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Poliakova N, Shrier LA, Harris SK, Bélanger RE. Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products. Tob Use Insights 2024; 17:1179173X241259603. [PMID: 38846268 PMCID: PMC11155328 DOI: 10.1177/1179173x241259603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
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Affiliation(s)
- Natalia Poliakova
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Lydia A. Shrier
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sion Kim Harris
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard E. Bélanger
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Feliu A, Fernández E, Castellano Y, Enríquez M, Saura J, Cabezas C, Colom J, Suelves JM, Pla M, Parejo M, Mondon S, Barrio P, Andreu M, Raich A, Bernabeu J, Vilaplana J, Roca X, Bautista P, Guydish J, Martínez C. Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study. Addict Sci Clin Pract 2022; 17:66. [PMID: 36451226 PMCID: PMC9709380 DOI: 10.1186/s13722-022-00348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic. METHODS Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.). DISCUSSION The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies. Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].
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Affiliation(s)
- Ariadna Feliu
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.512891.6CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernández
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.512891.6CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences. School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.512891.6CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Marta Enríquez
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
| | - Carmen Cabezas
- grid.454735.40000000123317762Government of Catalonia, Public Health Secretariat, Barcelona, Spain
| | - Joan Colom
- grid.500777.2Public Health Agency of Catalonia, Barcelona, Spain
| | - Josep M. Suelves
- grid.500777.2Public Health Agency of Catalonia, Barcelona, Spain ,grid.36083.3e0000 0001 2171 6620Universitat Oberta de Catalunya, Barcelona, Spain
| | - Margarida Pla
- grid.5841.80000 0004 1937 0247Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
| | - Mar Parejo
- grid.5841.80000 0004 1937 0247Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
| | - Sílvia Mondon
- grid.410458.c0000 0000 9635 9413Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pablo Barrio
- grid.410458.c0000 0000 9635 9413Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Magalí Andreu
- grid.410458.c0000 0000 9635 9413Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonia Raich
- grid.488391.f0000 0004 0426 7378Mental Health Department, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Jordi Bernabeu
- grid.488391.f0000 0004 0426 7378Mental Health Department, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Jordi Vilaplana
- grid.15043.330000 0001 2163 1432Serra Húnter Fellow, Computer Science Department, Universitat de Lleida, Lleida, Spain
| | - Xavier Roca
- grid.413396.a0000 0004 1768 8905Addictive Behaviors Unit, Psychiatry Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Pablo Bautista
- grid.5841.80000 0004 1937 0247Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain
| | - Joseph Guydish
- grid.266102.10000 0001 2297 6811Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158 USA
| | - Cristina Martínez
- grid.418701.b0000 0001 2097 8389Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain ,Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.512891.6CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet del Llobregat, Barcelona, Spain ,grid.266102.10000 0001 2297 6811Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158 USA
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Notzon DP, Pavlicova M, Glass A, Mariani JJ, Mahony AL, Brooks DJ, Levin FR. ADHD Is Highly Prevalent in Patients Seeking Treatment for Cannabis Use Disorders. J Atten Disord 2020; 24:1487-1492. [PMID: 27033880 PMCID: PMC5568505 DOI: 10.1177/1087054716640109] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To estimate the prevalence of ADHD and determine an effective screening test for ADHD in a population-seeking treatment for cannabis use disorders. Method: The Conners Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; CAADID) was used to generate sensitivity and specificity data for ADHD screening tests, which were then administered to 99 participants seeking treatment for cannabis use disorders to estimate ADHD prevalence. Results: The prevalence estimated from the Wender Utah Rating Scale (WURS) was 45% (sensitivity = 0.88, sensitivity of 0.75), from the Conners Adult ADHD Rating Scale (CAARS) 34% (sensitivity = 0.80, specificity = 0.91), from the WURS + CAARS 36% (sensitivity = 0.71, specificity = 0.95), and from the Adult ADHD Self-Report Scale (ASRS) 46% (sensitivity = 0.61, specificity = 0.86). Conclusion: The prevalence of ADHD in adults seeking treatment for cannabis use disorders is estimated to be between 34% and 46%. The WURS paired with the CAARS provides excellent sensitivity and specificity for the diagnosis of ADHD in this population.
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Affiliation(s)
- Daniel P. Notzon
- New York State Psychiatric Institute, NY, USA
- Columbia University, New York, NY, USA
| | | | | | - John J. Mariani
- New York State Psychiatric Institute, NY, USA
- Columbia University, New York, NY, USA
| | | | | | - Frances R. Levin
- New York State Psychiatric Institute, NY, USA
- Columbia University, New York, NY, USA
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Wilhelm J, Abudayyeh H, Perreras L, Taylor R, Peters EN, Vandrey R, Hedeker D, Mermelstein R, Cohn A. Measuring the temporal association between cannabis and tobacco use among Co-using young adults using ecological momentary assessment. Addict Behav 2020; 104:106250. [PMID: 31918167 DOI: 10.1016/j.addbeh.2019.106250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Jess Wilhelm
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Haneen Abudayyeh
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Lexie Perreras
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Reddhyia Taylor
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Erica N Peters
- Battelle Memorial Institute, Public Health Center for Substance Use Research, 6115 Falls Rd., Baltimore, MD, 21209, United States.
| | - Ryan Vandrey
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States.
| | - Donald Hedeker
- The University of Chicago, Department of Public Health Sciences, 5841 S. Maryland Ave., Rm. W-254, MC2000, Chicago, IL 60637, United States.
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, Psychology Department, 1747 W. Roosevelt Rd. 544 WROB, MC 275, Chicago, IL 60607, United States.
| | - Amy Cohn
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States.
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King N, Floren S, Kharas N, Thomas M, Dafny N. Glutaminergic signaling in the caudate nucleus is required for behavioral sensitization to methylphenidate. Pharmacol Biochem Behav 2019; 184:172737. [PMID: 31228508 PMCID: PMC6692216 DOI: 10.1016/j.pbb.2019.172737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/25/2023]
Abstract
Methylphenidate (MPD) is a widely prescribed psychostimulant for the treatment of attention deficit hyperactivity disorder, and is growing in use as a recreational drug and academic enhancer. MPD acts on the reward/motive and motor circuits of the CNS to produce its effects on behavior. The caudate nucleus (CN) is known to be a part of these circuits, so a lesion study was designed to elucidate the role of the CN in response to acute and chronic MPD exposure. Five groups of n = 8 rats were used: control, sham CN lesions, non-specific electrolytic CN lesions, dopaminergic-specific (6-OHDA toxin) CN lesion, and glutaminergic-specific (ibotenic acid toxin) CN lesions. On experimental day (ED) 1, all groups received saline injections. On ED 2, surgeries took place, followed by a 5-day recovery period (ED 3-7). Groups then received six daily MPD 2.5 mg/kg injections (ED 9-14), then three days of washout with no injection (ED 15-17), followed by a re-challenge with the previous 2.5 mg/kg MPD dose (ED 18). Locomotive activity was recorded for 60 min after each injection by a computerized animal activity monitor. The electrolytic CN lesion group responded to the MPD acute and chronic exposures similarly to the control and sham groups, showing an increase in locomotive activity, i.e. sensitization. The dopaminergic-specific CN lesion group failed to respond to MPD exposure both acute and chronically. The glutaminergic-specific CN lesion group responded to MPD exposure acutely but failed to manifest chronic effects. This confirms the CN's dopaminergic system is necessary for MPD to manifest its acute and chronic effects on behavior, and demonstrates that the CN's glutaminergic system is necessary for the chronic effects of MPD such as sensitization. Thus, the dopaminergic and glutaminergic components of the CN play a significant role in differentially modulating the acute and chronic effects of MPD respectively.
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Affiliation(s)
- Nicholas King
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Samuel Floren
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Natasha Kharas
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Ming Thomas
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States
| | - Nachum Dafny
- Department of Neurobiology and Anatomy, University of Texas Health at the McGovern Medical School, 6431 Fannin Street, Houston, TX 77030, United States.
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Dawes K, Andersen A, Vercande K, Papworth E, Philibert W, Beach SR, Gibbons FX, Gerrard M, Philibert R. Saliva DNA Methylation Detects Nascent Smoking in Adolescents. J Child Adolesc Psychopharmacol 2019; 29:535-544. [PMID: 31180231 PMCID: PMC6727474 DOI: 10.1089/cap.2018.0176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Early identification of smoking, essential for the successful implementation of interventions, arrests the escalation of smoking and smoking-associated risk behaviors in adolescents. However, because nascent smoking is typically episodic and infrequent, enzyme-linked immunoassay reagent-based approaches that detect cotinine, a key nicotine metabolite, are not effective in identifying adolescents in the earliest stages of smoking. Epigenetic methods may offer an alternative approach for detecting early-stage smokers. In prior work, we and others have shown that the methylation status of cg05575921 of whole-blood DNA accurately predicts smoking status in regularly smoking adults and is sensitive to nascent smoking. Yet, the blood draws necessary to obtain DNA for this method may be poorly accepted by adolescents. Saliva could be an alternative source of DNA. However, the ability of saliva DNA methylation status to predict smoking status among adolescents is unknown. Methods: To explore the possibility of using salivary DNA for screening purposes, we examined the DNA methylation status at cg05575921 in saliva DNA samples from 162 high school aged subjects for whom we also had paired serum cotinine values. Results: Overall, the reliability of self-report of nicotine/tobacco use in these adolescents was poor with 67% of all subjects whose serum levels of cotinine was ≥2 ng/mL (n = 75) denying any use of nicotine-containing products in the past 6 months. However, the correspondence of the two biological measures of smoking was high, with serum cotinine positivity being strongly correlated with cg05575921 methylation (p < 0.0001). Receiver operating characteristic (ROC) analyses showed that cg05575921 methylation status could be used to classify those with positive serum cotinine values (≥2 ng/mL) from those denying smoking and have undetectable levels of cotinine. Conclusions: We conclude that saliva DNA methylation assessments hold promise as a means of detecting nascent smoking.
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Affiliation(s)
- Kelsey Dawes
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Allan Andersen
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Kyra Vercande
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | - Emma Papworth
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | | | - Steven R.H. Beach
- Center for Family Research, University of Georgia, Athens, Georgia
- Department of Psychology, University of Georgia, Athens, Georgia
| | | | - Meg Gerrard
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Robert Philibert
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
- Behavioral Diagnostics, Coralville, Iowa
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McClure EA, Baker NL, Sonne SC, Ghitza UE, Tomko RL, Montgomery L, Babalonis S, Terry GE, Gray KM. Tobacco use during cannabis cessation: Use patterns and impact on abstinence in a National Drug Abuse Treatment Clinical Trials Network study. Drug Alcohol Depend 2018; 192:59-66. [PMID: 30218864 PMCID: PMC6200636 DOI: 10.1016/j.drugalcdep.2018.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/06/2018] [Accepted: 07/22/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is common for cannabis users to also use tobacco. While data suggest that tobacco users have more difficulty achieving cannabis cessation, secondary analyses of clinical trial data sets may provide insight into the moderating variables contributing to this relationship, as well as changes in tobacco use during cannabis treatment. Those were the aims of this secondary analysis. METHODS The parent study was a multi-site trial of N-acetylcysteine for cannabis dependence conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants were treatment-seeking adults (ages 18-50) who met criteria for cannabis dependence (N = 302). For cigarette smokers (n = 117), tobacco use was assessed via timeline follow-back and nicotine dependence was assessed via the Fagerström Test for Nicotine Dependence (FTND). Outcome measures included: 1) changes in tobacco use based on treatment assignment, nicotine dependence, and concurrent cannabis reduction/abstinence, and 2) independent associations between nicotine dependence and cannabis abstinence. RESULTS Cigarette smokers accounted for 39% of the sample (117/302), with a median FTND score of 3.0 (10-point scale). Among those with lower baseline nicotine dependence scores, cigarette smoking was reduced in the active treatment group compared to placebo. Those with moderate/high levels of nicotine dependence showed slight increases in smoking following active treatment. Nicotine dependence did not affect cannabis cessation. CONCLUSIONS Cigarette smoking during cannabis treatment was affected, but depended on baseline nicotine dependence severity, though dependence levels did not impact cannabis abstinence. Interventions that address both tobacco and cannabis are needed, especially due to an increasing prevalence of cannabis use.
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Affiliation(s)
- Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Nathaniel L Baker
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Susan C Sonne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Udi E Ghitza
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, United States
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - LaTrice Montgomery
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Shanna Babalonis
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Garth E Terry
- Northwest Network Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, United States; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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Beckham JC, Adkisson KA, Hertzberg J, Kimbrel NA, Budney AJ, Stephens RS, Moore SD, Calhoun PS. Mobile contingency management as an adjunctive treatment for co-morbid cannabis use disorder and cigarette smoking. Addict Behav 2018; 79:86-92. [PMID: 29268146 DOI: 10.1016/j.addbeh.2017.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabis is the most widely used illicit drug in the U.S. with 19.8 million current users. Population-based data indicate that almost all cannabis users (90%) have a lifetime history of tobacco smoking and the majority (74%) currently smoke tobacco. Among cannabis users, smoking tobacco is associated with increased frequency of cannabis use, increased morbidity, and poorer cannabis cessation outcomes. There is a lack of research, however, focused on addressing cessation of both substances simultaneously. The purpose of the current pilot study was to evaluate the feasibility and acceptability of a multi-component tobacco/cannabis abstinence treatment. METHODS Five participants completed Abstinence Reinforcement Therapy, an intervention that included five sessions of cognitive-behavioral telephone counseling for tobacco/cannabis, pharmacotherapy for smoking cessation, and five weeks of mobile contingency management to remain abstinent from tobacco and cannabis. RESULTS Feasibility of recruitment, retention and treatment completion was high. Satisfaction with the treatment was also high. CONCLUSION Results support the feasibility and acceptability of this approach with dual cannabis and tobacco users and suggest that further research examining the efficacy of this approach is warranted.
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Affiliation(s)
- Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA.
| | - Kelsie A Adkisson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA
| | - Jeffrey Hertzberg
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH 03766, USA
| | - Robert S Stephens
- Virginia Polytechnic Institute and State University, Department of Psychology, Blacksburg, VA 24061, USA
| | - Scott D Moore
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
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Antognoli E, Koopman Gonzalez S, Trapl E, Cavallo D, Lim R, Lavanty B, Flocke S. The Social Context of Adolescent Co-Use of Cigarillos and Marijuana Blunts. Subst Use Misuse 2018; 53:654-661. [PMID: 28933976 PMCID: PMC5820125 DOI: 10.1080/10826084.2017.1355388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of cigarillos for smoking as a tobacco product and for making marijuana blunts is increasing among adolescents. Previous research has documented the co-use of these products, however little is known about the contextual features that generate and sustain this practice. OBJECTIVE This study aims for a deeper understanding of why and how co-use of cigarillos and marijuana blunts occurs. METHODS Between December 2015 and April 2016, we conducted in-depth interviews with 30 adolescents aged 14-18 who reported smoking ≥1 cigarillo per week. Semi-structured interviews were designed to capture participants' smoking products, practices, and preferences, as well as their beliefs and experiences about smoking. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. RESULTS All participants reported smoking cigarillos for use as a tobacco product, averaging 13 per week. Twenty-five (83%) also reported using cigarillos to smoke marijuana blunts. A preference for group smoking and product sharing, and the belief that cigarillos extend the high of marijuana were found to promote the co-use of these products. Cigarillos were also found to be used as a substitute for blunts when marijuana was unavailable or when its use was being restricted or monitored. Conclusions/Importance: This analysis of adolescent cigarillo and marijuana co-use demonstrates how marijuana use can initiate, increase, and reinforce tobacco use. These findings can be used to inform public health education campaigns and other programs and policies aimed at reducing cigarillo and marijuana use by youth.
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Affiliation(s)
- Elizabeth Antognoli
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Rock Lim
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Brittany Lavanty
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Flocke
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
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Arria AM, Caldeira KM, Bugbee BA, Vincent KB, O’Grady KE. Marijuana use trajectories during college predict health outcomes nine years post-matriculation. Drug Alcohol Depend 2016; 159:158-65. [PMID: 26778758 PMCID: PMC4724514 DOI: 10.1016/j.drugalcdep.2015.12.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/25/2015] [Accepted: 12/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several studies have linked marijuana use with a variety of health outcomes among young adults. Information about marijuana's long-term health effects is critically needed. METHODS Data are from a ten-year study of 1253 young adults originally recruited as first-year college students and assessed annually thereafter. Six trajectories of marijuana use during college (Non-Use, Low-Stable, Early-Decline, College-Peak, Late-Increase, Chronic) were previously derived using latent variable growth mixture modeling. Nine health outcomes assessed in Year 10 (modal age 27) were regressed on a group membership variable for the six group trajectories, holding constant demographics, baseline health status, and alcohol and tobacco trajectory group membership. RESULTS Marijuana trajectory groups differed significantly on seven of the nine outcomes (functional impairment due to injury, illness, or emotional problems; psychological distress; subjective well-being; and mental and physical health service utilization; all ps<.001), but not on general health rating or body mass index. Non-users fared better than the Late-Increase and Chronic groups on most physical and mental health outcomes. The declining groups (Early-Decline, College-Peak) fared better than the Chronic group on mental health outcomes. The Late-Increase group fared significantly worse than the stable groups (Non-Use, Low-Stable, Chronic) on both physical and mental health outcomes. CONCLUSIONS Even occasional or time-limited marijuana use might have adverse effects on physical and mental health, perhaps enduring after several years of moderation or abstinence. Reducing marijuana use frequency might mitigate such effects. Individuals who escalate their marijuana use in their early twenties might be at especially high risk for adverse outcomes.
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Affiliation(s)
- Amelia M. Arria
- Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Behavioral and Community Health, 2387 School of Public Health Building, College Park, MD 20742, USA. , ,
| | - Kimberly M. Caldeira
- Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Behavioral and Community Health, 2387 School of Public Health Building, College Park, MD 20742, USA. , ,
| | - Brittany A. Bugbee
- Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Behavioral and Community Health, 2387 School of Public Health Building, College Park, MD 20742, USA. , ,
| | - Kathryn B. Vincent
- Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Behavioral and Community Health, 2387 School of Public Health Building, College Park, MD 20742, USA. , ,
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, 3109 Biology-Psychology Building, College Park, MD 20742, USA.
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11
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Mamey MR, Barbosa-Leiker C, McPherson S, Burns GL, Parks C, Roll J. An application of analyzing the trajectories of two disorders: A parallel piecewise growth model of substance use and attention-deficit/hyperactivity disorder. Exp Clin Psychopharmacol 2015; 23:422-7. [PMID: 26389639 PMCID: PMC4658254 DOI: 10.1037/pha0000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers often want to examine 2 comorbid conditions simultaneously. One strategy to do so is through the use of parallel latent growth curve modeling (LGCM). This statistical technique allows for the simultaneous evaluation of 2 disorders to determine the explanations and predictors of change over time. Additionally, a piecewise model can help identify whether there are more than 2 growth processes within each disorder (e.g., during a clinical trial). A parallel piecewise LGCM was applied to self-reported attention-deficit/hyperactivity disorder (ADHD) and self-reported substance use symptoms in 303 adolescents enrolled in cognitive-behavioral therapy treatment for a substance use disorder and receiving either oral-methylphenidate or placebo for ADHD across 16 weeks. Assessing these 2 disorders concurrently allowed us to determine whether elevated levels of 1 disorder predicted elevated levels or increased risk of the other disorder. First, a piecewise growth model measured ADHD and substance use separately. Next, a parallel piecewise LGCM was used to estimate the regressions across disorders to determine whether higher scores at baseline of the disorders (i.e., ADHD or substance use disorder) predicted rates of change in the related disorder. Finally, treatment was added to the model to predict change. While the analyses revealed no significant relationships across disorders, this study explains and applies a parallel piecewise growth model to examine the developmental processes of comorbid conditions over the course of a clinical trial. Strengths of piecewise and parallel LGCMs for other addictions researchers interested in examining dual processes over time are discussed.
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Affiliation(s)
- Mary Rose Mamey
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,Corresponding author: Please address all requests for reprints to Mary Rose Mamey, Department of Psychology, Johnson Tower 310, Washington State University, Pullman, WA, 99164-4820, U.S.A.; Phone: (949) 933-4700;
| | - Celestina Barbosa-Leiker
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - Sterling McPherson
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - Craig Parks
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - John Roll
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
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12
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Wagner B, Riggs P, Mikulich-Gilbertson S. The importance of distribution-choice in modeling substance use data: a comparison of negative binomial, beta binomial, and zero-inflated distributions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:489-97. [PMID: 26154448 DOI: 10.3109/00952990.2015.1056447] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is important to correctly understand the associations among addiction to multiple drugs and between co-occurring substance use and psychiatric disorders. Substance-specific outcomes (e.g. number of days used cannabis) have distributional characteristics which range widely depending on the substance and the sample being evaluated. OBJECTIVES We recommend a four-part strategy for determining the appropriate distribution for modeling substance use data. We demonstrate this strategy by comparing the model fit and resulting inferences from applying four different distributions to model use of substances that range greatly in the prevalence and frequency of their use. METHODS Using Timeline Followback (TLFB) data from a previously-published study, we used negative binomial, beta-binomial and their zero-inflated counterparts to model proportion of days during treatment of cannabis, cigarettes, alcohol, and opioid use. The fit for each distribution was evaluated with statistical model selection criteria, visual plots and a comparison of the resulting inferences. RESULTS We demonstrate the feasibility and utility of modeling each substance individually and show that no single distribution provides the best fit for all substances. Inferences regarding use of each substance and associations with important clinical variables were not consistent across models and differed by substance. CONCLUSION Thus, the distribution chosen for modeling substance use must be carefully selected and evaluated because it may impact the resulting conclusions. Furthermore, the common procedure of aggregating use across different substances may not be ideal.
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Affiliation(s)
| | - Paula Riggs
- b Department of Psychiatry , University of Colorado , Aurora , CO , USA
| | - Susan Mikulich-Gilbertson
- a Department of Biostatistics and Informatics , and.,b Department of Psychiatry , University of Colorado , Aurora , CO , USA
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13
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McClure EA, Campbell ANC, Pavlicova M, Hu M, Winhusen T, Vandrey RG, Ruglass LM, Covey LS, Stitzer ML, Kyle TL, Nunes EV. Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study. J Subst Abuse Treat 2015; 53:39-46. [PMID: 25595301 PMCID: PMC4414703 DOI: 10.1016/j.jsat.2014.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. METHODS In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (aim #1), specifically among those in the experimental treatment group (aim #2), and the moderating effect of being a smoker on treatment outcomes (aim #3). RESULTS Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. CONCLUSIONS This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina School of Medicine, 67 President St., Charleston, SC, 29425, United States.
| | - Aimee N C Campbell
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States; Mount Sinai St. Luke's Hospital, Department of Psychiatry and Behavioral Health, 1111 Amsterdam Avenue, New York, NY 10025, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, CUMC, Columbia University, 722W. 168th street, New York, NY 10032, United States
| | - Meichen Hu
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Theresa Winhusen
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, United States
| | - Ryan G Vandrey
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Lesia M Ruglass
- The City College of New York, CUNY, 160 Convent Avenue, New York, NY 10031, United States
| | - Lirio S Covey
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Maxine L Stitzer
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson St., Orlando, FL 32804, United States
| | - Edward V Nunes
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
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14
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Goodwin RD, Sheffer CE, Chartrand H, Bhaskaran J, Hart CL, Sareen J, Bolton J. Drug Use, Abuse, and Dependence and the Persistence of Nicotine Dependence. Nicotine Tob Res 2014; 16:1606-12. [DOI: 10.1093/ntr/ntu115] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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McClure EA, Baker NL, Gray KM. Cigarette smoking during an N-acetylcysteine-assisted cannabis cessation trial in adolescents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:285-91. [PMID: 24720376 DOI: 10.3109/00952990.2013.878718] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Tobacco and cannabis use are both highly prevalent worldwide. Their co-use is also common in adults and adolescents. Despite this frequent co-occurrence, cessation from both substances is rarely addressed in randomized clinical trials. Given evidence that tobacco use may increase during cannabis cessation attempts, and additionally that tobacco users have poorer cannabis cessation outcomes, we explored tobacco outcomes, specifically cigarette smoking, from an adolescent cannabis cessation trial that tested the efficacy of N-acetylesteine (NAC). METHODS Cannabis-dependent adolescents (ages 15-21; n = 116) interested in cannabis treatment were randomized to NAC (1200 mg bid) or matched placebo for 8 weeks. Participants did not need to be cigarette smokers or be interested in smoking cessation to qualify for inclusion. RESULTS Approximately 59% of enrolled participants were daily and non-daily cigarette smokers, and only differed from non-smoking participants on the compulsion sub-scale of the Marijuana Craving Questionnaire. Among cigarette smokers who were retained in the study, there was no change in cigarettes per day for either NAC or placebo groups during the eight-week treatment phase. Being a cigarette smoker did not appear to influence the effects of NAC on cannabis abstinence, though there was a trend in the placebo group of poorer cannabis outcomes for cigarette smokers vs. non-smokers. CONCLUSIONS No evidence was found of compensatory cigarette smoking during this cannabis cessation trial in adolescents. Further work assessing interventions to reduce both cannabis and tobacco use in this population is greatly needed.
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16
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Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence. Drug Alcohol Depend 2014; 134:228-234. [PMID: 24183498 PMCID: PMC3865597 DOI: 10.1016/j.drugalcdep.2013.10.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several gaps in the literature on individuals with co-occurring cannabis and tobacco use exist, including the extent of psychiatric, psychosocial, and physical health problems. We examine these gaps in an epidemiological study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), of a large, nationally representative sample. METHODS The sample was drawn from Wave 2 NESARC respondents (N=34,653). Adults with current cannabis use disorders and nicotine dependence (CUD+ND) (n=74), CUD only (n=100), and ND only (n=3424) were compared on psychiatric disorders, psychosocial correlates (e.g., binge drinking; partner violence), and physical health correlates (e.g., medical conditions). RESULTS Relative to those with CUD only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, Clusters A and B personality disorders, and narcissistic personality disorder, and reported engaging in a significantly higher number of antisocial behaviors. Relative to those with ND only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, anxiety disorders, and paranoid, schizotypal, narcissistic, and borderline personality disorders; were significantly more likely to report driving under the influence of alcohol and being involved in partner violence; and reported engaging in a significantly higher number of antisocial behaviors. CUD+ND was not associated with physical health correlates. CONCLUSIONS Poor treatment outcomes for adults with co-occurring cannabis use disorders and nicotine dependence may be explained in part by differences in psychiatric and psychosocial problems.
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17
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Bron TI, Bijlenga D, Kasander MV, Spuijbroek AT, Beekman ATF, Kooij JJS. Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study. Eur Neuropsychopharmacol 2013; 23:542-54. [PMID: 22809706 DOI: 10.1016/j.euroneuro.2012.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/01/2012] [Accepted: 06/07/2012] [Indexed: 12/25/2022]
Abstract
Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate.
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Affiliation(s)
- Tannetje I Bron
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
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18
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Hammerness P, Joshi G, Doyle R, Georgiopoulos A, Geller D, Spencer T, Petty CR, Faraone SV, Biederman J. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr 2013; 162:22-7.e2. [PMID: 22878114 DOI: 10.1016/j.jpeds.2012.06.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/07/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although attention-deficit hyperactivity disorder (ADHD) is a well-known risk factor for cigarette smoking, prospective studies aimed at reducing smoking risk in this population are critically needed. STUDY DESIGN This was a 2-year, prospective, open-label clinical trial of extended-release methylphenidate for smoking prevention in adolescents with ADHD (n = 154). Smoking outcomes were assessed with the Fagerstrom Tolerance Questionnaire. Comparisons were made using data from a historical, naturalistic sample of ADHD (n = 103) and non-ADHD comparators (n = 188) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial. RESULTS The smoking rate at endpoint (mean, 10 months of methylphenidate treatment) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically (7.1% vs 8.0% vs 10.9%; P > .20). In contrast, the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment (7.1% vs 19.6%; P = .009 [not significant], adjusting for comorbid conduct disorder and alcohol and drug abuse). CONCLUSION Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD. If confirmed, this finding would have significant clinical and public health impacts.
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Affiliation(s)
- Paul Hammerness
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02138, USA.
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Caldeira KM, O’Grady KE, Vincent KB, Arria AM. Marijuana use trajectories during the post-college transition: health outcomes in young adulthood. Drug Alcohol Depend 2012; 125:267-75. [PMID: 22464050 PMCID: PMC3390463 DOI: 10.1016/j.drugalcdep.2012.02.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the relatively high prevalence of marijuana use among college students, little information exists regarding health outcomes associated with different use patterns or trajectories. METHODS Seven annual personal interviews (years 1-7) were administered to 1253 individuals, beginning in their first year in college. Growth mixture modeling was used to identify trajectories of marijuana, alcohol, and tobacco use frequency during years 1-6. Logistic regression was used to evaluate the relationship between marijuana use trajectories and several year 7 health outcomes, holding constant year 1 health, demographics, and alcohol and tobacco use trajectories. RESULTS Six marijuana use trajectories were identified: non-use (71.5% (wt) of students), low-stable (10.0% (wt)), late-increase (4.7% (wt)), early-decline (4.3% (wt)), college-peak (5.4% (wt)), and chronic (4.2% (wt)). The six marijuana trajectory groups were not significantly different on year 1 health-related variables, but differed on all ten year 7 health outcomes tested, including functional impairment due to injury, illness, or emotional problems; general health rating; psychiatric symptoms; health-related quality of life; and service utilization for physical and mental health problems. Non-users fared significantly better than most of the marijuana-using trajectory groups on every outcome tested. Chronic and late-increase users had the worst health outcomes. CONCLUSIONS Marijuana use patterns change considerably during college and the post-college period. Marijuana-using students appear to be at risk for adverse health outcomes, especially if they increase or sustain a frequent pattern of use.
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Affiliation(s)
- Kimberly M. Caldeira
- Faculty Research Associate, Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Family Science, 1142 School of Public Health Building, College Park, MD 20742, USA
| | - Kevin E. O’Grady
- Associate Professor, Department of Psychology, University of Maryland, 3147F Biology/Psychology Building, College Park, MD 20742, USA
| | - Kathryn B. Vincent
- Faculty Research Associate, Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Family Science, 1142 School of Public Health Building, College Park, MD 20742, USA
| | - Amelia M. Arria
- Corresponding Author and Reprint Requests: Amelia M. Arria, Director, Center on Young Adult Health and Development, University of Maryland School of Public Health, Department of Family Science, 1142 School of Public Health Building, College Park, MD 20742, USA. Phone: 1-301-405-9795; Fax: 1-301-314- 013; . Amelia M. Arria is also a Senior Scientist at the Treatment Research Institute, 600 Public Ledger Building; 150 S. Independence Mall West; Philadelphia, PA 19106, USA
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Tamm L, Trello-Rishel K, Riggs P, Nakonezny PA, Acosta M, Bailey G, Winhusen T. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder. J Subst Abuse Treat 2012; 44:224-30. [PMID: 22889694 DOI: 10.1016/j.jsat.2012.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/19/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with substance use disorder (SUD) and is associated with poor substance-use treatment outcomes. A trial evaluating osmotic-release oral system methylphenidate (OROS-MPH) for adolescents with ADHD and SUD, concurrently receiving behavioral therapy, revealed inconsistent medication effects on ADHD or SUD. Clinical care for this population would be advanced by knowledge of treatment outcome predictors. Data from the randomized placebo-controlled trial (n = 299) were analyzed. Significant treatment predictors included: 1) Substance use severity, associated with poorer ADHD and SUD outcomes, 2) ADHD severity, associated with better ADHD and SUD outcomes, 3) comorbid conduct disorder, associated with poorer ADHD outcomes, and 4) court-mandated status, associated with better SUD outcomes but poorer treatment completion. An interaction effect showed that OROS-MPH improved SUD outcomes in adolescents with comorbid conduct disorder compared to placebo. While severe SUD may require more intensive psychosocial treatment, OROS-MPH may improve substance treatment outcomes in adolescents with co-morbid attention and conduct problems.
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Affiliation(s)
- Leanne Tamm
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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21
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Abstract
AIMS A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e. concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use. METHODS A systematic review of the literature on clinical diagnoses, psychosocial problems and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users versus cannabis- or tobacco-only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys. RESULTS Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be associated consistently with a greater likelihood of tobacco use disorders, more psychosocial problems or poorer tobacco cessation outcomes. CONCLUSIONS Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case.
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Affiliation(s)
- Erica N Peters
- Department of Psychiatry, Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA.
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22
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Abstract
AIMS Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use. METHODS Selective review of published studies. RESULTS Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking. CONCLUSIONS There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge.
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Affiliation(s)
- Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, St Louis, MO 63110, USA.
| | - Alan J. Budney
- University of Arkansas for Medical Sciences, Dept. of Psychiatry, 4301 West Markham Street, Slot 843, Little Rock, AK 72205
| | - Michael T. Lynskey
- Washington University School of Medicine, Dept. of Psychiatry, 660 S. Euclid, CB 8134, Saint Louis. MO 63110
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