Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana

Background: The changing political and social climate surrounding marijuana use, coupled with the fact that available estimates of marijuana use disorder prevalence are outdated and do not adequately represent adolescents, underscore the need for up-to-date and comprehensive prevalence estimates of marijuana use disorder. Objectives: To provide recent national estimates of marijuana use disorder as a function of usage patterns, age, and other sociodemographic, substance use, and mental health variables. Methods: Analyses of data from the 2014 National Survey on Drug Use and Health examined the prevalence of marijuana use disorder among respondents (N = 55,271) with various sociodemographic, substance use, and mental health characteristics. Logistic and multinomial regression analyses examined the correlates of marijuana use disorder as a function of these variables, with a special focus on age. Results: In 2014, 3.49% of lifetime, 11.62% of past-year, and 15.32% of past-30-day marijuana users met DSM-IV criteria for a marijuana use disorder; rates among youth generally were at least double those of adults across reported time frame and intensity of use. Regression analyses indicated that young age, black race/ethnicity, greater intensity of use, current tobacco/nicotine use, and alcohol and other drug use disorders were associated with increased odds of a marijuana use disorder. Conclusions: A significant proportion of marijuana users, especially youth, are at risk for having a marijuana use disorder, even at relatively low levels of use.     

Medical use of cannabis: an addiction medicine perspective

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis‐based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.     

Exercise as an adjunctive treatment for cannabis use disorder

Background: Despite cannabis being the most widely used illicit substance in the United States, individuals diagnosed with cannabis use disorder (CUD) have few well-researched, affordable treatment options available to them. Although found to be effective for improving treatment outcomes in other drug populations, exercise is an affordable and highly accessible treatment approach that has not been routinely investigated in cannabis users. Objectives: The aim of this paper is to inform the topic regarding exercise’s potential as an adjunctive treatment for individuals with CUD. Methods: We reviewed the evidence surrounding cannabis use and its current treatment in the United States, explored the rationale for including exercise in the treatment of substance use disorders (SUDs), and in particular, proposed a biological mechanism (i.e., endocannabinoids (eCBs)) that should be examined when utilizing exercise for the treatment of CUD. Results: Cannabis use is widespread and increasing in the United States. Chronic, heavy cannabis use may dysregulate the endogenous cannabinoid system, which has implications for several psychobiological processes that interact with the eCB system such as reward processing and the stress response. Given that exercise is a potent activator of the eCB system, it is mechanistically plausible that exercise could be an optimal method to supplement cessation efforts by reducing psychophysical withdrawal, managing stress, and attenuating drug cravings. Conclusion: We suggest there is a strong behavioral and physiological rationale to design studies which specifically assess the efficacy of exercise, in combination with other therapies, in treating CUD. Moreover, it will be especially important to include the investigation of psychobiological mechanisms (e.g., eCBs, hippocampal volume), which have been associated with both exercise and SUDs, to examine the broader impact of exercise on behavioral and physiological responses to treatment.     

Hypothalamic-pituitary-adrenal axis reactivity to social stress and adolescent cannabis use: the TRAILS study

Aims To investigate the relationship of life‐time and repeated cannabis use with hypothalamic–pituitary–adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents. Design Adolescents who reported life‐time or repeated cannabis use, life‐time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), which was based on the Trier Social Stress Task. Setting A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study]. Participants A total of 591 adolescents (51% male) who participated in the GSST, which was an additional measurement during the third assessment wave. Measurements HPA axis stress‐reactivity was indexed by four cortisol samples collected before, during and after the GSST. Furthermore, all adolescents in our study completed self‐reported questionnaires on life‐time and repeated cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, experimental session risk status, socio‐economic status, mood and time of the experimental session. Findings Life‐time cannabis users had significantly lower stress‐reactivity levels when compared to abstainers [odds ratio (OR) = 0.68, confidence interval (CI) = 0.55–0.85, P < 0.01] and life‐time tobacco users (OR = 0.79, CI = 0.64–0.98, P < 0.05). In addition, repeated cannabis users also exhibited lower stress‐reactivity levels when compared to life‐time ever users of either tobacco or cannabis (OR = 0.74, CI = 0.53–0.98, P < 0.05). Conclusions Lower hypothalamic–pituitary–adrenal‐axis stress‐reactivity in adolescents is related specifically to life‐time and repeated cannabis use.     

Assessment of the validity of the CUDIT-R in a subpopulation of cannabis users

Background: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R) is an 8-item measure used to screen for cannabis use disorders (CUD). Despite widespread use of the tool, assessments of the CUDIT-R’s validity in subpopulations are limited. Objectives: The current study tested the structural validity and internal consistency of one of the most widely used screening measures for CUD (i.e., CUDIT-R) among a sample of military veterans who use cannabis for medicinal purposes. Methods: The present study used confirmatory factor analysis (CFA) to test the internal consistency and validity of the single-factor structure of the original screener among a sample of veterans who use cannabis for medicinal purposes (n = 90 [90% male]; M_age = 55.31, SD = 15.37). Measures included demographics and the CUDIT-R, obtained from the baseline assessment of an ongoing longitudinal study. Results: The CFA revealed that the single-factor model previously validated in recreational using samples only accounted for 38.34% of total variance in responses on the CUDIT-R (χ² = 66.09, df = 28, p < 0.05; RMSEA = 0.06) and demonstrated acceptable but modest internal consistency (Cronbach’s α = 0.73). Conclusion: More psychometric work is needed to determine the reliability and validity of using the CUDIT-R to screen for CUD among military veterans who use medicinal cannabis and other subpopulations of cannabis users.     

Reaching out towards cannabis: approach-bias in heavy cannabis users predicts changes in cannabis use

Aims Repeated drug exposure can lead to an approach‐bias, i.e. the relatively automatically triggered tendencies to approach rather that avoid drug‐related stimuli. Our main aim was to study this approach‐bias in heavy cannabis users with the newly developed cannabis Approach Avoidance Task (cannabis‐AAT) and to investigate the predictive relationship between an approach‐bias for cannabis‐related materials and levels of cannabis use, craving, and the course of cannabis use. Design, settings and participants Cross‐sectional assessment and six‐month follow‐up in 32 heavy cannabis users and 39 non‐using controls. Measurements Approach and avoidance action‐tendencies towards cannabis and neutral images were assessed with the cannabis AAT. During the AAT, participants pulled or pushed a joystick in response to image orientation. To generate additional sense of approach or avoidance, pulling the joystick increased picture size while pushing decreased it. Craving was measured pre‐ and post‐test with the multi‐factorial Marijuana Craving Questionnaire (MCQ). Cannabis use frequencies and levels of dependence were measured at baseline and after a six‐month follow‐up. Findings Heavy cannabis users demonstrated an approach‐bias for cannabis images, as compared to controls. The approach‐bias predicted changes in cannabis use at six‐month follow‐up. The pre‐test MCQ emotionality and expectancy factor were associated negatively with the approach‐bias. No effects were found on levels of cannabis dependence. Conclusions Heavy cannabis users with a strong approach‐bias for cannabis are more likely to increase their cannabis use. This approach‐bias could be used as a predictor of the course of cannabis use to identify individuals at risk from increasing cannabis use.