1
|
Dawson D, Stjepanovic D, Lorenzetti V, Hall WD, Leung J. How much cannabis is used in a joint in Australia? An experimental investigation into use by potency and frequency. Drug Alcohol Rev 2024; 43:226-232. [PMID: 37717253 DOI: 10.1111/dar.13747] [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: 03/20/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Cannabis use is highly prevalent in Australia, yet current survey metrics measure tetrahydrocannabinol (THC) exposure with limited accuracy. Often survey items measure cannabis quantity by assuming specific modes of use (i.e., 'how many joints do you use?'), which fail to capture variations in cannabis use and the diverse modes of use (e.g., joints, cones, spliffs). This study investigated how much cannabis is used in these modes of administration in an Australian sample. METHODS Participants (N = 31, Mage = 25.77; 51% university students) completed the Roll a Joint Paradigm in which they rolled joints, spliffs and packed cones as they would typically, using oregano as 'cannabis.' Participants then prepared each again but with cannabis of higher or lower potency. RESULTS The amount of cannabis used across different modes of administration was variable: joints (range 0.10-1.25 g), spliffs (range 0.12-1.21 g) and cones (range 0.03-0.41 g). Participants who used cannabis daily rolled three times the amount of cannabis into a joint. DISCUSSION AND CONCLUSIONS The amount of cannabis used in common modes of administration may be highly variable. Daily use may be associated using larger quantities of cannabis. Titration attempts based on potency were not proportional or consistent across modes of administration. The results indicate people may adjust the quantity of cannabis based on perceived potency, however, not proportional to THC concentration. Inconsistency in the amount of cannabis used based on potency and within different modes of administration may represent a problem for self-report metrics which ask participants to report cannabis use in joints.
Collapse
Affiliation(s)
- Danielle Dawson
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Daniel Stjepanovic
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Queensland Alliance for Environmental Health Science, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Loya JM, Tangney JP, Stuewig JB. Are Borderline Personality Disorder Features Differentially Related to Pre-Incarceration Alcohol, Cannabis, Cocaine, and Opioid Dependence Among People Recently Incarcerated in Jail? J Pers Disord 2022; 36:623-640. [PMID: 36181491 DOI: 10.1521/pedi.2022.36.5.623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) and substance use disorders (SUDs) commonly co-occur across various settings. However, little research has examined how BPD features relate to specific types of SUDs. This study examined whether BPD features assessed shortly after incarceration were differentially related to symptoms of dependence on alcohol, cannabis, cocaine, and opioids experienced in the 12 months prior to incarceration among 510 people recently incarcerated in jail. Follow-up multigroup analyses evaluated whether gender or race moderated the relation of BPD features to the four SUDs. Using structural equational modeling, the relationships of BPD features were compared to each of the four preincarceration dependence symptoms. BPD features were significantly related to dependence on each of the four substances, but the link between BPD features and cocaine dependence was stronger than BPD's association with alcohol, cannabis, or opioid dependence. These findings generalized across men and women and across White and Black people.
Collapse
Affiliation(s)
- Jennifer M Loya
- Yale School of Medicine, New Haven, Connecticut.,George Mason University, Fairfax, Virginia
| | | | | |
Collapse
|
3
|
Cousijn J, Toenders YJ, Velzen LS, Kaag AM. The relation between cannabis use, dependence severity and white matter microstructure: A diffusion tensor imaging study. Addict Biol 2022; 27:e13081. [PMID: 34402136 PMCID: PMC9285423 DOI: 10.1111/adb.13081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 01/12/2023]
Abstract
Despite the significant societal and personal burden of cannabis use, the impact of long‐term use and Cannabis Use Disorder (CUD) on white matter microstructure is still unclear. Previous studies show inconsistent findings, in part due to heterogeneity in methodology, variable severity of cannabis use, and potential confounding effects of other mental health issues and substance use. The goal of this diffusion tensor imaging (DTI) study was to compare whole‐brain white matter microstructure between 39 near daily cannabis users and 28 controls closely matched on age, sex, alcohol use, cigarette use and mental health. Within the group of cannabis users, associations between white matter microstructure and recent cannabis use, dependence severity, and age of onset and duration of weekly use were investigated. White matter microstructure did not differ between cannabis users and controls and did not covary with recent cannabis use, dependence severity, or duration of use. Earlier onset of weekly cannabis use was related to lower fractional anisotropy (FA) in various sections of the right inferior longitudinal fasciculus and uncinate fasciculus. These findings suggest that long‐term near‐daily cannabis use does not necessarily affect white matter microstructure, but vulnerability may be higher during adolescence. These findings underscore the importance of sample composition and warrant further studies that investigate the moderating role of age of onset in the impact of cannabis on the brain.
Collapse
Affiliation(s)
- Janna Cousijn
- Neuroscience of Addiction (NofA) Lab, Department of Psychology, Education & Child Studies Erasmus University Rotterdam Rotterdam The Netherlands
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
| | - Yara J. Toenders
- Orygen, The National Centre of Excellence in Youth Mental Health Parkville Victoria Australia
- Centre for Youth Mental Health The University of Melbourne Parkville Victoria Australia
| | - Laura S. Velzen
- Orygen, The National Centre of Excellence in Youth Mental Health Parkville Victoria Australia
- Centre for Youth Mental Health The University of Melbourne Parkville Victoria Australia
| | - Anne Marije Kaag
- Department of Clinical, Neuro‐ and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam Vrije Universiteit Amsterdam The Netherlands
| |
Collapse
|
4
|
Scherbaum N, Mikoteit T, Witkowski L, Bonnet U, Specka M, Schifano F, Lieb B. New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients? Int J Environ Res Public Health 2021; 18:ijerph182413014. [PMID: 34948622 PMCID: PMC8702029 DOI: 10.3390/ijerph182413014] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Abstract
Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.
Collapse
Affiliation(s)
- Norbert Scherbaum
- LVR-Hospital Essen, Department of Addiction Medicine and Addictive Behavior, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (L.W.); (M.S.)
- Correspondence:
| | | | - Lilia Witkowski
- LVR-Hospital Essen, Department of Addiction Medicine and Addictive Behavior, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (L.W.); (M.S.)
| | - Udo Bonnet
- Evangelisches Krankenhaus Castrop-Rauxel, Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, 44577 Castrop-Rauxel, Germany;
| | - Michael Specka
- LVR-Hospital Essen, Department of Addiction Medicine and Addictive Behavior, Medical Faculty, University of Duisburg-Essen, 45147 Essen, Germany; (L.W.); (M.S.)
| | - Fabrizio Schifano
- Psychopharmacology, Substance Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK;
| | - Bodo Lieb
- Katholisches Krankenhaus Hagen, Klinik für Psychiatrie and Psychotherapie, 58119 Hagen, Germany;
| |
Collapse
|
5
|
Mair C, Sumetsky N, Kranich C, Freisthler B. Availability of medical cannabis dispensaries and cannabis abuse/dependence-related hospitalizations in California. Addiction 2021; 116:1908-1913. [PMID: 33565655 PMCID: PMC10680151 DOI: 10.1111/add.15420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/18/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate associations between both current- and prior-year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016. DESIGN Spatial analysis of ZIP code-level hospitalization discharge data using Bayesian Poisson hierarchical space-time models over 4 years. SETTING AND CASES California, USA from 2013 to 2016 (6832 space-time ZIP code units). MEASUREMENTS We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD-9-CM or ICD-10-CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code-level economic and demographic conditions. FINDINGS One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior-year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off-premises alcohol outlet density and lower on-premises alcohol outlet density and poverty were all associated with decreased ZIP code-level risk of cannabis abuse/dependence hospitalizations. CONCLUSIONS In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same-year but not next-year hospitalizations for cannabis use disorder.
Collapse
Affiliation(s)
- Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Natalie Sumetsky
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | | |
Collapse
|
6
|
Nicolini H, Martínez-Magaña JJ, Genis-Mendoza AD, Villatoro Velázquez JA, Camarena B, Fleiz Bautista C, Bustos-Gamiño M, Aguilar García A, Lanzagorta N, Medina-Mora ME. Cannabis Use in People With Obsessive-Compulsive Symptomatology: Results From a Mexican Epidemiological Sample. Front Psychiatry 2021; 12:664228. [PMID: 34040556 PMCID: PMC8141625 DOI: 10.3389/fpsyt.2021.664228] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Recent studies suggest that the endocannabinoid system could play an important role in the physiopathology of obsessive-compulsive disorder (OCD). There are reports of effective treatment with derivatives of tetrahydrocannabinol (THC). The study of the genetic factor associated with psychiatric disorders has made possible an exploration of its contribution to the pharmacological response. However, very little is known about the genetic factor or the prevalence of cannabis use in the Mexican population with OCD. The objective of this study is to compare the prevalence of use and dependence on cannabis in individuals with obsessive-compulsive symptomatology (OCS) with that of individuals with other psychiatric symptoms (psychosis, depression, and anxiety), and to explore the association between genetic risk and use. The study includes a total of 13,130 individuals evaluated in the second stage of the 2016 National Survey of Drug, Alcohol, and Tobacco Use (Encodat 2016), with genetic analysis (polygenic risk scoring) of a subsample of 3,521 individuals. Obsessive symptomatology had a prevalence of 7.2% and compulsive symptomatology a prevalence of 8.6%. The proportion of individuals with OCS who had ever used cannabis was 23.4%, and of those with cannabis dependency was 2.7%, the latter figure higher than that in individuals with other psychiatric symptoms (hypomania, 2.6%; anxiety, 2.8%; depression, 2.3%), except psychosis (5.9%). Individuals with OCS who reported using cannabis had an increased genetic risk for cannabis dependence but not for OCD. We thus cannot know how the increased genetic risk of cannabis dependence in people with OCD is influenced by their pharmacological response to derivatives of THC. The results, however, suggest paths for future studies.
Collapse
Affiliation(s)
- Humberto Nicolini
- Genomics Laboratory of Psychiatric and Neurodegenerative Diseases, National Institute of Genomic Medicine, Mexico City, Mexico
| | - José Jaime Martínez-Magaña
- Genomics Laboratory of Psychiatric and Neurodegenerative Diseases, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Alma Delia Genis-Mendoza
- Genomics Laboratory of Psychiatric and Neurodegenerative Diseases, National Institute of Genomic Medicine, Mexico City, Mexico.,Juan N. Navarro Children's Psychiatric Hospital, Psychiatric Care Services, Mexico City, Mexico
| | - Jorge Ameth Villatoro Velázquez
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico.,Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Beatriz Camarena
- Department of Pharmacogenetics, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Clara Fleiz Bautista
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico.,Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Marycarmen Bustos-Gamiño
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Alejandro Aguilar García
- Department of Pharmacogenetics, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | | | - María Elena Medina-Mora
- Data Analysis and Survey Unit, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico.,Global Studies Seminar, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| |
Collapse
|
7
|
Braidwood R, Mansell S, Waldron J, Rendell PG, Kamboj SK, Curran HV. Non-Dependent and Dependent Daily Cannabis Users Differ in Mental Health but Not Prospective Memory Ability. Front Psychiatry 2018; 9:97. [PMID: 29636705 PMCID: PMC5880932 DOI: 10.3389/fpsyt.2018.00097] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/09/2018] [Indexed: 11/13/2022] Open
Abstract
Research suggests that daily cannabis users have impaired memory for past events, but it is not clear whether they are also impaired in prospective memory (PM) for future events. The present study examined PM in daily cannabis users who were either dependent (n = 18) or non-dependent (n = 18), and compared them with non-using controls (n = 18). The effect of future event simulation (FES) on PM performance was also examined. Participants were matched across groups on age, gender, and highest level of education. The virtual week (VW) was used to objectively assess PM abilities, both at baseline and following FES. Other measures used were: cannabis use variables, immediate and delayed prose recall, phonemic and category fluency, spot-the-word test (premorbid intelligence), Beck Depression Inventory, Beck Anxiety Inventory, and a measure of schizotypy (Oxford-Liverpool Inventory of Feelings and Experiences: unusual experiences subscale). No group differences were found in PM performance on the VW, and FES did not improve PM performance in any group. Dependent cannabis users scored higher on depression, anxiety, and schizotypy than both other groups with non-dependent cannabis users scoring at a similar level to controls. There were no group differences in alcohol use. Findings suggest that when carefully matched on baseline variables, and not differing in premorbid IQ or alcohol use, young, near-daily cannabis users do not differ from non-using controls in PM performance.
Collapse
Affiliation(s)
- Ruth Braidwood
- Clinical Psychopharmacology Unit (CPU), University College London, London, United Kingdom
| | - Samantha Mansell
- Clinical Psychopharmacology Unit (CPU), University College London, London, United Kingdom
| | - Jon Waldron
- Clinical Psychopharmacology Unit (CPU), University College London, London, United Kingdom
| | - Peter G Rendell
- Cognition and Emotion Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit (CPU), University College London, London, United Kingdom
| | - H Valerie Curran
- Clinical Psychopharmacology Unit (CPU), University College London, London, United Kingdom
| |
Collapse
|
8
|
Vsevolozhskaya OA, Anthony JC. Estimated probability of becoming a case of drug dependence in relation to duration of drug-taking experience: a functional analysis approach. Int J Methods Psychiatr Res 2017; 26:e1513. [PMID: 27356948 PMCID: PMC5199633 DOI: 10.1002/mpr.1513] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 01/13/2023] Open
Abstract
Measured as elapsed time from first use to dependence syndrome onset, the estimated "induction interval" for cocaine is thought to be short relative to the cannabis interval, but little is known about risk of becoming dependent during first months after onset of use. Virtually all published estimates for this facet of drug dependence epidemiology are from life histories elicited years after first use. To improve estimation, we turn to new month-wise data from nationally representative samples of newly incident drug users identified via probability sampling and confidential computer-assisted self-interviews for the United States National Surveys on Drug Use and Health, 2004-2013. Standardized modules assessed first and most recent use, and dependence syndromes, for each drug subtype. A four-parameter Hill function depicts the drug dependence transition for subgroups defined by units of elapsed time from first to most recent use, with an expectation of greater cocaine dependence transitions for cocaine versus cannabis. This study's novel estimates for cocaine users one month after first use show 2-4% with cocaine dependence; 12-17% are dependent when use has persisted. Corresponding cannabis estimates are 0-1% after one month, but 10-23% when use persists. Duration or persistence of cannabis smoking beyond an initial interval of a few months of use seems to be a signal of noteworthy risk for, or co-occurrence of, rapid-onset cannabis dependence, not too distant from cocaine estimates, when we sort newly incident users into subgroups defined by elapsed time from first to most recent use. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Olga A Vsevolozhskaya
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - James C Anthony
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
9
|
Abstract
OBJECTIVE Susac syndrome, a rare disorder, is thought to be mediated by autoantibodies. One of the potential targets of these autoantibodies could be an antigen in the microvessels of the brain, the retina, and the inner ear leading to central nervous system (CNS) alterations, visual disturbances, and hearing deficits. Our aim is to expand clinicians' diagnostic options when facing psychosis due to medical conditions. METHODS A case report was conducted for this study. RESULTS This paper reports the case of a young male drug user who presented with psychosis, confusion and CNS vasculitis. First deemed to be drug-induced CNS vasculitis, it was finally diagnosed as Susac syndrome. CONCLUSIONS Although an infrequent entity, Susac syndrome should remain an option in the differential diagnosis of several neurological and psychiatric presentations.
Collapse
Affiliation(s)
- Pablo Barrio
- a Addictive Behaviours Unit , Clinical Neuroscience Institute, Clinic Hospital of Barcelona , Barcelona , Spain
| | - Mercè Balcells
- a Addictive Behaviours Unit , Clinical Neuroscience Institute, Clinic Hospital of Barcelona , Barcelona , Spain
| | - Delón La Puma
- b Neurology Department , Clinical Neuroscience Institute, Clinic Hospital of Barcelona , Barcelona , Spain
| | - Carles Gaig
- b Neurology Department , Clinical Neuroscience Institute, Clinic Hospital of Barcelona , Barcelona , Spain
| |
Collapse
|
10
|
Hill SY, Jones BL, Steinhauer SR, Zezza N, Stiffler S. Longitudinal predictors of cannabis use and dependence in offspring from families at ultra high risk for alcohol dependence and in control families. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:383-95. [PMID: 26756393 PMCID: PMC5444658 DOI: 10.1002/ajmg.b.32417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 03/01/2015] [Accepted: 01/04/2016] [Indexed: 11/06/2022]
Abstract
Cannabis use is common among adolescents. Identification of the factors associated with continued heavy use into young adulthood and development of cannabis abuse and dependence is of considerable importance. The role of familial risk for addiction and an associated endophenotype, P300 amplitude, has not previously been related to cannabis use and dependence. A prospective longitudinal study spanning childhood and young adulthood provided the opportunity for exploring these factors, along with genetic variation, in the cannabis use behaviors of 338 young adult offspring from high and low familial risk for alcohol dependence families (ages 19-30). P300 data were collected multiple times in childhood. The association between young adult patterns of cannabis use or cannabis abuse/dependence was tested with genetic variation in the cannabinoid gene, CNR1, the ANKK1-DRD2 gene, and childhood developmental trajectories of P300. Young adult patterns of cannabis use was characterized by three patterns: (i) no use throughout; (ii) declining use from adolescence through young adulthood; and (iii) frequent use throughout. Following the low P300 trajectory in childhood predicted cannabis abuse and dependence by young adulthood. A four SNP ANKK1-DRD2 haplotype (G-G-G-C) was found to be significantly associated with the frequency of use patterns (P = 0.0008). Although CNR1 variation overall was not significantly associated with these patterns, among individuals with cannabis abuse/dependence the presence of one or both copies of the rs806368 A > G minor allele conferred a 5.4-fold increase (P = 0.003) in the likelihood that they would be in the frequent and persistent use group rather than the declining use group.
Collapse
Affiliation(s)
- Shirley Y. Hill
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Correspondence to: Shirley Y. Hill, Ph.D., Department of Psychiatry, University of Pittsburgh Medical Center, 3811 O’ Hara St. Pittsburgh, PA 15213.
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Nicholas Zezza
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott Stiffler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
11
|
Davis JP, Smith DC, Morphew JW, Lei X, Zhang S. Cannabis Withdrawal, Posttreatment Abstinence, and Days to First Cannabis Use Among Emerging Adults in Substance Use Treatment: A Prospective Study. J Drug Issues 2016; 46:64-83. [PMID: 26877548 PMCID: PMC4748964 DOI: 10.1177/0022042615616431] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Very little prospective research investigates how cannabis withdrawal is associated with treatment outcomes, and this work has not used the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) thresholds for cannabis withdrawal. The sample included 110 emerging adults entering outpatient substance use treatment who were heavy cannabis users with no other drug use and limited alcohol use. We used survival analyses to predict days to first use of cannabis and logistic regression to predict whether participants were abstinent and living in the community at 3 months. Those meeting criteria for cannabis withdrawal were more likely to return to use sooner than those not meeting criteria for cannabis withdrawal. However, the presence of cannabis withdrawal was not a significant predictor of 3-month abstinence. Emerging adults with DSM-5 cannabis withdrawal may have difficulty initiating abstinence in the days following their intake assessment, implying the need for strategies to mitigate their more rapid return to cannabis use.
Collapse
Affiliation(s)
| | | | | | - Xinrong Lei
- University of Illinois at Urbana–Champaign, Urbana, IL, USA
| | - Saijun Zhang
- University of Illinois at Urbana–Champaign, Urbana, IL, USA
| |
Collapse
|
12
|
Hines LA, Morley KI, Strang J, Agrawal A, Nelson EC, Statham D, Martin NG, Lynskey MT. The association between speed of transition from initiation to subsequent use of cannabis and later problematic cannabis use, abuse and dependence. Addiction 2015; 110:1311-20. [PMID: 25917230 PMCID: PMC4509683 DOI: 10.1111/add.12963] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 12/18/2014] [Revised: 01/22/2015] [Accepted: 04/17/2015] [Indexed: 12/01/2022]
Abstract
AIMS To test whether speed of transition from initiation use to subsequent use of cannabis is associated with likelihood of later cannabis dependence and other outcomes, and whether transition speed is attributable to genetic or environmental factors. DESIGN Cross-sectional interview study. SETTING Australia. PARTICIPANTS A total of 2239 twins and siblings who reported using cannabis at least twice [mean age at time of survey = 32.0, 95% confidence interval (CI) = 31.9 - 32.1, range = 22-45]. MEASUREMENTS Time between initiation and subsequent cannabis use (within 1 week; within 3 months; between 3 and 12 months; more than 1 year later), later use of cannabis and symptoms of DSM-IV cannabis abuse/dependence. Multinomial regression analyses (comparison group: more than 1 year later) adjusted the association between speed of transition and the outcomes of cannabis daily use, abuse/dependence and treatment-seeking after controlling for socio-demographic, childhood, mental health, peer and licit drug factors. Twin modelling estimated the proportion of variance in transition speed attributable to genetic (A), common environment (C) and unique environmental (E) factors. FINDINGS Subsequent use of cannabis within 1 week of initiation was associated with daily use [odds ratio (OR) = 2.64, 95% CI = 1.75-3.99], abuse and/or dependence (OR = 3.25, 95% CI = 2.31-4.56) and treatment-seeking for cannabis problems (OR = 1.89, 95% CI = 1.03-3.46). Subsequent use within 3 months was associated with abuse and/or dependence (OR = 1.61, 95% CI = 1.18-2.19). The majority of the variation of the speed of transition was accounted for by unique environment factors (0.75). CONCLUSIONS Rapid transition from initiation to subsequent use of cannabis is associated with increased likelihood of subsequent daily cannabis use and abuse/dependence.
Collapse
Affiliation(s)
- Lindsey A. Hines
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Katherine I. Morley
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Elliot C. Nelson
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Dixie Statham
- School of Social Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Nicholas G. Martin
- Queensland Institute of Medical Research, Medical Research Institute, Brisbane, Australia
| | - Michael T. Lynskey
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| |
Collapse
|
13
|
Wetherill L, Agrawal A, Kapoor M, Bertelsen S, Bierut LJ, Brooks A, Dick D, Hesselbrock M, Hesselbrock V, Koller DL, Le N, Nurnberger JI, Salvatore JE, Schuckit M, Tischfield JA, Wang JC, Xuei X, Edenberg HJ, Porjesz B, Bucholz K, Goate AM, Foroud T. Association of substance dependence phenotypes in the COGA sample. Addict Biol 2015; 20:617-27. [PMID: 24832863 PMCID: PMC4233207 DOI: 10.1111/adb.12153] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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] [Indexed: 12/01/2022]
Abstract
Alcohol and drug use disorders are individually heritable (50%). Twin studies indicate that alcohol and substance use disorders share common genetic influences, and therefore may represent a more heritable form of addiction and thus be more powerful for genetic studies. This study utilized data from 2322 subjects from 118 European-American families in the Collaborative Study on the Genetics of Alcoholism sample to conduct genome-wide association analysis of a binary and a continuous index of general substance dependence liability. The binary phenotype (ANYDEP) was based on meeting lifetime criteria for any DSM-IV dependence on alcohol, cannabis, cocaine or opioids. The quantitative trait (QUANTDEP) was constructed from factor analysis based on endorsement across the seven DSM-IV criteria for each of the four substances. Heritability was estimated to be 54% for ANYDEP and 86% for QUANTDEP. One single-nucleotide polymorphism (SNP), rs2952621 in the uncharacterized gene LOC151121 on chromosome 2, was associated with ANYDEP (P = 1.8 × 10(-8) ), with support from surrounding imputed SNPs and replication in an independent sample [Study of Addiction: Genetics and Environment (SAGE); P = 0.02]. One SNP, rs2567261 in ARHGAP28 (Rho GTPase-activating protein 28), was associated with QUANTDEP (P = 3.8 × 10(-8) ), and supported by imputed SNPs in the region, but did not replicate in an independent sample (SAGE; P = 0.29). The results of this study provide evidence that there are common variants that contribute to the risk for a general liability to substance dependence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nhung Le
- Washington University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hutchinson DM, Silins E, Mattick RP, Patton GC, Fergusson DM, Hayatbakhsh R, Toumbourou JW, Olsson CA, Najman JM, Spry E, Tait RJ, Degenhardt L, Swift W, Butterworth P, Horwood LJ. How can data harmonisation benefit mental health research? An example of The Cannabis Cohorts Research Consortium. Aust N Z J Psychiatry 2015; 49:317-23. [PMID: 25747858 DOI: 10.1177/0004867415571169] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Delyse M Hutchinson
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Australia Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Edmund Silins
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Australia Psychological Sciences and Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - David M Fergusson
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Reza Hayatbakhsh
- School of Population Health, University of Queensland, Brisbane, QLD, Australia
| | - John W Toumbourou
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Australia Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Australia Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Australia Psychological Sciences and Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Jake M Najman
- Schools of Population Health and Social Science, University of Queensland, Brisbane, Australia
| | - Elizabeth Spry
- Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Wendy Swift
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Peter Butterworth
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australia
| | - L John Horwood
- Psychological Sciences and Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | | |
Collapse
|
15
|
Abstract
BACKGROUND Marijuana is the most commonly used illicit substance in the United States and worldwide. Marijuana use is a problem of increasing magnitude among adolescents. Use typically begins in adolescence and is associated with a variety of adverse outcomes. METHOD This article will present an overview of trends in marijuana use, and will review the endocannabinoid system and marijuana. It will discuss recent policy developments in US and their implications, especially for adolescents. Existing treatments will be reviewed, including findings from a recent randomized double-blind trial of N-acetylcysteine, a compound that reverses the dysregulation of the glutamate system that occurs in substance dependence. CONCLUSIONS The core treatment approaches include psychosocial interventions, sometimes in combination with each other. While a reduction in days of use is often achieved with most of these approaches, abstinence is a much more elusive goal. The evidence base for effective treatments remains inadequate especially with regard to adolescents, and there is an urgent need for more research in this area. Promising new treatments include N-acetylcysteine in conjunction with contingency management.
Collapse
|
16
|
Boden MT, McKay JR, Long WR, Bonn-Miller MO. The effects of cannabis use expectancies on self-initiated cannabis cessation. Addiction 2013; 108:1649-57. [PMID: 23627879 PMCID: PMC6440474 DOI: 10.1111/add.12233] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 06/22/2012] [Revised: 10/20/2012] [Accepted: 04/19/2013] [Indexed: 11/28/2022]
Abstract
AIMS To prospectively investigate the relation between cannabis use expectancies and cannabis use prior to and during a self-initiated cannabis cessation attempt. DESIGN Cohort design that followed participants for 4 weeks following a self-initiated cessation attempt. SETTING United States Department of Veterans Affairs medical center. PARTICIPANTS One hundred cannabis dependent military veterans. MEASUREMENTS The Marijuana Effects Expectancy Questionnaire at baseline; the timeline follow-back procedure at baseline and during the cessation attempt. FINDINGS Cannabis use at baseline was associated with positive (P = 0.01), but not negative (P = 0.25), expectancies. Cannabis lapse was associated with positive (P = 0.03) and negative expectancies (P = 0.01), and relapse was associated with positive (P = 0.04), but not negative (P = 0.21), expectancies. The trajectory of average cannabis use during the cessation period was associated with positive (P = 0.03), but not negative (P = 0.96), expectancies. Results were similar in effect and statistical significance when adjusting for demographic factors, motivation to quit cannabis, mental disorder diagnoses, and alcohol and tobacco use, and when analyzing complete data sets obtained through multiple imputation. CONCLUSIONS In the USA, cannabis use expectancies, especially those regarding the positive effects of cannabis use, appear to be strongly and consistently linked to cannabis use and quit failure.
Collapse
Affiliation(s)
- Matthew Tyler Boden
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.
| | | | | | | |
Collapse
|
17
|
van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Reliability and validity of the Severity of Dependence Scale for detecting cannabis dependence in frequent cannabis users. Int J Methods Psychiatr Res 2013; 22:138-43. [PMID: 23670783 PMCID: PMC6878253 DOI: 10.1002/mpr.1385] [Citation(s) in RCA: 22] [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] [Indexed: 11/10/2022] Open
Abstract
The Severity of Dependence Scale (SDS) measures with five items the degree of psychological dependence on several illicit drugs, including cannabis. Its psychometric properties have not yet been examined in young adult frequent cannabis users, an eminently high-risk group for cannabis dependence. Internal consistency and criterion validity of the SDS were investigated within an enriched community based sample of 577 Dutch frequent (≥ three days per week in the past 12 months) cannabis users between 18-30 years. Criterion validity was tested against the Composite International Diagnostic Interview (CIDI) 3.0 DSM-IV diagnosis cannabis dependence, and psychometric properties were assessed separately for males and females and for ethnic subgroups. Principal component analysis showed that all items of the scale loaded on a single factor and reliability of the SDS total score was good (Cronbach's α = 0.70). However, criterion validity against the CIDI diagnosis cannabis dependence was low: area under curve (AUC) was 0.68 (95% confidence interval: 0.64-0.73) and at the optimal differentiating cut-off (SDS ≥ 4), sensitivity was 61.3% and specificity 63.5%. Results were similar for subgroups on gender and ethnicity. While internal consistency of the SDS is good, its use as a screener to differentiate between dependence and non-dependence within populations of young adult frequent cannabis users is not recommended.
Collapse
Affiliation(s)
- Peggy van der Pol
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
18
|
Liebregts N, van der Pol P, Van Laar M, de Graaf R, van den Brink W, Korf DJ. The Role of Study and Work in Cannabis Use and Dependence Trajectories among Young Adult Frequent Cannabis Users. Front Psychiatry 2013; 4:85. [PMID: 23950748 PMCID: PMC3739012 DOI: 10.3389/fpsyt.2013.00085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/27/2013] [Indexed: 11/13/2022] Open
Abstract
Life course theory considers events in study and work as potential turning points in deviance, including illicit drug use. This qualitative study explores the role of occupational life in cannabis use and dependence in young adults. Two and three years after the initial structured interview, 47 at baseline frequent cannabis users were interviewed in-depth about the dynamics underlying changes in their cannabis use and dependence. Overall, cannabis use and dependence declined, including interviewees who quit using cannabis completely, in particular with students, both during their study and after they got employed. Life course theory appeared to be a useful framework to explore how and why occupational life is related to cannabis use and dependence over time. Our study showed that life events in this realm are rather common in young adults and can have a strong impact on cannabis use. While sometimes changes in use are temporary, turning points can evolve from changes in educational and employment situations; an effect that seems to be related to the consequences of these changes in terms of amount of leisure time and agency (i.e., feelings of being in control).
Collapse
Affiliation(s)
- Nienke Liebregts
- Law Faculty, Bonger Institute of Criminology, University of Amsterdam , Amsterdam , Netherlands
| | | | | | | | | | | |
Collapse
|
19
|
Han S, Yang BZ, Kranzler HR, Oslin D, Anton R, Farrer LA, Gelernter J. Linkage analysis followed by association show NRG1 associated with cannabis dependence in African Americans. Biol Psychiatry 2012; 72:637-44. [PMID: 22520967 PMCID: PMC3699339 DOI: 10.1016/j.biopsych.2012.02.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 12/22/2011] [Revised: 02/14/2012] [Accepted: 02/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND A genetic contribution to cannabis dependence (CaD) has been established but susceptibility genes for CaD remain largely unknown. METHODS We employed a multistage design to identify genetic variants underlying CaD. We first performed a genome-wide linkage scan for CaD in 384 African American (AA) and 354 European American families ascertained for genetic studies of cocaine and opioid dependence. We then conducted association analysis under the linkage peak, first using data from a genome-wide association study from the Study of Addiction: Genetics and Environment, followed by replication studies of prioritized single nucleotide polymorphisms (SNPs) in independent samples. RESULTS We identified the strongest linkage evidence with CaD (logarithm of odds = 2.9) on chromosome 8p21.1 in AAs. In the association analysis of the Study of Addiction: Genetics and Environment sample under the linkage peak, we identified one SNP (rs17664708) associated with CaD in both AAs (odds ratio [OR] = 2.93, p = .0022) and European Americans (OR = 1.38, p = .02). This SNP, located at NRG1, a susceptibility gene for schizophrenia, was prioritized for further study. We replicated the association of rs17664708 with CaD in an independent AAs sample (OR = 2.81, p = .0068). The joint analysis of the two AA samples demonstrated highly significant association between rs17664708 and CaD with adjustment for either global (p = .00044) or local ancestry (p = .00075). CONCLUSIONS Our study shows that NRG1 is probably a susceptibility gene for CaD, based on convergent evidence of linkage and replicated associations in two independent AA samples.
Collapse
Affiliation(s)
- Shizhong Han
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut and VA CT Healthcare Center, West Haven, Connecticut. USA
| | - Bao-Zhu Yang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut and VA CT Healthcare Center, West Haven, Connecticut. USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- VISN 4 MIRECC, Philadelphia VAMC, Philadelphia, Pennsylvania, USA
| | - David Oslin
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- VISN 4 MIRECC, Philadelphia VAMC, Philadelphia, Pennsylvania, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lindsay A. Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Genetics & Genomics, Biostatistics, and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut and VA CT Healthcare Center, West Haven, Connecticut. USA
- Departments of Genetics and of Neurobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
20
|
Carroll KM, Nich C, LaPaglia DM, Peters EN, Easton CJ, Petry NM. Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less. Addiction 2012; 107:1650-9. [PMID: 22404223 PMCID: PMC3509418 DOI: 10.1111/j.1360-0443.2012.03877.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitive-behavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence. SETTING Community-based out-patient treatment program in New Haven, Connecticut, USA. DESIGN Twelve-week randomized clinical trial of four treatment conditions: CM for abstinence alone or combined with CBT, CBT alone or combined with CM with rewards for CBT session attendance and homework completion. PARTICIPANTS A total of 127 treatment-seeking young adults (84.3% male, 81.1% minority, 93.7% referred by criminal justice system, average age 25.7 years). MEASUREMENTS Weekly urine specimens testing positive for cannabis, days of cannabis use via the time-line follow-back method. FINDINGS Within treatment, reinforcing homework and attendance did not significantly improve CBT outcomes, and the addition of CBT worsened outcomes when added to CM for abstinence (75.5 versus 57.1% cannabis-free urine specimens, F = 2.25, P = 0.02). The CM for abstinence condition had the lowest percentage of cannabis-negative urine specimens and the highest mean number of consecutive cannabis-free urine specimens (3.3, F = 2.33, P = 0.02). Attrition was higher in the CBT alone condition, but random effect regression analyses indicated this condition was associated with the greatest rate of change overall. Cannabis use during the 1-year follow-up increased most rapidly for the two enhanced groups. CONCLUSIONS Combining contingency management and cognitive-behavioural therapy does not appear to improve success rates of treatment for cannabis dependence in clients involved with the criminal justice system.
Collapse
Affiliation(s)
- Kathleen M. Carroll
- Division of Substance Abuse, Yale University School of Medicine, New Haven, CT, USA
| | - Charla Nich
- Division of Substance Abuse, Yale University School of Medicine, New Haven, CT, USA
| | - Donna M. LaPaglia
- Division of Substance Abuse, Yale University School of Medicine, New Haven, CT, USA
| | - Erica N. Peters
- Division of Substance Abuse, Yale University School of Medicine, New Haven, CT, USA
| | - Caroline J. Easton
- Division of Substance Abuse, Yale University School of Medicine, New Haven, CT, USA
| | - Nancy M. Petry
- University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
21
|
Buckner JD, Heimberg RG, Schneier FR, Liu SM, Wang S, Blanco C. The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2012; 124:128-34. [PMID: 22266089 DOI: 10.1016/j.drugalcdep.2011.12.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [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: 11/08/2011] [Revised: 12/27/2011] [Accepted: 12/29/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cannabis use disorders (CUD) are highly comorbid with social anxiety disorder (SAD), and SAD may be a risk factor for cannabis dependence. This study explored these relationships in several ways. First, we examined whether SAD was more likely to be related to cannabis dependence than abuse. Second, we examined the temporal relations between CUD and SAD. Third, we examined whether SAD was related to faster transition from age of first cannabis use to CUD onset relative to other anxiety disorders. Fourth, we tested whether having both disorders was associated with greater impairment and psychiatric comorbidity. METHOD The sample consisted of adults from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions, 2957 of whom had CUD and no SAD, 1643 had SAD and no CUD, and 340 had CUD-SAD. RESULTS SAD was more likely to be related to cannabis dependence than abuse. This relation remained after controlling for race, sex, and some other psychiatric disorders (including some anxiety disorders). Age-of-onset data suggest SAD onset prior to CUD onset for most CUD-SAD respondents. CUD-SAD was related to greater impairment and psychiatric comorbidity than either disorder alone. CONCLUSIONS Although SAD is related to CUD, it has a stronger association with cannabis dependence than abuse. This link is not better accounted for by other psychopathology measured in this study. SAD onset prior to CUD for the majority of CUD-SAD respondents. Importantly, the co-occurrence of these two disorders appears to result in greater impairment and distress than either disorder alone.
Collapse
|
22
|
Mason BJ, Crean R, Goodell V, Light JM, Quello S, Shadan F, Buffkins K, Kyle M, Adusumalli M, Begovic A, Rao S. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology 2012; 37:1689-98. [PMID: 22373942 PMCID: PMC3358737 DOI: 10.1038/npp.2012.14] [Citation(s) in RCA: 130] [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] [Indexed: 11/09/2022]
Abstract
There are no FDA-approved pharmacotherapies for cannabis dependence. Cannabis is the most widely used illicit drug in the world, and patients seeking treatment for primary cannabis dependence represent 25% of all substance use admissions. We conducted a phase IIa proof-of-concept pilot study to examine the safety and efficacy of a calcium channel/GABA modulating drug, gabapentin, for the treatment of cannabis dependence. A 12-week, randomized, double-blind, placebo-controlled clinical trial was conducted in 50 unpaid treatment-seeking male and female outpatients, aged 18-65 years, diagnosed with current cannabis dependence. Subjects received either gabapentin (1200 mg/day) or matched placebo. Manual-guided, abstinence-oriented individual counseling was provided weekly to all participants. Cannabis use was measured by weekly urine toxicology and by self-report using the Timeline Followback Interview. Cannabis withdrawal symptoms were assessed using the Marijuana Withdrawal Checklist. Executive function was measured using subtests from the Delis-Kaplan Executive Function System. Relative to placebo, gabapentin significantly reduced cannabis use as measured both by urine toxicology (p=0.001) and by the Timeline Followback Interview (p=0.004), and significantly decreased withdrawal symptoms as measured by the Marijuana Withdrawal Checklist (p<0.001). Gabapentin was also associated with significantly greater improvement in overall performance on tests of executive function (p=0.029). This POC pilot study provides preliminary support for the safety and efficacy of gabapentin for treatment of cannabis dependence that merits further study, and provides an alternative conceptual framework for treatment of addiction aimed at restoring homeostasis in brain stress systems that are dysregulated in drug dependence and withdrawal.
Collapse
Affiliation(s)
- Barbara J Mason
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA 92037, USA.
| | - Rebecca Crean
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | - Vivian Goodell
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | | | - Susan Quello
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | - Farhad Shadan
- Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | - Kimberly Buffkins
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | - Mark Kyle
- Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | | | - Adnan Begovic
- Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | - Santosh Rao
- Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| |
Collapse
|
23
|
van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. The Dutch Cannabis Dependence (CanDep) study on the course of frequent cannabis use and dependence: objectives, methods and sample characteristics. Int J Methods Psychiatr Res 2011; 20:169-81. [PMID: 21815231 PMCID: PMC3467998 DOI: 10.1002/mpr.345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/19/2011] [Accepted: 05/17/2011] [Indexed: 11/11/2022] Open
Abstract
This paper presents an overview of the prospective cohort design of the Dutch Cannabis Dependence (CanDep) study, which investigates (i) the three-year natural course of frequent cannabis use (≥ three days per week in the past 12 months) and cannabis dependence; and (ii) the factors involved in the transition from frequent non-dependent cannabis use to cannabis dependence, and remission from dependence. Besides its scientific relevance, this knowledge may contribute to improve selective and indicated prevention, early detection, treatment and cannabis policies. The secondary objectives are the identification of factors related to treatment seeking and the validation of self report measures of cannabis use. Between September 2008 and April 2009, baseline data were collected from 600 frequent cannabis users with an average age of 22.1 years, predominantly male (79.3%) and an average cannabis use history of 7.1 years; 42.0% fulfilled a (12-month DSM-IV) diagnosis of cannabis dependence. The response rate was 83.7% after the first follow up at 18 months. The second and last follow-up is planned at 36 months. Computer assisted personal interviews (CAPI) were conducted which covered: cannabis use (including detailed assessments of exposure, motives for use and potency preference); use of other substances; DSM-IV internalizing and externalizing mental disorders; treatment seeking; personality; life events; social support and social functioning.
Collapse
Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
24
|
Levin FR, Mariani JJ, Brooks DJ, Pavlicova M, Cheng W, Nunes E. Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2011; 116:142-50. [PMID: 21310551 PMCID: PMC3154755 DOI: 10.1016/j.drugalcdep.2010.12.010] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [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: 08/27/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 02/07/2023]
Abstract
Cannabis dependence is a substantial public health problem. Behavioral treatments have shown promise, but there are no effective medications for cannabis dependence. The purpose of this study was to evaluate the safety and efficacy of dronabinol, a synthetic form of delta-9-tetrahydrocannabinol, a naturally occurring pharmacologically active component of marijuana, in treating cannabis dependence. 156 cannabis-dependent adults were enrolled in a randomized, double-blind, placebo-controlled, 12-week trial. After a 1-week placebo lead-in phase, participants were randomized to receive dronabinol 20mg twice a day or placebo. Doses were maintained until the end of week 8 and then tapered off over 2 weeks. All participants received weekly motivational enhancement and relapse prevention therapy. Marijuana use was assessed using the timeline follow back method. There was no significant difference between treatment groups in the proportion of participants who achieved 2 weeks of abstinence at the end of the maintenance phase (dronabinol: 17.7%; placebo: 15.6%). Although both groups showed a reduction in marijuana use over time, there were no differences between the groups. Treatment retention was significantly higher at the end of the maintenance phase on dronabinol (77%), compared to placebo (61%) (P=.02), and withdrawal symptoms were significantly lower on dronabinol than placebo (P=.02). This is the first trial using an agonist substitution strategy for treatment of cannabis dependence. Dronabinol showed promise, it was well-tolerated, and improved treatment retention and withdrawal symptoms. Future trials might test higher doses, combinations of dronabinol with other medications with complementary mechanisms, or with more potent behavioral interventions.
Collapse
Affiliation(s)
- Frances R. Levin
- New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, New York, NY 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - John J. Mariani
- New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, New York, NY 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Brooks
- New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, New York, NY 10032, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Wendy Cheng
- New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, New York, NY 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Edward Nunes
- New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, New York, NY 10032, USA
,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
| |
Collapse
|
25
|
Abstract
OBJECTIVE Our aim was to review recent studies and estimate the rate of cannabis use disorders (CUDs) in schizophrenia, as well as to examine the factors affecting this rate. METHODS We conducted an electronic search of 3 literature databases and a manual search of articles from 1996 to 2008. The key words used were "schizophreni*," "psychos*s," "psychotic," "cannabis abuse," "cannabis dependence," "cannabis use disorder," "substance use disorder," "substance abuse," "substance dependence," and "dual diagnosis." Articles that reported diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases were included. Regression analysis was used to examine how estimated rates of CUDs are affected by various study characteristics such as the classification system, inpatient vs outpatient status, study location, proportion of males, age of the sample, or duration of illness. RESULTS Thirty-five studies met our search criteria. The median current rate of CUDs was 16.0% (interquartile range [IQR] = 8.6-28.6, 10 studies), and the median lifetime rate was 27.1% (IQR = 12.2-38.5, 28 studies). The median rate of CUDs was markedly higher in first-episode vs long-term patients (current 28.6%/22.0%, lifetime 44.4%/12.2%, respectively) and in studies where more than two-thirds of the participants were males than in the other studies (33.8%/13.2%). CUDs were also more common in younger samples than in the others (current 38.5%/16.0%, lifetime 45.0%/17.9%). CONCLUSIONS Approximately every fourth schizophrenia patient in our sample of studies had a diagnosis of CUDs. CUDs were especially common in younger and first-episode patient samples as well as in samples with a high proportion of males.
Collapse
Affiliation(s)
- Johanna Koskinen
- Department of Psychiatry, University of Oulu and Oulu University Hospital, PO Box 5000, FIN-90014, Oulu, Finland.
| | | | | | | | | |
Collapse
|
26
|
Okuda M, Hasin DS, Olfson M, Khan SS, Nunes EV, Montoya I, Liu SM, Grant BF, Blanco C. Generalizability of clinical trials for cannabis dependence to community samples. Drug Alcohol Depend 2010; 111:177-81. [PMID: 20537813 PMCID: PMC3227418 DOI: 10.1016/j.drugalcdep.2010.04.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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: 08/28/2009] [Revised: 02/16/2010] [Accepted: 04/27/2010] [Indexed: 11/30/2022]
Abstract
There is growing concern that results of tightly controlled clinical trials may not generalize to broader community samples. To assess the proportion of community dwelling adults with cannabis dependence who would have been eligible for a typical cannabis dependence treatment study, we applied a standard set of eligibility criteria commonly used in cannabis outcome studies to a large (N=43,093) representative US adult sample interviewed face-to-face, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Approximately 80% of the community sample of adults with a diagnosis of cannabis dependence (N=133) would be excluded from participating in clinical trials by one or more of the common eligibility criteria. Individual study criteria excluded from 0% to 41.0% of the community sample. Legal problems, other illicit drug use disorders, and current use of fewer than 5 joints/week excluded the largest percentage of individuals. These results extend to cannabis dependence concerns that typical clinical trials likely exclude most community dwelling adults with the disorder. The results also support the notion that clinical trials tend to recruit highly selective samples, rather than adults who are representative of typical patients. Clinical trials should carefully evaluate the effects of eligibility criteria on the generalizability of their results. Even in efficacy trials, stringent exclusionary criteria could limit the representativeness of study results.
Collapse
Affiliation(s)
- Mayumi Okuda
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Deborah S. Hasin
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Sharaf S. Khan
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Edward V. Nunes
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Ivan Montoya
- Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Room 4143, Bethesda, MD 20892-9551
| | - Shang-Min Liu
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Carlos Blanco
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032
| |
Collapse
|
27
|
Hartman CA, Hopfer CJ, Haberstick B, Rhee SH, Crowley TJ, Corley RP, Hewitt JK, Ehringer MA. The association between cannabinoid receptor 1 gene (CNR1) and cannabis dependence symptoms in adolescents and young adults. Drug Alcohol Depend 2009; 104:11-6. [PMID: 19443135 DOI: 10.1016/j.drugalcdep.2009.01.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [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: 04/08/2008] [Revised: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study examined the genetic association between variation in the cannabinoid receptor 1 (CNR1) gene and cannabis dependence symptoms. METHOD Adolescent and young adult subjects were recruited from three settings: a treatment program for youth with substance use disorders, the criminal justice system, and the community. A case-control sample consisted of 224 cases who endorsed at least one dependence symptom and 108 controls who tried cannabis but endorsed no symptoms. A family-based sample of 219 families was also analyzed. RESULTS Case-control analysis identified a nominal association between SNP rs1049353 and having one or more cannabis dependence symptoms (p=.029), but the association did not hold up in a combined sample. Family-based analysis found a trend for the same SNP (p=.07). We did not replicate a previous report that SNP rs806380 was associated with the development of cannabis dependence. CONCLUSION These results provide inconclusive evidence of association between rs1049353/rs806380 and the development of cannabis dependence, and underscore the importance of replicating results of genetic association studies. Additional family-based studies are needed to clarify the role of the CNR1 gene, and its various SNPs, in the development of cannabis use disorders.
Collapse
|
28
|
Agrawal A, Wetherill L, Dick DM, Xuei X, Hinrichs A, Hesselbrock V, Kramer J, Nurnberger JI, Schuckit M, Bierut LJ, Edenberg HJ, Foroud T. Evidence for association between polymorphisms in the cannabinoid receptor 1 (CNR1) gene and cannabis dependence. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:736-40. [PMID: 19016476 PMCID: PMC2703788 DOI: 10.1002/ajmg.b.30881] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genomic studies of cannabis use disorders have been limited. The cannabinoid receptor 1 gene (CNR1) on chromosome 6q14-15 is an excellent candidate gene for cannabis dependence due to the important role of the G-protein coupled receptor encoded by this gene in the rewarding effects of Delta9-tetrahydrocannabinol. Previous studies have found equivocal evidence for an association between SNPs in CNR1 and a general vulnerability to substance use disorders. We investigate the association between 9 SNPs spanning CNR1 and cannabis dependence in 1,923 individuals. Two SNPs that were previously associated with cannabis dependence in other studies were also significant with this phenotype in our analyses [rs806368 (P = 0.05) and rs806380 (P = 0.009)]. Haplotype analyses revealed the association to be largely driven by the SNP rs806380. These results suggest a role for the cannabinoid receptor 1 gene in cannabis dependence.
Collapse
Affiliation(s)
- Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hartman CA, Gelhorn H, Crowley TJ, Sakai JT, Stallings M, Young SE, Rhee SH, Corley R, Hewitt JK, Hopfer CJ. Item response theory analysis of DSM-IV cannabis abuse and dependence criteria in adolescents. J Am Acad Child Adolesc Psychiatry 2008; 47:165-73. [PMID: 18176333 DOI: 10.1097/chi.0b013e31815cd9f2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine three aspects of adolescent cannabis problems: do DSM-IV cannabis abuse and dependence criteria represent two different levels of severity of substance involvement, to what degree do each of the 11 abuse and dependence criteria assess adolescent cannabis problems, and do the DSM-IV items function similarly across different adolescent populations? METHOD We examined 5,587 adolescents ages 11 to 19, including 615 youths in treatment for substance use disorders, 179 adjudicated youths, and 4,793 youths from the community. All of the subjects were assessed with a structured diagnostic interview. Item response theory was used to analyze symptom endorsement patterns. RESULTS Abuse and dependence criteria were not found to represent different levels of severity of problem cannabis use in any of the samples. Among the 11 abuse and dependence criteria, problems cutting down and legal problems were the least informative for distinguishing problem users. Two dependence criteria and three of the four abuse criteria indicated different severities of cannabis problems across samples. CONCLUSIONS We found little evidence to support the idea that abuse and dependence are separate constructs for adolescent cannabis problems. Furthermore, certain abuse criteria may indicate severe substance problems, whereas specific dependence items may indicate less severe problems. The abuse items in particular need further study. These results have implications for the refinement of the current substance use disorder criteria for DSM-V.
Collapse
|