Mental health problems and interest in marijuana treatment among marijuana-using college students

Background

There is growing recognition that marijuana use among college students is associated with marijuana-related problems. Yet little work has examined whether use is associated with mental health problems and whether there is a dose effect such that individuals engaging in more frequent use evince relatively greater psychiatric impairments. Further, little is known about factors related to interest in marijuana treatment among students experiencing marijuana-related problems.

Method

The current study examined academic and psychiatric functioning as well as interest in marijuana treatment among undergraduates (N = 1,689). Approximately 29% acknowledged marijuana use, with 9.8% using weekly or more.

Results

More frequent marijuana use was related to more academic difficulties. Marijuana use (among both weekly and less frequent users) was related to greater psychiatric impairment. Interest in marijuana treatment was examined among students with 2+ marijuana-related problems (n = 251). Of those, 22.7% expressed interest in marijuana treatment. Factors positively related to treatment interest included: marijuana use frequency, use-related problems, friends' marijuana use, age, employment status, and some types of mental health problems.

Conclusions

Marijuana use among college students is associated with academic, psychiatric, and marijuana-related impairments. However, there is some interest in treatment to manage marijuana use among undergraduates, particularly among those with more frequent and more problematic marijuana use.     

Protective Behavioral Strategies Mediate the Relation Between Sensation Seeking and Marijuana-Related Consequences

Background: Greater levels of sensation seeking are associated with experiencing more marijuana-related consequences (MRC). Protective behavioral strategies (PBS) use is associated with both the lower frequency of marijuana use and fewer marijuana-related consequences. However, research has not examined whether PBS use mediates the relation between sensation seeking and MRC. Methods: The current study is a secondary data analysis of the initial Marijuana Outcomes Study Team data collection. A path analysis was conducted to assess for indirect effects from both risk and experience seeking (facets of sensation seeking) to MRC via frequency of PBS use, controlling for marijuana use frequency. Results: We found negative relations between both experience seeking and PBS and MRC, and a positive relation between risk seeking and MRC. Furthermore, PBS mediated the relation between both risk and experience seeking and MRC. Conclusions: Results suggest that PBS is a mediator of the sensation seeking-MRC relationship. Discussions about selecting and implementing PBS use may be particularly useful for treatment of clients high in risk seeking.     

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations

Background: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. Objectives: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. Methods: College students who reported marijuana use in the past 12?months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.     

Marijuana use motives and social anxiety among marijuana-using young adults

Given the high rates of co-occurring marijuana use and social anxiety, the present investigation examined the relations among marijuana use motives, marijuana use and problems, and social anxiety in 159 (54.7% female) young adults (M(age)=18.74, SD=1.20). As expected, after covarying for a number of variables related to both marijuana use and social anxiety (e.g. gender, alcohol use problems, anxiety sensitivity), social anxiety predicted greater numbers of marijuana use problems. Interestingly, social anxiety was not related to marijuana use frequency. Also consistent with prediction, social anxiety was a significant predictor of coping and conformity motives for marijuana use above and beyond relevant variables. Finally, coping motives for marijuana use mediated the relation between social anxiety and marijuana use problems. These data provide novel evidence for the unique effects of coping-motivated marijuana use in the link between marijuana-related impairment and social anxiety.     

Characteristics of clinically anxious versus non-anxious regular, heavy marijuana users

Both the key mechanism of action for marijuana (the endocannabinoid system) and the symptoms associated with marijuana withdrawal suggest an important link to anxiety. Despite this link, there is a dearth of research on the characteristics of heavy marijuana users with clinical-level anxiety compared to those with heavy marijuana use alone. Over 10,000 participants (friends or affiliates of the National Organization for the Reform of Marijuana Laws) provided data via online survey. After careful, conservative screening, anxiety, other psychopathology, other drug use, and marijuana-related problems were examined in 2567 heavy marijuana users. Subsequently, 275 heavy users with clinical-level anxiety were compared to demographically-equivalent non-anxious heavy users on psychopathology, drug use, and cannabis-related problems. Among several psychological variables (including anxiety, depression, schizotypy, and impulsivity), anxiety was most strongly predictive of amount of marijuana used and marijuana-related problems. Group comparison (n=550 total) revealed that clinically anxious heavy users exhibited more use, more non-anxiety psychopathological symptoms, and a greater number and severity of marijuana-related problems than their non-anxious peers. The findings reveal that anxiety shows an important relation to marijuana use and related problems among regular, heavy users. Further examinations of common and unique factors predisposing individuals for anxiety and marijuana abuse appear warranted.     

An affective and cognitive model of marijuana and alcohol problems

This study examined a six-month prospective model of marijuana and alcohol problems among college students. Among marijuana users, there was an indirect positive association between use utility and Time 1 (T1) marijuana-related problems through T1 marijuana use, whereas there was a direct positive association between affect lability and T1 marijuana-related problems. A multi-group analysis of alcohol problems compared models for users of alcohol and marijuana and users of alcohol only. For both groups, there was a direct positive association between T1 use utility and T2 alcohol consumption and an indirect association with T2 alcohol problems via alcohol consumption. Impulsivity was directly and positively associated with T1 alcohol problems among the alcohol-only group. For the alcohol-only group, impulsivity moderated the association between T2 consumption and problems, making it stronger. Associations between affect lability and alcohol problems as well as alcohol consumption and problems were stronger in the alcohol and marijuana group. Results support differential pathways to substance-related problems, an indirect pathway, in which problems are an unintended consequence of goal-directed use activity, as well as direct and interactive pathways in which problems may be viewed as consequences of broader regulatory problems.     

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies

Abstract

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (M_age = 20.26, SD?=?3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30?days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.     

Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: an application of the acquired preparedness model

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.     

Psychometric evaluation of the Marijuana Reduction Strategies Self-Efficacy Scale with young recreational marijuana users

Introduction

This study evaluated the cue-reactivity and several psychometric properties of a questionnaire designed to assess marijuana users' self-efficacy to employ 21 specific cognitive-behavioral strategies to reduce their marijuana use.

Method

Using a web-based recruitment and data-collection procedure, 513 regular marijuana users completed dependent measures following marijuana-related or control cue exposure.

Results

Although exposure to marijuana-related stimuli significantly increased reported craving, mean reduction-strategy self-efficacy scores did not differ as a function of cue exposure. Reliability analyses supported retaining all 21 items as a single scale. Reduction-strategy self-efficacy was positively associated with marijuana-refusal self-efficacy and with recent past use of reduction strategies, was negatively associated with quantity and frequency of marijuana use and marijuana-related problems, and was positively but weakly associated with general self-efficacy. The most frequently reported strategies that were employed reflected restricting marijuana use to once per day, not keeping a large stash available, turning down unwanted hits, and not obtaining more marijuana right away if one's supply runs out.

Conclusions

These findings further support the reliability and validity of the questionnaire when administered to a diverse sample of regular marijuana users.     

Personal strivings and marijuana use initiation,frequency, and problems

This study examined relations between perceived conflict/utility of marijuana use in achieving valued personal goals and marijuana use initiation, marijuana use frequency, and marijuana-related problems. Personal strivings are higher order goals that may influence marijuana use to the extent that they are congruent or incongruent with use. Participants were 592 young adults who generated lists of personal strivings independent of the substance use assessment. They then evaluated their 10 most important strivings with regard to the perceived conflict/utility of several levels of marijuana use in achieving their most important strivings. Less marijuana use-striving conflict was positively associated with use initiation and frequency. A significant gender interaction emerged in the prediction of use frequency; marijuana use-striving conflict was more strongly associated with use frequency for men than women. The relationship between use-striving conflict and marijuana-related problems was mediated fully by use frequency.     

Marijuana Motivations Across Adolescence: Impacts on Use and Consequences

Background. Motivational models for marijuana use have focused on reasons to use marijuana, but rarely consider motives to abstain. Objectives: We examined how both adolescent marijuana abstinence motives and use motives contribute to marijuana use and problems at the end of emerging adulthood. Methods. 434 community recruited youth who had not initiated marijuana use at baseline were followed from adolescence (at ages 12, 15, and 18 years) into emerging adulthood (age 25 years). Motives to abstain and to use marijuana, marijuana consumption, and marijuana-related problems were assessed across time. Results. Endorsing more motives to abstain from marijuana across adolescence predicted less marijuana use in emerging adulthood and fewer marijuana-related problems when controlling for past motives to abstain and marijuana-related behavior. Positive reinforcement use motives related to increased marijuana consumption and problems, and negative reinforcement motives predicted problems when controlling for past marijuana use motives and behaviors. Expansion motives during adolescence related to lower marijuana use in emerging adulthood. When considered together, motives to abstain buffered the effect of negative reinforcement motives on outcomes at age 25 for youth endorsing a greater number of abstinence motives. Conclusions/ Implications. Given these findings, inclusion of both motives to use and abstain is warranted within comprehensive models of marijuana use decision making and may provide important markers for prevention and intervention specialists.     

Social anxiety and marijuana-related problems: The role of social avoidance

BackgroundPeople with elevated social anxiety seem vulnerable to marijuana-related impairment. Yet little work has examined core facets of social anxiety that may be especially related to marijuana-related problems.MethodThe present study examined the relationships between current (past three months) marijuana-related problems and two aspects of social anxiety (fear in social situations and social avoidance) among current (N = 102) marijuana users.ResultsAlthough both social fear and social avoidance were significantly correlated with marijuana-related problems, only social avoidance was uniquely related to marijuana problems (after controlling for social fear, sex, negative affect, alcohol problems, and marijuana use frequency). Sex moderated the relationship between social avoidance and marijuana-related problems such that men with greater social avoidance exhibited the greatest severity of marijuana-related problems.ConclusionsAvoidance of social situations appears robustly related to marijuana-related problems. This finding has important implications for theoretical models that can inform treatment of co-occurring social anxiety and marijuana problems.     

Marijuana use,risk perception,and consequences: Is perceived risk congruent with reality?

The present study evaluates differences in risk perception related to marijuana use as a function of past use and, among those who report marijuana use, as a function of frequency of use and having experienced a consequence in the past. Participants were 725 incoming first year college students in a longitudinal study examining the efficacy of a marijuana prevention program. Analyses of cross-sectional data indicated that risk perception was greater among non-users of marijuana than for those who reported marijuana use (and, in turn, who were more likely to have actually experienced a drug-related consequence). Among marijuana users, risk perception was not influenced by the frequency of marijuana use nor was it influenced by the actual experience of a drug-related consequence. The findings suggest that for abstainers, perceived risk and the potential consequences of marijuana use may serve a protective role against the initiation of marijuana use. For those who use marijuana, intervention efforts utilizing motivation enhancement approaches could explore the discrepancy between perceived risks and actual experienced consequences.     

Psychometric properties of a valuations scale for the Marijuana Effect Expectancies Questionnaire

Given that marijuana remains the most commonly used illicit substance, identification of the role of potentially malleable cognitive factors in marijuana-related behaviors remains an important goal. The Marijuana Effect Expectancies Questionnaire (MEEQ; Schafer & Brown, 1991) assesses marijuana effect expectancies that are differentially related to marijuana use and use-related problems. Evaluation of the desirability of marijuana effect expectancies may provide additional information regarding cognitions related to marijuana use behaviors. The present study examined the psychometric properties of the Marijuana Effect Expectancy Questionnaire—Valuations Scale (MEEQ-V) which was developed for this study to assess the desirability of marijuana effect expectancies. The sample was comprised of 925 (73.0% female) undergraduate participants, 41.9% of whom endorsed lifetime marijuana use and 24.7% of whom reported current (past three-month) use. The MEEQ-V scales demonstrated adequate internal consistency. Most (but not all) MEEQ-V scales were correlated with their corresponding MEEQ scale. There was some support for convergent validity. MEEQ-V scales were differentially related to frequency of marijuana use and use-related problems. Most MEEQ-V scales were related to frequency of marijuana use above and beyond variance attributable to corresponding MEEQ scales. Results suggest that assessment of desirability of marijuana's effects could provide unique and important information about cognitions related to marijuana use behaviors.     

Predictors of marijuana treatment outcomes: The role of self-efficacy

This study tested the ability of sets of demographic, socioeconomic, marijuana use/abuse, psychological distress, and self-efficacy variables to predict posttreatment indices of marijuana intake and problems related to use. Subjects were 167 adults who participated in one of two outpatient treatments for marijuana dependence and completed the 3-, 6-, and 12-month posttreatment follow-ups. Only pretreatment marijuana quantity-frequency of intake and self-efficacy variables made significant and consistent contributions to the regression equations predicting posttreatment frequency of use. In contrast, socioeconomic and severity of abuse indicators predicted posttreatment marijuana-related problems. Contrary to social cognitive theory (Bandura, 1986), there was no evidence that self-efficacy mediated the effects of other predictors. Results are discussed in terms of the specificity of predictor-outcome relationships and the need for improvements in self-efficacy measurement.     

The Impact of Marijuana Legalization on Adolescent Use,Consequences, and Perceived Risk

Background: Currently, only four states have legalized recreational marijuana use for adults over 21 years of age. Therefore, little is known about the influence that legalization will have on adolescent marijuana use. Objectives: This study examines how marijuana legalization has impacted the frequency and consequences of adolescent use in a sample of participants in a school-based, substance use intervention. We hypothesized that adolescents enrolled in the intervention in years after marijuana legalization would present with more problematic use compared to those enrolled prior, and that changes in the perceived risk of marijuana would be a mechanism of problematic use. Methods: Participants were 262 students enrolled in a school-based substance use intervention in 2010 to 2015. The Customary Drinking and Drug Use Record, Alcohol and Drug Use Consequences Questionnaire, and a decisional balance matrix were used to assess marijuana frequency, negative consequences, and perceived risk of use. A mediation model was used to test the degree to which marijuana legalization may lead to increased frequency and consequences of use through perceived risk. Results: Findings indicated a significantly positive correlation between marijuana-related consequences and perceived risk post legalization. Despite relatively equal use between both groups, adolescents in the legalization group experienced higher levels of perceived risk and increased negative consequences. Conclusions/Importance: Due to the rising legalization status of marijuana in the United States, it is imperative that psychoeducation is provided to adults and adolescents about the consequences of underage marijuana use.     

Support for Marijuana Legalization and Predictors of Intentions to Use Marijuana More Often in Response to Legalization Among U.S. Young Adults

Background: As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. Objective: This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Methods: Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18–34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Results: Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults.     

Marijuana use and later problems: when frequency of recent use explains age of initiation effects (and when it does not)

Tobacco, alcohol, and marijuana are among the most commonly used drugs during adolescence. Initiation of marijuana use typically peaks at age 15, with risk of initiation continuing throughout adolescence. The goal of the current study was to prospectively examine the influence of age of marijuana initiation on four outcomes: physical health, mental health, illicit drug use other than marijuana, and marijuana-use related consequences at age 18. We controlled for several important predictors of adolescent drug use and its associated consequences, including demographics, social bonding variables, personality variables, and recent use of marijuana. Baseline survey data were collected in 1984 at grade 7 and follow up surveys were conducted at grades 8, 9, 10, and 12 (N = 2079). This initiates-only sample was 47% female, 66% White, 11% African American, 13% Hispanic, 5% Asian, and 5% other race or ethnicity. Findings indicated that age of initiation predicted marijuana consequences and other illicit drug use after controlling for demographic, social, and behavioral factors. However, once frequency of recent marijuana use was included in the models, age of initiation was only associated with other illicit drug use. Both primary and secondary prevention are needed to curb marijuana use and its associated harms.     

Expectancies and marijuana use frequency and severity among young females

This study examined associations between the endorsement of drug use expectancies and the frequency and severity of marijuana use in a community sample of 332 women aged 18–24 years who were not explicitly seeking treatment for their marijuana use. Participants were enrolled in a larger intervention study of motivational interviewing for various health behaviors and provided self-reports of their current and past marijuana use, marijuana abuse/dependence symptoms, and marijuana use expectancies. Marijuana use expectancies were measured using the six subscales of the Marijuana Effects Expectancy Questionnaire (MEEQ). Use frequency was defined as the number of use days in the past month, severity as the total number of DSM-IV marijuana abuse or dependence symptom criteria met. Replicating and extending prior research, expectations regarding Relaxation and Tension Reduction emerged as a robust belief in this cohort, predicting not only frequency (p < .01) but also severity (p < .01) of marijuana use in multivariate analyses. Severity of marijuana use was further predicted by expectations regarding loss of control, affective changes following marijuana use, and other aspects of emotion dysregulation (Global Negative Effects, p < .01). These findings document meaningful associations between substance-related cognitions and use behavior and suggest that marijuana users who hold certain beliefs regarding marijuana use may be particularly susceptible to clinically significant problems associated with their substance use. As such, marijuana use expectancies may represent a clinical target that could be incorporated into future interventions.