Cannabis Use and Disorder From Childhood to Adulthood in a Longitudinal Community Sample With American Indians

Abstract

Objective Recent changes in DSM criteria require new documentation of the prevalence and developmental sequences of cannabis use disorder. Our goal was to study the early course of DSM-5 cannabis use disorder (CUD) and its overlap with DSM-IV and consumption constructs in a community-representative sample with American Indians. Method Data came from the prospective-longitudinal, population-based Great Smoky Mountains Study in North Carolina (N = 1,420, including n = 349 American Indians). Cannabis use and disorder were assessed during yearly interviews from ages 9 to 16, and again at ages 19, 21, 26, and 30 (up to 11 assessments per participant between 1993 and 2015). Results By age 30, approximately 70% of participants had used cannabis, 34% had used daily, and 18% had met criteria for DSM-5 CUD. Approximately 1 in 4 cannabis users met criteria for CUD at some point. Those who met criteria initiated use over two years earlier (at age 13.3) compared to other users. Despite higher risks due to increased poverty, American Indians’ patterns of use were similar to the rest of the sample. Concordance between DSM-5 CUD and DSM-IV abuse/dependence was substantial, but was even higher between DSM-5 CUD and daily use. Conclusion It was common to have either used cannabis daily or to have met criteria for DSM-5 CUD by adulthood. DSM-5 CUD was an improvement over DSM-IV diagnostic constructs by raising the threshold for diagnosis.

Predicting Persistent, Limited, and Delayed Problematic Cannabis Use in Early Adulthood: Findings From a Longitudinal Study

“…Although highly correlated, these constructs are not synonymous (see also our previous publication detailing the point prevalence of CUD and daily use from ages 9 to 30 years). 3 Specifically, among the total 415 reports of CUD observed in the weighted sample over the course of the study, 72.1% of the observations coincided with an account of daily use. Conversely, only 57.4% of daily use reports (n=382) overlapped with CUD endorsement.…”

“…1, 2 Among active users, 18–30% report problematic cannabis use, characterized by cannabis use disorder (CUD) or daily use. 3 Such problematic use peaks at ages 19–21 and subsequently decreases or plateaus, 4 and is associated with long-term health and social consequences, including higher risk for altered brain development, 5 psychosis and exacerbated symptoms of schizophrenia, 6 escalation to harsher drug use, 7 and lower educational attainment and employment. 8 Substantial progress has been made in identifying risk factors for substance use in the early life course.…”

“…23, 24 Altogether, this work builds on our previous study that examined differences by race/ethnicity and sex for point prevalence of cannabis use, frequencies, and DSM-5 CUD from 9–30 years of age. 3 …”

Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents

“…Notably, peak risk for SUD also starts to decline several years prior to that found in the general population, and continuity in abuse/dependence across the life course does not appear to be prevalent. American Indian adults have similar, if not lower, rates of alcohol and marijuana use than whites (Copeland et al, 2017;Cunninham et al, 2016). High rates of lifetime SUD found among various Indigenous populations may be a function of early and cumulative abuse/dependence cases, rather than sustained risk across the life course (Copeland et al, 2017).…”

Cannabis Use Among Remote Indigenous Australians: Opportunities to Support Change Identified in Two Waves of Sampling

“…While cannabis remains the most widely used illicit substance worldwide, its use has generally decreased in countries like the United States, Canada, New Zealand and Australia ( 1 ). In contrast, rates of cannabis use in the Indigenous populations of these developed economies are 1.3–1.9 times higher than respective national averages ( 2 – 5 ). Systematic evidence is lacking on the specific impacts of cannabis in Indigenous populations, and on how to assist Indigenous peoples to reduce harms.…”