Examining within-person associations between alcohol and cannabis use and hooking up among adolescents and young adults in the United States

OBJECTIVE

This study examined daily associations between alcohol use, cannabis use, and simultaneous alcohol and cannabis/marijuana (SAM) use with the likelihood of hooking up (uncommitted sexual encounter that may or may not include intercourse).

METHOD

We used a longitudinal measurement burst ecological momentary assessment (EMA) design with 3-week EMA bursts with daily measurements repeated quarterly across 12 months. 1,009 (57 % female, Mean age = 20.00 [SD = 3.21]) Texan adolescents and young adults ages 15-25 participated in the study. Mixed effects logistic regression models were estimated using maximum likelihood estimation to evaluate the associations between substance use and hooking up.

RESULTS

Within-person results indicated that participants were more likely to hook up on days with alcohol use and on days with cannabis use, but not on days with SAM use. Participants were also more likely to hook up on drinking days with higher-than-usual alcohol use. Between-person results indicated that participants who used alcohol more often or cannabis more often on average were more likely to hook up, and participants who tended to drink more on drinking days were more likely to hook up.

CONCLUSIONS

Given the significant daily-level associations between alcohol and cannabis use and hooking up behavior, public health initiatives should focus on developing interventions to reduce alcohol and cannabis use and promote safer hooking up behavior among adolescents and young adults.

Cannabis as a shareable commodity in a social discounting task

Cannabis use and cannabis use disorder diagnoses continue to increase in United States college-aged students as more states legalize recreational cannabis. Previous studies have attempted to associate cannabis use with delay discount rates, which involves participants making choices for smaller sooner versus larger later hypothetical rewards. More smaller sooner choices result in higher discount rates and suggest increased impulsivity. Delay discounting studies have shown a significant, but small effect size with people who use cannabis more likely to choose the smaller sooner rewards, relative to people who do not use cannabis. The present study tested whether students with different experience using cannabis (people who currently use cannabis, people who formerly used cannabis, or people who never used cannabis) would be sensitive to sharing a proportion of hypothetical marijuana with another individual at a given social distance, as a putative measure for cannabis value. Results from two separate data sets showed that students classified as current cannabis users were significantly less likely to share a proportion of hypothetical marijuana across a range of social distances, relative to students that self-reported never using cannabis. Students classified as either former or current users were not statistically different. These results were consistent with previous delay discounting results and showed a medium effect size (η² ≥ 0.10) for each data set, both separately and when combined. These results indicate that social distance is a meaningful variable that can be used in a modified discounting task to assess differential cannabis value in a student population who are increasingly susceptible to cannabis use disorder. These results may have future clinical implications. Social discount rates for cannabis may be able to differentiate individuals who will continue recreational use versus individuals that may develop cannabis dependence problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Executive functions and behavioral economic demand for cannabis among young adults: Indirect associations with cannabis consumption and cannabis use disorder

Behavioral economic demand for cannabis is robustly associated with cannabis consumption and cannabis use disorder (CUD). However, few studies have examined the processes underlying individual differences in the relative valuation of cannabis (i.e., demand). This study examined associations between executive functions and cannabis demand among young adults who use cannabis. We also examined indirect associations of executive functions with cannabis consumption and CUD symptoms through cannabis demand. Young adults (N = 113; 58.4% female; mean age 22 years) completed a Marijuana Purchase Task. Participants also completed cognitive tasks assessing executive functions (set shifting, inhibitory control, working memory) and semistructured interviews assessing past 90-day cannabis consumption (number of grams used) and number of CUD symptoms. Poorer inhibitory control was significantly associated with greater Omax (peak expenditure on cannabis) and greater intensity (cannabis consumption at zero cost). Poorer working memory was significantly associated with lower elasticity (sensitivity of consumption to escalating cost). Lower inhibitory control was indirectly associated with greater cannabis consumption and CUD symptoms through greater Omax and intensity, and poorer working memory was indirectly associated with greater cannabis consumption and CUD symptoms through reduced elasticity. This study provides novel evidence that executive functions are associated with individual differences in cannabis demand. Moreover, these results suggest that cannabis demand could be a mechanism linking poorer executive functioning with heavier cannabis use and CUD, which should be confirmed in future longitudinal studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Youth Aggression and Peer Victimization as Predictors of Adolescent Alcohol and Marijuana Use: A Longitudinal Analysis of Youth with Aggressive Behavior Problems

Youth who are behaviorally aggressive and victimized by their peers comprise a significant population with specific risks and vulnerabilities relative to substance use. The goals of the current study were to examine the roles that youth aggression and peer victimization play in determining the timing of alcohol and marijuana use initiation and the frequency of use 5-years later in a sample of at-risk, aggressive youth. 360 youth (Mage= 10.17 years; 65% boys, 35% girls; 78.1% African American, 20.3% Caucasian, 1.4% Hispanic, and 0.3% other) recruited for a prevention program for at-risk youth were followed for 5 years (4th - 9th grade). Cox PH regressions were conducted to predict timing of alcohol and marijuana use initiation. Zero-inflated negative binomial regressions were used to predict frequency of alcohol and marijuana use 5 years later. Results showed that peer victimization inferred decreased risk of alcohol use initiation. However, this effect was only observed for youth with relatively moderate, and low levels of aggression. Findings suggest that differences in youth aggression and victimization interact to predict distinct outcomes, suggesting the need for a more comprehensive approach when working with aggressive youth who have experienced peer victimization.

A test of competing mediators linking trouble sleeping to cannabis use in adolescents and emerging adults

This study examined day-level associations between trouble sleeping and three cannabis-use indices (likelihood/quantity of use and impaired control). We evaluated behavioral and cognitive mediators of the association between trouble sleeping and cannabis outcomes. Youth (N = 86, ages 15-24, 48.8% female, 58.8% White, 18.6% Latine) who regularly used cannabis were recruited for an intervention study. This preregistered secondary data analysis leveraged data from a 1-week ecological momentary assessment (EMA) study completed prior to intervention. Trouble sleeping, cannabis use, and impaired control over use were assessed each morning; negative affect, risk-taking propensity, and cannabis craving were assessed multiple times and aggregated to create a daily average. Multilevel structural equation modeling evaluated hypothesized temporally sequenced associations and putative mechanisms at the day (i.e., within) and person (i.e., between) level. In bivariate analyses at the person level, there were large-effect associations between trouble sleeping and craving and negative affect, and between craving and cannabis-use likelihood and quantity (rs from .34 to .48). In multilevel analyses at the day level, participants were less likely to use cannabis the next day after reporting more trouble sleeping (β = -.65, p < .001). Trouble sleeping was not directly associated with subsequent cannabis-use quantity or impaired control, or indirectly via negative affect, risk-taking propensity, or craving. Trouble sleeping had differential relations with cannabis-use indices at the day and person levels. To promote youth health and reduce cannabis use, future research may consider the unique, person- and situation-driven mechanistic processes at play. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interpretations and experiences of subjective effects for alcohol alone and when combined with cannabis: A mixed-methods approach

Subjective effects generally describe the feelings one has when consuming substances. There are several tools available for measuring alcohol-related subjective effects but there are reasons to believe that effects are interpreted differently across participants. The assessment of alcohol-related subjective effects is further complicated by the fact that many people use other substances with alcohol, including cannabis. The present study used a mixed-methods approach to evaluate interpretations of 21 subjective effects used in common assessments among a college student sample (N = 99; primarily White [79%], Hispanic [60%] women [74%], 72% of which reported lifetime couse of alcohol and cannabis). We sought to (a) estimate the prevalence of each effect and the amount of alcohol/number of drinks (and, for those with simultaneous use, amount of cannabis/number of hits) required to experience each effect and (b) evaluate how participants interpreted each effect that they had ever experienced when drinking (for our sample who had used only alcohol) or when simultaneously using alcohol and cannabis (for our sample who had reported simultaneous use). Across both samples, we found that several effects were far more common than others and participants had varied interpretations of each subjective effect. Further, qualitative results demonstrated that participants interpreted some subjective effects in a way that differed from the original intention of the measure. Results suggest a degree of measurement error when using common subjective effects assessment tools. Findings lay the groundwork for standardized measures of subjective effects for simultaneous use and have implications for future real-world assessment and intervention work. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

First Comes Substance Use, Then Comes Social Media Posts? Examining the Temporal Ordering and Relative Strength of Relations Across Alcohol, Tobacco and Marijuana Use and Posting Behavior

Social media posts represent a major route by which youth share their substance use cognitions and experiences with others. Extant research has primarily examined relations between alcohol-related posts and posters' own alcohol use, yet little is known about the role of social media in the use of less socially accepted substances, namely tobacco and marijuana. Our study represents the first to examine the relative strength of this relation across alcohol, tobacco, and marijuana. The current research used a one-month time lag to tease apart the temporal ordering of substance-use-posting and participants' own substance use. A sample of 282 15-20-year-olds (Mage = 18.4, SD = 1.3, 52.9% female) in the United States completed two self-report surveys, one month apart. Results of a cross-lagged panel model revealed significant effects of alcohol and marijuana consumption on subsequent alcohol- and marijuana-related posting, respectively (i.e., selection effects). However, reverse relations (i.e., self-effects) were not significant. Further, we found no differences in the strength of selection effects across substances, suggesting they are similar for both more (alcohol) and less (marijuana and tobacco) socially acceptable substances. Results point to the importance of using young people's social media posts as a way to help identify individuals at risk for heightened substance use and social media as a mechanism for targeted prevention programming.

Sexual orientation-based microaggressions and cannabis use outcomes among sexual minority individuals: The impact of negative affect and coping-motivated cannabis use

INTRODUCTION

Sexual minority individuals report significantly more cannabis use and problems than their heterosexual peers, possibly due to their frequent experiences with sexual orientation-based microaggressions. As a result, sexual minority individuals may turn to cannabis use to cope with the negative affect associated with these experiences. No known studies have tested this hypothesis; therefore, the current study tested if sexual orientation microaggressions are positively associated with negative affect (anxiety and depression), cannabis coping motives, and cannabis-related outcomes (frequency, problems); if coping motives are positively associated with cannabis-related outcomes; and if negative affect and cannabis use to cope with negative affect serially mediate the relation between sexual orientation microaggressions and cannabis-related outcomes.

METHODS

Sexual minority undergraduate students who reported cannabis use in the past three months (N = 328; 71.3 % cis-female) completed an online survey.

RESULTS

Microaggressions were significantly positively correlated with anxiety, depression, coping-motivated cannabis use, cannabis-related problems, non-sexual orientation-related stress, and overt sexual orientation-based discrimination. Additionally, after controlling for non-sexual orientation-related stress and overt sexual orientation-based discrimination, microaggressions were indirectly positively related to cannabis use frequency and problems via the sequential effects of negative affect and coping motives. This relation remained significant when examining negative affect specific to sexual orientation microaggressions and cannabis use to cope with this microaggressions-specific negative affect.

CONCLUSIONS

Results highlight the adverse impact of sexual orientation microaggressions in terms of negative affect and negative cannabis-related outcomes.

Effect of a selective personality-targeted prevention program on 7-year illicit substance related outcomes: A secondary analysis of a cluster randomized controlled trial

BACKGROUND

This study evaluated the efficacy of the selective personality-targeted PreVenture program in reducing cannabis and stimulant use over a 7-year period spanning adolescence and early adulthood.

METHODS

A cluster randomized controlled trial was conducted in 14 Australian schools. Schools were randomized to PreVenture, a brief personality-targeted selective intervention, comprising two 90-minute facilitator-led sessions delivered one week apart, or a control group (health education as usual). Only students who scored highly on one of four personality traits (anxiety sensitivity, negative thinking, impulsivity, sensation seeking) were included. Students completed online self-report questionnaires between 2012 and 2019: at baseline; post-intervention; 1-, 2-, 3-, 5.5- and 7-years post-baseline. Outcomes were past 6-months cannabis use, stimulant use (MDMA, methamphetamine or amphetamine) and cannabis-related harms.

RESULTS

The sample comprised 438 adolescents (Mage=13.4 years; SD=0.47) at baseline. Retention ranged from 51% to 79% over the 7-years. Compared to controls, the PreVenture group had significantly reduced odds of annual cannabis-related harms (OR=0.78, 95% CI=0.65-0.92). However, there were no significant group differences in the growth of cannabis use (OR=0.84, 95% CI=0.69-1.02) or stimulant use (OR=1.07, 95% CI=0.91-1.25) over the 7-year period.

CONCLUSIONS

PreVenture was effective in slowing the growth of cannabis-related harms over time, however owing to missing data over the 7-year trial, replication trials may be warranted to better understand the impact of the PreVenture intervention on cannabis and stimulant use among young Australians. Alternative implementation strategies, such as delivering the intervention in later adolescence and/or providing booster sessions, may be beneficial.

Intentions to Use Cannabis Postpartum: A Qualitative Study of Pregnant Individuals Who Used Cannabis During Early Pregnancy

Objective: To examine plans for postpartum cannabis use among pregnant individuals who used cannabis during early pregnancy. Materials and Methods: Eighteen virtual focus groups were conducted from November 17, 2021, to December 17, 2021, with 23 Black and 30 White pregnant adults in Kaiser Permanente Northern California, who self-reported prenatal cannabis use during early pregnancy. Focus groups were recorded, transcribed, and analyzed using thematic analysis. Results: The sample (N = 53) had a mean age of 30.3 years (standard deviation = 5.2) at recruitment; 70% reported daily, 25% weekly, and 6% ≤ monthly cannabis use at entrance to prenatal care. Some participants viewed cannabis as critical for coping with postpartum mental and physical health challenges, while others questioned whether cannabis use would fit with their parental lifestyle, and some planned to abstain altogether. Most planned to use cannabis postpartum, but with lower frequency than before pregnancy, and in ways consistent with harm reduction (e.g., smoking outside to avoid secondhand or thirdhand smoke exposure). Many were motivated to abstain from cannabis while breastfeeding, and some desired more data on the safety of cannabis and breastfeeding, or intended to "pump and dump," believing it would reduce potential transfer of Δ9-tetrahydrocannabinol (THC) to their infant. Responses from Black and White participants were generally similar, but White participants were more likely to report plans to use cannabis while breastfeeding and to want information about cannabis and breastfeeding. Conclusions: Pregnant individuals with prenatal cannabis use had varied plans for cannabis use postpartum. Many were motivated to abstain or use cannabis less frequently than pre-pregnancy, especially during lactation.

High Risk or Risky Highs: Understanding the Links Between Alcohol and Cannabis Use on the Transition From Suicidal Ideation to Attempts in Australian Men

Alcohol and cannabis use are consistently associated with greater risk of suicide, particularly among men and in higher-income countries (e.g., Australia). Adult data (n = 7,464) from waves 1 and 2 of Ten to Men: The Australian Longitudinal Study on Male Health were used to explore whether alcohol and/or cannabis use increased the longitudinal risk of a suicide attempt among suicidal ideators. Cannabis use was associated with increased risk of transitioning from suicidal ideation to making a suicide attempt; no association was found for alcohol. Broadly, these findings indicate that greater cannabis but not alcohol use may increase risk of transitioning to making a suicide attempt among those who are thinking about suicide.

Nomophobia and Alcohol, Tobacco, and Cannabis Consumption in Adolescents in Galicia

This study aimed at exploring the association of nomophobia with alcohol, tobacco, and/or cannabis consumption among high school students. We carried out a cross-sectional study among high school and vocational training students in Galicia, Northwest Spain (N = 3,100). Collected data included nomophobia, sociodemographic variables, and alcohol, tobacco, and cannabis consumption. Nomophobia was measured using the validated Nomophobia Questionnaire. Adjusted odds ratios (ORs) and their 95 percent confidence intervals (CIs) were estimated using generalized linear mixed models. More than a quarter of the adolescents (27.7 percent) had nomophobia. We found an association between nomophobia and a high level of tobacco smoking in the last month in boys (OR = 2.16; 95 percent CI: 1.55-3.03). Nomophobia was also associated with higher odds of binge drinking in both genders (girls: OR = 1.86; 95 percent CI: 1.61-3.52; boys: OR = 2.29; 95 percent CI: 1.68-3.13) and with cannabis consumption in boys (OR = 1.74; 95 percent CI: 1.07-2.81). Our findings highlight the importance of a comprehensive investigation of the factors underlying alcohol, tobacco, and cannabis consumption in the adolescent population.

The Associations of Basic Psychological Need Satisfaction and Need Frustration with Cannabis-Related Outcomes in a Multi-Site Sample of College Students

Psychological need satisfaction and need frustration, proposed by self-determination theory, may serve as conditions that foster health-promoting and health-impairing behaviors related to cannabis use. In the present study, we examined the measurement model of psychological need satisfaction and need frustration and their associations with cannabis protective behavioral strategies use, negative cannabis-related consequences, and cannabis use severity. Data were from 1394 college students from 10 universities across the U.S. who reported past-month cannabis use. A higher-order factor model representing general psychological need satisfaction and need frustration provided a good fit to the data. Regressing the three observed cannabis outcome variables onto these higher-order latent factors, we found that greater need satisfaction was associated with more frequent cannabis protective behavioral strategies use and fewer negative cannabis-related consequences. Greater need frustration was associated with greater negative cannabis-related consequences and cannabis use severity. Further, an interaction effect between need satisfaction and need frustration emerged for each cannabis outcome such that greater need satisfaction attenuated the associations between need frustration and cannabis outcomes and greater need frustration strengthened the associations between need satisfaction and cannabis outcomes. Implications for the roles of need satisfaction and need frustration in cannabis use and future intervention development are discussed.

Sleep, Alcohol and Cannabis Use in College Students With and Without Attention-Deficit/Hyperactivity Disorder

Background: Relations among attention-deficit/hyperactivity disorder (ADHD), sleep, and substance-related negative consequences are largely unknown. In this cross-sectional study, we examined associations among ADHD diagnosis, sleep, and alcohol-related consequences. We also evaluated the independent and interactive effects of sleep and ADHD on alcohol-related negative consequences, above and beyond levels of alcohol use. Methods: College students who drink alcohol with (n = 51) and without (n = 50) ADHD completed an assessment that included a diagnostic interview assessing ADHD, and questionnaire measures of sleep quality, substance use, and associated consequences. Analyses utilized a series of hierarchical linear regression models and explored these aims for cannabis use in a subset of participants (n = 52 participants that used cannabis). Results: College students who drink alcohol with ADHD reported significantly worse sleep quality and more alcohol-related consequences, relative to those without ADHD. When ADHD and sleep quality were included in the model, ADHD-but not sleep quality-was independently associated with alcohol consequences, but not cannabis consequences. There were no moderating effects of ADHD on the associations between sleep and substance-related consequences. Conclusions: Students who drank alcohol with ADHD may be particularly vulnerable to experiencing poor sleep and consequences from their substance use, compared to their heavy drinking peers without ADHD. Future, larger scale studies should consider longitudinal effects as well as underlying mechanisms of risk.

Cannabis use in adolescents and anxiety symptoms and disorders: a systematic review and meta-analysis

Background: The use of cannabis is highly prevalent during adolescence compared to the general adult population. In addition to the high comorbidity between cannabis use and anxiety disorders, early evidence suggests that cannabis may precede the development of anxiety. Moreover, adolescence represents a major developmental period for both neurobiological and psychological processes, placing these individuals at a heightened vulnerability to the influence of cannabis.Objectives: This systematic review and meta-analysis examined the prospective associations between adolescent cannabis use and subsequent anxiety outcomes (i.e. anxiety disorders and/or symptoms).Methods: Following PRISMA guidelines, a systematic review and meta-analysis were conducted encompassing data from articles published between database inception and September 2022.Results: Six longitudinal studies were identified for quantitative analysis, while twelve non-overlapping longitudinal studies were identified for qualitative review (total N = 18; 33380 subjects). Meta-analytical findings supported an association between adolescent cannabis use and the development of a subsequent anxiety disorder (Odds Ratio = 2.14, 95% CI: 1.37-3.36, p < .01). These findings were consistent with our qualitative synthesis where nine of the twelve longitudinal studies observed a significant relationship between adolescent cannabis use and exacerbation of anxiety symptoms later in life, irrespective of an anxiety disorder diagnosis.Discussion: In summary, the current evidence suggests a prospective association between adolescent cannabis use and later anxiety symptoms and disorders. These findings underscore the importance of refining research methodologies, considering sex-based differences and controlling for confounding factors, as well as implementing educational initiatives and developing clinical interventions to address the mental health risks associated with cannabis use among adolescents.

Age-related patterns in high-risk alcohol and cannabis use and their associations with positive and negative affect in young adulthood

OBJECTIVE

We examined age-varying associations between young adult simultaneous alcohol and marijuana/cannabis use (SAM) and heavy episodic drinking (HED) and positive and negative affect to inform harm reduction efforts.

METHODS

Young adults reporting past-year alcohol use (n = 556; ages 19-25) were recruited in a state where alcohol and nonmedical cannabis use was legal for those 21 +. Participants provided 24 repeated monthly assessments. Among those reporting past-month cannabis use on at least one survey, logistic time-varying effect models estimated (1) the age-varying prevalence of and associations between past-month SAM and HED and (2) age-varying unique associations of affect with SAM and HED.

RESULTS

There was a positive age-varying association between HED and SAM over time that was highest at age 19 (OR = 7.56), decreased until age 20.7 (OR = 3.39), increased until age 23.0 (OR = 4.85), and decreased until the association became non-significant by age 25. Negative affect was positively associated with SAM from ages 20.7 to 23.0, peaking at age 21.8 (OR = 1.36). Positive affect was positively associated with HED from ages 19.4 to 20.4 (peak OR = 1.25) and ages 22.5 to 24.5 (peak OR = 1.38). In contrast, positive affect was not uniquely associated with SAM nor negative affect with HED across ages 19-25.

CONCLUSIONS

While HED and SAM were positively associated throughout young adulthood and interventions could target them in tandem, their associations with affect suggest differential etiologic processes. Preventive intervention and harm reduction efforts should attend to psychological context in which these behaviors occur.

Predictors of morning cannabis use among young adults: Between- and within-person associations from 24 consecutive months of data

Morning cannabis use is associated with heavier, frequent cannabis use and more cannabis-related negative consequences, yet little empirical research has examined its predictors. Using 24 months of longitudinal data, the present study tested demographic, psychosocial, and behavioral predictors of morning cannabis use among young adults at the monthly- and person-levels. Young adults (N = 778) were part of a larger study on substance use and social role transitions; participants completed a baseline survey and up to 24 consecutive monthly surveys. Hypotheses were tested using logistic multilevel models to estimate odds ratios for any vs. no morning use in a given month. At the monthly level, social anxiety motives and cannabis use frequency on a given month were positively associated with morning cannabis use. At the person level, typical coping motives, average cannabis use frequency, and male sex were positively associated with morning cannabis use. Findings advance our understanding of individual and psychosocial predictors of morning cannabis use among young adults. Notably, social anxiety motives may represent a malleable target for intervention efforts that could reduce risky use patterns associated with morning use. Such efforts may be especially prudent for young men, as our findings indicated morning cannabis use probabilities were much higher for men than women.

Limited psychological and social effects of lifetime cannabis use frequency: Evidence from a 30-year community study of 4,078 twins

BACKGROUND

Cannabis use is associated with outcomes like income, legal problems, and psychopathology. This finding rests largely on correlational research designs, which rely at best on statistical controls for confounding. Here, we control for unmeasured confounders using a longitudinal study of twins.

METHOD

In a sample of 4,078 American adult twins first assessed decades ago, we used cotwin control mixed effects models to evaluate the effect of lifetime average frequency of cannabis consumption measured on substance use, psychiatric, and psychosocial outcomes.

RESULTS

On average, participants had a lifetime cannabis frequency of about one to two times per month, across adolescence and adulthood. As expected, in individual-level analyses, cannabis use was significantly associated with almost all outcomes in the expected directions. However, when comparing each twin to their cotwin, which inherently controls for shared genes and environments, we observed within-pair differences consistent with possible causality in three of the 22 assessed outcomes: cannabis use disorder symptoms (βW-Pooled = .15, SE = .02, p = 1.7 × 10-22), frequency of tobacco use (βW-Pooled = .06, SE = .01, p = 1.2 × 10-5), and illicit drug involvement (βW-Pooled = .06, SE = .02, p = 1.2 × 10-4). Covariate specification curve analyses indicated that within-pair effects on tobacco and illicit drug use, but not cannabis use disorder, attenuated substantially when covarying for lifetime alcohol and tobacco use.

CONCLUSIONS

The cotwin control results suggest that more frequent cannabis use causes small increases in cannabis use disorder symptoms, approximately 1.3 symptoms when going from a once-a-year use to daily use. For other outcomes, our results are more consistent with familial confounding, at least in this community population of twins. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults

BACKGROUND

This study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months.

METHODS

Perceptions of danger, normative beliefs, perceived likelihood of negative consequences, and other driving-related variables were collected via online surveys in Canadian (n = 158; 50.0% female, 84.8% White, mean age = 32.73 years [SD = 10.61]) and US participants (n = 678; 50.9% female, 73.6% White, mean age = 33.85 years [SD = 10.12]). Driving cognitions and DACU quantity/frequency were compared between samples using univariate analyses of variance, and Spearman's (ρ) correlations were performed to examine associations between driving cognitions and DACU quantity/frequency.

RESULTS

The two samples did not significantly differ in self-reported level of cannabis use, lifetime quantity of DACU, or the number of times they drove within two hours of cannabis use in the past three months (Ps > .12). Compared to US participants, Canadians perceived driving within two hours of cannabis use as more dangerous (P < 0.001, ηp2 = 0.013) and reported more of their friends would disapprove of DACU (P = 0.03, ηp2 = 0.006). There were no differences in the number of friends who would refuse to ride with a driver who had used cannabis (P = 0.15) or the perceived likelihood of negative consequences (Ps > 0.07). More favorable perceptions were significantly correlated with greater lifetime DACU and driving within two hours of use (ρ = 0.25-0.53, Ps < 0.01).

CONCLUSIONS

These findings reveal differences in distal risk factors for DACU between Canada and the US and may inform prevention efforts focusing on perceptions of risk and social acceptance of DACU.

Cognitive Distortions Associated with Alcohol and Marijuana Use in Uruguayan Citizens

Background: Psychological distress (i.e., incipient symptoms of anxiety, stress, and depression) may promote substance use through increased emission of cognitive distortions. These are automatic irrational thoughts that can promote distress, which in turn increases substance use. Aim: This study analyzed, in a sample of Uruguayan citizens, the unique contribution of cognitive distortions on the frequency and quantity of alcohol or marijuana use, over and above the contribution of psychological distress or the use of emotion regulation strategies. We also assessed whether these variables were associated with having initiated or resumed the use of a substance. Methods: A survey asked about alcohol and marijuana use, psychological distress, emotion regulation strategies, and cognitive distortions. The study comprised a convenience sample of 1132 participants (Mean age = 29.07 ± 8.19 years, 72.26% women). Separate hierarchical linear regression analyses were conducted on the frequency and quantity of alcohol or marijuana use, whereas a logistic regression was applied on having initiated or resumed the use of a substance. Results: Several cognitive distortions were significant predictors of frequency and quantity of alcohol consumption or frequency of marijuana use, over and above psychological distress. Differential emission of automatic thoughts was also associated, along with higher scores of psychological distress, with a significantly higher probability of having initiated the use of a new substance or having resumed the use of a substance. Conclusions: Cognitive distortions may promote alcohol and marijuana use. Interventions aimed at modifying these distortions should be considered to reduce the emission of these behaviors.

The relationship between depressed affect, parental monitoring, and sex on cannabis use among American Indian youth

BACKGROUND AND OBJECTIVES

American Indian (AI) adolescents report higher rates of cannabis use than national US adolescents. Previous study examined interactive relationships between depressed affect and family factors on AI adolescent alcohol use. These factors have not been investigated for cannabis use. We examined whether parental monitoring dampened risk for cannabis use due to depressed affect, and potential moderation by sex.

METHODS

We measured cannabis use, depressed affect, parental monitoring, and sex among reservation area AI youth among students in grades 7-12 attending 45 schools. We used censor-inflated regression models to identify parental monitoring as a moderator of the relationship between depressed affect and cannabis use.

RESULTS

In the logistic portion of censor-inflated models, level of depressed affect and parental monitoring significantly related to last 30-day cannabis use. Higher levels of parental monitoring at lower levels of depressed affect related to lower likelihood of cannabis use. Female students had greater likelihood of endorsing cannabis use at higher levels of depressed affect. In the linear portion of the censor-inflated regression models, sex and level of parental monitoring significantly related to cannabis use frequency. Male students endorsed more frequent cannabis use while higher levels of parental monitoring related to lower frequency of use.

DISCUSSION AND CONCLUSIONS

Parental monitoring may dampen the effect of depressed affect on cannabis use among AI youth on reservations.

SCIENTIFIC SIGNIFICANCE

Future interventions should foster skill-building prevention efforts directed at coping with depression, along with parental training for effective monitoring. Special attention to AI female adolescents may be indicated.

Exploring associations between affect and marijuana use in everyday life via specification curve analysis

Although frequently hypothesized, the evidence for associations between affect and marijuana use in everyday life remains ambiguous. Inconsistent findings across existing work may be due, in part, to differences in study design and analytic decisions, such as study inclusion criteria, the operationalization of affect, or the timing of affect assessment. We used specification curves to assess the robustness of the evidence for affect predicting same-day marijuana use and marijuana use predicting next-day affect across several hundred models that varied in terms of decisions that reflect those typical in this literature (e.g., whether to average affect prior to marijuana use or select the affect report closest in time to marijuana use). We fitted these curves to data from two ecological momentary assessment studies of regular marijuana and/or alcohol using college students (N = 287). Results provided robust evidence that marijuana use was slightly less likely following experiences of negative affect and slightly more likely following positive affect. Specification curves suggested that differences in previous findings are most likely a function of the specific emotion items used to represent affect rather than differences in inclusion criteria, the temporal assessment and modeling of affect, or the covariates added to the model. There was little evidence for an association between marijuana use and next-day affect. Overall, our findings provide evidence against the predictions made by affect reinforcement models in college students and suggest that future research should model the associations of marijuana use with discrete emotional states rather than general negative and positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Negative Affect Regulation and Marijuana Use in College Students: Evaluating the Mediating Roles of Coping and Sleep Motives

Negative affect regulation models suggest that marijuana may be used to reduce negative affect. Extant research has provided support for these models, indicating that specific motives for marijuana use, particularly coping motives (i.e., using to alleviate negative affects), mediate relations between affective vulnerabilities and marijuana outcomes. However, sleep motives (i.e., using to promote sleep) have been neglected from such models, despite their theoretical relevance. The present study tested two multiple mediation models in a large sample of marijuana-using college students (N = 1,453) to evaluate the indirect effects of coping and sleep motives in paths from depressive and anxiety symptoms to marijuana outcomes (use, consequences, and cannabis use disorder [CUD] symptoms). Both coping and sleep motives mediated the effects of depressive/anxiety symptoms on each marijuana variable. Moreover, significant double mediated effects were found, such that higher affective symptoms were associated with greater motives; which were associated with more marijuana use; which was related to more negative consequences and CUD symptoms. The findings provide support for sleep motives as a relevant pathway between affective vulnerabilities and marijuana outcomes. Additional research is needed to evaluate the potential benefits of interventions targeting specific marijuana motives.

Adolescent Substance Use Is Associated With Altered Brain Response During Processing of Negative Emotional Stimuli

OBJECTIVE

Substance misuse is often associated with emotional dysregulation. Understanding the neurobiology of emotional responsivity and regulation as it relates to substance use in adolescence may be beneficial for preventing future use.

METHOD

The present study used a community sample, ages 11-21 years old (N = 130, Mage = 17), to investigate the effects of alcohol and marijuana use on emotional reactivity and regulation using an Emotional Go-NoGo task during functional magnetic resonance imaging. The task consisted of three conditions, where target (Go) stimuli were either happy, scared, or calm faces. Self-report lifetime (and past-90-day) drinking and marijuana use days were provided at all visits.

RESULTS

Substance use was not differentially related to task performance based on condition. Whole-brain linear mixed-effects analyses (controlling for age and sex) found that more lifetime drinking occasions was associated with greater neural emotional processing (Go trials) in the right middle cingulate cortex during scared versus calm conditions. In addition, more marijuana use occasions were associated with less neural emotional processing during scared versus calm conditions in the right middle cingulate cortex and right middle and inferior frontal gyri. Substance use was not associated with brain activation during inhibition (NoGo trials).

CONCLUSIONS

These findings demonstrate that substance use-related alterations in brain circuitry are important for attention allocation and the integration of emotional processing and motor response when viewing negative emotional stimuli.

Developmental trajectories of Big Five personality traits among adolescents and young adults: Differences by sex, alcohol use, and marijuana use

OBJECTIVE

Individual differences in adolescent personality are related to a variety of long-term health outcomes. While previous studies have demonstrated sex differences and non-linear changes in personality development, these results remain equivocal. The current study utilized longitudinal data (n = 831) from the National Consortium on Alcohol and Neurodevelopment in Adolescence to examine sex differences in the development of personality and the association between substance use and personality.

METHOD

Participants (ages 12-21 at baseline) completed the Ten-Item Personality Inventory and self-reported past year alcohol and marijuana use at up to 7 yearly visits. Data were analyzed using generalized additive mixed-effects models and linear mixed-effects models.

RESULTS

Findings support linear increases in agreeableness and conscientious and decreases in openness with age and inform on timing of sex-specific non-linear development of extraversion and emotional stability. Further, results provide novel information regarding the timing of the association between substance use and personality, and replicate past reporting of differential associations between alcohol and marijuana use and extraversion, and sex-dependent effects of marijuana use on emotional stability.

CONCLUSIONS

These findings highlight the importance of modeling sex differences in personality development using flexible non-linear modeling strategies, and accounting for sex- and age-specific effects of alcohol and marijuana use.

Understanding and Addressing the Unique Challenges and Conditions of the Veteran: Improving Sleep and Well-Being

Veterans are those who have served our country in one of the branches of armed forces or military reserves. The Veterans Health Administration is the largest integrated health system in the nation, providing health care services and latest research for veterans. Non-Veteran Health Administration primary care clinicians, who also take care of veterans, deserve to have an understanding of the unique challenges and conditions these individuals face and the resources that are available to improve sleep health and well-being of all veterans. This article guides these clinicians to manage sleep disorders, mental health disorders, and substance use among veterans.

Effect of COVID-19 disruptions on young adults' affect and substance use in daily life

OBJECTIVE

Guided by accounts of adjustment in daily life as a key indicator of health, the current study examined prospective changes in young adults' emotions and substance behaviors assessed during a normative baseline period and during the acute COVID-19 disruption period in late March/early April 2020. The COVID-19 assessment also collected psychosocial risk factors expected to moderate changes in adjustment across time.

METHOD

Participants included 295 young adults (70.8% female; ages 18-21 at baseline), drawn from an ongoing study of daily behaviors and health in college life that oversampled for recent substance behaviors, who completed both the baseline and COVID-19 assessments. Hypotheses were tested using analyses of repeated-measures data that included covariates of length of time between assessments and sampling group status.

RESULTS

Direct tests in support of hypotheses indicated an increase in negative affect (d = .67, p < .001), and greater alcohol use (d = .75, p < .001) and marijuana use (d = .58, p < .001), in daily life across time. Levels of positive affect (d = .08, p > .05), nicotine use (d = .01, p > .05), and prescription drug misuse (d = .003, p > .05) did not reliably change in tests of direct models. Moderation tests indicated several risk factors for experiencing steeper increases in negative affect, and increased likelihood of marijuana and nicotine use, in daily life across time.

CONCLUSIONS

Findings offer implications for future research and clinical efforts to improve young adult adjustment in response to the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cannabis dabbing: An emerging trend

ABSTRACT

Cannabis dabbing refers to the recreational inhalation of extremely concentrated tetrahydrocannabinol, the main psychotropic cannabinoid derived from the marijuana plant. The practice carries significant health and legal risks. This article discusses what nurses need to know about dabbing and how they can educate patients who may be engaging in risky behavior.

Driving after marijuana use among U.S. adolescents: Prevalence profiles and related behaviors

OBJECTIVES

The interplay between marijuana legislation, perceptions of risks associated with marijuana use, and marijuana-related risk behaviors is an ever changing and complex issue. Marijuana impaired driving is of concern as legalization continues to expand in the United States. While driving after using marijuana has been shown to be prevalent among adults, little research has examined the behavior in adolescents. The aim of the present study was to examine the prevalence of driving after using marijuana among U.S. adolescents, with an examination of the relationship to age of marijuana initiation and marijuana usage patterns.

METHODS

We analyzed data from the 2017 Youth Risk Behavior Survey, a nationally representative sample of high schools students in the U.S. The sample was current marijuana users, defined as past 30 day use. Driving after using marijuana was the main outcome variable, with analyses examining the association between the outcome and age of initiation and patterns of use. Prevalence ratios were obtained by modeling Poisson regression to examine factors associated with driving under the influence of marijuana.

RESULTS

Nearly half of all marijuana users reported driving after use during the past 30 days, and did not differ between males and females. Prevalence of driving after using marijuana was significantly higher among heavy users (PR = 2.8; 95% CI 2.1-3.6). A higher prevalence of driving after drinking alcohol (PR = 1.7; 95% CI 1.5-1.9) was also found among those who had driven after using marijuana.

CONCLUSIONS

Among adolescent marijuana users, the prevalence of driving after using marijuana was high. Enhanced surveillance, prevention, and control measures are necessary to mitigate the negative impacts of marijuana consumption and related behaviors.

Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders

Importance

Cannabis use and cannabis use disorder (CUD) are common among youths and young adults with mood disorders, but the association of CUD with self-harm, suicide, and overall mortality risk is poorly understood in this already vulnerable population.

Objective

To examine associations of CUD with self-harm, suicide, and overall mortality risk in youths with mood disorders.

Design, Setting, and Participants

A population-based retrospective cohort study was performed using Ohio Medicaid claims data linked with death certificate data. The analysis included 204 780 youths (aged 10-24 years) with a diagnosis of mood disorders between July 1, 2010, and December 31, 2017, who were followed up to 365 days from the index diagnostic claim until the end of enrollment, the self-harm event, or death. Statistical analysis was performed from April 4 to July 17, 2020.

Exposure

Physician-diagnosed CUD defined using outpatient and inpatient claims from 180 days prior to the index mood disorder diagnostic claim through the 365-day follow-up period.

Main Outcomes and Measures

Nonfatal self-harm, all-cause mortality, and deaths by suicide, unintentional overdose, motor vehicle crashes, and homicide. Marginal structural models using inverse probability weights examined associations between CUD and outcomes.

Results

This study included 204 780 youths (133 081 female participants [65.0%]; mean [SD] age at the time of mood disorder diagnosis, 17.2 [4.10] years). Cannabis use disorder was documented for 10.3% of youths with mood disorders (n = 21 040) and was significantly associated with older age (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26), male sex (ARR, 1.79; 95% CI, 1.74-1.84), Black race (ARR, 1.39; 95% CI, 1.35-1.44), bipolar or other mood disorders (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25), prior history of self-harm (ARR, 1.66; 95% CI, 1.52-1.82), previous mental health outpatient visits (ARR, 1.26; 95% CI, 1.22-1.30), psychiatric hospitalizations (ARR, 1.66; 95% CI, 1.57-1.76), and mental health emergency department visits (ARR, 1.54; 95% CI, 1.47-1.61). Cannabis use disorder was significantly associated with nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) and all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), including death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16) and homicide (AHR, 3.23; 95% CI, 1.22-8.59). Although CUD was associated with suicide in the unadjusted model, it was not significantly associated in adjusted models.

Conclusions and Relevance

Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.

The relationship between cannabis use and cognition in people with bipolar disorder: A systematic scoping review

Bipolar disorder (BD) and cannabis use are highly comorbid and are each associated with cognitive impairment.  Given the prevalence of cannabis use in people with BD, it is important to understand whether the two interact to impact cognitive function. We performed a systematic scoping review to determine what is currently known in this field. We systematically searched PubMed, Embase, CINAHL, Web of Science, and PsycINFO for studies on the relationship between cannabis use and cognition in people with BD or relevant animal models. Six observational human studies and no animal studies met inclusion criteria. Two studies found cannabis use in BD was associated with better performance in some cognitive domains, while three studies found no association. One study found cannabis use in BD was associated with worse overall cognition. Overall, most identified studies suggest cannabis use is not associated with significant cognitive impairment in BD; however, the scope of knowledge in this field is limited, and more systematic studies are clearly required. Future studies should focus on longitudinal and experimental trials, and well-controlled observational studies with rigorous quantification of the onset, frequency, quantity, duration, and type of cannabis use, as well as BD illness features.

The importance of psychology for shaping legal cannabis regulation

Different patterns of cannabis use can be traced directly back to different interactions between 2 types of variables: pharmacological and environmental. As legal cannabis expands in the U.S. and around the world, state and national regulatory agencies are gaining control over these variables. Specifically, regulatory agencies are increasingly capable of altering (a) the pharmacological properties of cannabis products and (b) the way these products are distributed to the population. Consequently, cannabis regulatory agencies are in a unique position to use evidence from psychological science to alter cannabis consumption patterns in ways that mitigate potential harm to public health. However, most state-level legal cannabis regulatory systems in the U.S. are not yet evidence-based or public health-oriented. This applied review and commentary draws on evidence from the psychological science literature to help regulators better understand the types of behaviors they must address and guide empirically supported regulation of THC-laden cannabis, whether used putatively for medical or recreational reasons. This review is organized into 3 parts that correspond to the 3 primary agents within the cannabis regulation ecosystem: (a) the cannabis consumer, (b) the cannabis industry, and (c) the cannabis regulatory agency. Within this structure, the review addresses critical psychological variables that drive cannabis consumer and industry behaviors and discusses how regulatory agencies can use this information to protect public health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Anticipated Effects of Cannabis Scale (AECS): Initial development and validation of an affect- and valence-based expectancy measure

Prior research suggests that cannabis expectancies are related to cannabis misuse and problems. Although there are established measures of cannabis expectancies, existing measures have psychometric limitations and/or are lengthy. Existing measures typically have a two-factor structure of positive and negative expectancies, but recent conceptualizations of alcohol expectancies support a valence- (positive vs. negative) and arousal-based (high vs. low arousal) structure. Thus, the present study sought to test a similar structure for cannabis. Cannabis expectancy items underwent 2 preliminary studies, assessing item valance/arousal (n = 233) and relevance to cannabis (n = 124). A final pool of 76 items underwent exploratory factor analysis (n = 303), and remaining items underwent confirmatory factor analysis in a separate sample (n = 469). Lastly, an additional sample (n = 435) examined validity. Results suggested a 3-factor structure (general positive, high arousal negative, low arousal negative) for the 17-item Anticipated Effects of Cannabis Scale (AECS), which was invariant across cannabis use frequency, sex, and race/ethnicity. Positive expectancies were strongly associated with cannabis use, whereas low arousal negative expectancies were protective against cannabis frequency; high arousal negative expectancies were strongly associated with more negative consequences and dependence symptoms. In addition, the proposed interpretation of AECS test scores showed evidence of incremental validity relative to another abbreviated measure. The current study provides initial support for the AECS, a brief, psychometrically sound cannabis expectancies measure. The AECS captures the full range of cannabis effects and may be suited to test discrepancies between cannabis expectancies and subjective response. Additional research is needed to validate its structure and predictive utility. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intelligence quotient decline following frequent or dependent cannabis use in youth: a systematic review and meta-analysis of longitudinal studies

Previous systematic reviews and meta-analyses of cross-sectional data assessing the effect of cannabis on cognitive functioning and intelligence show inconsistent results. We hypothesized that frequent and dependent cannabis use in youth would be associated with Intelligence Quotient (IQ) decline. This study is a systematic review and meta-analysis. We searched Embase, PubMed and PsychInfo from inception to 24 January 2020. We included studies with non-treatment seeking samples and pre- and post-exposure measures of IQ. We requested data from authors if summary data was not available from published work. We preregistered our review with PROSPERO (ID no. CRD42019125624). We found seven cohort studies including 808 cases and 5308 controls. We found a significant effect for the association between frequent or dependent cannabis use in youth and IQ change, Cohen's d = -0.132 (95% CI -0.198 to -0.066) p < 0.001. Statistical heterogeneity between studies was also low at I2 = 0.2%. Study quality was moderate to high. This translates to an average decline of approximately 2 IQ points following exposure to cannabis in youth. Future studies should have longer periods of follow up to assess the magnitude of developmental impact.

Marijuana, but not alcohol, use frequency associated with greater loneliness, psychological distress, and less flourishing among young adults

OBJECTIVE

To assess whether frequency of marijuana and alcohol use are cross-sectionally associated with indicators of social and emotional well-being including loneliness, psychological distress, and flourishing across important life domains among young adults.

METHOD

The study sample included 562 participants ages 22-29 who were originally recruited from an urban Pacific Northwest region in the US as part of a longitudinal study of social role transitions and alcohol use. At one assessment, participants completed an online survey that included a 3-item measure of loneliness, a 4-item measure of depression and anxiety symptoms, and a 12-item measure of flourishing as well as measures of marijuana and alcohol use frequency. Linear and generalized linear models were used to estimate associations of marijuana and alcohol use frequency with indicators of well-being.

RESULTS

Greater frequency of marijuana use was associated with higher levels of loneliness, higher levels of psychological distress, and lower levels of flourishing, with the greatest difference observed for daily marijuana users compared to non-users. However, these indicators of well-being did not significantly differ by levels of alcohol use frequency.

CONCLUSION

Study findings suggest that frequent users of marijuana, but not alcohol, may experience more loneliness, more psychological distress, and less flourishing. Intervention approaches for frequent marijuana users may be warranted to reduce impacts of loneliness and psychological distress and improve overall well-being.

[Examination of emotion regulation difficulties, coping, impulsivity, external-internal control and sensation seeking among occasional and regular marijuana users]

INTRODUCTION

Several studies have investigated the relationship between personality and psychoactive substance use. Researches of personality and marijuana use suggests that certain personality traits differentiate between occasional and regular marijuana consumers. Understanding the relationship between individual persona - lity traits and marijuana use is a key step in the development of prevention and treatment methods. In the current study, we present the development of emotion regulation difficulties, coping with stress, impulsivity, external-internal control and sensation seeking in occasional and regular marijuana users.

METHODS

322 people participated in our study, within this 51 occasional and 56 regular marijuana users and 215 non-marijuana users who formed the control group. The examined personality traits were measured with the Diffi - culties in Emotion Regulation Scale, the Coping Inventory for Stressful Situations, the Barratt Impulsiveness Scale, the Internal-External Locus of Control Scale and the Sensation Seeking Scale.

RESULTS

Varying levels of marijuana use increased difficulty in emotion regulation as well as impulsivity. Addi tio nally, the use of emotion-oriented coping strategies were most common in occasional and regular marijuana use. Regular marijuana users were more likely to have external control than occasional users. Non-marijuana users were less sen - sation seekers that the two groups of marijuana users, however, we did not find significant difference between occasio nal and regular users.

Perceptions of U.S. and Canadian Cannabis Package Warnings Among U.S. Adults

BACKGROUND

Cannabis warning labels can communicate risks, but there is little research on warning perceptions and differences by product type.

METHODS

In a 2019 online survey, 1,000 U.S. adults (500 cannabis users and 500 cannabis non-users who used tobacco) were randomly assigned to view no warning or one of four U.S. or Canadian warnings displayed on images of packaging for dried flower or edible cannabis. The warnings described cannabis risks related to psychosis, addiction, lack of FDA oversight, and impaired driving. We used linear regression to examine perceptions of warnings and product harm as a function of product type (dried or edible) and warning. We examined which warning participants selected as most effective for discouraging youth use and impaired driving.

RESULTS

Participants found the addiction warning (cannabis users: B = -1.04, p < 0.001; cannabis non-users: B = 1.17, p < 0.001) and psychosis warning (users: B = -0.65, p < 0.05; non-users: B = -0.71, p < 0.05) less believable than the driving warning but indicated that they learned more from the psychosis warning than the driving warning (users: B = 0.88, p < 0.01; non-users (B = 1.60, p < 0.001). Participants viewing any warning considered smoking cannabis to be more harmful than those viewing no warning (all p < 0.05). The psychosis warning was most frequently selected as the best warning for discouraging youth use.

CONCLUSIONS

Warnings have the potential to educate consumers and impact cannabis harm perceptions. Warnings have similar effects across product types, potentially eliminating the need for product type-specific warnings. The association of cannabis use with risk for psychosis, a topic addressed in Canadian warnings, could be a useful topic of focus in U.S. warnings.

Parsing impulsivity in individuals with anxiety and depression who use Cannabis

BACKGROUND

Individuals with anxiety/depression may impulsively use cannabis to acutely induce positive affect and attenuate aversive mood states. However, few studies have attempted to parse impulsivity displayed by anxious/depressed cannabis users. This investigation examined what aspects of impulsivity characterize those individuals using self-report and functional MRI (fMRI) measures.

METHODS

Individuals with any lifetime anxiety/depression diagnoses and problematic cannabis use ("Anx/Dep+CB"; n=42) were compared to a propensity score-matched group with very low cannabis use ("Anx/Dep-lowCB"; n=42), and a healthy control group (n=37). Impulsivity was measured using the UPPS-P Impulsivity Questionnaire and the Stop Signal Task (SST) during fMRI. For UPPS-P, regression models estimated group-by-impulsivity subscale interactions with post-hoc pairwise tests. For the SST, similar regression models were estimated with four a-priori regions of interest (ROIs; right opercularis, orbitalis, dorsal and ventral anterior insula) during stop-success and stop-failure processing. Null SST findings were followed up using Bayes factor analysis to quantify the evidence in support of the null hypothesis.

RESULTS

For the UPPS-P, a significant group-by-subscale interaction indicated that the Anx/Dep+CB group exhibited higher levels of impulsivity on the negative- and positive-urgency subscales relative to both comparison groups. Higher negative-urgency correlated with heavier lifetime cannabis use across groups. For the SST, there were no ROI task activation differences. Bayes factor analysis determined the null findings were at least three times more likely than the alternative hypothesis for all ROIs.

CONCLUSIONS

Impulsivity under periods of heightened affect, but not motor response inhibitions, characterized anxious/depressed individuals who use cannabis.

Longitudinal associations between amygdala reactivity and cannabis use in a large sample of adolescents

RATIONALE

The amygdala is a key brain structure to study in relation to cannabis use as reflected by its high-density of cannabinoid receptors and functional reactivity to processes relevant to drug use. Previously, we identified a correlation between cannabis use in early adolescence and amygdala hyper-reactivity to angry faces (Spechler et al. 2015).

OBJECTIVES

Here, we leveraged the longitudinal aspect of the same dataset (the IMAGEN study) to determine (1) if amygdala hyper-reactivity predicts future cannabis use and (2) if amygdala reactivity is affected by prolonged cannabis exposure during adolescence.

METHODS

First, linear regressions predicted the level of cannabis use by age 19 using amygdala reactivity to angry faces measured at age 14 prior to cannabis exposure in a sample of 1119 participants. Next, we evaluated the time course of amygdala functional development from age 14 to 19 for angry face processing and how it might be associated with protracted cannabis use throughout this developmental window. We compared the sample from Spechler et al. 2015, the majority of whom escalated their use over the 5-year interval, to a matched sample of non-users.

RESULTS

Right amygdala reactivity to angry faces significantly predicted cannabis use 5 years later in a dose-response fashion. Cannabis-naïve adolescents demonstrated the lowest levels of amygdala reactivity. No such predictive relationship was identified for alcohol or cigarette use. Next, follow-up analyses indicated a significant group-by-time interaction for the right amygdala.

CONCLUSIONS

(1) Right amygdala hyper-reactivity is predictive of future cannabis use, and (2) protracted cannabis exposure during adolescence may alter the rate of neurotypical functional development.

Initial evaluation of Manitoba's cannabis surveillance system

The Government of Manitoba created a cannabis public health surveillance system in 2018 in preparation for nonmedical cannabis legalization on 17 October, 2018. An initial evaluation was conducted to assess the usefulness, flexibility and simplicity attributes of the system, using an online stakeholder survey, website metrics, system analysis and interviews. Resulting recommendations included creating a detailed communication plan for surveillance products, changing the format and frequency of reporting, maintaining strong relationships with partners and building towards a centralized provincial substance use surveillance database and surveillance system.

Incidental finding of age and time disorientation in a clinical sample of patients with schizophrenia: Findings from a short term follow up survey regarding cannabis use

Age disorientation has been described in a subtype of patients with schizophrenia. The current article reports on an incidental finding from our survey study on patterns of cannabis use pre-post legalization in patients with schizophrenia. For the purpose of the survey study, patients were asked to fill out a total of 41 survey questions. The same participants were contacted over the phone 8 weeks post-legalization. Responses to the survey questions were consistent pre- and post-legalization except for four items which required estimation of time/age. This incidental finding highlights the need for further exploration of this phenomenon by future studies.

Marijuana use and health behaviors in a US clinic sample of patients with sickle cell disease

Introduction

As marijuana use becomes more common, it is essential clinicians understand the relationship between marijuana use and health behaviors.

Methods

Using a retrospective cohort of adolescents and adults with sickle cell disease (SCD) stratified into a young (<25 years) and older cohort (> = 25 years), we conducted multiple linear regression examining relationship of marijuana use (independent variable) on each dependent variable (SCD self-management score and pain management).

Results

Among young cohort, 16.9% used marijuana compared to 21.8% of older cohort. The younger cohort reporting marijuana use had lower mean self-care scores (β = -2.74;p = 0.009) and were more likely to have admissions to the hospital for pain (β = 0.87;p = 0.047) compared to non-users. In contrast, the older cohort reporting marijuana use had more days treating pain at home (β = 0.44;p = 0.035).

Conclusions

Only a minority of patients with SCD reported lifetime marijuana use. Among those reporting marijuana use, there were different associations with self-care and health-related behaviors by age. The older cohort who endorsed marijuana use reported more days of treating pain at home, although this did not translate into increased acute care visits for pain crisis. Among youth, endorsing marijuana use was associated with worse SCD self-care.

Youth's Proximity to Marijuana Retailers and Advertisements: Factors Associated with Washington State Adolescents' Intentions to Use Marijuana

The current study explored the influences of advertising exposure, numbers of marijuana retailers, distance to retailers, and constructs from the integrative model of behavioral prediction, including outcome beliefs, perceived norms, and efficacy, on youth's intentions to use marijuana in a state in which the use of recreational marijuana is legal. A state-wide online cross-sectional survey of 350 adolescents ages 13-17, residing in Washington state, was conducted in June 2018. The results of the regression analysis suggest that exposure to marijuana advertising, positive and negative outcome beliefs, and perceived peer norms were associated with intention to use marijuana. Distances to retailers moderated the relationships between exposure to advertising and intentions, as well as between positive outcome beliefs and intentions. States that have legalized recreational marijuana should continue considering the location of retailers in relation to neighborhoods and advertising regulations to reduce the appeal to youth. Additionally, prevention efforts could aim to influence outcome beliefs and norms in an attempt to reduce adolescents' intentions to use recreational marijuana.

Digital media use and subsequent cannabis and tobacco product use initiation among adolescents

BACKGROUND

Digital media engagement, such as browsing the internet or social media posting, may be associated with cannabis and tobacco product use initiation among adolescents. Whether certain digital media exposure confers greater - or reduced - risk for specific cannabis or tobacco products is unknown.

METHODS

Adolescents completed surveys on digital media and substance use every 6 months from 2015 to 2017 (4 waves). Self-reported digital media use (14 items) was classified into six subcategories (e.g., "social media posting," "reading news/articles & browsing photos"). Random-effect repeated-measures regression models examined the association of exposure to each digital media subcategory with subsequent cannabis or tobacco product use initiation in the next 6 months, among baseline cannabis and tobacco never-users (n = 1841; n = 1558, respectively).

RESULTS

High frequency digital media use (multiple times/day) of "social media posting" (vs. no high frequency use; OR = 1.95; 95%CI:1.20-3.17) and "checking in" (OR = 1.71; 95%CI:1.23-2.38) was associated with greater odds of any cannabis product use initiation 6 months later. "Reading news/articles & browsing photos" was associated with decreased odds of initiation (OR = 0.52; 95%CI:0.34-0.79). "Checking in" and "reading news/articles & browsing photos" were similarly associated with any tobacco use initiation. "Chatting and shopping" was associated with greater odds (OR = 4.63; 95%CI:1.53-14.06) of e-cigarette initiation, but not of other product use initiation.

CONCLUSIONS

Some subcategories of digital media use conferred increased odds, others conferred reduced odds, and others were not associated with cannabis and tobacco use initiation. Research exploring mechanisms that put users of specific digital media at greater risk for substance use initiation is warranted.

On the discounting of cannabis and money: Sensitivity to magnitude vs. delay

BACKGROUND

While using most drugs of abuse is associated with higher than control rates of delay discounting, cannabis use may be the exception. As such, between-commodity differences in delay discounting (i.e., money vs. cannabis) have not been thoroughly examined. We examined these between-commodity differences using modern analytic techniques to disentangle effects of subjects' sensitivity to magnitude and delay as potential drivers of any obtained delay discounting rate differences.

METHOD

; Fifty-eight college students (n = 33 cannabis users, n = 25 non-users) completed a monetary delay discounting task - with the cannabis users completing the cannabis problems questionnaire as well a delay discounting of cannabis task- in an on-campus laboratory.

RESULTS

Responding between groups differed on the cannabis problems questionnaire, but not on delay discounting of monetary outcomes. Cannabis users, however, discounted cannabis at higher rates than money. Multilevel logistic regression revealed that these between-commodity delay discounting differences were due to subjects' differential sensitivity to the magnitude of these two commodities, rather than sensitivity to delay to receiving these commodities.

CONCLUSIONS

Although differences in delay discounting rate were not obtained between students that did and did not use cannabis, cannabis users did discount cannabis at higher rates than they did money - suggesting considerable generality of the between commodity differences in delay discounting obtained elsewhere. The current between-commodity delay discounting differences appear to be driven by differential sensitivity to the reinforcer magnitudes presented in each task - a finding that awaits replication across other comparisons before statements about generality can be made.

Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance

Acute exposure to cannabis comes with neurocognitive impairment, leading to increased risk of human error and injury. Evidence however indicates that such acute effects are less prominent in chronic users, suggesting cannabis tolerance. Models of cannabis tolerance stress the importance of neurobiological or behavioral adaptations following repeated cannabis exposure. The pharmacodynamic model relates neuroadaptive changes in the brain to a blunted response to cannabis. Downregulation of CB1 receptors in chronic cannabis users has been associated with a normalization of dopaminergic output from the ventral tegmental area to the mesolimbic circuit, and a reduction of impairment during acute cannabis exposure. Such neuroadaptions are absent in occasional users, who show strong increments of dopamine and glutamate levels in the striatum, a loss of functional connectivity within the mesolimbic circuit and neurocognitive impairments when exposed to cannabis. Evidence for a behavioral model of cannabis tolerance that poses that users can have volitional control to overcome functional impairment during cannabis intoxication is relatively weak, and at best shows limited control over a limited number of behavioral functions. Cannabis tolerance is most likely to occur in users that consume high doses of cannabis continuously, at a high pace, for a prolonged period of time. Knowledge on frequency, dose and duration of cannabis use that is needed to achieve, maintain or lessen tolerance however is very limited, but will be of importance in the context of cannabis therapeutics and in legal settings when evaluating the impact of cannabis exposure on human function.

Information Seeking as A Predictor of Risk Behavior: Testing A Behavior and Risk Information Engagement Model (BRIE)

Prior theoretical models of information seeking have examined its role, primarily, as a determinant of recommended behaviors. In this study, we develop and test the "behavior and risk information engagement" (BRIE) model, which accounts for the reciprocal effects of information seeking from interpersonal and media sources on two risk behaviors - nonmedical marijuana and amphetamine use. We test the model among young Israeli adults (N = 800) using a three-wave prospective observational study (at 6-month intervals). Autoregressive cross-lagged structural equation models showed good fit. Information seeking from interpersonal sources at baseline predicted amphetamine use and marijuana use at 6 months. In both models, seeking drug-related information from interpersonal sources at baseline was also a predictor of seeking information from media sources at 6 months. Information seeking from media sources at 6 months was also a significant predictor of amphetamine use at 12 months. Implications for theory and practice are discussed.

Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis

Background

Cannabis use is common among marginalized people who use illicit drugs (PWUD) but reasons for use remain poorly investigated. We sought to explore how different intentions for cannabis use relate to social, structural, and behavioural factors among PWUD in Vancouver, Canada.

Methods

We used data from cannabis-using participants in two community-recruited prospective cohort studies of PWUD. Using latent class analysis, we identified discrete cannabis-using groups based on self-reported intentions for use. Generalized estimating equations were used to examine correlates of class membership.

Results

Between June 2016 and December 2018, 2,686 observations from 897 participants cannabis-using PWUD were analyzed. Four latent classes of cannabis use emerged: Class 1 (31.6%), characterized by non-medical purposes; Class 2 (37.5%), characterized by non-pain therapeutic use (e.g., stress, nausea/loss of appetite, and insomnia); characterized by Class 3 (21.9%) predominantly pain relief; and Class 4 (9.0%), characterized by a wide range of therapeutic uses in addition to pain management, including insomnia, stress, nausea/loss of appetite, and harm reduction. Class-specific structural, substance-, and health-related differences were observed, including indicators of better physical and mental health among the “recreational” class, despite evidence of more structural vulnerabilities (e.g., homelessness, incarceration).

Conclusions

Our findings demonstrate a wide spectrum of motivations for cannabis use among PWUD. We observed important health-related differences between latent classes, demonstrating possible unmet healthcare needs among PWUD reporting therapeutic cannabis use. These findings inform ongoing policy surrounding access to cannabis for harm reduction purposes and applications of medical cannabis for PWUD.

Does Cannabis Use Predict More Severe Types of Alcohol Consequences? Longitudinal Associations in a 3-Year Study of College Students

BACKGROUND

Prior research shows that negative drinking outcomes among young adults may be exacerbated by cannabis use. However, to date, there have been few longitudinal studies of associations between cannabis use and negative alcohol-related consequences. This study examined longitudinal within-person associations between cannabis use and several domains of negative alcohol consequences among young adults and explored the moderating role of sex.

METHOD

We analyzed data from N = 997 students assessed 4 times per year over the first 3 years of university. At each time point, participants completed measures of past-month cannabis use frequency, typical weekly number of drinks, and 8 domains of negative alcohol consequences. Longitudinal associations were examined in multilevel models.

RESULTS

Within-person changes in frequency of cannabis use were not uniquely associated with changes in total alcohol consequences aggregated across several alcohol consequence domains. However, when examining alcohol consequence domains separately, within-person increases in cannabis use frequency were specifically associated with increases in some (but not all) of the more severe types of alcohol consequences, including risky behaviors, poor self-care, and alcohol dependence symptoms. No support was observed for the moderating role of sex in the longitudinal within-person associations between cannabis use and alcohol consequence domains.

CONCLUSIONS

Findings suggest that within-person changes in cannabis use frequency among young adults are associated with corresponding changes in some domains of alcohol consequences (but not others) when examined over the course of several years. Results may inform targeted harm reduction interventions for young adult drinkers who use cannabis, although future research is needed to clarify the mechanisms of the observed associations.