Cannabis Use and Risk of Psychiatric Disorders: Prospective Evidence From a US National Longitudinal Study

IMPORTANCE:

With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use.

OBJECTIVE:

To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population.

DESIGN, SETTING, AND PARTICIPANTS:

A nationally representative sample of US adults aged 18 years or older was interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 34 653 respondents who were interviewed in both waves. Data analysis was conducted from March 15 to November 30, 2015.

MAIN OUTCOMES AND MEASURES:

We used multiple regression and propensity score matching to estimate the strength of independent associations between cannabis use at wave 1 and incident and prevalent psychiatric disorders at wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). In both analyses, the same set of wave 1 confounders was used, including sociodemographic characteristics, family history of substance use disorder, disturbed family environment, childhood parental loss, low self-esteem, social deviance, education, recent trauma, past and present psychiatric disorders, and respondent's history of divorce.

RESULTS:

In the multiple regression analysis of 34 653 respondents (14 564 male [47.9% weighted]; mean [SD] age, 45.1 [17.3] years), cannabis use in wave 1 (2001-2002), which was reported by 1279 respondents, was significantly associated with substance use disorders in wave 2 (2004-2005) (any substance use disorder: odds ratio [OR], 6.2; 95% CI, 4.1-9.4; any alcohol use disorder: OR, 2.7; 95% CI, 1.9-3.8; any cannabis use disorder: OR, 9.5; 95% CI, 6.4-14.1; any other drug use disorder: OR, 2.6; 95% CI, 1.6-4.4; and nicotine dependence: OR, 1.7; 95% CI, 1.2-2.4), but not any mood disorder (OR, 1.1; 95% CI, 0.8-1.4) or anxiety disorder (OR, 0.9; 95% CI, 0.7-1.1). The same general pattern of results was observed in the multiple regression analyses of wave 2 prevalent psychiatric disorders and in the propensity score-matched analysis of incident and prevalent psychiatric disorders.

CONCLUSIONS AND RELEVANCE:

Within the general population, cannabis use is associated with an increased risk for several substance use disorders. Physicians and policy makers should take these associations of cannabis use under careful consideration.

Below:  Prevalence of Psychiatric Disorders in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions by Level of Cannabis Use in Wave 1

Purchase full article at:   http://goo.gl/no1tOh

By:  Blanco C1, Hasin DS2, Wall MM2, Flórez-Salamanca L3, Hoertel N4, Wang S2, Kerridge BT2, Olfson M2.

• 1Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland.
• 2Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York.
• 3Assistance Publique-Hôpitaux de Paris, Corentin Celton Hospital, Paris, France4Department of Psychiatry, Paris Descartes University, Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Paris, France.
• 4Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York3Assistance Publique-Hôpitaux de Paris, Corentin Celton Hospital, Paris, France4Department of Psychiatry, Paris Descartes University, Pôle de Recher. 
• JAMA Psychiatry. 2016 Feb 17. doi: 10.1001/jamapsychiatry.2015.3229. 

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Association of Comorbid Psychopathology with the Duration of Cannabis Use Disorders

Risk factors for the development of cannabis use disorders (CUDs) have been well–researched. Comparatively little is known, however, about factors associated with the persistence of CUDs over time. 

This research explored whether the temporal sequencing of comorbid psychiatric disorders in relation to the onset of the index CUD episode were associated with the length of this episode. 

Four comprehensive diagnostic assessments were conducted between ages 16 and 30 with a large and regionally representative community sample (n = 816), among which 173 persons were diagnosed with a lifetime CUD. In separate unadjusted analyses, any internalizing disorder and any mood disorder with onset prior to that of the index CUD episode were each significantly and negatively associated with CUD duration. These effects, however, were reduced to trend-level in adjusted analyses that controlled for putative confounders. Following the onset of the index CUD episode, the subsequent occurrence of any axis I disorder, internalizing disorder, externalizing disorder, or other substance use disorder during the index CUD episode was significantly and positively associated with the duration of that episode in both unadjusted and adjusted analyses. 

These findings collectively suggest that the presence of internalizing-spectrum disorders prior to the onset of the index CUD episode affords some modest protection against protracted episodes, whereas the emergence of broad-spectrum psychopathology within the index CUD episode, most notably non-cannabis substance use disorders, is associated with greater disorder persistence. 

The relevance of these findings for various motivational models of cannabis addiction is discussed.

Descriptive Statistics for Demographic Variables and Bivariate Associations with the Duration of Index Cannabis Use Disorder Episode (n = 173)

Predictor	% (SE) or M (SD)	Coef (SE)	p	r2
Participant Characteristics, % (SE)
Male	52 (4)	26.1 (6.7)	.001	.082
Non-white	9 (2)	1.7 (12.0)	.890	<.001
Pubertal timing
Early vs. on-time	25 (4)	−6.2 (7.9)	.428	.004
Late vs. on-time	18 (3)	16.4 (10.7)	.127	.017
Early vs. late	60 (6)	−22.7 (12.8)	.082	.050
History of repeating grade before age 12	14 (3)	4.0 (10.0)	.694	.001
Family Demographic Variables
Dual versus single parent household, % (SE)	44 (4)	−4.5 (7.0)	.523	.002
At least one parent completed college, % (SE)	41 (4)	−4.6 (7.1)	.516	.003
Mean parent age at T1, M (SD)	41.5 (5.6)	−1.1 (0.3)	.081	.018
Number of older siblings, M (SD)	0.9 (1.1)	−2.8 (3.1)	.359	.005

Notes. SE = standard error; M = mean; SD = standard deviation; Coef = regression coefficient estimate.

Full article at:   http://goo.gl/pcfeg4

By:   Richard F. Farmer, Derek B. Kosty, John R. Seeley, Jeff M. Gau, Susan C. Duncan, Denise D. Walker, and Peter M. Lewinsohn

Richard F. Farmer, Oregon Research Institute;

Contributor Information.

Correspondence concerning this report should be directed to Richard Farmer, Oregon Research Institute, 1776 Millrace Drive, Eugene, Oregon, 97403, United States of America. Email: gro.iro@remrafr

Richard F. Farmer, Derek B. Kosty, John R. Seeley, Jeff M. Gau, Susan C. Duncan, and Peter M. Lewinsohn, Oregon Research Institute; Denise D. Walker, School of Social Work, University of Washington.

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Psychosocial Determinants of Cannabis Dependence: A Systematic Review of the Literature

BACKGROUND:

Many studies have examined factors associated with the first onset of cannabis use and abuse. Currently, there is relatively little research regarding conditions under which cannabis dependence is more likely to emerge. Although previous studies have examined different potential determinants of cannabis dependence, to our knowledge, a systematic review is lacking.

AIMS:

The study aims to identify recent findings regarding psychosocial determinants of cannabis dependence and to summarize them systematically.

METHODS:

A literature search in 4 databases - Embase, Medline, PsycINFO and PSYNDEX - was conducted. Searches were limited to publications between 2000 and April 2014, English and German as languages and humans as study subjects.

RESULTS:

Our search detected a total of 10,568 studies. Twenty-six studies finally met inclusion criteria. Consumption patterns such as a regularcannabis use independent of social context and an early onset of use (11-15 years) were correlates of cannabis dependence. Moreover, early reactions to cannabis use and coping-oriented use motives explained additional variance. Stress factors and critical life events such as parental separation and early parental death as well as mental and social conflicts have also been linked with development of cannabis dependence. Additionally, comorbid mental disorders correlated with cannabis dependence.

CONCLUSION:

Numerous factors were shown to have an impact on transition to cannabis dependence. In particular, a wide range of mental disorders has been linked to an elevated risk of becoming dependent. The development of a dependence syndrome seems to be associated with diverse processes, in which social, biological and intra-individual factors interact in a complex manner. Nevertheless, the link between cannabisdependence and predisposing factors could not be resolved convincingly by most studies due to methodological weaknesses regarding dependence criteria.

Full article at:   http://goo.gl/FsURt5

By:   Schlossarek S1, Kempkensteffen J, Reimer J, Verthein U.

• 1Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 

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