Self-reported psychopathological symptoms in recreational ecstasy (MDMA) users are mainly associated with regular cannabis use: further evidence from a combined cross-sectional/longitudinal investigation

Rationale 3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) has become a widely used recreational drug among young people. This is of great concern, since MDMA is neurotoxic in animal studies and its use has been associated with psychological distress and a variety of self-reported psychiatric symptoms. However, exploring the origins of psychopathology in ecstasy users is hampered by the frequent polydrug use and by the cross-sectional design of all investigations, so far.Objectives The present study combines a cross-sectional with a longitudinal approach to further clarify the impact of the use of other illicit drugs on psychopathological symptoms reported by ecstasy users.Methods At baseline, we administered self-rating scales for impulsivity, sensation seeking and general psychological complaints to 60 recreational ecstasy users and 30 matched controls. From the initial sample of ecstasy users, 38 subjects were re-examined 18 months later.Results At baseline, ecstasy users reported significantly more psychological complaints than controls. However, self-reported psychopathology was mainly associated with regular cannabis use. At follow-up, subjects who had abstained from ecstasy use during the follow-up period did not differ from those reporting continued consumption. In contrast, subjects with regular concomitant cannabis use during the follow-up period reported more anxiety, interpersonal sensitivity and obsessive-compulsive behaviour than cannabis-abstinent users. Finally, higher levels of obsessive-compulsive behaviour, interpersonal sensitivity, depression, anxiety, phobic anxiety and paranoid ideation were significantly correlated with the duration of regular interim cannabis use.Conclusions The present findings suggest that self-reported psychopathology in ecstasy users is predominantly attributable to concomitant use of cannabis. Abstinence from cannabis and not ecstasy seems to be a reliable predictor for remission of psychological complaints in ecstasy users.     

Cannabis Use and Depressive Mood in Adolescence: The Mediating/Moderating Role of Anxiety,Cannabis Effect Expectancies,and Peer Users

abstract

The aim of this study was to clarify the relationship between depressive mood and lifetime cannabis use in adolescents, particularly through the mediating role of anxiety and cannabis use effect expectancies, and the moderating role of peer cannabis use. A questionnaire was administered to 1,246 adolescents (16 to 17 years old). Analysis of variance (ANOVA), chi-square, logistic regressions, and mediation/moderation analyses were performed. Results demonstrate that depressive adolescents show a greater probability of cannabis use when they have friends who also consume cannabis. Also, social anxiety has a preventing effect against cannabis use. However, if adolescents have few or no friends who use cannabis, depression does not appear to be a risk factor, and social anxiety becomes a stronger preventing factor against early cannabis use.     

Population-Based Associations Among Cannabis Use,Anxiety, and Depression in Norwegian Adolescents

Objective: The aim of the study was to explore the use of cannabis among Norwegian adolescents and examine associations with self-reported symptoms of anxiety and depression, age, and dose/frequency of use. Methods: A total of 36,714 Norwegian adolescents between the ages of 13 and 17 completed a cross-sectional national survey. Results: Cannabis users reported significantly more symptoms of anxiety and depression compared to non-users. There were no significant differences on anxiety and depression scores between those who had tried the drug once and those who had tried it six times or more. Both cannabis use and the prevalence of symptoms of anxiety and depression were found to increase with age. Girls reported less use of cannabis and slightly more symptoms of anxiety and depression compared to boys. Conclusions: The present study contributes to the existing knowledge about important associations between cannabis use and symptoms of anxiety and depression in adolescents. Future research should focus on longitudinal methods in order to better understand the role of environmental and neurobiological explanatory factors.     

Interrelationships among depression,anxiety, flourishing,and cannabis use in youth

AimsThe objective of the study was to examine if depression or anxiety was associated with youth cannabis use; and investigate whether flourishing, an indicator of overall wellbeing, moderates these associations.MethodsStudents (N=6550) were recruited from 10 secondary schools (grade 9-12) in Ontario and British Columbia, Canada. Self-report questionnaires were used to assess symptoms of depression [CESD-R-10], anxiety [GAD-7], flourishing [Deiner’s Flourishing Scale], and cannabis use. Logistic regression and product-term interactions were used to examine the associations between mental health and youth cannabis use, and the potential moderating effect(s) of flourishing.ResultsIn our sample, 32% of participants had ever used cannabis, and 42% and 32% reported elevated depressive and anxiety symptoms, respectively. Associations between depression, anxiety, and cannabis use were no longer significant when flourishing was added to the models. In addition, there was no evidence suggesting a moderating effect of flourishing (all interactions were not statistically significant). Instead, robust associations were found between flourishing and cannabis use (ever use and frequency).ConclusionsIndicators of mental wellbeing, such as flourishing, appear to be associated with a lower likelihood of cannabis use, even after controlling for depression and anxiety. Results suggest prevention strategies for youth cannabis use should aim to foster mental wellbeing among all youth, rather than exclusively targeting those experiencing mental health problems. Future longitudinal studies should test the sequential relationship between cannabis use and changes in both positive and negative mental health.     

Multisubstance Use Among Treatment-Seeking Smokers: Synergistic Effects of Coping Motives for Cannabis and Alcohol Use and Social Anxiety/Depressive Symptoms

Objective: This study examined the impact of coping motives for cannabis and alcohol use on the relation between social anxiety/depressive symptoms and severity of substance use for alcohol, tobacco, and cannabis among treatment-seeking smokers who also use cannabis and alcohol. Methods: The sample included 197 daily cigarette smokers (M_Age 34.81 years, SD = 13.43) who reported using cannabis and alcohol. Results: Hierarchical multiple regression analyses were conducted wherein separate models were constructed for each dependent variable. Among individuals with higher social anxiety, alcohol coping motives were associated with heavier drinking, and this was more pronounced among those low in depressive symptoms. Similarly, those at greater risk for nicotine dependence were anxious individuals with lower depressive symptoms who endorse coping-oriented motives for using cannabis. Further, among those with higher social anxiety, cannabis coping motives were associated with marginally greater drinking, particularly for those high in depressive symptoms. Conclusions: The present findings support the perspective that among multisubstance users, the interplay between social anxiety, depressive symptoms, and coping-oriented motives for using one substance (e.g., cannabis or alcohol) may pose difficulties in refraining from other substances (e.g., tobacco). This observation highlights the importance of tailoring multisubstance treatments to specific needs of multiusers for whom single-substance interventions may be less effective. Findings also support previous work exploring the benefits of concurrently treating co-occurring substance use and lend credence to the perspective that motivation to use substances for coping reasons is of central theoretical and clinical relevance.     

The association between adolescent cannabis use and anxiety: A parallel process analysis

IntroductionAssociations between anxiety symptoms and cannabis use have been previously explored, yet the directionality of these associations remains highly debatable. The present study aims to prospectively examine patterns of cannabis use and anxiety during adolescence focusing on their co-development and bidirectional influences.MethodsAdolescents (n = 250) of predominantly Hispanic ethnicity, aged 14–17 at baseline, exposed to drugs, alcohol, or cigarettes completed three (bi-annual) assessments across a 1-year period. Latent growth curve modeling (LGCM) and parallel process growth curves were conducted to examine potential associations in the joint development of anxiety and cannabis use.ResultsOur results suggest that, during adolescence, early cannabis use has a greater influence on prospective reports of anxiety, than vice versa. Specifically, adolescents exhibiting higher initial levels of cannabis use displayed more persisting self-reported anxiety across time, as compared to those with less frequent use (b = 0.28, p = 0.024). In contrast, early levels of anxiety were not found to influence rates of change in cannabis use. These analyses considered concurrent depression, alcohol, and nicotine use.ConclusionsOur findings suggest that prevention and targeted intervention programs for cannabis use in adolescence would benefit from anxiety management strategies; in order to reduce subsequent anxiety associated with cannabis use. Future studies should continue to employ longitudinal designs across larger time periods and aim to replicate these findings with more diverse samples.     

早期教育对父母亲心理健康的影响

目的 调查坚持参加早教学习班的父母亲的心理健康状况.方法 采用90项症状清单（SCL-90）对常规参加早教学习训练的父母亲在婴儿4个月、6个月时进行心理健康评估,与未坚持参加早教训练的父母亲的心理健康状况作对照.结果 在婴儿4个月和6个月时,两组在躯体化、强迫症状、抑郁、焦虑4个因子为筛选阳性的例数有差异,实验组4个月和6个月时例数分别为40例和20例;对照组分别是119例和81例,两组比较差异有统计学意义,P＜0.05.结论 坚持参加早期教育训练班对父母亲心理健康有积极的正面影响,能有效地减轻躯体化、强迫、焦虑、抑郁的症状.     

Substance Abuse Treatment for Adolescents: How are Family Factors Related to Substance Use Change?

Abstract

Parental involvement in adolescents' substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths' recovery are not well understood. The present study examines the association between (1) changes in adolescents' substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers' mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents' access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions.     

Symptoms of obsessive-compulsive disorder predict cannabis misuse

IntroductionCannabis use has been linked to many psychological disorders. There is, however, a paucity of research investigating the link between cannabis use and obsessive-compulsive disorder (OCD). The present study sought to examine this link by exploring associations between severity of OCD symptoms, cannabis use, and cannabis misuse; determining whether these associations exist above and beyond symptoms of anxiety, depression, and stress; and testing the mediating role of cannabis coping motives (i.e., using cannabis to cope with negative affect and other problems).MethodsA large sample of young adult cannabis users (n = 430) completed an online survey containing measures of OCD symptoms, cannabis use, cannabis misuse, and cannabis use motives.ResultsSeverity of OCD (as indexed by higher scores on the Obsessive-Compulsive Inventory-Revised) was unrelated to frequency and quantity of cannabis use, but it was significantly, positively related to increased cannabis misuse. These effects persisted after controlling for anxiety, depression, and stress. The specific feature of obsessing was found to consistently predict cannabis misuse. Finally, an indirect effect of severity of OCD on cannabis misuse via coping motives was discovered.ConclusionsTogether, these findings indicate that there may be an association between OCD and cannabis misuse that is independent of anxiety, depression, and stress, and that is mediated by coping motives. Based on these findings, we recommend that individuals with OCD symptoms avoid using cannabis because they may be more vulnerable to the development of problematic use and cannabis use disorder.     

烫吸海洛因成瘾者SCL-90应用研究

采用精神症状自评量表（ＳＣＬ－９０）对１２４例烫吸海洛因成瘾者进行评定，结果表明，海洛因成瘾者戒断前后躯体化、抑郁、焦虑、敌对性、精神病性分值显著高于常模，戒断前强迫、偏执也高于常模。戒断前和戒断后２０ｄＳＣＬ－９０比较，强迫、人际关系、抑郁、恐怖、偏执分戒断前明显高于戒断后。在单一症状≥３分的前１２项主要症状中，戒断前多较戒断后重，失眠、易烦恼、激动、肌肉酸痛戒断前后变化不大。提示海洛因成瘾者戒断前后存在明显的心理问题和躯体症状，应加强心理治疗和稽延性戒断症状的药物控制，以利于康复。     

Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes

Background: Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Methods: Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. Results: Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. Conclusion: The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.     

Cross-domain correlates of cannabis use disorder severity among young adults

BackgroundCorrelates of cannabis use and dependence among young adults have been widely studied. However, it is not known which factors are most strongly associated with severity of cannabis use dependence (CUD) severity. Identification of the salient correlates of CUD severity will be of increasing clinical significance as use becomes more socially normative.MethodsThis study used a data-driven, hypothesis-free approach to examine the most robust correlates of CUD severity among a sample of 76 young adults (ages 18 to 25 years) who used cannabis at least weekly. Seventy-one candidate variables were examined for association with CUD severity. These included demographic variables, self-reported and psychodiagnostic assessments of mood and anxiety, self-reported measures of personality, cannabis and other substance use characteristics, and objective and subjective measures of cognition.ResultsOf the 71 candidate variables considered, 27 were associated with CUD severity on a univariate level at a p-value ≤.20. Correlates of CUD severity in the multivariable model using stepwise selection were: more frequent cannabis use in the past 90 days, greater expectancies that cannabis causes cognitive and behavioral impairment, greater self-reported metacognitive deficits, greater anxiety, and lower reaction time variability on a test of sustained attention. Internal validation tests support high prediction accuracy of all variables in the multivariable model, except for lower reaction time variability.ConclusionsCannabis use frequency, beliefs about use, perceived cognitive abilities, and anxiety are robustly associated with CUD severity in young adult, regular cannabis users, and may be important in guiding prevention and treatment efforts.     

Recreational ecstasy/MDMA and other drug users from the UK and Italy: psychiatric symptoms and psychobiological problems

RATIONALE: Recreational drug use is increasingly widespread amongst young people, but there are concerns that psychoactive drugs may be associated with psychiatric symptoms or psychobiological problems. OBJECTIVES: To assess the psychiatric health status of a large, non-clinical sample of young adults from Italy and the UK, and relate it to their use of ecstasy/MDMA and other recreational drugs. METHODS: The UEL Recreational Drug Use Questionnaire was completed by 768 young people (mean age 21.7 years) from four European cities. The subjects comprised 150 non-drug users, 185 alcohol/tobacco users, 97 cannabis and alcohol/tobacco users, 102 illicit polydrug but not ecstasy users, 115 light (<20 times) ecstasy polydrug users, and 119 heavy (>20 times) ecstasy polydrug users. The unpaid volunteers completed the SCL-90 self-rating inventory for psychiatric symptoms when off drug, with 30 additional questions covering positive moods and life experiences. RESULTS: Heavy ecstasy polydrug users reported significantly higher scores than non-drug users on several SCL-90 factors, including phobic anxiety, obsessive-compulsive behaviour, anxiety, psychoticism, somatisation, and significantly higher rates of 'loss of sex interest or pleasure'. Self-rated symptom scores increased in line with greater drug use, so that polydrug users who had never taken ecstasy also reported a variety of psychobiological impairments. In contrast, positive moods and life experiences were broadly similar across subgroups. CONCLUSIONS: The recreational use of ecstasy/MDMA is associated with a range of psychiatric symptoms and psychobiological problems. However, these problems are not specific to ecstasy users but are also evident in other recreational polydrug users.     

Associations between self-reported cannabis use frequency,potency, and cannabis/health metrics

BackgroundResearch shows that cannabis use frequency is associated with cannabis dependence and health metrics. However, much less is known about how self-reported cannabis potency (THC and CBD) may be associated with the same metrics, and whether any associations exist after accounting for frequency of cannabis use. Moreover, even less is known about how these relations may differ across cannabis product forms. This exploratory study examined 1) associations between cannabis frequency, potency, and cannabis/health metrics, and 2) whether associations between potency and cannabis/health metrics remained after controlling for frequency of use.MethodsUsing a sample of adult recreational cannabis users in Colorado (N = 300), we tested the relationship between self-reported cannabis use metrics of frequency and potency of flower, edible, and concentrate products with separate measures of problematic cannabis use (i.e., dependence, withdrawal, craving), depression, anxiety, and general perceived health.ResultsGreater frequency of flower and concentrate (but not edible) use were associated with greater problematic cannabis use, and greater concentrate use frequency was also associated with more mental health problems. Partial correlations controlling for average frequency of use across all product forms and CBD potency per product showed that one significant association between THC potency and cannabis/health metrics remained (i.e., higher THC concentrate potency with better health), and one emerged (i.e., higher THC concentrate potency with lower cannabis withdrawal).ConclusionsFrequency of use is reliably associated with problematic cannabis use for flower and concentrates, but it did not account for all observed associations in this study. Differences in patterns of associations between frequency and potency and cannabis/health metrics across cannabis forms suggest a need for better understanding user reports of THC and CBD potency, individual differences among users, and improved measurement.     

美沙酮维持综合干预治疗对阿片类依赖者心理健康的影响

目的:研究美沙酮维持综合干预治疗对阿片类依赖者心理健康的影响。方法:随机对35例参加美沙酮维持治疗(MMT)的阿片类依赖者,在治疗前、治疗满一个月、治疗满两个月做症状自平量表(SCL-90)测评,用简明统计学处理器2.0进行计量资料t检验分析。结果:与治疗前相比,在治疗满一月后患者的SCL-90中的躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、其他因子均降低,差异有高度显著性(P<0.01);精神病性因子差异有显著性(P<0.05);治疗满两个月与满一个月比较,强迫症状和抑郁因子差异具有高度显著性(P<0.01);躯体化、焦虑、敌对、恐怖、偏执、精神病性和其他因子差异无显著性(P>0.05)。结论:对阿片类药物依赖者进行MMT结合心理治疗、行为治疗和家庭治疗可以明显改善病人的心理健康水平,而且随着治疗时间的延长,效果会更好。     

难治性癫(癎)患者临床症状自评90项量表测评结果分析

目的 了解难治性癫(癎)患者的心理健康状况.方法 对40例初中以上文化水平,无智力缺陷的成人患者,使用临床症状自评90项(SCL-90)量表进行测量,测定结果 进行统计学分析.结果 40例患者测评结果:总分最高分227分,最低分103分,平均(159.63±35.04)分,其中躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等因子分均高于中国成人常模,差异均有统计学意义(P＜0.05或P＜0.01).结论 难治性癫(癎)患者心理健康水平明显低于普通人群,在积极手术治疗的同时应关注该群体存在的心理健康问题,对提高疗效及患者的生活质量有重要意义.

Abstract：

Objective To study the mental health in the patients with intractable epilepsy. Methods Totally 40 adult patients with middle school level or above, no mental deficiency, were tested with symptom checklist 90 scale. Results The patients with intractable epilepsy associated with different degrees of mental problems including somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety and hostility. The factor scores of refractory epilepsy were higher than those of normal adult. The differences were significant (P＜ 0.05). Conclusion The intractable epilepsy patient's psychological health is significantly lower than the normal people.     

Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence

Recently, reports have suggested that cannabis withdrawal occurs commonly in adults with cannabis dependence, though it is unclear whether this extends to those with comorbid depression or to comorbid adolescents. We hypothesized that cannabis withdrawal would be common among our sample of comorbid adolescents and young adults, and that the presence of cannabis withdrawal symptoms would be associated with a self-reported past history of rapid reinstatement of cannabis dependence symptoms (rapid relapse). The participants in this study included 170 adolescents and young adults, including 104 with cannabis dependence, 32 with cannabis abuse, and 34 with cannabis use without dependence or abuse. All of these subjects demonstrated current depressive symptoms and cannabis use, and most demonstrated current DSM-IV major depressive disorder and current comorbid cannabis dependence. These subjects had presented for treatment for either of two double-blind, placebo-controlled trials involving fluoxetine. Cannabis withdrawal was the most commonly reported cannabis dependence criterion among the 104 subjects in our sample with cannabis dependence, being noted in 92% of subjects, using a two-symptom cutoff for determination of cannabis withdrawal. The most common withdrawal symptoms among those with cannabis dependence were craving (82%), irritability (76%), restlessness (58%), anxiety (55%), and depression (52%). Cannabis withdrawal symptoms (in the N=170 sample) were reported to have been associated with rapid reinstatement of cannabis dependence symptoms (rapid relapse). These findings suggest that cannabis withdrawal should be included as a diagnosis in the upcoming DSM-V, and should be listed in the upcoming criteria list for the DSM-V diagnostic category of cannabis dependence.     

Cannabis use moderates the relationship between pain and negative affect in adults with opioid use disorder

IntroductionAdults in Medication-Assisted Treatment (MAT) for opioid addiction are at risk for substance use relapse and opioid overdose. They often have high rates of cannabis use and comorbid symptoms of pain, depression, and anxiety. Low levels of self-efficacy (confidence that one can self-manage symptoms) are linked to higher symptom burdens and increased substance use. The effects of cannabis use on symptom management among adults with MAT are currently unclear. Therefore, the primary purpose of this study is to examine whether cannabis use moderates the relationships between pain and negative affect (i.e., depression and anxiety) and whether self-efficacy influences these interactions.MethodsA total of 150 adults receiving MAT and attending one of two opioid treatment program clinics were administered a survey containing measures of pain, depression, anxiety, self-efficacy, and cannabis use.ResultsCannabis use frequency moderated the relationships between pain and depression as well as pain and anxiety. Specifically, as cannabis use frequency increased, the positive relationships between pain and depression and pain and anxiety grew stronger. However, cannabis use was no longer a significant moderator after controlling for self-efficacy.ConclusionsResults suggest that cannabis use strengthens, rather than weakens, the relationships between pain and depression and pain and anxiety. These effects appear to be driven by decreased self-efficacy in cannabis users. It is important to understand how self-efficacy can be improved through symptom self-management interventions and whether self-efficacy can improve distressing symptoms for people in MAT.     

Association Between Personality Disorders Traits and Problematic Cannabis Use in Adolescents

Background: There are few studies on the contribution of personality disorder traits to cannabis use disorders in adolescents. Objectives: The aim of the study was to evaluate the association of personality disorder traits to problematic cannabis use. Methods: Participants were 111 high school students who completed self-report questionnaires, mainly the Cannabis Use Disorders Identification Test, assessing problematic cannabis use, and the Personality Diagnostic Questionnaire using the scales evaluating personality disorders most often linked to adolescent cannabis use. Results: A multiple regression analysis showed that personality disorder traits explained a high part of the variance in problematic cannabis use symptoms. Schizotypal and borderline personality traits were positively associated to problematic cannabis use symptoms after adjustment for anxious and depressive symptoms. Conclusions: This study suggests the importance of evaluating personality disorder traits in studies of risk factors or consequences of problematic cannabis use.