Is there a relationship between cannabis use problems, emotion dysregulation, and mental health problems among adults with chronic pain?

Emotional dysregulation in relation to substance use and behavioral addictions: Findings from five separate meta-analyses

Background/objective

Emotional dysregulation (ED) is a transdiagnostic variable underlying various psychiatric disorders, including addictive behaviors (ABs). This meta-analysis examines the relationship between ED and ABs (alcohol, tobacco, cannabis, gambling, and gaming), and indicators of AB engagement (frequency, quantity/time of use, severity, and problems).

Method

Searches were conducted in PubMed, Scopus, WoS, and PsycINFO. Five separate meta-analysis were run using random-effects models. Moderators (age, sex, continental region, and sample type; community vs. clinical), and publication bias were evaluated.

Results

A total of 189 studies (N = 78,733; 51.29 % women) were identified. ED was significantly related to all ABs. Problems and severity indicators exhibited the largest effects (r's .118-.372, all p <.023). There were larger effect sizes for cannabis problems (r = .372), cannabis severity (r = .280), gaming severity (r = .280), gambling severity (r = .245), gambling problems (r = .131), alcohol problems (r = .237), alcohol severity (r = .204), and severity of nicotine dependence (r = .118). Lack of impulse control exhibited some of the largest effects in relation to ABs. Clinical samples of cannabis users vs. community-based exhibited larger magnitude of associations.

Conclusions

Interventions targeting ABs should address lack of strategies and impulsive behaviors as an emotion regulation strategy specifically, as it is a common risk factor for ABs.

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Examining Differences in Emotion Dysregulation Between Emerging Adult Alcohol-Only Users, Abstainers, and Simultaneous Users

Objective

Simultaneous use of alcohol and cannabis is associated with more negative consequences than use of either substance alone. Research suggests that emotion dysregulation is linked to alcohol, cannabis, and polysubstance use. However, no previous research has examined whether emotion dysregulation scores differ among individuals without past month substance use (abstainers), individuals who report past-month alcohol use only (no past month cannabis or simultaneous use; alcohol-only users), and individuals who engage in past-month simultaneous alcohol and cannabis use (simultaneous users). Our aim was to examine differences in overall levels of emotion dysregulation and emotion dysregulation subscales between these groups.

Methods

The sample included 468 college students. Participants completed an online survey assessing demographics, emotion dysregulation, average number of drinks per week, days of monthly cannabis use, and simultaneous use of alcohol and cannabis.

Results

A one-way ANOVA showed significant differences in emotion dysregulation between alcohol-only users, abstainers, and simultaneous users. A Bonferroni post hoc analysis revealed significant differences in emotion dysregulation for simultaneous users (p = .004) compared to alcohol-only users and abstainers. A series of ANOVAs were run to examine emotion dysregulation subscale scores and significant differences were found for impulse control difficulties (p = .003) and limited access to emotion regulation strategies (p = .005) for simultaneous users compared to alcohol-only users and abstainers, and for non-acceptance of emotional responses (p = .018) for simultaneous users compared to and alcohol-only users.

Conclusion

These findings indicate that simultaneous users have higher levels of emotion dysregulation, higher levels of impulse control difficulties, greater non-acceptance of emotions, and greater lack of access to emotion regulation strategies compared to abstainers and alcohol-only users.

Psychological Distress, Cannabis Use Frequency, and Cannabis Use Disorder Among US Adults in 2020

Using 2020 National Survey on Drug Use and Health data (N = 27,170, age 18+), we examined associations of psychological distress with: (1) cannabis use frequency among all adults, and (2) cannabis use disorder (CUD) among cannabis users. Of all adults, 18.2% reported past-year cannabis use, 12.9% reported mild-moderate psychological distress, and 12.9% reported serious psychological distress. Greater proportions of cannabis users, especially those under age 35, reported psychological distress. Of cannabis users, 28.1% met DSM-5 CUD criteria. Multinomial logistic regression results showed that serious, compared to no, psychological distress was significantly associated with cannabis use at all frequency levels. Both mild-moderate and serious levels of distress were associated with similar elevated CUD risk (RRR = 1.57, 95% CI = 1.15-2.15 for mild-moderate distress; RRR = 1.58, 95% CI = 1.19-2.09 for serious distress) and 2-4 times higher risks of having moderate or severe, compared to mild, CUD and higher odds of having alcohol use disorder. The prevalence of CUD and other substance use/use disorder among cannabis users is concerning as are the significant associations of psychological distress with greater cannabis use frequency, CUD, and other substance use/use disorder. Younger adults especially may benefit from increased behavioral health services given their high prevalence of psychological distress, cannabis use, and CUD.

Relationship Between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review

INTRODUCTION

Suicide is one of the main causes of death in adults and adolescents, so research focused on identifying risk factors for suicidal behavior is needed. In recent years, emotion regulation, mainly the presence of difficulties regulating one's own negative emotions, has been associated with negative mental health outcomes.

OBJECTIVE

The purpose of this study was to systematically review the available evidence on the association between emotion regulation and suicide (ideation and attempt) in both adults and adolescents.

METHOD

A systematic search of scientific articles published in English and Spanish was carried out through the databases PsycINFO, MEDLINE, Scopus, and the Cochrane Library.

RESULTS

We identified 76 eligible studies, of which 70 reported that people with difficulties in emotion regulation reported higher levels of suicide ideation and more suicide attempts. The results were consistent in adolescents and adults, in clinical and general population samples, and when studies assessed both emotion regulation processes and strategies. However, few studies were longitudinal and most of them were with women.

CONCLUSIONS

We discuss the theoretical implications of the results, suggesting that actual psychological models might benefit from considering individual differences in ER in understanding why people engage in suicide behavior. Clinical implications are also discussed.HIGHLIGHTSDifficulties regulating one's emotions is associated with suicide behavior (SI and SA).Consistent results at all the ages and in the clinical and general population.Individual differences in ER could help researchers to understand suicide.

Serum lipid analysis and isotopic enrichment is suggestive of greater lipogenesis in young long-term cannabis users: A secondary analysis of a case-control study

Cannabis is now legal in many countries and while numerous studies have reported on its impact on cognition and appetite regulation, none have examined fatty acid metabolism in young cannabis users. We conducted an exploratory analysis to evaluate cannabis impact on fatty acid metabolism in cannabis users (n = 21) and non-cannabis users (n = 16). Serum levels of some saturated and monounsaturated fatty acids, including palmitic, palmitoleic, and oleic acids were higher in cannabis users compared to nonusers. As palmitic acid can be derived from diet or lipogenesis from sugars, we evaluated lipogenesis using a de novo lipogenesis index (palmitate/linoleic acid) and carbon-specific isotope analysis, which allows for the determination of fatty acid ¹³ C signature. The significantly higher de novo lipogenesis index in the cannabis users group along with a more enriched ¹³ C signature of palmitic acid suggested an increase in lipogenesis. In addition, while serum glucose concentration did not differ between groups, pyruvate and lactate were lower in the cannabis user group, with pyruvate negatively correlating with palmitic acid. Furthermore, the endocannabinoid 2-arachidonoylglycerol was elevated in cannabis users and could contribute to lipogenesis by activating the cannabinoid receptor 1. Because palmitic acid has been suggested to increase inflammation, we measured peripheral cytokines and observed no changes in inflammatory cytokines. Finally, an anti-inflammatory metabolite of palmitic acid, palmitoylethanolamide was elevated in cannabis users. Our results suggest that lipogenic activity is increased in cannabis users; however, future studies, including prospective studies that control dietary intake are required.

Prevalence and correlates of cannabis abuse among residents in the community of Fort McMurray, a city in Northern Alberta which had endured multiple natural disasters

BACKGROUND

Cannabis is one of the widely used drugs for relaxation and may be abuse among users. Researchers have given attention to cannabis use among the general population while vulnerable populations who have experience multiple traumas may be at risk of cannabis abuse. Other factors may influence cannabis abuse among people exposed to traumas.

OBJECTIVE

The study aims to determine the prevalence and correlates of self-reported cannabis abuse among residents of Fort McMurray, a city in Northern Alberta, Canada.

METHODS

A cross-sectional survey was conducted using an online questionnaire. Sociodemographic data, trauma exposure, and clinical characteristics were collected to identify the possible risk factor of cannabis abuse. Data were analyzed with SPSS version 25 using a chi-square test and binary logistic regression analysis. Correlation analysis was also performed to ascertain likely cannabis abuse and the association with other mental health conditions.

RESULTS

Overall, participants who completed the survey were one hundred and eighty-sixed out of the two hundred and forty-nine residents who accessed the online survey, giving a response rate of 74.7%. The prevalence of self-reported cannabis abuse among participants was 14%. Most of the participants were females (159, 85.5%), more than 40 years of age (98, 52.7%), employed (175, 94.1%), owned their house (145, 78.0%), and 103 (60.6%) reported being exposed to at least a trauma (COVID-19, flooding, or wildfire). Regarding regression analysis results, participants living in a rented accommodation were nearly four times more likely to abuse cannabis (OR = 3.86; 95% CI: 1.34-11.14) than those owning their houses. Similarly, male participants were more than 6-folds more likely to abuse cannabis than the female gender (OR= 6.25; 95% CI: 1.89-20), and participants in a relationship were six times more likely to abuse cannabis than participants not in a relationship (OR = 6.33; 95% CI: 1.67-24.39). The study also found significant association of depressive symptoms (X ² = 4.561; p = 0.033) and anxiety symptoms (X ² = 4.700; p = 0.030) with likely cannabis abuse.

CONCLUSION

Demographic factors significantly predicted likely cannabis abuse in the Fort McMurray population, and cannabis abuse significantly correlated with presence of moderate to high anxiety and depression symptoms. It is essential to mobilized resources to support vulnerable communities and manage cannabis abuse.

Emotion regulation and substance use: A meta-analysis

There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted M_age = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p < 0.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Emotion Dysregulation Moderates the Association Between Stress and Problematic Cannabis Use

Background: Research suggests emotion dysregulation is a transdiagnostic risk factor for substance use and addiction and that stress may lead to problematic cannabis use. Thus, the current study examines how emotion dysregulation moderates the associations between stress (stressful life events and perceived stress) and problematic cannabis use. Methods: Eight hundred and fifty-two adults reporting any lifetime cannabis use completed an anonymous online survey. Participants completed a brief demographic questionnaire and were asked to report their past 30-day use of cannabis, alcohol, nicotine, and illicit substances. Problematic cannabis use (via the Marijuana Problem Scale), emotion dysregulation (via the Difficulties in Emotion Regulation Scale), perceived stress (via the Perceived Stress Scale), and stressful life events (via the Holmes-Rahe Life Stress Inventory) were assessed. Hierarchical multiple linear regressions were conducted. Results: Findings indicate that when examining the moderating role of emotion dysregulation, more stressful life events and less perceived stress were associated with more severe problematic cannabis use, and these associations were stronger at higher levels of emotion dysregulation. Conclusions: These results demonstrate a strong step toward understanding how emotion dysregulation moderates the relationship between stress and problematic cannabis use; however, longitudinal studies are needed to determine directionality of effects. Overall, these results suggest the importance of examining emotion dysregulation as a moderator of both stressful life events and stress perception as they relate to problematic cannabis use.