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Borodovsky JT, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Struble CA, Habib MI, Budney AJ. Typical Hits, Grams, or Joints: Evaluating Cannabis Survey Measurement Strategies for Quantifying Consumption. Cannabis Cannabinoid Res 2024; 9:646-658. [PMID: 36577020 PMCID: PMC10998027 DOI: 10.1089/can.2022.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: Standardized survey measures that capture diverse cannabis consumption patterns are needed to inform public health and policy. Our team is developing a flexible, personalized, low-burden survey item inventory to measure cannabis use patterns and estimate milligrams of THC (mgTHC) consumption in large samples. This study aimed to identify measurement gaps and analysis implications associated with an initial pool of candidate items that assessed use of cannabis flower and concentrate products (smoked and/or vaporized). Methods: Adult cannabis consumers (n=4247) completed an online survey assessing cannabis use frequency, quantity, product types, product potencies (%THC), and methods of administration. Participants chose to report their consumption quantities using one of three units: "hits per day," "grams per week," or "joints per week." Respondents also indicated whether their past 7-day consumption pattern represented their typical pattern. Results: Eighty-one percent had used cannabis daily in the past week. Thirty-two percent, 53%, and 15% chose to report flower and concentrate consumption quantity in hits, grams, and joints, respectively. Approximately 80-90% of responses for the number of hits, grams, and joints consumed were less than the maximum response option-suggesting that response options captured the full range of potential cannabis consumption behaviors. Those who chose grams or joints units were generally more likely to endorse higher risk cannabis use (e.g., morning use, high %THC products) in the past week than those who chose the hits unit (adjusted Odds Ratio range: 1.2-3.9). Among those who reported that the past week represented their typical behavior (83%), past 30-day and past 7-day frequencies were highly correlated (Spearman's Rho=0.77)-supporting the feasibility of using lower burden "typical week" items to extrapolate patterns beyond a 1-week time frame. Conclusion: Results from this online convenience sample of frequent cannabis consumers suggest that the current items yield coherent and expected response patterns. Although additional testing is required, a standardized, flexible survey instrument for large-scale assessment of cannabis patterns and calculation of mgTHC seems within reach.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, New York, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
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Borodovsky JT, Struble CA, Habib MI, Hasin DS, Shmulewitz D, Walsh C, Livne O, Aharonovich E, Budney AJ. Exploring survey methods for measuring consumption quantities of cannabis flower and concentrate products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:733-745. [PMID: 37774316 PMCID: PMC10795727 DOI: 10.1080/00952990.2023.2246635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/06/2023] [Indexed: 10/01/2023]
Abstract
Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined "grams" and "hits" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a "two-item approach," which divided total grams by total hits, and "one-item approach," which divided 0.5 grams by responses to the question: "How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). "Two-item" and "one-item" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose "hits" or "grams" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized "hit sizes" that may improve mgTHC estimates.
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Affiliation(s)
- Jacob T. Borodovsky
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Cara A. Struble
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Mohammad I. Habib
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY 10032, USA
| | - Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Ofir Livne
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Alan J. Budney
- Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Pkwy, Lebanon, NH 03766, USA
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Benny C, Steele BJ, Patte KA, Leatherdale ST, Pabayo R. Income inequality and daily use of cannabis, cigarettes, and e-cigarettes among Canadian secondary school students: Results from COMPASS 2018-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104014. [PMID: 37003193 DOI: 10.1016/j.drugpo.2023.104014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Cannabis, cigarette, and e-cigarette use among Canadian adolescents is a major public health concern. Income inequality has been associated with adverse mental health among youth and may contribute to the risk of frequent cannabis, cigarette, and e-cigarette use. We tested the association between income inequality and the risk of daily cannabis, cigarette, and e-cigarette use among Canadian secondary school students. METHODS We used individual-level survey data from Year 6 (2018/19) of Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary Behavior (COMPASS) and area-level data from the 2016 Canadian Census. Three-level logistic models were used to assess the relationship between income inequality and adolescent daily and current cannabis use, cigarette smoking, and e-cigarette use. RESULTS The analytic sample included 74,501 students aged 12-19. Students were most likely to report being male (50.4%), white (69.1%), and having weekly spending money over $100 (23.5%). We found that a standard deviation unit increase in Gini coefficient was significantly associated with increased likelihood of daily cannabis use (OR=1.25, 95% CI = 1.01-1.54) when adjusting for relevant covariates. We found no significant relationship between income inequality and daily smoking. While Gini was not significantly associated with daily e-cigarette use, we observed a significant interaction between Gini and gender (OR=0.87, 95% CI= 0.80-0.94), indicating that increased income inequality was associated with higher risk of reporting daily e-cigarette use among females only. DISCUSSION An association between income inequality and the likelihood of reporting daily cannabis use across all students and daily e-cigarette use in females were observed. Schools in higher income inequality areas may benefit from targeted prevention and harm reduction programs. Results emphasize the need for upstream discussion on policies that can mitigate the potential effects income inequality.
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Affiliation(s)
- Claire Benny
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, T6G 1C9 Edmonton, Alberta, Canada.
| | - Brian J Steele
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, T6G 1C9 Edmonton, Alberta, Canada
| | - Karen A Patte
- Brock University Department of Health Sciences, 1812 Sir Isaac Brock Way, L2S 3A1 St. Catharines, Ontario, Canada
| | - Scott T Leatherdale
- University of Waterloo School of Public Health Sciences, 200 University Ave West, TJB 2317, N2L 3G1 Waterloo, Ontario, Canada
| | - Roman Pabayo
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, T6G 1C9 Edmonton, Alberta, Canada
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Karki P, Rangaswamy M. A Review of Historical Context and Current Research on Cannabis Use in India. Indian J Psychol Med 2023; 45:105-116. [PMID: 36925496 PMCID: PMC10011848 DOI: 10.1177/02537176221109272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The cultivation and use of cannabis is historically rooted in the Indian subcontinent and this rich heritage of cannabis use dates back to at least two thousand years. Cannabis remains an illicit substance in India despite its changing status globally with many countries legalizing cannabis use in recent years. Scientific research on cannabis use in India has also been sparse. Method Extensive search of online databases resulted in the identification of 29 original research studies pertaining to one of three areas of cannabis research; a) prevalence of cannabis use b) psychological correlates of cannabis use, c) cannabis use in substance use treatment settings. Findings We found that most Indian studies used very basic quantitative research designs and had poor scientific rigor. Samples were small, region specific and included only males. Data analyses were limited to descriptive methods. The criteria for cannabis use in most of the reviewed studies were not rigorous and prone to biases. Conclusion & Implications With changing attitudes and loosening of restrictions on cannabis use, the prevalence of new users is rising dramatically particularly in the college going population. This presents a strong need for research on motivations and attitudes to cannabis use and how those can influence patterns of use, and also the short- and long-term effects of use. More studies with stronger research designs (both cross sectional and longitudinal) are required for the study of cannabis use and this knowledge will be critical for managing the growing substance epidemic, generating public health solutions as well as formulating effective policy frameworks.
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Affiliation(s)
- Prakat Karki
- Dept. of Psychology, CHRIST (Deemed to be University), Bangalore, Karnataka, India
| | - Madhavi Rangaswamy
- Dept. of Psychology, CHRIST (Deemed to be University), Bangalore, Karnataka, India
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Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103716. [DOI: 10.1016/j.drugpo.2022.103716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
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Lorenzetti V, Hindocha C, Petrilli K, Griffiths P, Brown J, Castillo‐Carniglia Á, Caulkins JP, Englund A, ElSohly MA, Gage SH, Groshkova T, Gual A, Hammond D, Lawn W, López‐Pelayo H, Manthey J, Mokrysz C, Pacula RL, van Laar M, Vandrey R, Wadsworth E, Winstock A, Hall W, Curran HV, Freeman TP. The International Cannabis Toolkit (iCannToolkit): a multidisciplinary expert consensus on minimum standards for measuring cannabis use. Addiction 2022; 117:1510-1517. [PMID: 34590359 PMCID: PMC9298052 DOI: 10.1111/add.15702] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. METHODS A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. RESULTS The expert-based consensus agreed upon a three-layered hierarchical framework. Each layer-universal measures, detailed self-report and biological measures-reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. CONCLUSIONS Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation.
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Affiliation(s)
- Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, the Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health SciencesAustralian Catholic UniversityMelbourneAustralia
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Jamie Brown
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
| | - Álvaro Castillo‐Carniglia
- Society and Health Research Center and School of Public HealthUniversidad MayorSantiagoChile
- Department of Population HealthNYU Grossman School of MedicineNew YorkNYUSA
| | | | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mahmoud A. ElSohly
- National Center for Natural Products Research, School of PharmacyUniversity of MississippiUniversityMSUSA
- Department Pharmaceutics and Drug Delivery, School of PharmacyUniversity of Mississippi, UniversityMSUSA
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Teodora Groshkova
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
| | - Antoni Gual
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - David Hammond
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Will Lawn
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
- Addictions Department, Institute of Psychiatry, Psychology & NeuroscienceKings College LondonLondonUK
| | - Hugo López‐Pelayo
- Psychiatry DepartmentNeurosciences Institute, Hospital Clínic, IDIBAPS, RTABarcelonaSpain
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Rosalie Liccardo Pacula
- USC Sol Price School of Public PolicyUSC Leonard D. Schaeffer Center for Health Policy & EconomicsLos AngelesCAUSA
| | | | - Ryan Vandrey
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Elle Wadsworth
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
| | - Adam Winstock
- Behavioural Science and Health Institute of Epidemiology and HealthUniversity College LondonLondonUK
- Global Drug SurveyLondonUK
| | - Wayne Hall
- National Addiction Centre, King's College LondonLondonUK
- National Centre for Youth Substance Use ResearchThe University of QueenslandBrisbaneAustralia
| | - H. Valerie Curran
- Clinical Psychopharmacology Unit (CPU)University College LondonLondonUK
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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Abstract
Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.
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Affiliation(s)
- Deepika E Slawek
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Susanna A Curtis
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrSusieC2
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrArnsten
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrChinazo
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Schlag AK, Hindocha C, Zafar R, Nutt DJ, Curran HV. Cannabis based medicines and cannabis dependence: A critical review of issues and evidence. J Psychopharmacol 2021; 35:773-785. [PMID: 33593117 PMCID: PMC8278552 DOI: 10.1177/0269881120986393] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, pharmacokinetics and route of administration, frequency of use, as well as set and setting. Medical and recreational cannabis use differs in significant ways, highlighting the challenges of extrapolating findings from the recreational cannabis literature. There are many questions about the potential for medical cannabis use to lead to dependence. It is therefore imperative to address these questions in order to be able to minimise harms of medical cannabis use. We draw out seven recommendations for increasing the safety of medical cannabis prescribing. We hope that the present review contributes to answering some of the key questions surrounding medical cannabis dependence.
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Affiliation(s)
- Anne K Schlag
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
| | - Rayyan Zafar
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - David J Nutt
- Drug Science, St Peter’s House, London, UK
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
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Craft S, Winstock A, Ferris J, Mackie C, Lynskey MT, Freeman TP. Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence. Psychol Med 2020; 50:2364-2373. [PMID: 31607281 DOI: 10.1017/s0033291719002460] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. METHODS Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). RESULTS LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. CONCLUSIONS The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.
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Affiliation(s)
- Sam Craft
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Winstock
- University College London, London, UK
- Global Drug Survey Ltd, London, UK
| | - Jason Ferris
- Centre for Health Services Research, University of Queensland, QLD, Australia
| | - Clare Mackie
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael T Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom P Freeman
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients. J Psychosom Res 2020; 135:110130. [PMID: 32417435 DOI: 10.1016/j.jpsychores.2020.110130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown. METHODS This cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1-10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors. RESULTS Individuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05-4.01, and AOR = 5.95,95% CI = 1.97-17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01-4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures. CONCLUSIONS Depression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.
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Freeman TP, Lorenzetti V. 'Standard THC units': a proposal to standardize dose across all cannabis products and methods of administration. Addiction 2020; 115:1207-1216. [PMID: 31606008 DOI: 10.1111/add.14842] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/18/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Cannabis products are becoming increasingly diverse, and vary considerably in concentrations of ∆9 -tetrahydrocannabinol (THC) and cannabidiol (CBD). Higher doses of THC can increase the risk of harm from cannabis, while CBD may partially offset some of these effects. Lower Risk Cannabis Use Guidelines currently lack recommendations based on quantity of use, and could be improved by implementing standard units. However, there is currently no consensus on how units should be measured or standardized among different cannabis products or methods of administration. ARGUMENT Existing proposals for standard cannabis units have been based on specific methods of administration (e.g. joints) and these may not capture other methods, including pipes, bongs, blunts, dabbing, vaporizers, vape pens, edibles and liquids. Other proposals (e.g. grams of cannabis) cannot account for heterogeneity in THC concentrations among different cannabis products. Similar to alcohol units, we argue that standard cannabis units should reflect the quantity of primary active pharmacological constituents (dose of THC). On the basis of experimental and ecological data, public health considerations and existing policy, we propose that a 'standard THC unit' should be fixed at 5 mg THC for all cannabis products and methods of administration. If supported by sufficient evidence in future, consumption of standard CBD units might offer an additional strategy for harm reduction. CONCLUSIONS Standard ∆9 -tetrahydrocannabinol (THC) units can potentially be applied among all cannabis products and methods of administration to guide consumers and promote safer patterns of use.
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Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.,National Addiction Centre, King's College London, London,, UK.,Clinical Psychopharmacology Unit, University College London, London, UK
| | - Valentina Lorenzetti
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
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12
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Dellazizzo L, Potvin S, Dou BY, Beaudoin M, Luigi M, Giguère CÉ, Dumais A. Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation. Am J Psychiatry 2020; 177:619-626. [PMID: 32456503 DOI: 10.1176/appi.ajp.2020.19101008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to investigate the extent to which cannabis use among youths is associated with the risk of perpetrating physical violence. METHODS Searches were conducted in PubMed, PsycINFO, Web of Science, and Google Scholar for articles published from the inception of each database to July 2019. All studies that examined both cannabis use and the perpetration of physical violence in a sample of youths and young adults <30 years old were included. The meta-analysis was performed with a random-effects model. Risk of publication bias was assessed with Egger's test. Guidelines from the Meta-Analysis of Observational Studies in Epidemiology were followed. RESULTS After screening 11,348 potential studies, 30 study arms were included, yielding a total of 296,815 adolescents and young adults. The odds ratio for the pooled studies was 2.11 (95% CI=1.64, 2.72). The pooled odds ratios were 2.15 (95% CI=1.58, 2.94) and 2.02 (95% CI=1.26, 3.23) for the cross-sectional and longitudinal studies, respectively. Preliminary evidence suggests that the risk of violence was higher for persistent heavy users (odds ratio=2.81, 95% CI=1.68, 4.74) compared with past-year users (odds ratio=2.05, 95% CI=1.5, 2.8) and lifetime users (odds ratio=1.94, 95% CI=1.29, 2.93). The odds ratio for unadjusted studies was 2.62 (95% CI=1.89, 3.62), and for studies using odds ratios adjusted for potential confounding factors, 2.01 (95% CI=1.57, 2.56). CONCLUSIONS These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.
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Affiliation(s)
- Laura Dellazizzo
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Stéphane Potvin
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Bo Yi Dou
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Mélissa Beaudoin
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Mimosa Luigi
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Charles-Édouard Giguère
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
| | - Alexandre Dumais
- Research Center, Montreal University Institute of Mental Health, Montreal (Dellazizzo, Potvin, Dou, Beaudoin, Luigi, Giguère, Dumais); Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal (Dellazizzo, Potvin, Beaudoin, Luigi, Dumais); Faculty of Medicine, University of Montreal (Dou [medical student]); and Philippe-Pinel National Institute of Legal Psychiatry, Montreal (Dumais)
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13
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Biasutti WR, Leffers KSH, Callaghan RC. Systematic Review of Cannabis Use and Risk of Occupational Injury. Subst Use Misuse 2020; 55:1733-1745. [PMID: 32441179 DOI: 10.1080/10826084.2020.1759643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aim: A range of nations, including countries of the European Union, Australia, and the Americas have recently implemented or proposed reforms to how they control cannabis use, thereby departing from traditional approaches of criminal prohibition that have dominated throughout most of the twentieth century. Given these policy developments and the widespread global use of cannabis, it is critically important to understand the possible risks associated with cannabis use in relation to major societal harms. Methods: This systematic review investigates the potential link between cannabis use and occupational injury. Consequently, it appraises all available current literature from five databases, following Cochrane and PRISMA guidelines. Results: Seven of the 16 reviewed studies show evidence supporting a positive association between cannabis use and occupational injury. One study shows evidence supporting a negative association and the remaining eight studies show no evidence of a significant relation. None of the studies assessed cannabis-related impairment. Only three of the reviewed studies show clear evidence that cannabis use preceded the occupational-injury event. Conclusion: The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury. Further, the study quality assessment suggests significant biases in the extant literature are present due to potential confounding variables, selection of participants, and measurement of exposures and outcomes. Future high-quality evidence will be needed to elucidate the relation between cannabis use and occupational injury.
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Affiliation(s)
- Wade R Biasutti
- Northern Medical Program, University of British Columbia, Prince George, British Columbia
| | - Kurt S H Leffers
- Northern Medical Program, University of British Columbia, Prince George, British Columbia
| | - Russell C Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia; Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, British Columbia, Canada
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14
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Dellazizzo L, Potvin S, Athanassiou M, Dumais A. Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis. Front Psychiatry 2020; 11:567887. [PMID: 33192691 PMCID: PMC7525024 DOI: 10.3389/fpsyt.2020.567887] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
There has been a shift surrounding societal and legal perspectives on cannabis reflecting changing public attitudes towards the perceived safety and social acceptability of cannabis use. With cannabis liberalization internationally, the focus of most cannabis-related harms has been on effects with users themselves. Harm-to-others including injuries from violence have nevertheless been unfortunately largely overlooked. While studies remain heterogeneous, there is meta-analytical evidence pointing towards an association. The aims of this focused review are two-fold: (I) review the evidence from meta-analyses on the association between cannabis and violence; and (II) provide an overview of possible mechanisms relating cannabis use to violence. First, evidence from meta-analytical studies in youths, intimate partners, and individuals with severe mental disorders have shown that there is a global moderate association between cannabis use and violence, which is stronger in the latter more at-risk population. Preliminary data has even highlighted a potential dose-response relationship with larger effects in more frequent users. Although of importance, this subject has remained essentially forgotten as a public health concern. While literature remains inconclusive, data has suggested potential increases in cannabis use following liberalization policies. This may increase violent outcomes if the effect is directly related to the use of cannabis by means of its psychophysiological modifications. However, for the moment, the mechanisms associating cannabis use and violence remain to be clearly resolved. Considering the recency of policy changes on cannabis, further methodologically sound research using longitudinal designs should examine the effects that cannabis use may have on different forms of violence and the trends that emerge, while evaluating the effects of possible confounding factors (e.g. other substance use). In addition, as evidence-based research from meta-analyses have shown that cannabis use is associated with violence, measures must be taken to mitigate the risks.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Maria Athanassiou
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Institut national de psychiatrie légale Philippe-Pinel, Montreal, QC, Canada
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15
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Callaghan RC, Sanches M, Benny C, Stockwell T, Sherk A, Kish SJ. Who consumes most of the cannabis in Canada? Profiles of cannabis consumption by quantity. Drug Alcohol Depend 2019; 205:107587. [PMID: 31600617 DOI: 10.1016/j.drugalcdep.2019.107587] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 10/25/2022]
Abstract
AIM To establish whether the population-level pattern of cannabis use by quantity is similar to the distributions previously reported for alcohol, in which a small subset of drinkers accounts for a majority of total population alcohol consumption. METHOD The current study pooled Waves 1-3 of the 2018 National Cannabis Survey (n = 18,900; 2584 past-three-month cannabis users), a set of stratified, population-based surveys designed to assess cannabis consumption and related behaviors in Canada. Each survey systematically measured self-reported cannabis consumption by quantity across seven of the major cannabis-product types. In order to enable the conversion of self-reported consumption of non-flower cannabis products into a standard joint equivalent (SJE: equal to 0.5 g of dried cannabis), we created conversion metrics for physical production equivalencies across cannabis products. RESULTS Similar to the findings in the alcohol literature, study results show that cannabis consumption is highly concentrated in a small subset of users: the upper 10% of cannabis users accounted for approximately two-thirds of all cannabis consumed in the country. Males reported consuming more cannabis by volume than females (approximately 60% versus 40%), with young males (15-34 years old) being disproportionately represented in the heaviest-using subgroups. CONCLUSIONS Most of the cannabis used in Canada is consumed by a relatively small population of very heavy cannabis users. Future research should attempt to identify the characteristics of the heaviest-using groups, as well as how population-level cannabis consumption patterns relate to the calculus of cannabis-related harms in society.
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Affiliation(s)
- Russell C Callaghan
- University of Northern British Columbia, Northern Medical Program, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada; Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada.
| | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Biostatistical Consulting Unit, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Claire Benny
- University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Tim Stockwell
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada
| | - Adam Sherk
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Avenue, Victoria, British Columbia, V8N 5M8, Canada
| | - Stephen J Kish
- Centre for Addiction and Mental Health (CAMH), Human Brain Laboratory, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
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16
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Seidel AK, Pedersen A, Hanewinkel R, Morgenstern M. Cessation of cannabis use: A retrospective cohort study. Psychiatry Res 2019; 279:40-46. [PMID: 31295646 DOI: 10.1016/j.psychres.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
Given recent findings of a worldwide increase in cannabis use, a better understanding of the factors associated with cannabis use is needed. Most previous studies have focused on factors that predict the initiation of cannabis use, but less is known about factors associated with cessation. The present study is a retrospective cohort study of 6467 current or former cannabis users aged 15 to 46 years (mean age 22.5, SD = 4.8). Data were collected via an online survey advertised in social media. All analyzed participants had used cannabis for at least three years. Approximately 16.3% (n = 1055) of the sample population had not used cannabis in the previous 12 months and were classified as quitters; all others (83.7%, n = 5412) reported at least monthly use. Cessation was predicted by older current age, being female, nonmigrant status, less sensation seeking, using psychological treatment, more peer cannabis use during youth and more negative first experience with cannabis. An additional predictor was a nonincrease in the frequency of cannabis use in the first three years of use, indicating that trajectories of cannabis use are set early on and might be used to identify risk groups for early preventive measures.
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Affiliation(s)
- Ann-Kathrin Seidel
- Institute for Therapy and Health Research, Harmsstr. 2, D-24114 Kiel, Germany.
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Germany
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research, Harmsstr. 2, D-24114 Kiel, Germany
| | - Matthis Morgenstern
- Institute for Therapy and Health Research, Harmsstr. 2, D-24114 Kiel, Germany
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17
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Unpacking the Longitudinal Associations between the Frequency of Substance Use, Substance Use Related Problems, and Academic Achievement among Adolescents. J Youth Adolesc 2019; 48:1327-1341. [PMID: 31124037 DOI: 10.1007/s10964-019-01038-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/10/2019] [Indexed: 02/07/2023]
Abstract
Previous research repeatedly observed associations between academic achievement and substance use during adolescence. However, the simple frequency of substance use was not differentiated from the emergence of substance use related problems, such as abuse and dependence. This study presents autoregressive cross-lagged models describing inter-relations between academic achievement, frequency of substance use, and substance use related problems among a sample of 1034 seventh graders (46% female; 83% White North Americans; Mage = 12.64 years, SDage = 0.65) who participated in a four-year longitudinal study. The stability of measurement structure of frequency of substance use and substance use related problems was supported. Higher frequency of substance use and substance use related problems did not predict lower academic achievement. A higher academic achievement predicted a later increase in frequency of substance use and substance use related problems in boys, whereas a higher academic achievement predicted a lower frequency of substance use in girls. Although substance use related problems were mainly predicted by frequency of substance use, substance use can remain, nonetheless, non-problematic during adolescence.
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18
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Dellazizzo L, Potvin S, Beaudoin M, Luigi M, Dou BY, Giguère CÉ, Dumais A. Cannabis use and violence in patients with severe mental illnesses: A meta-analytical investigation. Psychiatry Res 2019; 274:42-48. [PMID: 30780061 DOI: 10.1016/j.psychres.2019.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Mélissa Beaudoin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Mimosa Luigi
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Bo Yi Dou
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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19
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Karlsson P, Ekendahl M, Månsson J, Raninen J. Has illicit drug use become normalised in groups of Swedish youth? A latent class analysis of school survey data from 2012 to 2015. NORDIC STUDIES ON ALCOHOL AND DRUGS 2019; 36:21-35. [PMID: 32934547 PMCID: PMC7434166 DOI: 10.1177/1455072518814306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/18/2018] [Indexed: 12/02/2022] Open
Abstract
Background: It is often assumed that illicit drug use has become normalised in the
Western world, as evidenced for example by increased prevalence rates and
drug-liberal notions in both socially advantaged and disadvantaged youth
populations. There is accumulating research on the characteristics of young
illicit drug users from high-prevalence countries, but less is known about
the users in countries where use is less common. There is reason to assume
that drug users in low-prevalence countries may be more disadvantaged than
their counterparts in high-prevalence countries, and that the normalisation
thesis perhaps does not apply to the former context. Aim: This article aims to explore to what extent such assertions hold true by
studying the characteristics of young illicit drug users in Sweden, where
prevalence is low and drug policy centres on zero tolerance. Material and Method: We draw on a subsample (n = 3374) of lifetime users of
illicit drugs from four waves of a nationally representative sample of
students in 9th and 11th grade (2012–2015). Latent class analysis (LCA) on
ten indicators pertaining to illicit drug use identified four classes which
we termed “Marijuana testers”, “Marijuana users”, “Cannabinoid users” and
“Polydrug users”. Findings: Indications of social advantage/disadvantage such as peer drug use, early
substance-use debut and truancy varied across groups, particularly between
“Marijuana testers” (low scores) and “Polydrug users” (high scores). Conclusions: Our findings corroborate the idea that the majority of those who have used
illicit drugs in the Swedish youth population have tried marijuana a few
times only. We discuss whether or not the comparably large share of socially
advantaged “Marijuana testers” in a comparably small sample of lifetime
users can be interpreted as a sort of normalisation in a prohibitionist drug
policy context.
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Affiliation(s)
| | | | | | - Jonas Raninen
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden
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20
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Hirst RB, Watson J, S Rosen A, Quittner Z. Perceptions of the cognitive effects of cannabis use: A survey of neuropsychologists' beliefs. J Clin Exp Neuropsychol 2018; 41:133-146. [PMID: 30124369 DOI: 10.1080/13803395.2018.1503644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Research evaluating the neuropsychological effects of cannabis has yielded mixed findings, with some studies finding cognitive deficits in cannabis users (primarily in learning and memory) and others finding no significant effects. It is important to understand how clinicians perceive this discrepancy in the empirical literature. However, no studies have assessed neuropsychologists' beliefs regarding the effects of cannabis on cognitive functioning. Thus, this study sought to evaluate how patient and cannabis-use factors influence neuropsychologists' perceptions of cannabis's cognitive effects. Method: Neuropsychologists (N = 261) read eight vignettes, each depicting cannabis users varying in age, gender, and cannabis-use history (frequency, duration, and recreational/medicinal use). Respondents rated the anticipated effects of cannabis in each vignette on nine cognitive domains. Mixed effects linear regression modeled the ratings of cognitive abilities as a function of neuropsychologist, neuropsychologists' training, vignette, patient age, gender, and frequency/duration/type of cannabis use, and treated neuropsychologist and vignette as random effects. Results: Duration of use had the most notable effect on neuropsychologists' ratings, with a small (0.1 to 0.2 SDs) yet statistically significant (p < .001) negative effect on each cognitive domain. Male gender and medicinal use also predicted lower cognitive ratings. Differences in ratings between neuropsychologists accounted for 73% of the total variability in each domain, whereas variability due to vignette alone was negligible (<1%). Conclusions: Results suggest that neuropsychologists believe that cannabis use results in broad but mild cognitive deficits, consistent with meta-analytic findings of active chronic cannabis users, particularly for males and for individuals using cannabis for medicinal purposes. Interestingly, neuropsychologists expected fewer cognitive effects in recreational cannabis users. Further, duration of use (rather than frequency) was believed to be the primary factor contributing to cognitive deficits.
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Affiliation(s)
- Rayna B Hirst
- a Department of Psychology , Palo Alto University , Palo Alto , CA , USA
| | - Jessica Watson
- a Department of Psychology , Palo Alto University , Palo Alto , CA , USA
| | - Alexis S Rosen
- a Department of Psychology , Palo Alto University , Palo Alto , CA , USA
| | - Zoe Quittner
- a Department of Psychology , Palo Alto University , Palo Alto , CA , USA
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21
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Zhand N, Milin R. What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review. Am J Addict 2018; 27:453-464. [PMID: 30113101 DOI: 10.1111/ajad.12783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbance is one of the hallmarks of cannabis withdrawal. Studies have indicated that treatment of this key symptom may facilitate abstinence. In the present paper we aim to provide a systematic review of the extant literature on pharmacological management of sleep disturbance associated with cannabis withdrawal. METHOD We conducted a systematic literature search across five electronic databases including PubMed, Psycinfo, MEDLINE, Cochrane review and Embase. Human studies using a pharmacological treatment for sleep disturbances associated with cannabis withdrawal were included. Review articles, case-series, open trials, posters, and editorials were excluded. RESULTS Seventeen publications, involving 562 participants, were included in this review. Major limitations involved small sample size, high dropout rate, methodological limitations, and heterogeneity of participants. Most of the studies were at high risk of bias, further downgrading the level of evidence. A meta-analysis was not performed due to lack of quantitative data, marked heterogeneity and low quality of the included studies. CONCLUSION There is not sufficient evidence for any of the reviewed treatment options. Methodological limitations in a majority of the studies rendered their findings preliminary. Of the twelve investigated pharmacological agents, Gabapentin, Lofexidine, Mirtazapine, Quetiapine, and Zolpidem showed some primary benefits for treatment of sleep difficulties associated with cannabis withdrawal; however, future prospective studies are required to confirm such results. SCIENTIFIC SIGNIFICANCE This review examines the current evidence for potential pharmacological options for treatment of cannabis withdrawal and associated sleep disturbance. It furthers our knowledge and provides groundwork for future research. (Am J Addict 2018;27:453-464).
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Affiliation(s)
- Naista Zhand
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Robert Milin
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Head, Division of Addiction and Mental Health, Department of Psychiatry, University of Ottawa, Ontario, Canada
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22
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Abstract
State-level marijuana liberalization policies have been evolving for the past five decades, and yet the overall scientific evidence of the impact of these policies is widely believed to be inconclusive. In this review we summarize some of the key limitations of the studies evaluating the effects of decriminalization and medical marijuana laws on marijuana use, highlighting their inconsistencies in terms of the heterogeneity of policies, the timing of the evaluations, and the measures of use being considered. We suggest that the heterogeneity in the responsiveness of different populations to particular laws is important for interpreting the mixed findings from the literature, and we highlight the limitations of the existing literature in providing clear insights into the probable effects of marijuana legalization.
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Affiliation(s)
- Rosalie Liccardo Pacula
- RAND Corporation, Santa Monica, California 90407; , .,National Bureau of Economic Research, Cambridge, Massachusetts 02138
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23
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Hindocha C, Freeman TP, Curran HV. Anatomy of a Joint: Comparing Self-Reported and Actual Dose of Cannabis and Tobacco in a Joint, and How These Are Influenced by Controlled Acute Administration. Cannabis Cannabinoid Res 2017; 2:217-223. [PMID: 29082319 PMCID: PMC5628568 DOI: 10.1089/can.2017.0024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: Major gaps exist in the measurement of cannabis exposure. The accuracy of self-reported cannabis and tobacco dose per joint is poorly characterized and has never been investigated following acute cannabis/tobacco exposure. Using an innovative "Roll a Joint" paradigm, this study aims to (1) compare estimated and actual dose of cannabis and tobacco per joint at baseline and (2) examine the acute effects of cannabis and/or tobacco on estimated and actual dose. Materials and Methods: We investigated this by using a randomized, double-blind, placebo-controlled crossover 2 (active cannabis, placebo cannabis)×2 (active tobacco, placebo tobacco) design in a laboratory setting. Participants were 24 recreational cousers of cannabis and tobacco. At baseline, they were asked to measure out the amount of cannabis and tobacco they would put in an average joint for themselves (dose per joint). Then, on each of four drug administration sessions, participants were again asked to do this for a joint they would want to smoke "right now." Self-reported and actual amount was recorded (g). Results: At baseline, the estimated amount of cannabis per joint (0.28±0.23 g) was double the actual amount (0.14±0.12 g) (p=0.003, d=0.723). No difference emerged between estimated (0.43±0.25 g) and actual (0.35±0.15 g) (p=0.125) amount of tobacco per joint. Compared to placebo, active cannabis reduced the actual dose of both cannabis (p=0.035) and tobacco (p<0.001) they put in a joint. Participants accurately estimated this reduction for tobacco (p=0.014), but not for cannabis (p=0.680). Conclusions: Self-reported dose per joint is accurate for tobacco but dramatically overestimates cannabis exposure and therefore should be viewed with caution. Cannabis administration reduced the amount of cannabis and tobacco added to joints, suggesting a reduction in dose during a smoking session. The "Roll A Joint" paradigm should be implemented for better accuracy in assessing dose per joint.
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Affiliation(s)
- Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
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Patte KA, Qian W, Leatherdale ST. Marijuana and Alcohol Use as Predictors of Academic Achievement: A Longitudinal Analysis Among Youth in the COMPASS Study. THE JOURNAL OF SCHOOL HEALTH 2017; 87:310-318. [PMID: 28382670 DOI: 10.1111/josh.12498] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/13/2016] [Accepted: 01/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND We tested the effect of initiating marijuana and alcohol use at varying frequencies on academic indices. METHODS In a sample of 26,475 grade 9-12 students with at least 2 years of linked longitudinal data from year 1 (Y1: 2012-2013), year 2 (Y2: 2013-2014), and year 3 (Y3: 2014-2015) of the COMPASS study, separate multinomial generalized estimating equations models tested the likelihood of responses to measures of academic goals, engagement, preparedness, and performance when shifting from never using alcohol or marijuana at baseline to using them at varying frequencies at follow -up. RESULTS Students who began using alcohol or marijuana were less likely to attend class regularly, complete their homework, achieve high marks, and value good grades, relative to their abstaining peers. Changing from abstaining to rare/sporadic-to-weekly drinking or rare/sporadic marijuana use predicted aspirations to continue to all levels of higher education, and initiating weekly marijuana use increased the likelihood of college ambitions, while more regular marijuana use reduced the likelihood of wanting to pursue graduate/professional degrees, over high school. CONCLUSIONS The importance of delaying or preventing substance use is evident in associations with student performance and engagement. The influence on academic goals varied by substance and frequency of initiated use.
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Affiliation(s)
- Karen A Patte
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, LHS 1628, Waterloo, ON N2L 3G1, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, LHS 1618C, Waterloo, ON N2L 3G1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, LHS 1617, Waterloo, ON N2L 3G1, Canada
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Cannabis use and Drug Related Problems among Adolescents in 27 European Countries: The Utility of the Prevention Paradox. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/nsad-2014-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims To study the prevalence of cannabis use and drug-related problems among European adolescents and the utility of the prevention paradox. Methods Survey data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007 in the 27 countries with information about drug use and drug-related problems was used. We analysed the proportion of all drug-related problems that occurred in a high risk group and among others who had used cannabis in the previous 12 months. The cut-off for the high risk group was chosen to include 10-15 % of the most frequent cannabis users. Results The high risk groups accounted for a substantial, but a minority, of drug-related problems among boys as well as girls. A minority of those who had used cannabis reported any drug-related problem. The proportion of adolescents with drug-related problems and the average number of problems increased with frequency of cannabis use. Conclusions We find support for policy measures of more general character, supported by the prevention paradox. However, this does not exclude a policy supporting frequent drug users if they can be identified
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Anthony JC, Lopez-Quintero C, Alshaarawy O. Cannabis Epidemiology: A Selective Review. Curr Pharm Des 2017; 22:6340-6352. [PMID: 27526792 PMCID: PMC5296933 DOI: 10.2174/1381612822666160813214023] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/15/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Globally, the most widely used set of compounds among the internationally regulated drugs is cannabis. OBJECTIVE To review evidence from epidemiological research on cannabis, organized in relation to this field's five main rubrics: quantity, location, causes, mechanisms, and prevention/ control. METHOD The review covers a selection of evidence from standardized population surveys, official statistics, and governmental reports, as well as published articles and books identified via MEDLINE, Web of Science, and Google Scholar as of July 2016. RESULTS In relation to quantity, an estimated 3% to 5% of the world population is thought to have tried a cannabis product, with at least one fairly recent use, mainly extra-medical and outside boundaries of prescribed use. Among cannabis users in the United States, roughly one in 7-8 has engaged in medical marijuana use. In relation to location, prevalence proportions reveal important variations across countries and between subgroups within countries. Regarding causes and mechanisms of starting to use cannabis, there is no compelling integrative and replicable conceptual model or theoretical formulation. Most studies of mechanisms have focused upon a 'gateway sequence' and person-to-person diffusion, with some recent work on disability-adjusted life years. A brief review of cannabis use consequences, as well as prevention and control strategies is also provided. CONCLUSION At present, we know much about the frequency and occurrence of cannabis use, with too little replicable definitive evidence with respect to the other main rubrics. Given a changing regulatory environment for cannabis products, new institutions such as an independent International Cannabis Products Safety Commission may be required to produce evidence required to weigh benefits versus costs. It is not clear that governmentsponsored research will be sufficient to meet consumer demand for balanced points of view and truly definitive evidence.
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Affiliation(s)
- James C. Anthony
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
| | - Catalina Lopez-Quintero
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
- Substance Use and HIV Neuropsychology (SUHN) Lab, Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, 33199, USA
| | - Omayma Alshaarawy
- Department of Epidemiology & Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
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Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJA, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016; 17:293-306. [PMID: 27052382 DOI: 10.1038/nrn.2016.28] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In an increasing number of states and countries, cannabis now stands poised to join alcohol and tobacco as a legal drug. Quantifying the relative adverse and beneficial effects of cannabis and its constituent cannabinoids should therefore be prioritized. Whereas newspaper headlines have focused on links between cannabis and psychosis, less attention has been paid to the much more common problem of cannabis addiction. Certain cognitive changes have also been attributed to cannabis use, although their causality and longevity are fiercely debated. Identifying why some individuals are more vulnerable than others to the adverse effects of cannabis is now of paramount importance to public health. Here, we review the current state of knowledge about such vulnerability factors, the variations in types of cannabis, and the relationship between these and cognition and addiction.
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Affiliation(s)
- H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - David A Lewis
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213, USA
| | - Celia J A Morgan
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK.,Psychopharmacology and Addiction Research Centre, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - Loren H Parsons
- The Scripps Research Institute, 10550 N. Torrey Pines Road, SP30-2001, La Jolla, California 92037, USA
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Abstract
Risk perception has been shown to be protective with regard to marijuana use. Notably, the risk perception of marijuana in individuals with substance abuse problems varies significantly from that of the general public. Understanding how risk perception is formed in substance users could explain these differences and help predict the consequences of policy changes. Using this framework, we explored risk perception and its formation in a sample of substance abusing veterans. Semi-structured interviews were conducted with veterans who were receiving treatment for substance abuse. Interviews were recorded digitally, transcribed verbatim, and analyzed using inductive thematic analysis. A prominent perspective among the 31 participants was that marijuana is significantly different from other drugs because it is safe, not addictive, not associated with physical withdrawal, and has less overt behavioral effects than other substances. Many of these participants drew upon their own innocuous experiences with the drug in developing this perspective, more so than information from any other source. A contrasting narrative emphasized marijuana's capacity to cause negative social consequences, act as a gateway to the use of other, more harmful substances, and cause paranoia or worsen psychosis. In conclusion, individual experience with marijuana featured more prominently in informing risk perception than any other source of information. Our results and previous literature suggest that the significant disconnect between the individual experiences of substance users and the current clinical and legal policy towards marijuana may weaken the legitimacy of public policy or the authority of the medical community.
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Mokrysz C, Landy R, Gage SH, Munafò MR, Roiser JP, Curran HV. Are IQ and educational outcomes in teenagers related to their cannabis use? A prospective cohort study. J Psychopharmacol 2016; 30:159-68. [PMID: 26739345 PMCID: PMC4724860 DOI: 10.1177/0269881115622241] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
There is much debate about the impact of adolescent cannabis use on intellectual and educational outcomes. We investigated associations between adolescent cannabis use and IQ and educational attainment in a sample of 2235 teenagers from the Avon Longitudinal Study of Parents and Children. By the age of 15, 24% reported having tried cannabis at least once. A series of nested linear regressions was employed, adjusted hierarchically by pre-exposure ability and potential confounds (e.g. cigarette and alcohol use, childhood mental-health symptoms and behavioural problems), to test the relationships between cumulative cannabis use and IQ at the age of 15 and educational performance at the age of 16. After full adjustment, those who had used cannabis ⩾ 50 times did not differ from never-users on either IQ or educational performance. Adjusting for group differences in cigarette smoking dramatically attenuated the associations between cannabis use and both outcomes, and further analyses demonstrated robust associations between cigarette use and educational outcomes, even with cannabis users excluded. These findings suggest that adolescent cannabis use is not associated with IQ or educational performance once adjustment is made for potential confounds, in particular adolescent cigarette use. Modest cannabis use in teenagers may have less cognitive impact than epidemiological surveys of older cohorts have previously suggested.
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Affiliation(s)
- C Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - R Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - SH Gage
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - MR Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - JP Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - HV Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
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30
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Monaghan M, Hamilton I, Lloyd C, Paton K. Cannabis matters? Treatment responses to increasing cannabis presentations in addiction services in England. DRUGS: EDUCATION, PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1090398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Associations of adolescent cannabis use with academic performance and mental health: A longitudinal study of upper middle class youth. Drug Alcohol Depend 2015; 156:207-212. [PMID: 26409752 PMCID: PMC4633365 DOI: 10.1016/j.drugalcdep.2015.09.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a hypothesis that low socioeconomic status (SES) may explain the link between cannabis use and poorer academic performance and mental health. A key question, therefore, is whether adolescent cannabis use is associated with poorer academic performance and mental health in high SES communities where there is reduced potential for confounding. METHODS Youth (n=254) from an upper middle class community were followed prospectively through the four years of high school (from age 14/15 to age 17/18). Past-year frequency of cannabis use was assessed annually. Official school records of academic performance and self-reported mental health symptoms (externalizing and internalizing symptoms) were assessed in grades 9 and 12. RESULTS Persistent cannabis use across the four years of high school was associated with lower grade-point average (β=-0.18, p=.006), lower Scholastic Aptitude Test (SAT) score (β=-0.13, p=.038), and greater externalizing symptoms (β=0.29, p<.001) in 12th grade, but not with greater internalizing symptoms (β=0.04, p=.53). Moreover, persistent cannabis use was associated with lower grade-point average (β=-0.13, p=.014) and greater externalizing symptoms (β=0.24, p=.002) in 12th grade, even after controlling for 9th grade levels of these outcomes. Similar associations were observed for persistent alcohol and tobacco use. Effects for persistent cannabis use became non-significant after controlling for persistent alcohol and tobacco use, reflecting the difficulties of disentangling effects of cannabis from effects of alcohol and tobacco. CONCLUSIONS Low SES cannot fully explain associations between cannabis use and poorer academic performance and mental health.
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Maggs JL, Staff J, Kloska DD, Patrick ME, O’Malley PM, Schulenberg J. Predicting Young Adult Degree Attainment by Late Adolescent Marijuana Use. J Adolesc Health 2015; 57. [PMID: 26206441 PMCID: PMC4514914 DOI: 10.1016/j.jadohealth.2015.04.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess whether infrequent and frequent marijuana use at age 19/20 years predicts receipt of educational degrees by the mid-20s, independent of confounding age 18 adolescent risk factors. METHODS Data were from the Monitoring the Future study, an annual nationally representative survey of high school seniors followed into adulthood. Thirteen cohorts (1990-2002) of high school seniors were followed longitudinally to their mid-20s (n = 4,925; 54% female). We used logistic regression and propensity score matching with successive inclusion of age 18 risk factors and substance use to compare age 19/20 frequent marijuana users (six or more occasions in past 30 days) to nonusers, frequent users to infrequent users (1-6 occasions), and infrequent users to nonusers on their likelihood of degree attainment by the mid-20s. RESULTS Frequent marijuana users were less likely than infrequent users and nonusers to earn bachelor's degrees, even after controlling for a host of age 18 risk factors (e.g., family socioeconomic background, academic performance, educational expectations, truancy). However, these differences were reduced in magnitude to statistical nonsignificance when we controlled for age 18 substance use. Across analyses, the proportion reaching this educational milestone did not differ significantly between infrequent users and nonusers. CONCLUSIONS Results support a growing body of work suggesting that frequent marijuana use predicts a lower likelihood of postsecondary educational attainment, and this difference may originate during secondary school.
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Affiliation(s)
- Jennifer L. Maggs
- Human Development and Family Studies 315 HHDev East, Pennsylvania State University, University Park, PA 16802, USA, 815.865.2028
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - Jeremy Staff
- Department of Sociology and Criminology 211 Oswald, Pennsylvania State University, University Park, PA 16802, USA
| | - Deborah D. Kloska
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - Patrick M. O’Malley
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
| | - John Schulenberg
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48106-1248, USA
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Ansell EB, Laws HB, Roche MJ, Sinha R. Effects of marijuana use on impulsivity and hostility in daily life. Drug Alcohol Depend 2015; 148:136-42. [PMID: 25595054 PMCID: PMC4330120 DOI: 10.1016/j.drugalcdep.2014.12.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Marijuana use is increasingly prevalent among young adults. While research has found adverse effects associated with marijuana use within experimentally controlled laboratory settings, it is unclear how recreational marijuana use affects day-to-day experiences in users. The present study sought to examine the effects of marijuana use on within-person changes in impulsivity and interpersonal hostility in daily life using smartphone administered assessments. METHODS Forty-three participants with no substance dependence reported on their alcohol consumption, tobacco use, recreational marijuana use, impulsivity, and interpersonal hostility over the course of 14 days. Responses were analyzed using multilevel modeling. RESULTS Marijuana use was associated with increased impulsivity on the same day and the following day relative to days when marijuana was not used, independent of alcohol use. Marijuana was also associated with increased hostile behaviors and perceptions of hostility in others on the same day when compared to days when marijuana was not used. These effects were independent of frequency of marijuana use or alcohol use. There were no significant effects of alcohol consumption on impulsivity or interpersonal hostility. CONCLUSIONS Marijuana use is associated with changes in impulse control and hostility in daily life. This may be one route by which deleterious effects of marijuana are observed for mental health and psychosocial functioning. Given the increasing prevalence of recreational marijuana use and the potential legalization in some states, further research on the potential consequences of marijuana use in young adults' day-to-day life is warranted.
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Affiliation(s)
- Emily B. Ansell
- Department of Psychiatry, Yale University School of Medicine, 2 Church St. South, Suite 209, New Haven, CT 06519
| | - Holly B. Laws
- Department of Psychiatry, Yale University School of Medicine, 2 Church St. South, Suite 209, New Haven, CT 06519
| | - Michael J. Roche
- Department of Psychology, The Pennsylvania State University, 140 Moore Building, University Park, PA 16802
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, 2 Church St. South, Suite 209, New Haven, CT 06519
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Three-Year Course of Cannabis Dependence and Prediction of Persistence. Eur Addict Res 2015; 21:279-90. [PMID: 26044258 DOI: 10.1159/000377625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
Abstract
AIMS To examine the course and the predictors of the persistence of cannabis dependence. METHODS Through cannabis outlets and chain referral, a prospective enriched community cohort of 207 young adults (aged 18-30) with DSM-IV cannabis dependence at baseline (T0) was formed and followed-up after 1.5 (T1) and 3 (T2) years. The presence of cannabis dependence, cannabis-related problems, functional impairment and treatment was assessed using the Composite International Diagnostic Interview (CIDI 3.0) and the Sheehan Disability Scale (SDS). Predictors of persistence were lifetime cannabis abuse and dependence symptoms, cannabis use characteristics, distant vulnerability factors (e.g. childhood adversity, family history of psychological/substance use problems, impulsivity, mental disorders), and proximal stress factors (recent life events, social support). RESULTS Four groups were distinguished: persistent dependent (DDD: 28.0%), stable non-persistent (DNN: 40.6%), late non-persistent (DDN: 17.9%) and recurrent dependent (DND: 13.5%). At T2, persisters (DDD) reported significantly more (heavy) cannabis use and cannabis problems than non-persisters (DNN/DDN/DND). Treatment seeking for cannabis-related problems was rare, even among persisters (15.5%). The number (OR = 1.23 (1.03-1.48)) and type ('role impairment' OR = 2.85 (1.11-7.31), 'use despite problems' OR = 2.34 (1.15-4.76)) of lifetime cannabis abuse/dependence symptoms were the only independent predictors of persistence with a total explained variance of 8.8%. CONCLUSIONS Persistence of cannabis dependence in the community is low, difficult to predict, and associated with a negative outcome. The substantial proportion of stable non-persisters suggests that screening and monitoring or low-threshold brief interventions may suffice for many non-treatment-seeking cannabis-dependent people. However, those with many lifetime abuse/dependence symptoms may benefit from more intensive interventions.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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35
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Affiliation(s)
- Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London WC1E 6BT, UK.
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London WC1E 6BT, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London WC1E 6BT, UK
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Hughes JR, Fingar JR, Budney AJ, Naud S, Helzer JE, Callas PW. Marijuana use and intoxication among daily users: an intensive longitudinal study. Addict Behav 2014; 39:1464-70. [PMID: 24935797 DOI: 10.1016/j.addbeh.2014.05.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/12/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most of the harm from marijuana use is experienced by daily users. Despite this, there has not been a detailed prospective description of daily marijuana use. METHODS We recruited daily marijuana users (n=142) by internet ads, Craigslist, flyers, etc. Participants were mostly women (58%) with a mean age of 33 and 47% were minorities. Participants called an Interactive Voice Response phone system to report marijuana and other drug use daily for 3months. RESULTS Participants averaged using marijuana 3.2 times per day. Almost all participants used multiple modes of delivery during the study. Bongs/vaporizers/pipes were the most common mode of use (45% of uses). Day-to-day variability in amount of use was relatively small. The median rating of intoxication was 3.8 on a 0-6 scale with no intoxication reported on 1% of days and severe intoxication on 24% of days. The large majority binge drank (71%) or used tobacco (73%). Fifteen during-study variables were associated with the frequency of marijuana use; running out of marijuana and social setting were the strongest correlates. Retrospective reports of "usual" use at study entry were often significantly different than daily reports of use during the study. CONCLUSIONS This is the first detailed prospective description of daily marijuana use. Most users used multiple times/day, used multiple modes to administer marijuana, were often intoxicated, and under-reported high rates of using alcohol and tobacco. The frequency of marijuana use was especially influenced by social factors. These results will help future studies better describe daily marijuana use.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States; Department of Psychology, University of Vermont, Burlington, VT 05405, United States; Department of Family Practice, University of Vermont, Burlington, VT 05405, United States.
| | - James R Fingar
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, United States
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05405, United States
| | - John E Helzer
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, United States
| | - Peter W Callas
- Department of Biostatistics, University of Vermont, Burlington, VT 05405, United States
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Grella CE, Rodriguez L, Kim T. Patterns of Medical Marijuana Use Among Individuals Sampled from Medical Marijuana Dispensaries in Los Angeles. J Psychoactive Drugs 2014; 46:267-75. [DOI: 10.1080/02791072.2014.944960] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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38
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Liebregts N, van der Pol P, van Laar M, de Graaf R, van den Brink W, Korf DJ. The role of leisure and delinquency in frequent cannabis use and dependence trajectories among young adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:143-52. [PMID: 25171910 DOI: 10.1016/j.drugpo.2014.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/10/2014] [Accepted: 07/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The link between leisure and cannabis use has been widely studied, but less so for young adults, and rarely with a focus on frequent cannabis use. Also, little is known about how changes in leisure develop over time and how they are related to transitions in cannabis use and dependence. METHOD As part of a 3-year longitudinal project, in a qualitative study 47 frequent male and female young adult cannabis users with (n=23) and without (n=24) dependence at baseline were interviewed in-depth after 1.5 and 3 years. RESULTS Frequent cannabis users (at baseline ≥3 days per week in the past 12 months) are involved in similar leisure activities as the general young adult population and live rather conventional lives, generally away from a delinquent subculture. They mostly regulate their cannabis use to leisure time, to enhance other leisure activities, including socialising and video gaming. While they often give precedence to responsibilities (e.g. work and study), dependent and non-dependent users differed in whether they actively adapted their leisure activities to their cannabis use, or their cannabis use to their leisure time. Both types of and time spent on leisure activities were associated with transitions in use and dependence. CONCLUSIONS While our findings generally support the normalisation thesis, it is questionable whether frequent but non-problematic cannabis use is socially accepted in wider society. This study also questions the diagnostic dependence vs. non-dependence dichotomy, and adds finer distinctions to the concept of cannabis dependence. Implications for prevention and treatment include facilitating structured spending of leisure time (e.g. sports), and targeting frequent users who spent much leisure time video gaming at home.
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Affiliation(s)
- Nienke Liebregts
- Bonger Institute of Criminology, Law Faculty, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, the Netherlands.
| | - Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Margriet van Laar
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Ron de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Dirk J Korf
- Bonger Institute of Criminology, Law Faculty, University of Amsterdam, PO Box 1030, 1000 BA Amsterdam, the Netherlands
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Spence N, Wells S, George J, Graham K. An Examination of Marijuana Use Among a Vulnerable Population in Canada. J Racial Ethn Health Disparities 2014; 1:247-256. [PMID: 27134815 DOI: 10.1007/s40615-014-0031-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although the perceived risk of cannabis has decreased over the last few years, the contribution of marijuana use to the burden of disease on society is significant. Globally, Indigenous peoples have rates of marijuana use that are significantly higher than that of the general population. Understanding patterns of use is fundamental to developing appropriate policy and programming strategies to improve health and well-being. METHODS This study examined the characteristics of respondents who had ever been frequent marijuana users (used more than once a week), among a cross-sectional sample of 340 people, aged 18 and over, from Kettle and Stony Point First Nation in Ontario, Canada. The research incorporated Aboriginal-specific measures, examining issues related to colonialism and racism. Logistic regression models were used to assess the extent that sociodemographic variables, body mass index, mental health (depression, anxiety), licit substance use (alcohol and tobacco), Historical Loss Scale, Childhood Trauma Scale, and Measure of Indigenous Racism Experience (MIRE) Interpersonal Racism Scale predicted ever having been a frequent marijuana user. RESULTS Aboriginal-specific issues were not associated with marijuana use nor was marijuana use related to depression or anxiety. However, ever engaging in frequent marijuana use was reported by more than half of the sample and associated with being younger, male, and a smoker. CONCLUSIONS The high prevalence of frequent marijuana use (53.2 %) suggests normalization of the substance that may indicate a potentially large public health problem.
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Affiliation(s)
- Nicholas Spence
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health (CAMH) The University of Western Ontario, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Samantha Wells
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Julie George
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
| | - Kathryn Graham
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle London, Ontario N6G4X8, Canada
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Temple EC. Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence. Addiction 2014; 109:1110-1. [PMID: 24903289 DOI: 10.1111/add.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van der Pol P, Liebregts N, Brunt T, van Amsterdam J, de Graaf R, Korf DJ, van den Brink W, van Laar M. Cross-sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study. Addiction 2014; 109:1101-9. [PMID: 24628797 DOI: 10.1111/add.12508] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/18/2013] [Accepted: 02/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Increased delta-9-tetrahydrocannabinol (THC) concentrations in cannabis may lead to higher THC exposure, cannabis dependence and treatment need, but users may also adapt the actual intake of THC through reduced inhalation of THC containing smoke (titration). We investigated whether consumers of stronger cannabis use less cannabis per joint or inhale less smoke than those using less potent cannabis and whether these factors predict cannabis dependence severity. METHODS Heavy cannabis users (n = 98) brought their own cannabis, rolled a joint and smoked it ad libitum in a naturalistic setting. We analysed the content of the joint, its association with smoking behaviour and the cross-sectional and prospective (1.5-year follow-up) relations between smoking behaviour and cannabis dependence severity (total number of DSM-IV dependence symptoms). RESULTS THC concentration in cannabis (range 1.10-24.70%) was correlated positively with cannabis dose per joint (b = 0.008, P = 0.01), but the resulting THC concentration per joint (range 0.24-15.72%) was associated negatively with inhalation volume (b = -0.05, P = 0.03). Smoking behaviour measures (number of puffs, inhaled volume, reduction of puff volume and puff duration while smoking) predicted follow-up dependence severity, independently of baseline dependence severity and monthly THC dose (number of joints × cannabis dose × cannabis THC concentration). Monthly THC dose only predicted follow-up dependence severity when unadjusted for baseline severity. CONCLUSIONS Cannabis users titrate their delta-9-tetrahydrocannabinol intake by inhaling lower volumes of smoke when smoking strong joints, but this does not fully compensate for the higher cannabis doses per joint when using strong cannabis. Thus, users of more potent cannabis are generally exposed to more delta-9-tetrahydrocannabinol. Smoking behaviour appears to be a stronger predictor for cannabis dependence severity than monthly delta-9-tetrahydrocannabinol dose.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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The link between dopamine function and apathy in cannabis users: an [18F]-DOPA PET imaging study. Psychopharmacology (Berl) 2014; 231:2251-9. [PMID: 24696078 DOI: 10.1007/s00213-014-3523-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/27/2014] [Indexed: 02/07/2023]
Abstract
RATIONALE Cannabis is the most widely used illicit drug in the world, and regular use has been associated with reduced motivation, i.e. apathy. Regular long-term cannabis use has been associated with reduced dopamine synthesis capacity. The mesolimbic dopaminergic system mediates the processing of incentive stimuli by modifying their motivational value, which in turn is modulated by endocannabinoid signalling. Thus, it has been proposed that dopaminergic dysfunction underlies the apathy associated with chronic cannabis use. OBJECTIVES The aim of this study was to examine the relationship between dopaminergic function and subjective apathy in cannabis users. METHODS We measured dopamine synthesis capacity (indexed as the influx rate constant K i(cer)) via 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine positron emission tomography and subjective apathy using the self-rated Apathy Evaluation Scale (AES-S) in 14 regular cannabis users. RESULTS All subjects scored in excess of 34 points on the AES-S (median [interquartile range] 59.5 [7.5]), indicative of significant apathy based on normative data. K i (cer) was inversely correlated to AES-S score in the whole striatum and its associative functional subdivision (Spearman's rho = -0.64, p = 0.015 [whole striatum]; rho = -0.69, p = 0.006 [associative]) but not in the limbic or sensorimotor striatal subdivisions. There were no significant relationships between AES-S and current cannabis consumption (rho = 0.28, p = 0.34) or age of first cannabis use (rho = 0.25, p = 0.40). CONCLUSIONS These findings indicate that the reduction in striatal dopamine synthesis capacity associated with chronic cannabis use may underlie reduced reward sensitivity and a motivation associated with chronic cannabis use.
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Asbridge M, Duff C, Marsh DC, Erickson PG. Problems with the identification of 'problematic' cannabis use: examining the issues of frequency, quantity, and drug use environment. Eur Addict Res 2014; 20:254-67. [PMID: 25196945 DOI: 10.1159/000360697] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 02/17/2014] [Indexed: 11/19/2022]
Abstract
Considerable recent attention has focused on how harmful or problematic cannabis use is defined and understood in the literature and put to use in clinical practice. The aim of the current study is to review conceptual and measurement shortcomings in the identification of problematic cannabis use, drawing on the WHO ASSIST instrument for specific examples. Three issues with the current approach are debated and discussed: (1) the identification of problematic cannabis use disproportionately relies on measures of the frequency of cannabis consumption rather than the harms experienced; (2) the quantity consumed on a typical day is not considered when assessing problematic use, and (3) screening tools for problematic use employ a 'one-size-fits-all approach' and fail to reflect on the drug use context (networks and environment). Our commentary tackles each issue, with a review of relevant literature coupled with analyses of two Canadian data sources--a representative sample of the Canadian adult population and a smaller sample of adult, regular, long-term cannabis users from four Canadian cities--to further articulate each point. This article concludes with a discussion of appropriate treatment interventions and approaches to reduce cannabis-related harms, and offers suggested changes to improve the measurement of problematic cannabis use.
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Affiliation(s)
- Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S., Canada
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Predicting the transition from frequent cannabis use to cannabis dependence: a three-year prospective study. Drug Alcohol Depend 2013; 133:352-9. [PMID: 23886472 DOI: 10.1016/j.drugalcdep.2013.06.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/27/2013] [Accepted: 06/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users. METHODS A prospective cohort of frequent cannabis users (aged 18-30, n=600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n=269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support). RESULTS Three-year cumulative incidence of cannabis dependence was 37.2% (95% CI=30.7-43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence. CONCLUSIONS In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. Validation of self-reported cannabis dose and potency: an ecological study. Addiction 2013; 108:1801-8. [PMID: 23627816 DOI: 10.1111/add.12226] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/20/2012] [Accepted: 04/19/2013] [Indexed: 11/26/2022]
Abstract
AIMS To assess the reliability and validity of self-reported cannabis dose and potency measures. DESIGN Cross-sectional study comparing self-reports with objective measures of amount of cannabis and delta-9-tetrahydrocannabinol (THC) concentration. SETTING Ecological study with assessments at participants' homes or in a coffee shop. PARTICIPANTS Young adult frequent cannabis users (n = 106) from the Dutch Cannabis Dependence (CanDep) study. MEASUREMENTS The objectively measured amount of cannabis per joint (dose in grams) was compared with self-reported estimates using a prompt card and average number of joints made from 1 g of cannabis. In addition, objectively assessed THC concentration in the participant's cannabis was compared with self-reported level of intoxication, subjective estimate of cannabis potency and price per gram of cannabis. FINDINGS Objective estimates of doses per joint (0.07-0.88 g/joint) and cannabis potency (1.1-24.7%) varied widely. Self-reported measures of dose were imprecise, but at group level, average dose per joint was estimated accurately with the number of joints made from 1 g [limit of agreement (LOA) = -0.02 g, 95% confidence interval (CI) = -0.29; 0.26], whereas the prompt card resulted in serious underestimation (LOA = 0.14 g, 95% CI = -0.10; 0.37). THC concentration in cannabis was associated with subjective potency ['average' 3.77% (P = 0.002) and '(very) strong' 5.13% more THC (P < 0.001) than '(very) mild' cannabis] and with cannabis price (about 1% increase in THC concentration per euro spent on 1 g of cannabis, P < 0.001), but not with level of intoxication. CONCLUSIONS Self-report measures relating to cannabis use appear at best to be associated weakly with objective measures. Of the self-report measures, number of joints per gram, cannabis price and subjective potency have at least some validity.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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van der Pol P, Liebregts N, de Graaf R, Ten Have M, Korf DJ, van den Brink W, van Laar M. Mental health differences between frequent cannabis users with and without dependence and the general population. Addiction 2013; 108:1459-69. [PMID: 23530710 DOI: 10.1111/add.12196] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/14/2012] [Accepted: 03/18/2013] [Indexed: 01/20/2023]
Abstract
AIMS To compare the prevalence of mental disorders between frequent cannabis users with and without dependence and the general population. DESIGN Cross-sectional comparison of interview data. SETTING Enriched community sample of frequent cannabis users and a representative sample of non-users and non-frequent users from the general population. PARTICIPANTS A total of 521 young adult (aged 18-30 years) frequent cannabis users, 252 of whom were with DSM-IV cannabis dependence (D+) and 269 without DSM-IV cannabis dependence (D-), and 1072 young adults from the general population. MEASUREMENTS Multinomial logistic regression was used to compare groups regarding the presence of DSM-IV mental disorders. Detailed measures of cannabis use, childhood adversity and other substance use were considered confounders. FINDINGS Compared with the general population, externalizing disorders were more prevalent in D- [odds ratio (OR) = 8.91, P < 0.001] and most prevalent in D+ (OR = 17.75, P < 0.001), but internalizing disorders were associated only with D+ (mood OR = 4.15, P < 0.001; anxiety OR = 2.20, P = 0.002). Associations were attenuated (and often became non-significant) after correction for childhood adversity and substance use other than cannabis. However, the prevalence of mental disorders remained higher in D+ compared with D- (OR = 2.40, P < 0.001), although cannabis use patterns were remarkably similar. CONCLUSIONS Cannabis use patterns, childhood adversity and the use of other substances are similar in dependent and non-dependent frequent cannabis users. With the exception of more externalizing disorders, the mental health condition of non-dependent frequent cannabis users is similar to that of the general population, whereas it is worse in dependent frequent cannabis users.
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Affiliation(s)
- Peggy van der Pol
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
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Hendricks PS, Delucchi KL, Humfleet GL, Hall SM. Alcohol and marijuana use in the context of tobacco dependence treatment: impact on outcome and mediation of effect. Nicotine Tob Res 2012; 14:942-51. [PMID: 22259148 DOI: 10.1093/ntr/ntr312] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Alcohol and marijuana are among the most commonly used substances together with tobacco worldwide, but their relationship to smoking cessation is unclear. Although alcohol use decreases the likelihood of abstinence from tobacco, mechanisms of this effect have not been identified. Moreover, a small literature has yielded inconsistent findings regarding the effect of marijuana use on tobacco dependence treatment outcome. The aims of this study were to test increased positive-reinforcement smoking urge as a mediator of the relationship between alcohol and cigarette use and evaluate the impact of marijuana use on abstinence from tobacco. METHODS Participants were adult cigarette smokers (N = 739) from 3 randomized clinical trials of smoking cessation treatment. Alcohol consumption and marijuana use were assessed at pretreatment and postcessation. Biochemically verified, 7-day point prevalence smoking abstinence was determined at Weeks 12, 24, 36, and 52, as were urges to smoke as measured by the Questionnaire of Smoking Urges. RESULTS Increased positive-reinforcement urge mediated the effect of postcessation alcohol use on smoking abstinence. Although pretreatment alcohol use was associated with a decreased likelihood of abstinence from tobacco, increased positive-reinforcement urge did not account for this relationship. Marijuana use was not associated with abstinence from tobacco. CONCLUSIONS Smoking cessation treatments should provide those who drink during a quit attempt techniques designed to mitigate positive-reinforcement urge to smoke. Additional research is needed to determine how pretreatment alcohol consumption exerts its effect on cigarette use. Modifying the use of marijuana might not be critical to the success of tobacco interventions.
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Affiliation(s)
- Peter S Hendricks
- Department of Health Behavior, University of Alabama at Birmingham, 227 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294, USA.
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Erickson PG. Lower risk cannabis use guidelines: for whom? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:328-329. [PMID: 22032095 PMCID: PMC6974283 DOI: 10.1007/bf03404170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Patricia G. Erickson
- Centre for Addiction and Mental Health, 33 Russell Street, T-418, Toronto, ON M5S 2S1 Canada
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Abstract
AIMS To investigate associations between cannabis use and subsequent receipt of social welfare assistance. DESIGN, SETTING AND PARTICIPANTS The Young in Norway Longitudinal Study. A population-based Norwegian sample (n = 2606) was followed-up from adolescence to late 20s. Self-report data were merged with data from national registers. MEASUREMENTS Data were extracted on the use of alcohol, tobacco and cannabis and other illegal substances. Information was also retrieved on socio-demographic and family factors, academic achievement, conduct problems and mental health. National registers provided data on social welfare assistance, educational level and crime statistics. FINDINGS We observed prospective bivariate associations between increasing levels of cannabis use and subsequent social welfare assistance (P < 0.0001). The associations were reduced after adjusting for a range of potentially confounding factors, but remained significant. Frequent cannabis users were at highly increased risk for subsequently receiving social welfare assistance. At 28 years, those with 50+ times cannabis use during the previous 12 months and had an odds ratio of 9.3 (95% confidence interval: 4.3-20.1) for receiving social welfare assistance in the following 2-year span. Users of cannabis also had longer periods of receiving social welfare assistance than others (P < 0.0001) and were less likely to leave the welfare assistance system (P < 0.0001). CONCLUSIONS In Norway the use of cannabis is linked with subsequent receipt of social welfare assistance whether the consequences are related to use of the substance per se, or to cultural factors and the illegal status of the cannabis. Future research should attempt to understand the interactions of factors behind these associations.
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Affiliation(s)
- Willy Pedersen
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway.
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van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. The Dutch Cannabis Dependence (CanDep) study on the course of frequent cannabis use and dependence: objectives, methods and sample characteristics. Int J Methods Psychiatr Res 2011; 20:169-81. [PMID: 21815231 PMCID: PMC3467998 DOI: 10.1002/mpr.345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/19/2011] [Accepted: 05/17/2011] [Indexed: 11/11/2022] Open
Abstract
This paper presents an overview of the prospective cohort design of the Dutch Cannabis Dependence (CanDep) study, which investigates (i) the three-year natural course of frequent cannabis use (≥ three days per week in the past 12 months) and cannabis dependence; and (ii) the factors involved in the transition from frequent non-dependent cannabis use to cannabis dependence, and remission from dependence. Besides its scientific relevance, this knowledge may contribute to improve selective and indicated prevention, early detection, treatment and cannabis policies. The secondary objectives are the identification of factors related to treatment seeking and the validation of self report measures of cannabis use. Between September 2008 and April 2009, baseline data were collected from 600 frequent cannabis users with an average age of 22.1 years, predominantly male (79.3%) and an average cannabis use history of 7.1 years; 42.0% fulfilled a (12-month DSM-IV) diagnosis of cannabis dependence. The response rate was 83.7% after the first follow up at 18 months. The second and last follow-up is planned at 36 months. Computer assisted personal interviews (CAPI) were conducted which covered: cannabis use (including detailed assessments of exposure, motives for use and potency preference); use of other substances; DSM-IV internalizing and externalizing mental disorders; treatment seeking; personality; life events; social support and social functioning.
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Affiliation(s)
- Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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