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Bernusky HCR, Tibbo PG, Conrod PJ, Yunus FM, Keough MT, Thompson KD, Krank MD, Hadwin AF, Stewart SH. Do anxiety symptoms and coping motives serially mediate the association between psychotic-like experiences and cannabis-related problems in undergraduate recent cannabis users? Addict Behav 2024; 151:107937. [PMID: 38113687 DOI: 10.1016/j.addbeh.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/01/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
Many Canadian emerging adults (ages 18-25 years) use cannabis, with 60 % of past-three-month users experiencing one or more cannabis-related problems (i.e., adverse consequences of use). While psychotic-like experiences (PLEs) and cannabis problems overlap, little is known about the mechanisms explaining this link. One hypothesis is that PLEs are distressing and give rise to anxiety, with which emerging adults attempt to cope through increased cannabis use, in turn increasing their risk for cannabis-related problems. We tested a chained-mediational model to determine if anxiety and coping-with-anxiety motives for cannabis use sequentially mediated the link between PLEs and cannabis problems in emerging adult undergraduates; a conditional process model tested for moderation by sex. Emerging adult cannabis users (N = 413; mean [SD] age = 19.1 [1.5] years; 71.9 % female) from five Canadian universities provided cross-sectional, self-report survey data in fall 2021. Validated measures of PLEs, anxiety, cannabis coping-with-anxiety motives, and cannabis-related problems were administered. Path analyses supported the hypothesized chained mediational indirect effect (b = 0.027, 95 % bootstrap CI [0.012, 0.050]). No direct effect was found (p =.698), suggesting that the PLEs-to-cannabis problems association is fully explained by anxiety and cannabis coping-with-anxiety motives. Inconsistent with hypotheses, mediation did not depend on sex (95 % CIs crossed zero); therefore, anxiety and cannabis coping-with-anxiety motives explain the link between PLEs and cannabis problems in emerging adults regardless of their sex. Results highlight anxiety and cannabis coping-with-anxiety motives as potentially important intervention targets in cannabis-using emerging adults with PLEs, possibly preventing the development/worsening of cannabis-related problems.
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Affiliation(s)
- Haley C R Bernusky
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada
| | - Patricia J Conrod
- Département de psychiatrie et d'addictologie, Université de Montréal, 2900, boulevard Édouard-Montpetit, bureau S-750, Pavillon Roger-Gaudry, Montréal, Québec H3T 1J4, Canada
| | - Fakir M Yunus
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Life Sciences Centre (Psychology Wing), Halifax, Nova Scotia B3H 4R2, Canada
| | - Matthew T Keough
- Department of Psychology, York University, 4700 Keele Street, 225 Behavioural Science Building, North York, Ontario M3J 1P3, Canada
| | - Kara D Thompson
- Department of Psychology, St. Francis Xavier University, 2323 Notre Dame Avenue, 125 Annex, Antigonish, Nova Scotia B2G 2W5, Canada
| | - Marvin D Krank
- Department of Psychology, University of British Columbia, 1147 Research Road, ART 334, Kelowna, British Columbia V1V 1V7, Canada
| | - Allyson F Hadwin
- Department of Educational Psychology and Leadership Studies, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada; Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Life Sciences Centre (Psychology Wing), Halifax, Nova Scotia B3H 4R2, Canada.
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Petros R, Walker DD, Pierce A, Monroe-DeVita M. Scoping Review of Cannabis-Reduction Psychosocial Interventions and Reasons for Use among Young Adults with Psychosis. J Dual Diagn 2023; 19:124-150. [PMID: 37391686 DOI: 10.1080/15504263.2023.2226024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Objective: No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods: A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts (N = 3,216) and full-texts (n = 136) resulted in 46 articles. Results: YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions: Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.
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Affiliation(s)
- Ryan Petros
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Denise D Walker
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Adam Pierce
- Mental Health and Neurosciences Division, VA Portland Health Care System, Portland, Oregon, USA
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Arranz S, Mané A, Bergé D, Monserrat C, Cabezas A, Vilella E, Sanchez-Gistau V. The impact of sex and cannabis on clinical features in first-admitted patients with psychosis. Eur Neuropsychopharmacol 2020; 36:235-243. [PMID: 32291209 DOI: 10.1016/j.euroneuro.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/22/2022]
Abstract
There is a scarcity of studies investigating the effect of sex on the clinical and treatment characteristics of first-admitted patients with first-episode psychosis (FEP). The reasons for using cannabis and the effect of cannabis on clinical features have not received enough attention either. We aim therefore, to investigate sex differences in the reasons for cannabis use and to determine the effects of sex, cannabis use and their interaction on clinical variables at admission and at discharge from the inpatient unit. 204 first-admitted FEPs in two inpatient units in Spain were included. The reasons for using cannabis were determined using the Dixon questionnaire. Clinical variables were compared between sexes and between cannabis users and non-users. Cannabis use was more frequent in males, but females were more likely to smoke cannabis to "feel relaxed". There was a main effect of sex on positive psychotic symptoms and antipsychotics dose and an interaction effect of cannabis and sex on global functioning at discharge .Our findings show sex differences in the reasons for cannabis use and in some clinical and treatment characteristics among FEP patients. More studies focusing on gender perspectives are needed to develop more individualized treatments.
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Affiliation(s)
- Sara Arranz
- Parc Sanitari Sant Joan de Dèu, Sant Boi de Llobregat, Barcelona, Spain; Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Dani Bergé
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Clara Monserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain
| | - Angel Cabezas
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Vanessa Sanchez-Gistau
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain.
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The relationship between cannabis use and cortisol levels in youth at ultra high-risk for psychosis. Psychoneuroendocrinology 2017; 83:58-64. [PMID: 28595088 PMCID: PMC5531192 DOI: 10.1016/j.psyneuen.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 02/01/2023]
Abstract
Recent studies have posited a relationship between cannabis use and the biological stress system, but this critical relationship has not been evaluated during the ultra high-risk (UHR) period immediately preceding the onset of psychotic disorders. Salivary cortisol samples were collected on 46 UHR and 29 control adolescents; these individuals were assessed for current cannabis use with a urine panel and self-report. UHR participants where separated into two groups: Current Cannabis Use (UHR-CU) and No Current Cannabis Use (UHR-NC). Healthy Control participants (HC) were free of cannabis use. Consistent with the literature, results indicate UHR individuals showed elevated cortisol levels when compared to HC participants. Further, we also observed that UHR-CU participants exhibited elevated levels when compared to both the non-using UHR and HC groups. Findings suggest that cannabis use may interact with underlying biological vulnerability associated with the hypothalamic-pituitary-adrenal (HPA) axis system.
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Gill KE, Poe L, Azimov N, Ben-David S, Vadhan NP, Girgis R, Moore H, Cressman V, Corcoran CM. Reasons for cannabis use among youths at ultra high risk for psychosis. Early Interv Psychiatry 2015; 9:207-10. [PMID: 24274357 PMCID: PMC4033707 DOI: 10.1111/eip.12112] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 10/26/2013] [Indexed: 12/15/2022]
Abstract
AIM Cannabis use is prevalent in schizophrenia and its risk states, despite its association with anxiety and positive symptoms. While schizophrenia patients report using cannabis for mood enhancement and social motives, it is not known what motivates clinical high risk (CHR) patients to use cannabis. METHODS Among 102 CHR patients, 24 (23%) endorsed cannabis use, and were queried as to reasons for use, using a scale previously administered in schizophrenia patients. We hypothesized a primary motivation for mood enhancement related to anhedonia. We evaluated the 'self-medication' hypothesis by examining if motivation for symptom relief was associated with concurrent severity of symptoms. RESULTS The rank order of reasons for use in CHR patients was similar to that previously reported by schizophrenia patients, with mood enhancement and social motives as primary reasons for use, and the motivation to use cannabis for symptom relief comparatively less common. Motivation for mood enhancement had a trend association with anhedonia. Motivation for symptom relief was entirely unrelated to concurrent severity of positive and anxiety symptoms. CONCLUSION As in schizophrenia, CHR patients primarily use cannabis for mood enhancement, especially in the context of decreased motivation to seek pleasure otherwise. Negative symptoms may drive cannabis use in schizophrenia and its risk states, which may exacerbate positive symptoms. By contrast, CHR patients do not report using cannabis to 'self-medicate' emergent positive symptoms. The understanding of motives for cannabis use among CHR patients may be informative for treatments aimed at reducing use, such as motivational interviewing.
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Affiliation(s)
- Kelly E Gill
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
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Kolliakou A, Castle D, Sallis H, Joseph C, O'Connor J, Wiffen B, Gayer-Anderson C, McQueen G, Taylor H, Bonaccorso S, Gaughran F, Smith S, Greenwood K, Murray RM, Di Forti M, Atakan Z, Ismail K. Reasons for cannabis use in first-episode psychosis: does strength of endorsement change over 12 months? Eur Psychiatry 2014; 30:152-9. [PMID: 25541346 DOI: 10.1016/j.eurpsy.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. METHODS FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. RESULTS Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. CONCLUSIONS Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use.
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Affiliation(s)
- A Kolliakou
- Department of Psychological Medicine, PO92, Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF London, UK.
| | - D Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - H Sallis
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Joseph
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - J O'Connor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - B Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - C Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - G McQueen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - H Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - S Bonaccorso
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - F Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - S Smith
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
| | - K Greenwood
- School of Psychology, University of Sussex, Sussex, UK
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - M Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Z Atakan
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - K Ismail
- Department of Psychological Medicine, PO92, Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF London, UK
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Thornton LK, Baker AL, Johnson MP, Lewin TJ. Attitudes and perceptions towards substances among people with mental disorders: a systematic review. Acta Psychiatr Scand 2012; 126:87-105. [PMID: 22486607 DOI: 10.1111/j.1600-0447.2012.01861.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop effective interventions for people with coexisting mental disorders (MD) and substance use, it may be beneficial to understand their attitudes and perceptions of substances. METHOD A systematic literature search regarding attitudes and perceptions towards tobacco, alcohol or cannabis among people with MD was conducted. Studies' methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS Twenty-one papers were included in the review and found to have generally low methodological quality. Papers investigated reasons for substance use, substance use expectancies, substances' perceived effects and reasons for quitting. People with psychotic disorders reported using substances primarily for relaxation and pleasure. Among people with mood disorders, alcohol was used primarily for social motives and tobacco for negative affect reduction. CONCLUSION For substance use interventions among people with MD to be more effective, it may be necessary to tailor interventions specifically for this population and customize by substance type. Gaps in the literature regarding attitudes and perceptions towards substance use among people with MD were identified, which future research should aim to address. These include designing and conducting methodologically rigorous research, investigating perceived harmfulness and knowledge of substances, and broadening recruitment of participants to include people with MD other than psychosis.
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Affiliation(s)
- L K Thornton
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia.
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Thornton LK, Baker AL, Lewin TJ, Kay-Lambkin FJ, Kavanagh D, Richmond R, Kelly B, Johnson MP. Reasons for substance use among people with mental disorders. Addict Behav 2012; 37:427-34. [PMID: 22197045 DOI: 10.1016/j.addbeh.2011.11.039] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/14/2011] [Accepted: 11/29/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders. METHODS Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression. RESULTS Participants had a mean age of 38 (SD=12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons. CONCLUSIONS It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.
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Affiliation(s)
- Louise K Thornton
- Centre for Brain and Mental Health Research, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia.
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Dekker N, Smeerdijk AM, Wiers RW, Duits JH, van Gelder G, Houben K, Schippers G, Linszen DH, de Haan L. Implicit and explicit affective associations towards cannabis use in patients with recent-onset schizophrenia and healthy controls. Psychol Med 2010; 40:1325-1336. [PMID: 19917142 DOI: 10.1017/s0033291709991814] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cannabis use is common in patients with recent-onset schizophrenia and this is associated with poor disease outcome. More insight in the cognitive-motivational processes related to cannabis use in schizophrenia may inform treatment strategies. The present study is the first known to compare implicit and explicit cannabis associations in individuals with and without psychotic disorder. METHOD Participants consisted of 70 patients with recent-onset psychotic disorder and 61 healthy controls with various levels of cannabis use. Three Single-Category Implicit Association Tests (SC-IAT) were used to assess 'relaxed', 'active' and 'negative' implicit associations towards cannabis use. Explicit expectancies of cannabis use were assessed with a questionnaire using the same words as the SC-IAT. RESULTS There were no differences in implicit associations between patients and controls; however, patients scored significantly higher on explicit negative affect expectancies than controls. Both groups demonstrated strong negative implicit associations towards cannabis use. Explicit relaxed expectancies were the strongest predictors of cannabis use and craving. There was a trend for implicit active associations to predict craving. CONCLUSIONS The findings indicate that patients suffering from schizophrenia have associations towards cannabis similar to controls, but they have stronger negative explicit cannabis associations. The strong negative implicit associations towards cannabis could imply that users of cannabis engage in a behaviour they do not implicitly like. Explicit relaxing expectancies of cannabis might be an important mediator in the continuation of cannabis use in patients and controls.
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Affiliation(s)
- N Dekker
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
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HIDES LEANNE, KAVANAGH DAVIDJ, DAWE SHARON, YOUNG ROSSM. The influence of cannabis use expectancies on cannabis use and psychotic symptoms in psychosis. Drug Alcohol Rev 2009; 28:250-6. [DOI: 10.1080/09595230802130158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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