Predicting the transition from frequent cannabis use to cannabis dependence: A three-year prospective study

Pol, Peggy van der; Liebregts, Nienke; Graaf, Ron de; Korf, D.J.; Brink, Wim van den; Laar, Margriet van

doi:10.1016/j.drugalcdep.2013.06.009

Cited by 144 publications

(110 citation statements)

References 66 publications

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“…As such, the 'typical' smoking topography may be indicative of using cannabis to cope with psychological distress/stress. Such an interpretation would be in line with findings from two other studies from the same research team, which also found that cannabis exposure/ THC variables did not distinguish dependent from nondependent users [4] nor predict future dependence in frequent users [5]. Instead, these studies found that cannabis dependence was predicted by consuming cannabis alone, use for coping and expansion motives, use of other substances and comorbid mood and anxiety disorders [4], and living alone, coping motives for use and stress [5].…”

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confidence: 88%

“…Such an interpretation would be in line with findings from two other studies from the same research team, which also found that cannabis exposure/ THC variables did not distinguish dependent from nondependent users [4] nor predict future dependence in frequent users [5]. Instead, these studies found that cannabis dependence was predicted by consuming cannabis alone, use for coping and expansion motives, use of other substances and comorbid mood and anxiety disorders [4], and living alone, coping motives for use and stress [5]. These findings are supportive of the self-medication hypothesis [6], and consistent with both Van Dam, Bedi & Earleywine's [7] proposition that anxiety is causally related to the development of abuse/dependence in heavy users, and Buckner & Carroll's [8] finding that, within a cannabis-dependent sample, reducing anxiety led to reduced cannabis use yet reducing cannabis use did not lead to decreased anxiety.…”

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confidence: 88%

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Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence

Temple

2014

Addiction

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Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependenceThe existence of a positive, and relatively strong, association between cannabis exposure/tetrahydrocannabinol (THC) dose and cannabis dependence is an assumption on which much cannabis-related research, public policy and health advice has been based. Van der Pol et al.'s [1] findings, however, throw this into some doubt. To understand why there is a discrepancy here, and its import, it is essential to consider how cannabis exposure/dose is typically measured and, thereby, how past studies may have clouded our understanding of the association between cannabis use and dependence.Cannabis exposure has been assessed in a variety of ways, tending to include measurement of some combination of age at first use, duration of use, quantity consumed and frequency of use, with the latter often employed in isolation as a proxy for THC dose [2]. Although known to be only approximations of exposure, these variables are used by researchers for a number of reasons. Foremost among these are the efficiencies associated with the use of self-report questionnaires, which are often completed anonymously by participants and remotely from researchers. The classification of cannabis as an illicit substance within most jurisdictions globally, however, also acts to prevent the vast majority of cannabis researchers from undertaking as thorough an assessment of cannabis exposure/dose as has been demonstrated by van der Pol et al. [1].In the relatively small number of studies where THC dose has been confirmed, this has generally been via 'cannabis cigarettes' purchased from the US National Institute on Drug Abuse (NIDA). These studies, however, do not replicate normal usage of cannabis, such as that assessed in van der Pol et al.'s study. Specifically, NIDA joints range from 3 to 7% in THC content and are typically smoked in a prescribed manner (i.e. uniform puff size/duration and breath hold) (e.g. [3]); in comparison, van der Pol et al.'s participants were using cannabis ranging from 3.6 to 15.7% THC and they smoked it as per usual, such that their smoking topographies varied. Taken together with the finding that total number of puffs and puff volume were significant predictors of dependence in van der Pol et al.'s study, these differences throw at least some doubt on the 'real world' validity of findings from previous studies (whether using real or proxy measures of exposure/dose) and illustrate how important naturalistic studies are to increasing our understanding of the acute and long-term effects of cannabis use, including dependence.Of particular interest here is the 'typical' smoking topography that van der Pol et al. [1] found was predictive of cannabis dependence. Taking more frequent puffs of greater volume when commencing a session is evocative of someone seeking a quick hit, such as to 'take the edge off', then smoking with less urgency as the desired effects kick in. As such, the 'typical' smoking topography may be i...

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confidence: 88%

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confidence: 88%

Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence

Temple

2014

Addiction

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“…Therefore, it may be worthwhile to explore additionally the predictors of the onset of dependence, as these could predict an adverse course in general, including persistence of dependence. Cannabis users with coping-oriented reasons to use cannabis have been found to be at a higher risk to develop dependence [18,23,24,25]. Similarly, a family history of substance use disorders has been associated with dependence, although in one of the retrospective studies it was not associated with remission [26,27,28].…”

Section: Introductionmentioning

confidence: 99%

“…These studies are, however, constrained by the absence of cannabis exposure measures [20,21] or imprecise estimates such as number of days using cannabis and number of cones per day [17]. Especially among frequent or dependent cannabis users, more detailed measures of exposure, including cannabis dose per joint and THC-concentration, may be better predictors of the course of cannabis dependence [18,22]. …”

Section: Introductionmentioning

confidence: 99%

“…Although age, years of cannabis use and the total quantity of cannabis use predicted dependence at follow-up only bivariately, the number of baseline cannabis abuse/dependence symptoms was the only independent and strongest predictor of ‘persistence'. The predictive power of individual cannabis abuse and dependence symptoms was not considered, while certain abuse/dependence symptoms (especially ‘impaired control over use') have been shown to be more predictive than others for persistent cannabis use [7], onset of cannabis dependence in frequent users [18] and persistence of alcohol use disorders [19]. Two retrospective studies showed higher remission rates in younger, female, highly educated and employed subjects, in subjects with a later onset of cannabis dependence, a shorter duration of cannabis dependence and in subjects without other mental disorders (conduct disorder (CD), personality disorder, alcohol dependence, cocaine dependence) [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Three-Year Course of Cannabis Dependence and Prediction of Persistence

et al. 2015

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Aims: To examine the course and the predictors of the persistence of cannabis dependence. Methods: Through cannabis outlets and chain referral, a prospective enriched community cohort of 207 young adults (aged 18-30) with DSM-IV cannabis dependence at baseline (T0) was formed and followed-up after 1.5 (T1) and 3 (T2) years. The presence of cannabis dependence, cannabis-related problems, functional impairment and treatment was assessed using the Composite International Diagnostic Interview (CIDI 3.0) and the Sheehan Disability Scale (SDS). Predictors of persistence were lifetime cannabis abuse and dependence symptoms, cannabis use characteristics, distant vulnerability factors (e.g. childhood adversity, family history of psychological/substance use problems, impulsivity, mental disorders), and proximal stress factors (recent life events, social support). Results: Four groups were distinguished: persistent dependent (DDD: 28.0%), stable non-persistent (DNN: 40.6%), late non-persistent (DDN: 17.9%) and recurrent dependent (DND: 13.5%). At T2, persisters (DDD) reported significantly more (heavy) cannabis use and cannabis problems than non-persisters (DNN/DDN/DND). Treatment seeking for cannabis-related problems was rare, even among persisters (15.5%). The number (OR = 1.23 (1.03-1.48)) and type (‘role impairment' OR = 2.85 (1.11-7.31), ‘use despite problems' OR = 2.34 (1.15-4.76)) of lifetime cannabis abuse/dependence symptoms were the only independent predictors of persistence with a total explained variance of 8.8%. Conclusions: Persistence of cannabis dependence in the community is low, difficult to predict, and associated with a negative outcome. The substantial proportion of stable non-persisters suggests that screening and monitoring or low-threshold brief interventions may suffice for many non-treatment-seeking cannabis-dependent people. However, those with many lifetime abuse/dependence symptoms may benefit from more intensive interventions.

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Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder

et al. 2023

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ImportanceCannabis use is increasing worldwide and is suspected to be associated with increased risk of psychiatric disorders; however, the association with affective disorders has been insufficiently studied.ObjectiveTo examine whether cannabis use disorder (CUD) is associated with an increased risk of psychotic and nonpsychotic unipolar depression and bipolar disorder and to compare associations of CUD with psychotic and nonpsychotic subtypes of these diagnoses.Design, Setting, and ParticipantsThis prospective, population-based cohort study using Danish nationwide registers included all individuals born in Denmark before December 31, 2005, who were alive, aged at least 16 years, and living in Denmark between January 1, 1995, and December 31, 2021.ExposureRegister-based diagnosis of CUD.Main Outcome and MeasuresThe main outcome was register-based diagnosis of psychotic or nonpsychotic unipolar depression or bipolar disorder. Associations between CUD and subsequent affective disorders were estimated as hazard ratios (HRs) using Cox proportional hazards regression with time-varying information on CUD, adjusting for sex; alcohol use disorder; substance use disorder; having been born in Denmark; calendar year; parental educational level (highest attained); parental cannabis, alcohol, or substance use disorders; and parental affective disorders.ResultsA total of 6 651 765 individuals (50.3% female) were followed up for 119 526 786 person-years. Cannabis use disorder was associated with an increased risk of unipolar depression (HR, 1.84; 95% CI, 1.78-1.90), psychotic unipolar depression (HR, 1.97; 95% CI, 1.73-2.25), and nonpsychotic unipolar depression (HR, 1.83; 95% CI, 1.77-1.89). Cannabis use was associated with an increased risk of bipolar disorder in men (HR, 2.96; 95% CI, 2.73-3.21) and women (HR, 2.54; 95% CI, 2.31-2.80), psychotic bipolar disorder (HR, 4.05; 95% CI, 3.52-4.65), and nonpsychotic bipolar disorder in men (HR, 2.96; 95% CI, 2.73-3.21) and women (HR, 2.60; 95% CI, 2.36-2.85). Cannabis use disorder was associated with higher risk for psychotic than nonpsychotic subtypes of bipolar disorder (relative HR, 1.48; 95% CI, 1.21-1.81) but not unipolar depression (relative HR, 1.08; 95% CI, 0.92-1.27).Conclusions and RelevanceThis population-based cohort study found that CUD was associated with an increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression. These findings may inform policies regarding the legal status and control of cannabis use.

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Predicting the transition from frequent cannabis use to cannabis dependence: A three-year prospective study

Abstract: In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.

Cited by 144 publications

References 66 publications

Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence

Commentary on van der Pol et al. (2014): Reconsidering the association between cannabis exposure and dependence

Three-Year Course of Cannabis Dependence and Prediction of Persistence

Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder

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