Background Emerging research suggests the COVID-19 pandemic has resulted in a significant increase in self-reported isolation and loneliness in a large proportion of the population. This is particularly concerning given that isolation and loneliness are associated with increased cannabis use, as well as using cannabis to cope with negative affect. Objective: We investigated whether self-isolation due to COVID-19 and using cannabis to cope with depression were unique and/or interactive predictors of cannabis use during the pandemic, after controlling for pre-pandemic levels of cannabis use. Method A sample of 70 emerging adults (mean age = 23.03; 34.3% male) who used both alcohol and cannabis pre-pandemic completed measures of cannabis use (i.e., quantity x frequency) and a novel COVID-19 questionnaire between March 23 and June 15, 2020. Pre-pandemic cannabis use levels had been collected four months earlier. Results Linear regressions indicated self-isolation and coping with depression motives for cannabis use during the pandemic were significant predictors of pandemic cannabis use levels after accounting for pre-pandemic use levels. There was no interaction between coping with depression motives and self-isolation on cannabis use during the pandemic. Conclusions Those who engaged in self-isolation were found to use 20% more cannabis during the pandemic than those who did not. Our results suggest that self-isolation is a unique risk factor for escalating cannabis use levels during the pandemic. Thus, self-isolation may inadvertently lead to adverse public health consequences in the form of increased cannabis use.
Our review of the relevant constitutional issues confirms that local governments have the authority to utilize laws and policies to reduce the density and number of tobacco retailers in their communities, given existing public health data. The analysis guides policy makers in crafting laws that comply with constitutional requirements by outlining the most important procedures and evidentiary justifications to use in development, implementation, and enforcement. This perspective also highlights the importance of reviewing state constitutions, statutes, and municipal codes and getting local input from attorneys and community stakeholders to assess the likely success of some methods over others.
Background
Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential.
Method
To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine.
Results
We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on “loss of control” eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials.
Discussion
Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.
Outpatient care (e.g., individual, group, or self‐help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self‐efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost‐effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.
Objective: Alcohol and cannabis use motives are often studied as contributors to risky substance use patterns. While various measures for capturing such motives exist, most contain 20+ items, which render their inclusion in certain research designs (e.g., daily diary) or with certain populations (e.g., polysubstance users) unfeasible. We sought to generate and validate six-item measures of cannabis and alcohol motives from existing measures, the Marijuana Motives Measure (MMM) and the Modified Drinking Motives Questionnaire-Revised (MDMQ-R). Methods: In Study 1, items were generated, feedback from 33 content-domain experts was obtained, and item revisions were made. In Study 2, the finalized brief cannabis and alcohol motives measures, along with the MMM, MDMQ-R, and substance-related measures, were administered to 176 emerging adult cannabis and alcohol users (71.6% female) at two timepoints, two months apart. Participants were recruited through a participant pool. Results: Study 1 experts indicated satisfactory ratings of face and content validity. Expert feedback was used to revise three items. Study 2 results suggest test-retest reliabilities for the single-item forms (r = .34 to .60) were similar to those obtained with full motives measures (r = .39 to .67). Validity was acceptable-to-excellent in that brief and full-length measures were significantly intercorrelated (r = .40 to .83). The brief and full-length measures had similar concurrent and predictive relationships for cannabis and alcohol quantity x frequency (coping-with-anxiety for cannabis and enhancement for alcohol) and problems (coping-with-depression), respectively. Conclusions: The brief measures represent psychometrically-sound measures of cannabis and alcohol use motives with substantially less participant burden than the MMM and MDMQ-R.
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