THC concentrate potency with better health), and one emerged (i.e., higher THC concentrate potency with lower cannabis withdrawal). CONCLUSIONS Frequency of use is reliably associated with problematic cannabis use for flower and concentrates, but it did not account for all observed associations in this study. Differences in patterns of associations between frequency and potency and cannabis/health metrics across cannabis forms suggest a need for better understanding user reports of THC and CBD potency, individual differences among users, and improved measurement.
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Affiliation(s)
- Christine M Steeger
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA.
| | - Leah N Hitchcock
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA
| | - Angela D Bryan
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Kent E Hutchison
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
| | - Karl G Hill
- Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St., Boulder, CO 80309, USA
| | - L Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, 344 UCB, Boulder, CO 80309, USA; Department of Psychology & Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309, USA
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9
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Burdzovic Andreas J, Sivertsen B, Lønning KJ, Skogen JC. Cannabis use among Norwegian university students: Gender differences, legalization support and use intentions, risk perceptions, and use disorder. Addict Behav Rep 2021; 13:100339. [PMID: 33604449 PMCID: PMC7873627 DOI: 10.1016/j.abrep.2021.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/16/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022] Open
Abstract
Past year cannabis use was fairly common in a sample of Norwegian college students. About 6% of users possibly met criteria for use disorder, function of use frequency. Legalization attitudes and risk perceptions were associated with cannabis use risk. Intentions to use cannabis if legal were evident even among some current non-users. Many non-users expressed uncertainty in legalization attitudes and risk perceptions.
Aims We explored past-year cannabis use and associated characteristics, focusing on legalization attitudes, use intentions, risk perceptions, and possible dependence among Norwegian university/college students. Methods We examined a nation-wide sample of Norwegian university/college students (N = 49,688; 67% female) who participated in the Students’ Health and Wellbeing Study (SHoT-study) in 2018. Participants reported past-year substance use, support for cannabis legalization, intent to use cannabis if legal, and perceived risks of weekly use. Past-year cannabis use (including use frequency) was examined in relation to these indicators. Legalization support, use intentions, and risk perceptions were examined in relation to use and gender. Potential cannabis use disorder was assessed with the Cannabis Abuse Screening Test (CAST) and examined in relation to use frequency and gender. Findings Past-year use was reported by 15.3% (11.8% women; 22.9% men). Majority of current users (roughly 90%) used no more than 50 times past year, and 6% (3.8% women; 8.5% men) met CAST use disorder criteria. Legalization support, use intentions, and no/low risk perceptions were significantly associated with greater odds of use, and greater use frequency among current users in both crude and adjusted models. Legalization support (23.0%), use intentions (14.0%), and perceptions of no/low risk (29.2%) were also relatively common even among current non-users, especially men. Male gender and more frequent use were associated with greater CAST scores and greater odds of use disorder. Conclusions Cannabis use was relatively common in this student sample. In addition to targeting frequent use, interventions may focus on cannabis-related attitudes and risk perceptions among uncertain/uninformed students.
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Affiliation(s)
- Jasmina Burdzovic Andreas
- Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Jussie Lønning
- The Norwegian Medical Association, Oslo, Norway.,The Student Welfare Association of Oslo and Akershus (SiO), Oslo, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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10
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Bayazit H, Dulgeroglu D, Selek S. Brain-Derived Neurotrophic Factor and Oxidative Stress in Cannabis Dependence. Neuropsychobiology 2021; 79:186-190. [PMID: 31779002 DOI: 10.1159/000504626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Neurotrophin levels and oxidative stress markers such as ceruloplasmin and free thiols have been shown to contribute to pathophysiology in several psychiatric disorders. OBJECTIVE Our aim is to evaluate whether those markers are altered in cannabis dependence. METHODS Forty-five cannabis-dependent patients diagnosed according to the DSM-IV criteria and 45 healthy controls matched according to sex, age, BMI, and smoking status were enrolled. Brain-derived neurotrophic factor (BDNF), ceruloplasmin, lipid hydroperoxide, and total free thiols were measured in both groups. Those who had psychiatric comorbidities were excluded before sampling. RESULTS We found significantly increased BDNF, ceruloplasmin, and lipid hydroperoxide, and decreased free thiol levels in patients with cannabis dependence. There is also a positive correlation between BDNF and lipid hydroperoxide (n = r = 0.472, p < 0.001) and a negative correlation between BDNF and total thiols (n = r = -0.412, p = 0.001). CONCLUSIONS Increased BDNF might be a sign of impaired neuronal plasticity that is crucial for memory formation and adaptive response to drug addiction. Neuronal plasticity in the ventral tegmental area dopaminergic neurons was implied to play a role in substance addiction disorders, and these adaptations can be secondary to oxidative stress. Our findings, including increased lipid hydroperoxide, ceruloplasmin, and decreased free thiols, might support this hypothesis. In conclusion, cannabis dependency alters BDNF levels and increases oxidative stress.
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Affiliation(s)
- Huseyin Bayazit
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, Texas, USA,
| | - Dilruba Dulgeroglu
- Community-Based Treatment Team, Bagcilar Education and Training Hospital, Istanbul, Turkey
| | - Salih Selek
- Department of Psychiatry, Texas University Health Science Center, Houston, Texas, USA
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11
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Craft S, Winstock A, Ferris J, Mackie C, Lynskey MT, Freeman TP. Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence. Psychol Med 2020; 50:2364-2373. [PMID: 31607281 DOI: 10.1017/s0033291719002460] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. METHODS Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). RESULTS LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. CONCLUSIONS The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.
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Affiliation(s)
- Sam Craft
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Winstock
- University College London, London, UK
- Global Drug Survey Ltd, London, UK
| | - Jason Ferris
- Centre for Health Services Research, University of Queensland, QLD, Australia
| | - Clare Mackie
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael T Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom P Freeman
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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12
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Leung J, Chan GCK, Hides L, Hall WD. What is the prevalence and risk of cannabis use disorders among people who use cannabis? a systematic review and meta-analysis. Addict Behav 2020; 109:106479. [PMID: 32485547 DOI: 10.1016/j.addbeh.2020.106479] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/14/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS We aim to quantify the prevalence and risk of having a cannabis use disorder (CUD), cannabis abuse (CA) or cannabis dependence (CD) among people in the general population who have used cannabis. METHOD We conducted a systematic review of epidemiological cross-sectional and longitudinal studies on the prevalence and risks of CUDs among cannabis users. We identified studies published between 2009 and 2019 through PubMed, the Global Burden Disease (GBD) Database, and supplementary searches up to 2020. The outcomes of interest were CUDs based on DSM or ICD criteria. Estimates were synthesized using random-effects meta-analyses, followed by meta-regression of study characteristics on effect sizes. RESULTS From 1383 records identified, 21 studies were included. Meta-analyses showed that among people who used cannabis, 22% (18-26%) have CUD, 13% (8-18%) have CA, and 13% (10-15%) have CD. Estimates from cohort studies, showed that the risk of developing CD increased to 33% (22-44%) among young people who engaged in regular (weekly or daily) use of cannabis. There was a lack of data from cohort studies to estimate the risk of CUD or CA among regular cannabis users. CONCLUSIONS Cannabis users need to be informed about the risks of developing CUDs and the higher risks among those who initiate early and use frequently during adolescence. Future studies are needed to examine how changes in cannabis policies may affect the risks of CUDs in the population.
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Affiliation(s)
- Janni Leung
- School of Psychology, Lives Lived Well Group, The University of Queensland, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
| | - Gary C K Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
| | - Leanne Hides
- School of Psychology, Lives Lived Well Group, The University of Queensland, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Australia.
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13
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Cougle JR, McDermott KA, Hakes JK, Joyner KJ. Personality disorders and social support in cannabis dependence: A comparison with alcohol dependence. J Affect Disord 2020; 265:26-31. [PMID: 31957689 PMCID: PMC7065916 DOI: 10.1016/j.jad.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/05/2019] [Accepted: 01/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cannabis use disorder (CUD) has been linked to personality disorders (PDs) and interpersonal problems, though these relationships have been understudied. We examined PDs and social support associated with cannabis dependence and how it may be distinguishable from alcohol dependence on these indices in a large representative sample. METHOD Data on social support and Diagnostic and Statistical Manual of Mental Disorders-IV substance dependence and PDs were assessed in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N > 34,500). RESULTS Cannabis dependence was associated with higher rates of personality disorders and lower social support. Lifetime cannabis dependence without alcohol dependence was associated with higher rates of all PDs than alcohol dependence without cannabis dependence (with the exception of borderline PD). Cannabis dependence alone was also associated with lower social support than alcohol dependence alone. LIMITATIONS The survey was conducted in 2004-2005 and relied on DSM-IV criteria. CONCLUSIONS These findings highlight a broad range of PDs as well as deficits in social support in cannabis dependence. The potential interrelationships between interpersonal dysfunction and CUD as well as the relevance of PDs to treatment for CUD warrant further research.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee 32304, FL, USA.
| | - Katherine A McDermott
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee 32304, FL, USA.
| | - Jahn K Hakes
- Center for Economic Studies, US Census Bureau, Suitland, Maryland, USA.
| | - Keanan J Joyner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee 32304, FL, USA.
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14
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Nielsen S, Sabioni P, Gowing L, Le Foll B. Pharmacotherapies for Cannabis Use Disorders: Clinical Challenges and Promising Therapeutic Agents. Handb Exp Pharmacol 2020; 258:355-372. [PMID: 31375922 DOI: 10.1007/164_2019_258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This chapter reviews pharmacotherapies that have been trialled for cannabis dependence, identifying those that warrant further research and those of little or uncertain value. A diverse range of medicines have been tested, representing a broad range of pharmacological strategies. These include tetrahydrocannabinol preparations, various types of antidepressant, anxiolytics, a glutamatergic modulator and the neuropeptide oxytocin. Cannabinoid agonists warrant further research. For the FAAH inhibitor PF-04457845, oxytocin, varenicline and gabapentin, although there is a signal to indicate further research is warranted, these medications do not yet have sufficient evidence to support clinical use, and larger, longer-term trials are needed in representative treatment-seeking populations. Special populations that warrant consideration are those with cannabis dependence and concurrent mental health conditions and those that develop dependence through therapeutic use.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Peninsula Campus, Frankston, VIC, Australia
| | - Pamela Sabioni
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Linda Gowing
- Discipline of Pharmacology, University of Adelaide, Adelaide, SA, Australia
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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15
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Schuster RM, Hareli M, Moser AD, Lowman K, Gilman J, Ulysse C, Schoenfeld D, Evins AE. Cross-domain correlates of cannabis use disorder severity among young adults. Addict Behav 2019; 93:212-8. [PMID: 30753972 DOI: 10.1016/j.addbeh.2019.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/13/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Correlates of cannabis use and dependence among young adults have been widely studied. However, it is not known which factors are most strongly associated with severity of cannabis use dependence (CUD) severity. Identification of the salient correlates of CUD severity will be of increasing clinical significance as use becomes more socially normative. METHODS This study used a data-driven, hypothesis-free approach to examine the most robust correlates of CUD severity among a sample of 76 young adults (ages 18 to 25 years) who used cannabis at least weekly. Seventy-one candidate variables were examined for association with CUD severity. These included demographic variables, self-reported and psychodiagnostic assessments of mood and anxiety, self-reported measures of personality, cannabis and other substance use characteristics, and objective and subjective measures of cognition. RESULTS Of the 71 candidate variables considered, 27 were associated with CUD severity on a univariate level at a p-value ≤.20. Correlates of CUD severity in the multivariable model using stepwise selection were: more frequent cannabis use in the past 90 days, greater expectancies that cannabis causes cognitive and behavioral impairment, greater self-reported metacognitive deficits, greater anxiety, and lower reaction time variability on a test of sustained attention. Internal validation tests support high prediction accuracy of all variables in the multivariable model, except for lower reaction time variability. CONCLUSIONS Cannabis use frequency, beliefs about use, perceived cognitive abilities, and anxiety are robustly associated with CUD severity in young adult, regular cannabis users, and may be important in guiding prevention and treatment efforts.
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16
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Montgomery L, McClure EA, Tomko RL, Sonne SC, Winhusen T, Terry GE, Grossman JT, Gray KM. Blunts versus joints: Cannabis use characteristics and consequences among treatment-seeking adults. Drug Alcohol Depend 2019; 198:105-111. [PMID: 30901744 PMCID: PMC6467739 DOI: 10.1016/j.drugalcdep.2019.01.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the high prevalence of blunt smoking among cannabis users, very few studies examine the clinical profile of blunt smokers relative to those using more common methods of cannabis use, such as joints. METHODS The current study uses baseline data from the ACCENT (Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment) study, a multi-site randomized pharmacotherapy clinical trial within the National Drug Abuse Treatment Clinical Trials Network, to predict the association between blunt and joint use frequency and cannabis use characteristics (e.g., grams of cannabis used) and consequences (e.g., withdrawal) among past-month cannabis users (N = 377) who were screened for study participation. RESULTS After controlling for race, age, gender, other forms of cannabis use (including joint use) and nicotine dependence, multivariable linear regression models indicated that the number of days of blunt use in the past month was a significant predictor of the average amount of cannabis per using day (t = 3.04, p < .01), the estimated average cost of cannabis (t = 2.28, p < .05) and Cannabis Withdrawal Scale scores (t = 1.94, p < .05). Frequency of joint use did not significantly predict any of the cannabis use characteristics or consequences. CONCLUSIONS Blunt smokers may present to treatment with greater amounts of cannabis smoked and more intense withdrawal symptoms, which may adversely impact their likelihood of successful abstinence. Cannabis-dependent blunt smokers may be more likely to benefit from treatment that targets physiological and mood-related withdrawal symptoms.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Susan C. Sonne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH 45229, USA
| | - Garth E. Terry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Jason T. Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Integrated Substance Abuse Programs, 11075 Santa Monica Blvd Ste 200, Los Angeles, CA 90025, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
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Zimmermann K, Kendrick KM, Scheele D, Dau W, Banger M, Maier W, Weber B, Ma Y, Hurlemann R, Becker B. Altered striatal reward processing in abstinent dependent cannabis users: Social context matters. Eur Neuropsychopharmacol 2019; 29:356-364. [PMID: 30658938 DOI: 10.1016/j.euroneuro.2019.01.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/18/2018] [Accepted: 01/06/2019] [Indexed: 12/14/2022]
Abstract
Public perception of cannabis as relatively harmless, alongside claimed medical benefits, have led to moves towards its legalization. Yet, long-term consequences of cannabis dependence, and whether they differ qualitatively from other drugs, are still poorly understood. A key feature of addictive drugs is that chronic use leads to adaptations in striatal reward processing, blunting responsivity to the substance itself and natural (non-drug) rewards. Against this background, the present study investigated whether cannabis dependence is associated with lasting alterations in behavioral and neural responses to social reward in 23 abstinent cannabis-dependent men and 24 matched non-using controls. In an interpersonal pleasant touch fMRI paradigm, participants were led to believe they were in physical closeness of or touched (CLOSE, TOUCH) by either a male or female experimenter (MALE, FEMALE), allowing contextual modulation of the perceived pleasantness and associated neural responses. Upon female compared to male touch, dependent cannabis users displayed a significantly attenuated increase of pleasantness experience compared to healthy controls. Controls responded to female as compared to male interaction with increased striatal activation whereas cannabis users displayed the opposite activation pattern, with stronger alterations being associated with a higher lifetime exposure to cannabis. Neural processing of pleasant touch in dependent cannabis users was found to be intact. These findings demonstrate that cannabis dependence is linked to blunted striatal processing of non-drug rewards and suggest that these alterations may contribute to social processing deficits.
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Affiliation(s)
- Kaeli Zimmermann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Keith M Kendrick
- MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, Clinical Hospital of the Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Xiyuan Ave 2006, 611731 Chengdu, China
| | - Dirk Scheele
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Wolfgang Dau
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, 53111 Bonn, Germany
| | - Markus Banger
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, 53111 Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), 53175 Bonn, Germany
| | - Bernd Weber
- Department of Epileptology, Center for Economics and Neuroscience, University of Bonn, Germany; Department of NeuroCognition, Life & Brain Center, 53105 Bonn, Germany
| | - Yina Ma
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute of Brain Research, Beijing Normal University, 100875 Beijing, China
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, 53105 Bonn, Germany
| | - Benjamin Becker
- MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, Clinical Hospital of the Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Xiyuan Ave 2006, 611731 Chengdu, China.
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18
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Rabin RA, Kozak K, Zakzanis KK, Remington G, Stefan C, Budney AJ, George TP. A method to achieve extended cannabis abstinence in cannabis dependent patients with schizophrenia and non-psychiatric controls. Schizophr Res 2018; 194:47-54. [PMID: 28506704 DOI: 10.1016/j.schres.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cannabis use disorders (CUD) are common in schizophrenia (~25%) compared to the general population (~3%). Tetrahydrocannabinol (THC), the principal psychoactive component in cannabis is fat-soluble, resulting in an extended period for cannabinoid elimination. While detection of cannabinoids in urine is indicative of prior cannabis exposure, time of last use is difficult to verify sustained abstinence for extended periods (e.g., 28-days) in chronic cannabis users. Therefore, we evaluated the utility of a sustained cannabis abstinence paradigm in patients with schizophrenia and non-psychiatric controls. METHODS Cannabis dependent patients (n=19) and controls (n=20) underwent 28-days of monitored cannabis abstinence facilitated with contingency management. Urine samples were taken twice weekly. Abstinence was evaluated using 1) Self-report; 2) Qualitative biochemical confirmation using MEDTOX; and 3) in a subset of participants (schizophrenia, n=13; controls, n=13) gas chromatography-mass spectrometry (GC-MS) was performed to obtain quantitative creatinine-normalized carboxy-THC (THC-COOH) metabolite levels <20ng/mL). Subjective assessments were used to assess behavioral correlates of cannabis abstinence and further supported time-dependent abstinence trajectories. RESULTS Abstinence rates of 42.1% (8/19) in patients and 55% (11/19) in controls (p=0.53) were observed. Increased cannabis withdrawal symptoms in both patients and controls supported abstinence. DISCUSSION Our results suggest a feasible method for identification of short-term cannabis abstinence in individuals with schizophrenia at rates comparable to controls. Monitoring sustained abstinence may have implications for potential interventions for CUDs in schizophrenia.
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
| | - Karolina Kozak
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Gary Remington
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03702, USA
| | - Tony P George
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND High-potency cannabis concentrates are increasingly popular in the United States, and there is concern that use of high-potency cannabis might increase risk for cannabis-related problems. However, little is known about the potential negative consequences of concentrate use. This study reports on associations between past-year use of a high-potency cannabis concentrate, known as butane hash oil (BHO), and cannabis-related problems. METHODS A sample of 821 college students were recruited to complete a survey about their health and behavior. Participants who had used cannabis in the past year (33%, n=273) completed questions about their cannabis use, including their use of BHO and cannabis-related problems in eight domains: physical dependence, impaired control, academic-occupational problems, social-interpersonal problems, self-care problems, self-perception, risk behavior, and blackouts. RESULTS Approximately 44% (n=121) of past-year cannabis users had used BHO in the past year. More frequent BHO use was associated with higher levels of physical dependence (RR=1.8, p<0.001), impaired control (RR=1.3, p<0.001), cannabis-related academic/occupational problems (RR=1.5, p=0.004), poor self-care (RR=1.3, p=0.002), and cannabis-related risk behavior (RR=1.2, p=0.001). After accounting for sociodemographic factors, age of onset of cannabis use, sensation seeking, overall frequency of cannabis use, and frequency of other substance use, BHO use was still associated with higher levels of physical dependence (RR=1.2, p=0.014). CONCLUSIONS BHO use is associated with greater physiological dependence on cannabis, even after accounting for potential confounders. Longitudinal research is needed to determine if cannabis users with higher levels of physiological dependence seek out BHO and/or if BHO use increases risk for physiological dependence.
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Affiliation(s)
- Madeline H Meier
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, United States.
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Papinczak ZE, Connor JP, Feeney GFX, Young RM, Gullo MJ. Treatment seeking in cannabis dependence: The role of social cognition. Drug Alcohol Depend 2017; 170:142-146. [PMID: 27894043 DOI: 10.1016/j.drugalcdep.2016.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Relatively few cannabis dependent individuals seek treatment and little is known about the determinants of treatment seeking. Social Cognitive Theory (SCT) provides a useful framework for examining human behaviour and motivation which may be helpful in explaining treatment seeking. This study examined the differences in cannabis outcome expectancies and cannabis refusal self-efficacy between treatment seekers and non-treatment seekers with cannabis dependence. DESIGN Non-treatment seekers were referred to an illicit drug diversion program. Treatment seekers commenced an outpatient cannabis treatment program and completed a comprehensive assessment that included measures of cannabis outcome expectancies and refusal self-efficacy. SETTING A public hospital alcohol and drug outpatient clinic. PARTICIPANTS 269 non-treatment seekers and 195 individuals commencing cannabis dependence treatment. MEASUREMENTS The Cannabis Expectancy Questionnaire (CEQ), Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), Severity of Dependence Scale - Cannabis (SDS-C), General Health Questionnaire (GHQ-28) and Readiness to Change Questionnaire (RTC) were completed. FINDINGS Treatment seekers had significantly higher levels of negative cannabis outcome expectancies and significantly lower levels of emotional relief refusal self-efficacy (belief in ability to resist using cannabis when experiencing negative affect) (ps<0.001). Treatment seekers had significantly higher levels of psychological distress and self-perceived cannabis dependence compared to non-treatment seekers (ps<0.001). CONCLUSIONS High negative cannabis outcome expectancies and low emotional relief refusal self-efficacy may play a key role in motivation to seek treatment.
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Affiliation(s)
- Zoe E Papinczak
- Centre for Youth Substance Abuse Research, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia; School of Psychology, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Jason P Connor
- Centre for Youth Substance Abuse Research, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia; Discipline of Psychiatry, School of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Gerald F X Feeney
- Centre for Youth Substance Abuse Research, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Ross McD Young
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Faculty of Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Matthew J Gullo
- Centre for Youth Substance Abuse Research, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia.
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Gullo MJ, Matveeva M, Feeney GFX, Young RM, Connor JP. Social cognitive predictors of treatment outcome in cannabis dependence. Drug Alcohol Depend 2017; 170:74-81. [PMID: 27883947 DOI: 10.1016/j.drugalcdep.2016.10.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence. DESIGN Outpatients completed a comprehensive assessment when commencing cannabis treatment and predictors of treatment outcome were tested. SETTING A university hospital alcohol and drug outpatient clinic. PARTICIPANTS 221 cannabis-dependent patients participated in a 6-week CBT program where the goal was abstinence. MEASUREMENTS Cannabis Expectancy Questionnaire and Cannabis Refusal Self-Efficacy Questionnaire, cannabis dependence severity [Severity of Dependence Scale], psychological distress [General Health Questionnaire] at baseline; the timeline follow-back procedure at baseline and each session. FINDINGS Patients reporting lower confidence in their ability to resist cannabis during high negative affect (emotional relief refusal self-efficacy) had a lower likelihood of abstinence (p=0.004), more days of use (p<0.001), and larger amount used (p<0.001). Negative cannabis expectancies predicted greater likelihood of abstinence (p=0.024). Higher positive expectancies were associated with lower emotional relief self-efficacy, mediating its association with outcome (p<0.001). CONCLUSIONS Emotional relief refusal self-efficacy and negative expectancies are predictive of better treatment outcomes for cannabis dependence. Positive expectancies may indirectly predict poorer outcome because of a negative association with self-efficacy, but this conclusion remains tentative as directionality could not be established.
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Affiliation(s)
- Matthew J Gullo
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Marya Matveeva
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia; School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Gerald F X Feeney
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Ross McD Young
- Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Faculty of Health, Queensland University of Technology, Brisbane QLD 4059, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane QLD 4059, Australia
| | - Jason P Connor
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD 4029, Australia; Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; School of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
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Aston ER, Metrik J, Amlung M, Kahler CW, MacKillop J. Interrelationships between marijuana demand and discounting of delayed rewards: Convergence in behavioral economic methods. Drug Alcohol Depend 2016; 169:141-147. [PMID: 27810657 PMCID: PMC5140845 DOI: 10.1016/j.drugalcdep.2016.10.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Distinct behavioral economic domains, including high perceived drug value (demand) and delay discounting (DD), have been implicated in the initiation of drug use and the progression to dependence. However, it is unclear whether frequent marijuana users conform to a "reinforcer pathology" addiction model wherein marijuana demand and DD jointly increase risk for problematic marijuana use and cannabis dependence (CD). METHODS Participants (n=88, 34% female, 14% cannabis dependent) completed a marijuana purchase task at baseline. A delay discounting task was completed following placebo marijuana cigarette (0% THC) administration during a separate experimental session. RESULTS Marijuana demand and DD were quantified using area under the curve (AUC). In multiple regression models, demand uniquely predicted frequency of marijuana use while DD did not. In contrast, DD uniquely predicted CD symptom count while demand did not. There were no significant interactions between demand and DD in either model. CONCLUSIONS These findings suggest that frequent marijuana users exhibit key constituents of the reinforcer pathology model: high marijuana demand and steep discounting of delayed rewards. However, demand and DD appear to be independent rather than synergistic risk factors for elevated marijuana use and risk for progression to CD. Findings also provide support for using AUC as a singular marijuana demand metric, particularly when also examining other behavioral economic constructs that apply similar statistical approaches, such as DD, to support analytic methodological convergence.
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Affiliation(s)
- Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7 Canada
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - James MacKillop
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7 Canada,Homewood Research Institute, Guelph, ON N1E 6K9
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Melroy-Greif WE, Wilhelmsen KC, Ehlers CL. Genetic variation in FAAH is associated with cannabis use disorders in a young adult sample of Mexican Americans. Drug Alcohol Depend 2016; 166:249-53. [PMID: 27394933 PMCID: PMC4983484 DOI: 10.1016/j.drugalcdep.2016.06.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cannabis is a commonly used drug and studies have shown that a significant portion of the variation in cannabis use disorders (CUDs) is heritable. Five genes known to play a role in the endocannabinoid system and CUDs were examined in a community sample of young adult Mexican Americans (MAs): CNR1, MGLL, FAAH, DAGLA, and DAGLB. METHODS Gene-based tests were run to test for association between each gene and two DSM-5 cannabis phenotypes. Subsequent linear regressions were run in PLINK using an additive model to determine which single nucleotide polymorphisms (SNPs) were driving the association. RESULTS FAAH was significantly associated with DSM-5 cannabis use disorder group count (DSM-5 CUD) using a gene-based test (p=0.0035). This association survived Bonferroni correction for multiple testing at p<0.004. Post hoc analyses suggested this association was driven by two common (minor allele frequency >5%) SNPs in moderate linkage disequilibrium, rs324420 and rs4141964, at p=0.0014 and p=0.0023, respectively. In both cases the minor allele increased risk for DSM-5 CUD. CONCLUSIONS Genetic variation in FAAH was associated with DSM-5 CUD in MAs. This association was primarily driven by the missense SNP rs324420. In vitro work has provided evidence that the risk allele generates an enzyme with decreased expression and cellular stability. Although this SNP has been previously associated with substance use in the literature, this is the first association in a young adult MA sample.
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Affiliation(s)
- Whitney E. Melroy-Greif
- Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Kirk C. Wilhelmsen
- Department of Genetics and Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Cindy L. Ehlers
- Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, La Jolla, CA 92037, USA,Corresponding author: Dr. Cindy L. Ehlers, Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, 10550 N. Torrey Pines Rd. La Jolla, CA 92037, Mail SP30-1501, Tel: 858-784-7058, Fax: 858-784-7409,
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Bonnet U, Borda T, Scherbaum N, Specka M. Abstinence phenomena of chronic cannabis-addicts prospectively monitored during controlled inpatient detoxification (Part II): Psychiatric complaints and their relation to delta-9-tetrahydrocannabinol and its metabolites in serum. Drug Alcohol Depend 2015; 155:302-6. [PMID: 26298553 DOI: 10.1016/j.drugalcdep.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/27/2015] [Accepted: 08/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the impact of inpatient detoxification treatment on psychiatric symptoms of chronic cannabis addicts and to analyze the influence of serum cannabinoid levels on the severity of these symptoms. METHODS Thirty five treatment-seeking, not active co-morbid chronic cannabis dependents (ICD-10) were studied on admission and on abstinence days 8 and 16, using several observational and self-report scales, such as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), and the Symptom Checklist-90-Revised (SCL-90-R). Simultaneously obtained serum was analyzed with regard to levels of delta-9-tetrahydrocannabinol (THC) and its main metabolites 11-hydroxy-delta-9-tetrahydrocannabinol (THC-OH) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). RESULTS At admission, nearly 90% of the patients were not, or only mildly, affected by depression, anxiety or manic symptoms. In contrast, patients' self-description indicated a strong psychiatric burden in approximately 60% of the cases. All patients improved significantly within 16 days of the treatment. Effect sizes ranged from 0.7 to 1.4. (Cohen's d) for the respective scales. Serum THC-levels were positively associated with impairment of cognition in HAMA and motor retardation in BPRS. All other test results were not significantly related to the serum levels of the measured cannabinoids. DISCUSSION Effects of the cannabis withdrawal syndrome and executive dysfunctions might explain the discrepancy between the observer ratings and self-reported psychiatric burden. CONCLUSION Inpatient cannabis detoxification treatment significantly improved psychiatric symptoms. Serum THC-levels were not associated with affective symptoms and anxiety but predicted cognitive impairment and motor retardation.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, D-44577, Castrop-Rauxel, Germany.
| | - Thorsten Borda
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, D-44577, Castrop-Rauxel, Germany
| | - Norbert Scherbaum
- Department of Addictive Behavior and Addiction Medicine, LVR-Klinikum Essen, University of Duisburg/Essen, D-45147, Essen, Germany
| | - Michael Specka
- Department of Addictive Behavior and Addiction Medicine, LVR-Klinikum Essen, University of Duisburg/Essen, D-45147, Essen, Germany
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Fergusson DM, Boden JM, Horwood LJ. Psychosocial sequelae of cannabis use and implications for policy: findings from the Christchurch Health and Development Study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1317-26. [PMID: 26006253 DOI: 10.1007/s00127-015-1070-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Christchurch Health and Development Study is a longitudinal study of a birth cohort of 1265 children who were born in Christchurch, New Zealand, in 1977. This cohort has now been studied from birth to the age of 35. SCOPE OF THIS REVIEW This article examines a series of findings from the CHDS that address a range of issues relating to the use of cannabis amongst the cohort. These issues include: (a) patterns of cannabis use and cannabis dependence; (b) linkages between cannabis use and adverse educational and economic outcomes; (c) cannabis and other illicit drug use; (d) cannabis and psychotic symptoms; (e) other CHDS findings related to cannabis; and (f) the consequences of cannabis use for adults using cannabis regularly. FINDINGS In general, the findings of the CHDS suggest that individuals who use cannabis regularly, or who begin using cannabis at earlier ages, are at increased risk of a range of adverse outcomes, including: lower levels of educational attainment; welfare dependence and unemployment; using other, more dangerous illicit drugs; and psychotic symptomatology. It should also be noted, however, that there is a substantial proportion of regular adult users who do not experience harmful consequences as a result of cannabis use. CONCLUSIONS Collectively, these findings suggest that cannabis policy needs to be further developed and evaluated in order to find the best way to regulate a widely-used, and increasingly legal substance.
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Abstract
BACKGROUND A valid measure of the relative economic value of marijuana is needed to characterize individual variation in the drug's reinforcing value and inform evolving national marijuana policy. Relative drug value (demand) can be measured via purchase tasks, and demand for alcohol and cigarettes has been associated with craving, dependence, and treatment response. This study examined marijuana demand with a marijuana purchase task (MPT). METHODS The 22-item self-report MPT was administered to 99 frequent marijuana users (37.4% female, 71.5% marijuana use days, 15.2% cannabis dependent). RESULTS Pearson correlations indicated a negative relationship between intensity (free consumption) and age of initiation of regular use (r=-0.34, p<0.001), and positive associations with use days (r=0.26, p<0.05) and subjective craving (r=0.43, p<0.001). Omax (maximum expenditure) was positively associated with use days (r=0.29, p<0.01) and subjective craving (r=0.27, p<0.01). Income was not associated with demand. An exponential demand model provided an excellent fit to the data across users (R(2)=0.99). Group comparisons based on presence or absence of DSM-IV cannabis dependence symptoms revealed that users with any dependence symptoms showed significantly higher intensity of demand and more inelastic demand, reflecting greater insensitivity to price increases. CONCLUSIONS These results provide support for construct validity of the MPT, indicating its sensitivity to marijuana demand as a function of increasing cost, and its ability to differentiate between users with and without dependence symptoms. The MPT may denote abuse liability and is a valuable addition to the behavioral economic literature. Potential applications to marijuana pricing and tax policy are discussed.
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Affiliation(s)
- Elizabeth R. Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
| | - James MacKillop
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, L8N 3K7 Canada
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Lundahl LH, Greenwald MK. Effect of oral THC pretreatment on marijuana cue-induced responses in cannabis dependent volunteers. Drug Alcohol Depend 2015; 149:187-93. [PMID: 25725933 PMCID: PMC10369174 DOI: 10.1016/j.drugalcdep.2015.01.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The current study tested whether oral Δ(9)-tetrahydrocannabinol (THC: 0-, 10-, and 20-mg) pretreatment would attenuate polysensory cue-induced craving for marijuana. METHODS Cannabis dependent participants (7 males and 7 females, who smoked on average 5.4 ± 1.1 blunts daily) completed 3 experimental sessions (oral THC pretreatment dose; counterbalanced order) using a placebo-controlled within-subject crossover design. During each session, participants completed a baseline evaluation and were first exposed to neutral cues then marijuana cues while physiological measures and subjective ratings of mood, craving, and drug effect were recorded. RESULTS Following placebo oral THC pretreatment, marijuana (vs. neutral) cues significantly increased ratings of marijuana craving (desire and urge to use, Marijuana Craving Questionnaire (MCQ)-Compulsivity scale), anxious mood and feeling hungry. Males also reported feeling more "Down" during marijuana cues relative to females. Pretreatment with oral THC (10-mg and/or 20-mg vs. placebo) significantly attenuated marijuana cue-induced increases in craving and anxiety but not hunger. Oral THC attenuation of the cue-induced increase in MCQ-Compulsivity ratings was observed in females only. Oral THC produced statistically (but not clinically) significant increases in heart rate and decreases in diastolic blood pressure, independent of cues. CONCLUSIONS These marijuana-cue findings replicate earlier results and further demonstrate that oral THC can attenuate selected effects during marijuana multi-cue exposure, and that some of these effects may be sex-related. Results of this study suggest oral THC may be effective for reducing marijuana cue-elicited (conditioned) effects. Further study is needed to determine whether females may selectively benefit from oral THC for this purpose.
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Affiliation(s)
- Leslie H Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.
| | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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Fischer BA, McMahon RP, Kelly DL, Wehring HJ, Meyer WA, Feldman S, Carpenter WT, Gorelick DA. Risk-taking in schizophrenia and controls with and without cannabis dependence. Schizophr Res 2015; 161:471-7. [PMID: 25467541 PMCID: PMC4308438 DOI: 10.1016/j.schres.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 11/05/2014] [Accepted: 11/09/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Risk-based decision making is altered in people with schizophrenia and in people with cannabis use compared to healthy controls; the pattern of risk-assessment in people with co-occurring schizophrenia and cannabis dependence is poorly understood. This study examined measures of risk-taking and decision-making in people with and without schizophrenia and/or cannabis dependence. METHODS Participants with schizophrenia (n=24), cannabis dependence (n=23), schizophrenia and co-occurring cannabis dependence (n=18), and healthy controls (n=24) were recruited from the community via advertisements and completed a one-visit battery of symptom, risk-based decision making, gambling behavior, cognitive, and addiction assessments. This report presents self-assessments of self-mastery, optimism, impulsivity, and sensation seeking and a behavioral assessment of risk (Balloon Analog Risk Task [BART]). RESULTS On self-report measures, participants with schizophrenia and co-occurring cannabis dependence were intermediate between those with only cannabis dependence or only schizophrenia on ratings of self-mastery, sensation-seeking, and impulsivity. There were no group differences on ratings of optimism. Their behavior on the BART was most similar to participants with only cannabis dependence or healthy controls, rather than to participants with only schizophrenia. CONCLUSIONS People with schizophrenia and co-occurring cannabis dependence may represent a unique group in terms of risk-perception and risk-taking. This has implications for interventions designed to influence health behaviors such as motivational interviewing.
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Affiliation(s)
- Bernard A Fischer
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Baltimore, MD, USA; Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Walter A Meyer
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William T Carpenter
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Baltimore, MD, USA; Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A Gorelick
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Benschop A, Liebregts N, van der Pol P, Schaap R, Buisman R, van Laar M, van den Brink W, de Graaf R, Korf DJ. Reliability and validity of the Marijuana Motives Measure among young adult frequent cannabis users and associations with cannabis dependence. Addict Behav 2015; 40:91-5. [PMID: 25240105 DOI: 10.1016/j.addbeh.2014.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/31/2014] [Accepted: 09/03/2014] [Indexed: 01/22/2023]
Abstract
The Marijuana Motives Measure (MMM) has so far been examined mainly in student populations, often with relatively limited involvement in cannabis use. This study evaluated the factor structure of the MMM in a demographically mixed sample of 600 young adult (18-30 years) frequent (≥ 3 days per week) cannabis users in the Netherlands. Analysis confirmed a five-factor solution, denoting coping, enhancement, social, conformity and expansion motives. Additionally, the original MMM was extended with two items (boredom and habit), which formed a distinct, internally consistent sixth factor labelled routine motives. In a multivariable logistic regression analysis, coping and routine motives showed significant associations with 12-month DSM-IV cannabis dependence. The results suggest general reliability and validity of the MMM in a heterogeneous population of experienced cannabis users.
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Affiliation(s)
- Annemieke Benschop
- Bonger Institute of Criminology, Faculty of Law, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, The Netherlands.
| | - Nienke Liebregts
- Bonger Institute of Criminology, Faculty of Law, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, The Netherlands
| | - Peggy van der Pol
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Rick Schaap
- Bonger Institute of Criminology, Faculty of Law, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, The Netherlands
| | - Renate Buisman
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Margriet van Laar
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Dirk J Korf
- Bonger Institute of Criminology, Faculty of Law, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, The Netherlands
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Liebregts N, van der Pol P, van Laar M, de Graaf R, van den Brink W, Korf DJ. The role of leisure and delinquency in frequent cannabis use and dependence trajectories among young adults. Int J Drug Policy 2014; 26:143-52. [PMID: 25171910 DOI: 10.1016/j.drugpo.2014.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/10/2014] [Accepted: 07/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The link between leisure and cannabis use has been widely studied, but less so for young adults, and rarely with a focus on frequent cannabis use. Also, little is known about how changes in leisure develop over time and how they are related to transitions in cannabis use and dependence. METHOD As part of a 3-year longitudinal project, in a qualitative study 47 frequent male and female young adult cannabis users with (n=23) and without (n=24) dependence at baseline were interviewed in-depth after 1.5 and 3 years. RESULTS Frequent cannabis users (at baseline ≥3 days per week in the past 12 months) are involved in similar leisure activities as the general young adult population and live rather conventional lives, generally away from a delinquent subculture. They mostly regulate their cannabis use to leisure time, to enhance other leisure activities, including socialising and video gaming. While they often give precedence to responsibilities (e.g. work and study), dependent and non-dependent users differed in whether they actively adapted their leisure activities to their cannabis use, or their cannabis use to their leisure time. Both types of and time spent on leisure activities were associated with transitions in use and dependence. CONCLUSIONS While our findings generally support the normalisation thesis, it is questionable whether frequent but non-problematic cannabis use is socially accepted in wider society. This study also questions the diagnostic dependence vs. non-dependence dichotomy, and adds finer distinctions to the concept of cannabis dependence. Implications for prevention and treatment include facilitating structured spending of leisure time (e.g. sports), and targeting frequent users who spent much leisure time video gaming at home.
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Affiliation(s)
- Nienke Liebregts
- Bonger Institute of Criminology, Law Faculty, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, the Netherlands.
| | - Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Margriet van Laar
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Ron de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Dirk J Korf
- Bonger Institute of Criminology, Law Faculty, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, the Netherlands
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Yip SW, DeVito EE, Kober H, Worhunsky PD, Carroll KM, Potenza MN. Pretreatment measures of brain structure and reward-processing brain function in cannabis dependence: an exploratory study of relationships with abstinence during behavioral treatment. Drug Alcohol Depend 2014; 140:33-41. [PMID: 24793365 PMCID: PMC4057888 DOI: 10.1016/j.drugalcdep.2014.03.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cannabis is widely abused, and efficacies of therapeutics for cannabis dependence remain suboptimal. Magnetic resonance imaging (MRI) may aid in the identification of biological markers for successful treatment outcomes (i.e., abstinence). METHODS Twenty men with cannabis dependence and twenty non-substance-using healthy comparison (HC) men underwent MRI scanning. Cannabis-dependent individuals then participated in a 12-week randomized clinical trial of behavioral treatments (contingency management (CM), cognitive behavioral therapy (CBT) or both). Pretreatment functional and structural data were compared between the cannabis-dependent and HC participants. In addition, individuals with cannabis dependence were subdivided based on the successful achievement of 21 days of consecutive abstinence during treatment to assess whether abstinent versus non-abstinent cannabis-dependent participants displayed different pretreatment functional and structural characteristics when compared to HC participants. RESULTS In comparison to HC participants, cannabis-dependent participants demonstrated greater ventral striatal activation during the receipt of losing outcomes and smaller putamenal volumes. Cannabis-dependent participants who did not subsequently achieve 21 days of consecutive abstinence had increased activity within the striatum during the receipt of losing outcomes, relative to HC participants. Cannabis-dependent participants who did not achieve 21 days of abstinence had decreased bilateral putamen volumes prior to treatment, relative to HC participants. CONCLUSIONS Individual differences in pretreatment striatal function and structure may relate to individual differences in treatment responses for cannabis dependence. While mechanisms underlying these associations require further exploration, the striatum might mediate treatment responses via its role in associative reward-learning (e.g., through skills training in CBT or reinforcement of abstinence in CM).
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Affiliation(s)
- Sarah W. Yip
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Elise E. DeVito
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Hedy Kober
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick D. Worhunsky
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
,Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Haberstick BC, Young SE, Zeiger JS, Lessem JM, Hewitt JK, Hopfer CJ. Prevalence and correlates of alcohol and cannabis use disorders in the United States: results from the national longitudinal study of adolescent health. Drug Alcohol Depend 2014; 136:158-61. [PMID: 24440049 PMCID: PMC3963405 DOI: 10.1016/j.drugalcdep.2013.11.022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/28/2013] [Accepted: 11/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited current information on the epidemiology of lifetime alcohol and cannabis use disorders in the United States is available. AIMS To present detailed information about the prevalence and sociodemographic correlates of lifetime alcohol and cannabis use disorders rates in the United States. To examine gender differences in hazard ratios for the onset of alcohol and cannabis dependence. METHODS Participants in Wave IV of the National Longitudinal Study of Adolescent Health (N=15,500, age range: 24-32) were interviewed between 2008 and 2009. Participants who exceeded screening thresholds were queried about lifetime DSM-IV alcohol and marijuana abuse and dependence symptoms. Age of substance dependence onset was queried. RESULTS Lifetime rates of alcohol abuse and dependence were 11.8 and 13.2%. Lifetime rates of cannabis abuse and dependence were 3.9 and 8.3%. Lifetime alcohol and cannabis dependence onset peaks were 23 and 20. Correlates of lifetime alcohol abuse included being male (OR 1.4), African-American (OR 0.7), income in the 2nd or 3rd quartile (OR 0.7 and 0.6). Correlates of lifetime alcohol dependence were: being male (OR 1.8), African-American (OR 0.5), and never being married (OR 1.5), and regions outside of the west (Midwest OR 0.7, South OR 0.6, Northeast OR 0.6). Correlates of cannabis abuse and dependence were being male (OR 1.8 and 1.4). CONCLUSIONS Lifetime alcohol and cannabis use disorders are highly prevalent in the US population. Men are at higher risk for alcohol and cannabis use disorders. Alcohol use disorders demonstrated specific sociodemographic correlates while marijuana use disorders did not.
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Affiliation(s)
- Brett C Haberstick
- Institute for Behavioral Genetics, University of Colorado, Boulder, Boulder, CO, USA.
| | - Susan E Young
- Department of Psychiatry, Health Sciences Center, University of Colorado, Denver, CO, USA
| | - Joanna S Zeiger
- Institute for Behavioral Genetics, University of Colorado, Boulder, Boulder, CO, USA
| | - Jeffrey M Lessem
- Institute for Behavioral Genetics, University of Colorado, Boulder, Boulder, CO, USA
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder, Boulder, CO, USA
| | - Christian J Hopfer
- Department of Psychiatry, Health Sciences Center, University of Colorado, Denver, CO, USA
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Abstract
Cannabis is the most commonly used illicit drug in the world. However, only few studies have shown the efficacy of pharmacologic agents in targeting cannabis withdrawal symptoms or reducing the reinforcing effects of cannabis. Baclofen has been shown to reduce cannabis withdrawal symptoms and the subjective effects of cannabis. We think that the clinical utility of baclofen for cannabis dependence is a reasonable approach. A case report using baclofen is presented and provides preliminary support for the use of baclofen in the management of cannabis dependence.
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Affiliation(s)
- Bruce Imbert
- APHM, Sainte-Marguerite University Hospital, 270, bd sainte marguerite, Marseille 13274, France
| | | | | | - Nicolas Simon
- APHM, Sainte-Marguerite University Hospital, Marseille, France
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Predicting the transition from frequent cannabis use to cannabis dependence: a three-year prospective study. Drug Alcohol Depend 2013; 133:352-9. [PMID: 23886472 DOI: 10.1016/j.drugalcdep.2013.06.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/27/2013] [Accepted: 06/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users. METHODS A prospective cohort of frequent cannabis users (aged 18-30, n=600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n=269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support). RESULTS Three-year cumulative incidence of cannabis dependence was 37.2% (95% CI=30.7-43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence. CONCLUSIONS In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Facilitators and barriers in treatment seeking for cannabis dependence. Drug Alcohol Depend 2013; 133:776-80. [PMID: 24035185 DOI: 10.1016/j.drugalcdep.2013.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relatively few cannabis dependent people seek treatment and little is known about determinants of treatment seeking. METHODS Treatment determinants were compared among 70 DSM-IV cannabis dependent patients and 241 non-treatment seeking DSM-IV cannabis dependent community subjects. In addition, perceived facilitators for treatment seeking were assessed in patients, whereas perceived barriers were assessed in 160/241 cannabis dependent community subjects not prepared to seek treatment (precluders), of whom 63/160 showed an objective treatment need, and 30/241 showed a subjective treatment need. RESULTS Compared to non-treatment seekers, patients reported more cannabis use (176.9 versus 82.8 joints monthly), more symptoms of dependence (5.6 versus 4.5), higher perceived lack of social support (70.0% versus 41.1%), more pressure to seek treatment (58.6% versus 21.6%), a more positive attitude to treatment, and more previous treatments. In addition, patients reported more mental health problems (internalising disorders 57.1% versus 24.5%; externalising disorders 52.9% versus 35.3%) and more functional impairments (8.4 versus 4.8 monthly days out of role). Cannabis dependent 'precluders' reported desire for self-reliance (50.0%), preference for informal help (22.5%), and absent treatment need (16.9%) as their main reasons not to seek treatment, whereas cannabis dependent community subjects with a subjective treatment need mainly expressed desire for self-reliance (36.7%), treatment ineffectiveness (16.7%), and avoiding stigma (13.3%). CONCLUSIONS Functional impairment, mental health problems and social pressure are important reasons to seek treatment in people with cannabis dependence. Treatment participation might improve if desire for self-reliance and the preference for informal help are considered, and perceived ineffectiveness of treatment and stigmatisation are publicly addressed.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
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Parkar SR, Ramanathan S, Nair N, Batra SA, Adarkar SA, Kund P, Baghel NS, Moghe SH. Are the effects of cannabis dependence on glucose metabolism similar to schizophrenia? An FDG PET understanding. Indian J Psychiatry 2011; 53:13-20. [PMID: 21431002 PMCID: PMC3056181 DOI: 10.4103/0019-5545.75552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cannabis has been associated with transient psychotic states; however, the causal relationship between cannabis and schizophrenia continues to remain a matter of debate. Epidemiological and some biological studies hint at cannabis being an independent risk factor for schizophrenia; this has not been definitively proved. AIMS We aimed to understand the patterns of glucose uptake in important brain regions among individuals with cannabis dependence and schizophrenia. Furthermore, we compared the interregional metabolic rates in pertinent neural circuits among individuals with cannabis dependence, schizophrenia and normal controls. SETTING AND DESIGN This is a case-control cross-sectional study that was carried out by a general psychiatry department in collaboration with a nuclear diagnosis unit. MATERIALS AND METHODS Male volunteers with cannabis dependence, schizophrenia and normal controls underwent FDG PET scanning. Glucose uptakes in pre-selected regions of interest were compared using MANOVA. Finally, Chow tests were used to compare interregional metabolic relationships in the mesocortical and cortical-subcortical-cerebellum circuits. RESULTS Significant differences (P<0.05) were noted among individuals with cannabis dependence and schizophrenia in the medial and lateral temporal regions. When the neural circuits were compared, significant interregional differences (P<0.05) were noted between individuals with cannabis dependence and normal controls. However, among individuals with cannabis dependence and schizophrenia, no significant differences (P>0.05) were noted in these patterns. CONCLUSIONS Our findings suggest that cannabis dependence can alter interregional relationships in a manner similar to schizophrenia. This indicates that cannabis could potentially play a role in the development of psychosis by altering neural circuits.
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Affiliation(s)
- Shubhangi R Parkar
- Department of Psychiatry, G. S. Medical College and King Edward Memorial Hospital, Mumbai, India
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Chaudhury S, Sudarsanan S, Salujha SK, Srivastava K. Cannabis Use in Psychiatrie Patients. Med J Armed Forces India 2005; 61:117-20. [PMID: 27407730 DOI: 10.1016/s0377-1237(05)80004-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Accepted: 06/11/2003] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Cannabis abuse has been associated with psychiatric disorders. METHODS The pattern of cannabis use and incidence of cannabis dependence and cannabis psychosis among 471 consecutive patients admitted to a tertiary care psychiatric center was investigated. RESULTS Cannabis use was reported by 67 (14.23%) patients of whom 42 (8.92%) were occasional users, 18 (3.82%) were classified as frequent users while 7 (1.49%) fulfilled criteria for cannabis dependence. 3 (0.64%) patients showed symptoms which were characteristic of cannabis psychosis. Among the 67 cannabis users, 56 (83.58%) had their first exposure to cannabis before entering service at 13-19 years of age. The remaining 14 (16.09%) began consuming cannabis 1-5 years after joining service. CONCLUSION The reasons given for using cannabis were curiosity about its effects 32 (47.76%), peer pressure 17 (25.37%) or traditional use during festivals 18 (26.87%).
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Affiliation(s)
- S Chaudhury
- Classified Specialist (Psychiatry), Command Hospital (Western Command), Chandimandir
| | - S Sudarsanan
- Commandant, Armed Forces Medical Stores Depot, Delhi Cantt
| | - S K Salujha
- Ex-Classified Specialist (Psychiatry), Military Hospital Jalandhar Cantt
| | - K Srivastava
- Scientist 'D'(Clinical Psychologist), Department of Psychiatry, Armed Forces Medical College, Pune-40
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