Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-04-28T08:53:37.297Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychotic-like experiences with cannabis use predict cannabis cessation and desire to quit: a cannabis discontinuation hypothesis

Published online by Cambridge University Press:  23 March 2018

Musa Sami ,
Caitlin Notley ,
Christos Kouimtsidis ,
Michael Lynskey  and
Sagnik Bhattacharyya
Musa Sami
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK South London and Maudsley NHS Foundation Trust, UK
Caitlin Notley
Affiliation:
Norwich Medical School, University of East Anglia,Norwich, UK
Christos Kouimtsidis
Affiliation:
Surrey and Borders Partnership NHS Foundation Trust, UK Department of Medicine, Division of Brain Sciences, Imperial College London, UK
Michael Lynskey
Affiliation:
National Addiction Centre, Addiction Sciences Building, King's College London, UK
Sagnik Bhattacharyya*
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK South London and Maudsley NHS Foundation Trust, UK
*
Author for correspondence: Sagnik Bhattacharyya, E-mail: sagnik.2.bhattacharyya@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Evidence suggests that cannabis-induced psychotic-like experiences may be a marker of psychosis proneness. The effect of such experiences on cannabis use has not systematically been examined.

Methods

We undertook a mixed-methods online survey of 1231 cannabis users (including 926 continued users) using the Cannabis Experiences Questionnaire. We examined the effect of psychotic-like and pleasurable experiences on cessation of cannabis and intention to quit. Socio-demographic variables, cannabis use parameters and substance misuse history were included as covariates. Free-text data explored subjective reasons for changes in use.

Results

Cessation of cannabis use was associated with greater psychotic-like experiences [p < 0.001, Exp(B) 1.262, 95% confidence interval (CI) 1.179–1.351], whilst continued cannabis users were more likely to report pleasurable experiences [p < 0.001, Exp(B) 0.717, 95% CI 0.662–0.776]. Intention to quit cannabis in continued users was associated with greater psychotic-like experiences [p < 0.003, Exp(B) 1.131, 95% CI 1.044–1.225], whilst intention to not quit was significantly associated with increased pleasurable experiences [p < 0.015, Exp(B) 0.892, 95% CI 0.814–0.978]. Whereas former users clearly ascribed cessation to negative experiences, continued users who expressed intention to quit less readily ascribed the intention to negative experiences.

Conclusions

Elucidation of psychotic-like experiences may form the basis of a therapeutic intervention for those who wish to quit. Cessation in those with cannabis-induced psychotomimetic experiences may offset the risk for the development of a psychotic disorder, in this higher risk group.

Keywords

Cannabiscessationdiscontinuationmarijuanapattern of usepsychosis riskpsychotic-like experiences
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 1 , January 2019 , pp. 103 - 112
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Barkus, E and Lewis, S (2008) Schizotypy and psychosis-like experiences from recreational cannabis in a non-clinical sample. Psychological Medicine 38, 1267–1276.Google Scholar
Barkus, EJ, Stirling, J, Hopkins, RS and Lewis, S (2006) Cannabis-induced psychosis-like experiences are associated with high schizotypy. Psychopathology 39, 175–178.Google Scholar
Bhattacharyya, S, Atakan, Z, Martin-Santos, R, Crippa, Ja, Kambeitz, J, Prata, D et al. (2012) Preliminary report of biological basis of sensitivity to the effects of cannabis on psychosis: AKT1 and DAT1 genotype modulates the effects of δ-9-tetrahydrocannabinol on midbrain and striatal function. Molecular Psychiatry 17, 1152–1155.Google Scholar
Bianconi, F, Bonomo, M, Marconi, A, Kolliakou, A, Stilo, SA, Iyegbe, C et al. (2016) Differences in cannabis-related experiences between patients with a first episode of psychosis and controls. Psychological Medicine 46, 995–1003.Google Scholar
Birnbaum, ML, Cleary, SD, Ramsay Wan, C, Pauselli, L and Compton, MT (2017) Factor structure of the Cannabis Experiences Questionnaire in a first-episode psychosis sample. Early Intervention in Psychiatry, 1–7. doi: 10.1111/eip.12509. [Epub ahead of print].Google Scholar
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.Google Scholar
Degenhardt, L and Hall, W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet 379, 55–70.Google Scholar
Di Forti, M, Iyegbe, C, Sallis, H, Kolliakou, A, Falcone, MA, Paparelli, A et al. (2012) Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biological Psychiatry 72, 811–816.Google Scholar
Di Forti, M, Morgan, C, Dazzan, P, Pariante, C, Mondelli, V, Marques, TR et al. (2009) High-potency cannabis and the risk of psychosis. British Journal of Psychiatry 195, 488–491.Google Scholar
D'Souza, DC, Abi-Saab, WM, Madonick, S, Forselius-Bielen, K, Doersch, A, Braley, G et al. (2005) Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry 57, 594–608.Google Scholar
Frisher, M, Crome, I, Martino, O and Croft, P (2009) Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophrenia Research 113, 123–128.Google Scholar
Gage, SH, Hickman, M and Zammit, S (2016) Association between cannabis and psychosis: epidemiologic evidence. Biological Psychiatry 79, 549–556.Google Scholar
Grant, JD, Scherrer, JF, Lyons, MJ, Tsuang, M, True, WR and Bucholz, KK (2005) Subjective reactions to cocaine and marijuana are associated with abuse and dependence. Addictive Behaviors 30, 1574–1586.Google Scholar
Henquet, C, Rosa, A, Krabbendam, L, Papiol, S, Fananás, L, Drukker, M et al. (2006) An experimental study of catechol-o-methyltransferase Val158Met moderation of delta-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology 31, 2748–2757.Google Scholar
Hill, M (2015) Perspective: be clear about the real risks. Nature 525, S14–S14.Google Scholar
Kandel, DB and Logan, JA (1984) Patterns of drug-use from adolescence to young adulthood. 1. Periods of risk for initiation, continued use, and discontinuation. American Journal of Public Health 74, 660–666.Google Scholar
Kandel, DB and Raveis, VH (1989) Cessation of illicit drug use in young adulthood. Archives of General Psychiatry 46, 109–116.Google Scholar
Kuepper, R, van Os, J, Lieb, R, Wittchen, H-U, Höfler, M and Henquet, C (2011) Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ (Clinical Research Ed.) 342, d738.Google Scholar
Le Strat, Y, Ramoz, N, Horwood, J, Falissard, B, Hassler, C, Romo, L et al. (2009) First positive reactions to cannabis constitute a priority risk factor for cannabis dependence. Addiction 104, 1710–1717.Google Scholar
Little, MA, Spruijt-Metz, D, Pokhrel, P, Sun, P, Ann Rohrbach, L and Sussman, S (2013) Predicting self-initiated marijuana use cessation among youth at continuation high schools. Frontiers in Psychiatry 4, 1–7.Google Scholar
Lyons, MJ, Toomey, R, Meyer, JM, Green, AI, Eisen, SA, Goldberg, J et al. (1997) How do genes influence marijuana use? The role of subjective effects. Addiction 92, 409–417.Google Scholar
Marconi, A, Di Forti, M, Lewis, CM, Murray, RM and Vassos, E (2016) Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophrenia Bulletin 42, 1262–1269.Google Scholar
Mason, O, Morgan, CJA, Dhiman, SK, Patel, A, Parti, N and Curran, HV (2009) Acute cannabis use causes increased psychotomimetic experiences in individuals prone to psychosis. Psychological Medicine 39, 951–956.Google Scholar
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TRE, Jones, PB, Burke, M et al. (2007) Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet 370, 319–328.Google Scholar
Kahn, RS, Linszen, DH, van OS, J, Wiersma, D, Bruggeman, R, Cahn, W, de Hann, L, Krabbendam, L, Myin-Germeys, I; Genetic Risk and outcome of Psychosis (Group) Investigators (2011) Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient-sibling and sibling-control pairs. Archives of General Psychiatry 68, 138–147.Google Scholar
Quinn, CA, Wilson, H, Cockshaw, W, Barkus, E and Hides, L (2017) Development and validation of the cannabis experiences questionnaire – intoxication effects checklist (CEQ-I) short form. Schizophrenia Research 189, 91–96.Google Scholar
Scherrer, JF, Grant, JD, Duncan, AE, Sartor, CE, Haber, JR, Jacob, T et al. (2009) Subjective effects to cannabis are associated with use, abuse and dependence after adjusting for genetic and environmental influences. Drug and Alcohol Dependence 105, 76–82.Google Scholar
Schoeler, T, Monk, A, Sami, MB, Klamerus, E, Foglia, E, Brown, R et al. (2016 a) Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. The Lancet Psychiatry 3, 215–225.Google Scholar
Schoeler, T, Petros, N, Di Forti, M, Klamerus, E, Foglia, E, Ajnakina, O et al. (2016 b) Effects of continuation, frequency and type of cannabis use on relapse in the first two years following onset of psychosis – an observational study. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license, Lancet Psychiatry 366, 1–7.Google Scholar
Schoeler, T, Petros, N, Di Forti, M, Pingault, J-B, Klamerus, E, Foglia, E et al. (2016 c) Association between continued cannabis use and risk of relapse in first-episode psychosis. JAMA Psychiatry 35, 557–574.Google Scholar
Stirling, J, Barkus, EJ, Nabosi, L, Irshad, S, Roemer, G, Schreudergoidheijt, B et al. (2008) Cannabis-induced psychotic-like experiences are predicted by high schizotypy: confirmation of preliminary results in a large cohort. Psychopathology 41, 371–378.Google Scholar
Thomas, H (1996) A community survey of adverse effects of cannabis use. Drug and Alcohol Dependence 42, 201–207.Google Scholar
Valmaggia, LR, Day, FL, Jones, C, Bissoli, S, Pugh, C, Hall, D et al. (2014) Cannabis use and transition to psychosis in people at ultra-high risk. Psychological Medicine 44, 2503–2512.Google Scholar
van den Bree, MBM, Pickworth, WB (2005) Risk factors predicting changes in marijuana involvement in teenagers. Archives of General Psychiatry 62, 311.Google Scholar
van Gastel, WA, Vreeker, A, Schubart, CD, MacCabe, JH, Kahn, RS and Boks, MPM (2014) Change in cannabis use in the general population: a longitudinal study on the impact on psychotic experiences. Schizophrenia Research 157, 266–270.Google Scholar
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC and Vandenbroucke, JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 370, 1453–1457.Google Scholar
Zeiger, JS, Haberstick, BC, Corley, RP, Ehringer, MA, Crowley, TJ, Hewitt, JK et al. (2010) Subjective effects to marijuana associated with marijuana use in community and clinical subjects. Drug and Alcohol Dependence 109, 161–166.Google Scholar
Supplementary material: File

Sami et al. supplementary material

Sami et al. supplementary material 1

Download Sami et al. supplementary material(File)
File 157.7 KB