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Carter-Rogers K, Al-Hamdani M, Kearney CPM, Smith SM. Risk-Taking, Social Support, and Belongingness Contribute to the Risk for Cannabis Use Frequency in University Students. Subst Use Misuse 2024; 59:1357-1366. [PMID: 38711241 DOI: 10.1080/10826084.2024.2341998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background: Cannabis use and misuse is known to be associated with a variety of negative health, academic, and work-related outcomes; therefore, it is important to study the factors that contribute to or moderate its use. Objectives: The aim of this study was to determine whether risky behavior, belongingness and social support as clustering variables play a role in cannabis use frequency. Method: In a university student sample, participant data on risky behavior, belongingness and social support were used to generate vulnerability profiles through cluster analysis (low vulnerability with low risk, low vulnerability with high belonging, moderate vulnerability, and high vulnerability). Using an analysis of variance, the vulnerability profiles were compared with respect to cannabis use frequency and quantity. Through chi-square tests we assessed whether these profiles are overrepresented in certain demographics. Results: The cluster analysis yielded four groups, which differed in their vulnerability for cannabis use. The most vulnerable cluster group had higher cannabis use frequency relative to the two least vulnerable groups. Low income vs. high income was also associated with high vulnerability group membership. International students were overrepresented in the low vulnerability with high belonging group relative to the low vulnerability with low-risk group. The opposite was observed for domestic students. Conclusions: This research adds to the expanding body of literature on cannabis use and misuse in Canada, which may contribute to public health policy and the prevention and treatment of cannabis addiction by providing new insight on who may be at risk.
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Affiliation(s)
| | - Mohammed Al-Hamdani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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2
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Yeap ZJS, Marsault J, George TP, Mizrahi R, Rabin RA. Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders? Am J Addict 2023; 32:367-375. [PMID: 36815595 DOI: 10.1111/ajad.13394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of cannabis use disorder (CUD) are higher in people with schizophrenia than in the general population. Irrespective of psychiatric diagnosis, tobacco co-use is prevalent in those with CUD and leads to poor cannabis cessation outcomes. The cannabis withdrawal syndrome is well-established and increases cannabis relapse risk. We investigated whether cannabis withdrawal severity differed as a function of high versus no/low tobacco dependence and psychiatric diagnosis in individuals with CUD. METHOD Men with CUD (N = 55) were parsed into four groups according to schizophrenia diagnosis and tobacco dependence severity using the Fagerstrom Test for Nicotine Dependence (FTND): men with schizophrenia with high tobacco dependence (SCT+, n = 13; FTND ≥ 5) and no/low tobacco dependence (SCT-, n = 22; FTND ≤ 4), and nonpsychiatric controls with high (CCT+, n = 7; FTND ≥ 5) and no/low (CCT-, n = 13; FTND ≤ 4) tobacco dependence. Participants completed the Marijuana Withdrawal Checklist following 12-h of cannabis abstinence. RESULTS There was a significant main effect of tobacco dependence on cannabis withdrawal severity (p < .001). Individuals with high tobacco dependence had significantly greater cannabis withdrawal severity (M = 13.85 [6.8]) compared to individuals with no/low tobacco dependence (M = 6.49, [4.9]). Psychiatric diagnosis and the interaction effects were not significant. Lastly, cannabis withdrawal severity positively correlated with FTND (r = .41, p = .002). CONCLUSION AND SCIENTIFIC SIGNIFICANCE Among individuals with CUD and high tobacco dependence, cannabis withdrawal severity was elevated twofold, irrespective of diagnosis, relative to individuals with CUD and no/low tobacco dependence. Findings from this study emphasize the importance of addressing tobacco co-use when treating CUD.
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Affiliation(s)
- Zac J S Yeap
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Justine Marsault
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Tony P George
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Romina Mizrahi
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rachel A Rabin
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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3
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Sullivan RM, Wallace AL, Stinson EA, Montoto KV, Kaiver CM, Wade NE, Lisdahl KM. Assessment of Withdrawal, Mood, and Sleep Inventories After Monitored 3-Week Abstinence in Cannabis-Using Adolescents and Young Adults. Cannabis Cannabinoid Res 2022; 7:690-699. [PMID: 34678051 PMCID: PMC9587800 DOI: 10.1089/can.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Among adolescents and young adults, cannabis use is prevalent. Prior studies characterizing withdrawal effects in this age range have primarily included treatment seeking or comorbid psychiatric samples; these studies have identified several affected domains, especially sleep, mood, and anxiety. The present study compared a community (i.e., nontreatment seeking) sample of cannabis-using and control participants on mood, anxiety, sleep, and withdrawal inventories during the course of a monitored 3-week cannabis abstinence period. Materials and Methods: Seventy-nine adolescent and young adult participants (cannabis-using group=37 and control group=42) were recruited from the community to undergo 3 weeks of confirmed abstinence (i.e., urine and sweat patch toxicology) and completion of Cannabis Withdrawal Symptom Criteria, State-Trait Anxiety Inventory, Beck's Depression Inventory, and Pittsburgh Sleep Quality Index across the study period. Repeated measures and cross-sectional regressions were used to examine main effects of group and interactions with time (where appropriate), while accounting for recent alcohol use and cotinine levels. Results: Cannabis-using participants reported higher mood (p=0.006), overall withdrawal (p=0.009), and sleep-related withdrawal (p<0.001) symptoms across abstinence compared to controls. Overall withdrawal severity (p=0.04) and sleep-related withdrawal symptoms (p=0.02) demonstrated a quadratic trajectory across the monitored abstinence periods, with an increase from baseline and subsequent decreases in symptom severity. No differences of anxiety scores (p=0.07) or trajectories (p=0.18) were observed. By study completion, groups did not differ among sleep quality components (all p's>.05). Conclusions: These findings revealed that nontreatment-seeking cannabis-using adolescents and young adults reported heightened total withdrawal symptoms during a 3-week sustained abstinence period relative to controls. Cannabis-using participants demonstrated an increase in withdrawal symptom trajectory during the first week followed by decreased symptoms from weeks 2 to 3, which contrasts with prior linear decreases observed in cannabis-using adolescent and young adults. More mood symptoms were observed in the cannabis-using group even while excluding for comorbid psychopathologies-along with significantly more sleep problems during the abstinence period. Implications include the necessity to provide psychoeducation for recreational, nontreatment-seeking cannabis-using individuals about cannabis withdrawal, mood symptoms, and sleep quality difficulties when cannabis cessation is attempted, to improve likelihood of long-term sustained abstinence.
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Affiliation(s)
- Ryan M. Sullivan
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Alexander L. Wallace
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Elizabeth A. Stinson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karina V. Montoto
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Christine M. Kaiver
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Kaur N, Bastien G, Gagnon L, Graham J, Mongeau-Pérusse V, Bakouni H, Morissette F, Theriault C, Fischer B, Jutras-Aswad D. Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review. Front Psychiatry 2022; 13:973988. [PMID: 36299544 PMCID: PMC9590692 DOI: 10.3389/fpsyt.2022.973988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence supporting associations between cannabis use and many health outcomes is growing, however it remains unclear how such associations vary across the lifespan. We therefore aim to answer the following questions: (1) Are the risks of cannabis's adverse effects on mental health and addiction-related outcomes different in adolescents than in adults? (2) What are the relationships between these cannabis's adverse effects and (a) an individual's age at first cannabis use, (b) age at assessment, and (c) duration of cannabis use? METHODS We searched Medline, Embase, CINAHL, and PsychINFO from inception to 18 October 2021. Two reviewers independently screened studies and descriptively synthesized results. RESULTS We included 140 studies. Cannabis effects on mental health and addiction-related outcomes were worse in adolescents, early cannabis initiators and cannabis users who consumed for longest periods. Evidence of worse long-term adverse effects in adolescents was substantial for psychosis, cannabis, and nicotine use disorders; mixed for depression, suicidality, other substance use and disorders; and limited for anxiety. Additionally, acute cannabis exposure had the opposite trend with adults more often reporting adverse effects than adolescents. CONCLUSION The available evidence suggests that cannabis use should be delayed as late as possible in adulthood and shortened in duration across the lifespan to decrease the risk of negative outcomes, while emphasizing the need for adapted harm reduction approaches. This scoping review provides evidence on the role of age and duration of exposure as determinants of cannabis-related adverse effects, which may inform prevention and harm reduction strategies. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/BYG72.
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Affiliation(s)
- Navdeep Kaur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gabriel Bastien
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lea Gagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Johann Graham
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Violaine Mongeau-Pérusse
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamzah Bakouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Camille Theriault
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Coughlin LN, Ilgen MA, Jannausch M, Walton MA, Bohnert KM. Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain. Addiction 2021; 116:2067-2075. [PMID: 33400332 PMCID: PMC8363170 DOI: 10.1111/add.15370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/26/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Research from cohorts of individuals with recreational cannabis use indicates that cannabis withdrawal symptoms are reported by more than 40% of those using regularly. Withdrawal symptoms are not well understood in those who use cannabis for medical purposes. Therefore, we prospectively examined the stability of withdrawal symptoms in individuals using cannabis to manage chronic pain. DESIGN, SETTING, PARTICIPANTS Using latent class analysis (LCA) we examined baseline cannabis withdrawal to derive symptom profiles. Then, using latent transition analysis (LTA) we examined the longitudinal course of withdrawal symptoms across the time points. Exploratory analyses examined demographic and clinical characteristics predictive of withdrawal class and transitioning to more or fewer withdrawal symptoms over time. A cohort of 527 adults with chronic pain seeking medical cannabis certification or re-certification was recruited between February 2014 and June 2015. Participants were recruited from medical cannabis clinic waiting rooms in Michigan, USA. Participants were predominantly white (82%) and 49% identified as male, with an average age of 45.6 years (standard deviation = 12.8). MEASUREMENTS Baseline, 12-month and 24-month assessments of withdrawal symptoms using the Marijuana Withdrawal Checklist-revised. FINDINGS A three-class LCA model including a mild (41%), moderate (34%) and severe (25%) symptom class parsimoniously represented withdrawal symptoms experienced by people using medical cannabis. Stability of withdrawal symptoms using a three-class LTA at 12 and 24 months ranged from 0.58 to 0.87, with the most stability in the mild withdrawal class. Younger age predicted greater severity and worsening of withdrawal over time. CONCLUSIONS Adults with chronic pain seeking medical cannabis certification or re-certification appear to experience mild to severe withdrawal symptoms. Withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory.
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Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan
| | - Mark A. Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Mary Jannausch
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan,Injury Prevention Center, University of Michigan
| | - Kipling M. Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System,Department of Epidemiology and Biostatistics, Michigan State University
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Claus BB, Specka M, McAnally H, Scherbaum N, Schifano F, Bonnet U. Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor? Front Psychiatry 2020; 11:598150. [PMID: 33343424 PMCID: PMC7744589 DOI: 10.3389/fpsyt.2020.598150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH). Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed. Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration (r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission (n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases. Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity-again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.
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Affiliation(s)
- Benedikt Bernd Claus
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heath McAnally
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Hammond CJ, Shirk SD, Foster DW, Potenza NB, Kraus SW, Mayes LC, Hoff RA, Potenza MN. Cannabis use, problem-gambling severity, and psychiatric disorders: Data from the National Epidemiological Survey on Alcohol and Related Conditions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:230-241. [PMID: 31246071 DOI: 10.1037/adb0000472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cannabis use and related disorders are common in adults and frequently co-occur with subsyndromal and pathological gambling. However, understanding how cannabis use may moderate relationships between problem-gambling severity and psychiatric disorders remains poorly understood. Data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 43,093 adults) were examined to investigate how cannabis use moderated associations between problem-gambling severity (with gambling groups based on the 10 Diagnostic and Statistical Manual [DSM-IV] inclusionary criteria for pathological gambling) and Axis I and Axis II psychiatric disorders. Problem-gambling severity groups included low frequency/nongambling, low-risk gambling, at-risk gambling, and problem/pathological gambling (PPG). Among both the group with lifetime cannabis use and that which never used cannabis, greater problem-gambling severity was associated with more psychopathology across mood, anxiety, substance-use and Axis II disorders. Significant Cannabis Use × Problem-Gambling Severity Group interactions were observed between PPG and major depression (OR = 0.35, 95% CI = [0.14-0.85]), cluster A personality disorders (OR = 0.37, 95% CI = [0.16-0.86])-especially paranoid personality disorder (OR = 0.34, 95% CI = [0.14-0.81])-and cluster B personality disorders (OR = 0.36, 95% CI = [0.18-0.75])-especially antisocial personality disorder (OR = 0.25, 95% CI = [0.11-0.60]). In all cases, associations between problem-gambling severity and psychopathologies were weaker among the lifetime-cannabis-using group as compared to the never-using group. Cannabis use moderates the relationships between problem-gambling severity and psychiatric disorders, with cannabis use appearing to account for some of the variance in the associations between greater problem-gambling severity and specific forms of psychopathology. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Livne O, Shmulewitz D, Lev-Ran S, Hasin DS. DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend 2019; 195:170-177. [PMID: 30361043 PMCID: PMC6359953 DOI: 10.1016/j.drugalcdep.2018.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults. METHOD Participants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N = 1527), the prevalence and demographic and clinical correlates of DSM-5 CWS were examined. RESULTS In frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p < 0.001), and with mood disorders (adjusted odds ratios [aOR] = 1.9-2.6), anxiety disorders (aOR = 2.4-2.5), personality disorders (aOR = 1.7-2.2) and family history of depression (aOR = 2.5) but not personal history of other substance use disorders or family history of substance use problems. CONCLUSIONS CWS is highly comorbid and disabling. Its shared symptoms with depressive and anxiety disorders call for clinician awareness of CWS and the factors associated with it to promote more effective treatment among frequent cannabis users.
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Affiliation(s)
- Ofir Livne
- Lev Hasharon Medical Center, P.O. Box 90000, Netanya 42100, Israel
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Shaul Lev-Ran
- Lev Hasharon Medical Center, P.O. Box 90000, Netanya 42100, Israel,Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Ramat Aviv, Tel Aviv 69978, Israel
| | - Deborah S. Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA,Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
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9
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Perron BE, Holt KR, Yeagley E, Ilgen M. Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain. Drug Alcohol Depend 2019; 194:401-409. [PMID: 30500688 DOI: 10.1016/j.drugalcdep.2018.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/24/2018] [Accepted: 09/29/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE To describe patterns of cannabis withdrawal among a large sample of those who use medical cannabis and test the association between withdrawal symptomology and functioning. PROCEDURES Adults ages 21 and older (N = 801) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, withdrawal symptomology, functioning and other related constructs. Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). FINDINGS Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables. CONCLUSIONS Cannabis withdrawal symptomology is highly prevalent among patients who use medical cannabis at least three times a week. Helping patients recognize the association between poorer functioning and withdrawal may be an effective way to highlight potentially negative consequences of regular and moderate heavy use.
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Affiliation(s)
- Brian E Perron
- School of Social Work, University of Michigan, Ann Arbor, MI, United States.
| | - Katlyn R Holt
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Emily Yeagley
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Editorial for the special issue on behavior change, health, and health disparities 2017. Prev Med 2017; 104:1-3. [PMID: 29092791 PMCID: PMC5858188 DOI: 10.1016/j.ypmed.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 01/12/2023]
Abstract
This Special Issue of Preventive Medicine (PM) is the 4th in a series on behavior change, health, and health disparities, a topic of critical importance to improving U.S. population health. The U.S. ranks near the bottom on measures of population health relative to other industrialized countries despite spending orders of magnitude more on health care than any other nation. Population health experts agree that the area of personal behavior, or lifestyle, such as substance abuse, physical inactivity/obesity, and non-adherence with medical regimens is the single largest contributor to this situation. These unhealthy behavior patterns disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in improving population health generally and curtailing health disparities more specifically. While perhaps more severe in the U.S., other industrialized countries are facing similar challenges with personal behavior patterns, adverse health impacts, and health disparities. Thus the topics discussed in this series have implications well beyond the U.S. In this 4th Special Issue we address (a) the potential health impacts of liberalizing laws on recreational marijuana use; (b) the ongoing challenge of tobacco use in vulnerable populations; and (b) the importance of weight management and physical activity in caring for vulnerable medical populations. Across each of these topics we include contributions from accomplished policymakers and scientists to acquaint readers with recent accomplishments and remaining knowledge gaps and challenges in these important topic areas.
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