Assessing problematic cannabis use

Many cannabis users do not report experiencing harm from use, suggesting that not all use is cause for concern. The objective of this research is to establish a threshold beyond which cannabis use becomes problematic. Thresholds from the cannabis portion of the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) and the Cannabis Use Disorders Identification Test (CUDIT) were compared against a simple frequency of use question (daily use) for their ability to identify problematic users. Data are drawn from the 2008 Canadian Alcohol and Drug Use Monitoring Survey (n?=?16,674). Effectiveness of the thresholds for predicting signs of problematic use was assessed in terms of sensitivity and specificity and in terms of positive and negative predictive values (NPV). The ASSIST (threshold of 8) and the CUDIT (thresholds of 6 and 8) outperformed the frequency measure with regards to sensitivity and specificity; the CUDIT with a threshold of 6 struck the best balance. With regards to positive predictive values, the CUDIT with a threshold of 8 revealed the highest value, whereas the daily use threshold, the CUDIT (threshold of 6 and 8) and the ASSIST (threshold of 8) revealed approximately the same NPV. Rates of harm were low for those using less than daily. Findings suggest that the CUDIT with a threshold of 6 may be best for use in population surveys when there is typically no reason to favor either sensitivity or specificity. Health care professionals may achieve greater precision using a threshold of 8 on the CUDIT.     

Risky Cannabis Use is Associated with Alexithymia,Frontal Lobe Dysfunction,and Impulsivity in Young Adult Cannabis Users

Abstract

Risky or problematic alcohol use by young adults has been found to be associated with factors such as alexithymia, frontal lobe dysfunction, reward sensitivity, and impulsivity. One interpretation is that these factors reflect inherent traits that predispose to risky substance use in general, a notion examined in the present study. Alexithymia, everyday frontal lobe functioning, sensitivity to reward and punishment, and impulsivity were examined in 138 young adult cannabis users who were divided into Low Risk (n = 99) and Risky (n = 39) users according to their Cannabis Use Disorder Identification Test (CUDIT) scores. Risky cannabis use was significantly positively associated with alexithymia, multiple signs of frontal lobe dysfunction in everyday life, and impulsivity. A broader pattern of dysfunction was indicated for risky cannabis use than for risky alcohol use in this sample. Findings are interpreted as likely reflecting not only inherent traits that predispose to risky substance use in general, but also perhaps residual effects of recent heavy cannabis use in the Risky user group. Longitudinal research is needed to disentangle these competing possibilities.     

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.     

Psychometric Properties of the Turkish Versions of the Cannabis Use Problems Identification Test (CUPIT) and the Adult Cannabis Problems Questionnaire (CPQ)

Cannabis and synthetic cannabinoids are widely used illicit substances in Turkey. The Cannabis Use Problems Identification Test (CUPIT) is a brief self-report screening instrument for detection of problematic cannabis use, whereas the Cannabis Problems Questionnaire (CPQ) is a measure for cannabis treatment outcome. The aim of this study was to evaluate the psychometric properties of the CUPIT and CPQ among Turkish male outpatients with cannabis (n = 52) and synthetic cannabinoid (n = 45) use disorder. Participants were evaluated with the CUPIT, the CPQ, and the Cannabis Withdrawal Scale (CWS). Principal Component Analysis (PCA) supported two-factor construct validity for CUPIT. Cronbach’s alpha was 0.84 for CUPIT-A factor, 0.83 for CUPIT-B factor, and 0.89 for CUPIT, when considered as a unidimensional scale. Cronbach’s alpha was 0.82 for CPQ-A factor, 0.73 for CPQ-B factor, 0.30 for CPQ-C, and 0.87 for CPQ, when considered as a unidimensional scale. The CUPIT and the CPQ were moderately correlated with the CWS (r = 0.63 and r = 0.74, respectively), whereas the CUPIT and the CPQ were strongly correlated with each other (r = 0.76). The Turkish version of the CUPIT and the CPQ can effectively identify substance use problems and treatment outcome, respectively, among outpatients with cannabis or synthetic cannabinoid use disorder.     

Relations between dissociative experiences,borderline personality disorder symptoms and cannabis use in adolescents and young adults

The aim of the study was to evaluate the relations between cannabis use, dissociative experiences and borderline personality disorder symptoms. A convenient sample of 212 subjects composed of high school students completed questionnaires assessing cannabis use frequency, the symptoms of dependence, the symptoms of dissociation and borderline personality disorder using the Dissociative Experience Scale (DES) completed by a subscale measuring hyper-personalization/hyper-realization experiences and the Borderline Personality Inventory (BPI), respectively; 114 (54%) were cannabis users. Multiple regression analyses showed that the frequency of cannabis use was negatively predicted by the frequency of spontaneous experiences of absorption and imaginative involvement and positively predicted by the frequency of experiences of absorption and hyper-personalization and hyper-realization linked to cannabis use. Cannabis dependence was predicted only by borderline personality symptoms. Positive dissociative experiences appear to be an important element in the understanding of cannabis use in adolescents and young adults.     

Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire

The Alcohol Use Disorders Identification Test (AUDIT) has been used to screen for hazardous and harmful alcohol consumption among general hospital populations but not in psychiatric patients. Using the AUDIT, we assessed alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders. Nine hundred and ninety consecutive admissions to the psychiatric units of two hospitals during a 12-month period underwent assessment. In each diagnostic group a high proportion of patients was alcohol-dependent. Among those with mood disorders 25.4% of men were alcohol-dependent, compared with 16.3% of women, while 34.5% of men with anxiety disorder were alcohol-dependent compared with 25.0% of women. Both gender differences were statistically significant. The differences were even greater for adjustment disorder (44.4% vs. 14.5%) and psychosis (29.2% and 4.2%, respectively). More men than women with anxiety disorder were classified as hazardous (24.1%vs. 11.7%) or harmful drinkers (13.8%vs. 3.3%), but for the other diagnostic groupings the percentages in these drinking categories were more nearly similar. Thus, there is a high rate of excessive alcohol consumption in people with psychiatric disorders, especially males. Such individuals may be particularly vulnerable to complications of alcohol misuse such as suicide and exacerbation of their disorder. The potential for decreased severity of psychiatric symptoms and a reduction in the number of hospital admissions following cessation or reduction in alcohol consumption is considerable. The AUDIT is a simple screening device for investigating alcohol use and dependence, and offers a means of initiating intervention in this population. [Hulse GK, Saundes JB, Roydhouse RM, Stodwell TR, Basso MR. Screening for hazardous alcohol use and dependence in Psychiatric in-patients using the AUDIT questionnaire. Drug Alcohol Rev 2000;19:291-298]     

Primary care validation of a single screening question for drinkers

OBJECTIVE: The aim of this study was to conduct a primary care validation study of a single screening question for alcohol misuse ("When was the last time you had more than X drinks in 1 day?," where X was four for women and X was five for men), which was previously validated in a study conducted in emergency departments. METHOD: This cross-sectional study was accomplished by interviewing 625 male and female adult drinkers who presented to five southeastern primary care practices. Patients answered the single question (coded as within 3 months, within 12 months, ever, or never), Alcohol Use Disorders Identification Test (AUDIT), and AUDIT consumption questions (AUDIT-C). Alcohol misuse was defined as either at-risk drinking, identified by a 29-day Timeline Followback interview or a current (past-year) alcohol-use disorder by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, or both. RESULTS: Among 625 drinkers interviewed, 25.6% were at-risk drinkers, 21.7% had a current alcohol- use disorder, and 35.2% had either or both conditions. Considering "within the last 3 months" as positive, the sensitivity of the single question was 80% and the specificity was 74%. Chi-square analyses revealed similar sensitivity across ethnic and gender groups; however, specificity was higher in women and whites (p = .0187 and .0421, respectively). Considering "within the last 12 months" as positive increased the question's sensitivity, especially for those with alcohol-use disorders. The area under the receiver operating characteristic curve of the single alcohol screening question (0.79) was slightly lower than for the AUDIT and AUDIT-C, but sensitivity and specificity were similar. CONCLUSIONS: A single question about the last episode of heavy drinking is a sensitive, time-efficient screening instrument that shows promise for increasing alcohol screening in primary care practices.     

Validation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test in a Swedish sample of suspected offenders with signs of mental health problems: Results from the Mental Disorder,Substance Abuse and Crime study

Substance abuse is common among offenders. One method widely used for the detection of substance abuse is screening. This study explored the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) screening tools in relation to (a) substance abuse and dependency diagnoses and (b) three problem severity domains of the sixth version of the Addiction Severity Index in a sample of 181 suspected offenders with signs of mental health problems. The screening tools showed moderate to high accuracy for identification of dependency diagnoses. The AUDIT was associated with alcohol problem severity, whereas the DUDIT was associated with drug and legal problem severity. Administering the screening tools in the current population yields valid results. However, the suggested cutoff scores should be applied with caution due to the discrepancy between present and previous findings.     

Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT)

The current study investigated the patterns and consequences of alcohol use among young people and their perceptions of associate health risk, and explored the clinical utility of the five-itemversion of the Alcohol Use Disorders Identification Test (AUDIT) in screening young people for hazardous drinking. A cross-sectional sample of 393 young people aged 16-19 years were accessed through two tertiary colleges in South London and self-completed an anonymous, confidential questionnaire recording the five-item AUDIT, patterns of alcohol consumption, hazardous consequences and perception of associate health risk. Over 90% of the sample reported drinking alcohol regularly, commonly excessive weekend use and related physical, psychological and social consequences. A significant minority (20.4% of males, 18.0% of females) reported consumption of alcohol in excess of UKrecommended limits, while almost a third (34.2%of males, 30.2%of females) reported scores in the 'hazardous' range of the five-item AUDIT. However, the majority had little perception of associate health risk, perceiving their use to be 'light' and unproblematic. Only one in 10 of those drinking at 'hazardous' levels recognized their alcohol use as problematic, most believing the hazardous consequences of this use were acceptable. Self-reported patterns of alcohol consumption (except age first used) and total number of psychological and social hazardous consequences were found to significantly predict AUDIT scores using linear regression analysis. Therefore the five-item AUDIT appears to have predictive validity, reflecting self-reported alcohol consumption, perception of associate health risk and hazardous consequences among young people. It is concluded that it may consequently have clinical utility as a simple screening tool (suitable for use by a variety of professionals in contact with young people) for the identification of hazardous alcohol consumption among this population. \[Miles H, Winstock A, Strang J. Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT). Drug Alcohol Rev 2001:20:9-18]     

Comparison of new alcohol use test, the Helsinki Alcohol Use Test questionnaire, and Alcohol Use Disorders Identification Test and laboratory markers serum gamma-glutamyl transferase and carbohydrate-deficient transferrin

The purpose of the present study was to compare and evaluate the new Helsinki Alcohol Use Test (HAUT) and Alcohol Use Disorders Identification Test (AUDIT) as screening instrument in the general working population. The relationship between the HAUT and serum gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) was also evaluated. Our results seem to indicate that the HAUT has good performance as screening instrument for alcohol-related problems in the general population.     

An examination of the utility of the AUDIT in people with schizophrenia

OBJECTIVE: To examine the reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) compared to a structured diagnostic interview, the Composite International Diagnostic Interview (CIDI; 12-month version) in psychiatric patients with a diagnosis of schizophrenia. METHOD: Patients (N = 71, 53 men) were interviewed using the CIDI (Alcohol Misuse Section; 12-month version) and then completed the AUDIT. RESULTS: The CIDI identified 32.4% of the sample as having an alcohol use disorder. Of these, 5 (7.0%) met diagnostic criteria for harmful use of alcohol, 1 (1.4%) met diagnostic criteria for alcohol abuse and 17 (23.9%) met diagnostic criteria for alcohol dependence. The AUDIT was found to have good internal reliability (coefficient = 0.85). An AUDIT cutoff of > or = 8 had a sensitivity of 87% and specificity of 90% in detecting CIDI-diagnosed alcohol disorders. All items except Item 9 contributed significantly to discriminant validity. CONCLUSIONS: The findings replicate and extend previous findings of high rates of alcohol use disorders in people with severe mental illness. The AUDIT was found to be reliable and valid in this sample and can be used with confidence as a screening instrument for alcohol use disorders in people with schizophrenia.     

Measuring change in cannabis use

We examined the ability of the Cannabis User Disorders Identification Test – Revised (CUDIT-R) to detect change in a treatment sample, including correlation with changes in other clinically relevant areas of functioning, and to determine reliable and clinically significant change thresholds. 133 cannabis-using patients taking part in a treatment trial for concurrent substance use and mood disorder were administered the 8-item CUDIT-R at baseline, 6 and 12 months, in addition to assessment of current cannabis use disorder, mood, alcohol use, motivation and employment status. Significant reductions in CUDIT-R scores were observed and were correlated with change in cannabis diagnosis, and improvement in mood. Higher motivation at baseline predicted greater reduction in CUDIT-R score. Reliable change was identified as occurring when CUDIT-R score changed by two or more, while clinically significant change, benchmarked against an increase or decrease of one DSM-IV cannabis dependence symptom, was equated to a CUDIT-R score changing by 3 or more points.     

Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site

The concurrent, construct, discriminative and predictive validity of the World Health Organization's Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian sample. One hundred and fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsely Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST; and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian sample, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.     

AKT1 Moderation of Cannabis-Induced Cognitive Alterations in Psychotic Disorder

Genetic variation in AKT1 may be associated with sensitivity to the psychotomimetic effects of cannabis as well as with increased risk for psychotic disorder following cannabis use. Investigation of the effect of this interaction on relevant intermediate phenotypes for psychosis, such as cognition, may help to clarify the underlying mechanism. Thus, verbal memory (visually presented Word Learning Task), sustained attention (Continuous Performance Test, CPT), AKT1 rs2494732 genotype, and cannabis use were examined in a large cohort of patients with psychotic disorder. No evidence was found for AKT1 × cannabis interaction on verbal memory. Cannabis use preceding onset of psychotic disorder did interact significantly with AKT1 rs2494732 genotype to affect CPT reaction time (β=8.0, SE 3.9, p=0.037) and CPT accuracy (β=−1.2, SE 0.4, p=0.003). Cannabis-using patients with the a priori vulnerability C/C genotype were slower and less accurate on the CPT, whereas cannabis-using patients with the T/T genotype had similar or better performance than non-using patients with psychotic disorder. The interaction was also apparent in patients with psychotic disorder who had not used cannabis in the 12 months preceding assessment, but was absent in the unaffected siblings of these patients and in healthy controls. In conclusion, cannabis use before onset of psychosis may have long-lasting effects on measures of sustained attention, even in the absence of current use, contingent on AKT1 rs2494732 genotype. The results suggest that long-term changes in cognition may mediate the risk-increasing effect of the AKT1 × cannabis interaction on psychotic disorder.     

Validation of the Alcohol Use Identification Test in a Prison Sample Living in the Arabian Gulf Region

The purpose of this study was to assess the utility of the Arabic translation of the Alcohol Use Disorders Identification Test (AUDIT) among a sample of male Muslim prisoners (N = 107) in Dubai, United Arab Emirates (UAE). Confirmatory factor analysis indicated a two-factor model to be the best fit of the data. Good internal reliability (α =.91) and predictive validity were also observed. While the limitations of the study are observed, these promising results suggest that the Arabic version of the AUDIT is a reliable and sound measure of alcohol use disorders among prisoners in the UAE.     

The Cannabis Problems Questionnaire: factor structure, reliability, and validity

AIM: To develop a multi-dimensional valid and reliable measure of cannabis-related problems. METHOD: The Cannabis Problems Questionnaire (CPQ) was developed from the Alcohol Problems Questionnaire to measure cannabis treatment outcome. The CPQ was administered on two occasions 1 week apart to a stratified sample of adults who had used cannabis at least once in the previous 3 months. Exploratory factor analyses were conducted and the relationship between items of the CPQ and measures of daily use and dependence assessed. The reliability of the CPQ was also assessed using a test-retest and inter-rater reliability methodology. RESULTS: Exploratory factor analyses revealed a three factor solution best described the data accounting for 57% of the variance in the larger item set. The CPQ is highly reliable with test-retest tetrachoric correlations of between 0.92 and 1.00 and inter-rater reliability correlations between 0.74 and 1.00. The total CPQ score classified DSM-IV cannabis dependence with 84% specificity and sensitivity and daily cannabis use with 83% specificity and 55% sensitivity. CONCLUSIONS: The 22-item CPQ is a valid, reliable and sensitive measure of cannabis-related problems for use with clinical and research populations of current cannabis users.     

A ‘standard joint’? The role of quantity in predicting cannabis-related problems

The ‘standard drink’ concept is widely used as a standardized measure of alcohol consumption. There is no equivalent measure of cannabis consumption, perhaps due to challenges such as varied joint size, tetrahydrocannabinol content, and means of delivery. This study introduces a new measure of cannabis quantity and examines whether it predicts cannabis-related social problems with and without controlling for frequency of use. Cannabis-related problems, measured by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), were predicted from cannabis use frequency (days in past month) and quantity (one joint = 0.5?g, five bong or pipe hits, 10 puffs), controlling for age and gender. The sample consisted of 665 participants aged 15–67 (mean?=?28.2, SD?=?11.8) from the British Columbia Alcohol and Other Drug Monitoring Project, High Risk Group Surveys, 2008 to 2009. Cannabis use frequency and quantity were positively associated with cannabis-related problems. Individuals who consumed cannabis daily and consumed more than one joint per day were at the greatest risk of problems. Controlling for frequency, the effect of quantity remained significant for failure to do what is expected due to cannabis use. This study suggests that quantity, above and beyond frequency, is an important predictor of cannabis problems. We discuss the potential usefulness and validity of this new measure in harm reduction.     

Six-Month Follow-Up of Computerized Alcohol Screening,Brief Intervention,and Referral to Treatment in the Emergency Department

ABSTRACT

The goal of this observational study was to measure change in alcohol consumption at 6 months following emergency department computerized alcohol screening brief intervention (CASI) and referral to treatment (ED-SBIRT) with integrated brief negotiated interview (BNI) and computer-generated personal alcohol reduction plans. At-risk patients received a BNI by CASI, including personalized feedback, assessment of readiness to change, reasons for cutting down, goal setting, and a printed personal alcohol reduction plan. Alcohol use was assessed by telephone interview 6 months after CASI. Factors associated with lower alcohol consumption were examined. Of the 385 participants who completed the BNI, were consented, and enrolled, 221 subjects completed the 6-month follow-up interview. Forty-seven percent of the study sample of at-risk patients were no longer drinking over the National Institute on Alcohol Abuse and Alcoholism (NIAAA)-recommended limits. Reductions were greater for patients with Alcohol Use Disorders Identification Test (AUDIT) scores of 1 to 7. Readiness to change was a good predictor of drinking below the recommended limits. The use of computerized ED-SBIRT with integrated personalized messaging and BNI holds promise as a viable screening and intervention modality for a wide range of emergency department patients.     

Cannabis use and psychotic disorders: an update

This paper evaluates three hypotheses about the relationship between cannabis use and psychosis in the light of recent evidence from prospective epidemiological studies. These are that: (1) cannabis use causes a psychotic disorder that would not have occurred in the absence of cannabis use; (2) that cannabis use may precipitate schizophrenia or exacerbate its symptoms; and (3) that cannabis use may exacerbate the symptoms of psychosis. There is limited support for the first hypothesis. As a consequence of recent prospective studies, there is now stronger support for the second hypothesis. Four recent prospective studies in three countries have found relationships between the frequency with which cannabis had been used and the risk of receiving a diagnosis of schizophrenia or of reporting psychotic symptoms. These relationships are stronger in people with a history of psychotic symptoms and they have persisted after adjustment for potentially confounding variables. The absence of any change in the incidence of schizophrenia during the three decades in which cannabis use in Australia has increased makes it unlikely that cannabis use can produce psychoses that would not have occurred in its absence. It seems more likely that cannabis use can precipitate schizophrenia in vulnerable individuals. There is also reasonable evidence for the third hypothesis that cannabis use exacerbates psychosis. [Hall W, Degenhardt L, Teeson M. Cannabis use and psychotic disorders: an update. Drug Alcohol Rev 2004;23:433-443]