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10 results

  • Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence

  • Sam Craft, Adam Winstock, Jason Ferris, Clare Mackie, Michael T. Lynskey, Tom P. Freeman
  • Journal:
    Psychological Medicine / Volume 50 / Issue 14 / October 2020
    Published online by Cambridge University Press:
    13 October 2019, pp. 2364-2373
  • Background

    As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use.

    Methods

    Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS).

    Results

    LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis.

    Conclusions

    The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

  • Risk factors for cocaine-induced psychosis in cocaine-dependent patients

  • C. Roncero, C. Daigre, B. Gonzalvo, S. Valero, X. Castells, L. Grau-López, F.J. Eiroa-Orosa, M. Casas
  • Journal:
    European Psychiatry / Volume 28 / Issue 3 / March 2013
    Published online by Cambridge University Press:
    25 November 2011, pp. 141-146

  • Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. This is the first European study on the relationship between CIP, consumption pattern variables and personality disorders. We evaluated 173 cocaine-dependent patients over 18 years; mostly males, whose average age was 33.6 years (SD = 7.8). Patients attending an outpatient addictions department were enrolled in the study and subsequently systematically evaluated using SCID I and SCID II interviews for comorbid disorders, a clinical interview for psychotic symptoms and EuropASI for severity of addiction. A high proportion of cocaine dependent patients reported psychotic symptoms under the influence of cocaine (53.8%), the most frequently reported being paranoid beliefs and suspiciousness (43.9%). A logistic regression analysis was performed, finding that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder and cannabis dependence history had 66.2% sensitivity 75.8% specificity predicting the presence of CIP. In our conclusions, we discuss the relevance of evaluating CIP in all cocaine dependent-patients, and particularly in those fulfilling the clinical profile derived from our results. These findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.

  • 14 - The Policy Implications of Cannabis Dependence

  • from Part IV - Policy
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 315-340

  • Summary

    This chapter summarizes the key features of cannabis dependence, and briefly discusses why dependence requires a policy response. It then explores the various ways in which the public health system may respond to cannabis dependence. A major development in responding to alcohol dependence and alcohol-related health problems has been the adoption of a public health perspective on alcohol use. The prohibition on the recreational use, cultivation, and sale of cannabis is primarily aimed at preventing young people from using cannabis. Public education campaigns can be used to inform drinkers about the risks of alcohol use. Adolescents are a priority group for research into treatment of cannabis dependence. The existence of cannabis dependence is a contested issued in the cannabis policy debate in the USA. The existence of cannabis dependence complicates the political task of those who want to decriminalize or legalize cannabis use.

  • 3 - Understanding the Pharmacology and Physiology of Cannabis Dependence

  • from Part I - The Nature of Cannabis Dependence
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 37-57

  • Summary

    This chapter summarizes several important advances of the actions of cannabis and its interaction with an endogenous cannabinoid system. The subsequent discovery of cannabinoid binding sites and the cloning of two cannabinoid receptor subtypes provide definitive support for the existence of cannabinoid receptors. The existence of an endocannabinoid system in the central nervous system has gained general acceptance as a result of the discovery of both endogenous cannabinoids and cannabinoid receptors. More recently, chronic marijuana use has been associated with an increased risk of cannabis dependence. Studies of drug self-administration in animals have proved valuable in elucidating the mechanisms of action underlying drug-reinforced behavior as well as predicting the abuse liability of new drugs. Evidence is also beginning to emerge suggesting that opioid receptors may play a modulatory role on cannabinoid dependence.

  • 15 - The Nature, Consequences and Treatment of Cannabis Dependence: Implications for Future Research and Policy

  • from Part V - Conclusion
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 343-356

  • Summary

    The phenomenon of cannabis dependence has been a topic of interest and varying levels of concern for well over 100 years. Cannabis's acute effects on attention, reaction time, and motor coordination predict impairment of driving and increased risk for accidents. The frequent coincidence of cannabis and alcohol use, a known contributor to motor vehicle accidents, has made it difficult to directly identify a causal link for cannabis. More recent research has found cannabis to independently increase risk for accidents. The reductions in cannabis use resulting from treatment were often substantial and accompanied by equally large decrements in self-reported problems. Systematic evaluation of treatment for adolescent cannabis users is in its early stages. Education about the risks of cannabis dependence should be part of any policy because it may deter initiation or escalation of use that could lead to dependence.

  • 7 - Contingency-Management Interventions for Cannabis Dependence

  • from Part II - Interventions with Cannabis-Dependent Adults
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 154-176

  • Summary

    Contingency management (CM) interventions represent one treatment approach that has great potential to effectively motivate and facilitate change in this challenging clinical population. CM interventions are based on extensive basic-science and clinical-research evidence demonstrating that drug use and abuse are heavily influenced by learning and conditioning and are quite sensitive to systematically applied environmental consequences. Behavioral-analytic theory and the empirical literature on behavior change in general suggests that the efficacy of CM interventions is influenced by the schedule used to deliver consequences the magnitude of the consequence, the choice of the target behavior, the selection of the type of consequence, and the monitoring of the target behavior. The chapter uses examples from cannabis CM program to describe these basic principles and illustrate their application. Almost half of those seeking treatment for marijuana abuse have criminal justice involvement and are referred to treatment by the legal system.

  • 6 - Cognitive-Behavioral and Motivational Enhancement Treatments for Cannabis Dependence

  • from Part II - Interventions with Cannabis-Dependent Adults
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 131-153

  • Summary

    Cognitive-behavioral (CBT) and motivational enhancement treatments (MET) are two of the most researched and most empirically supported approaches to the treatment of alcohol and drug use disorders. MET is based on motivational interviewing (MI), an empathic, reflective therapeutic style designed to resolve ambivalence and develop self-motivation for change. CBT targets the functional role that drug use plays in the individual's life. Clients learn to identify the antecedent feelings, thoughts, and situations that precipitate use, and then are helped to generate and master alternate responses. Both group and individual CBT interventions have been found to be efficacious with cannabis-dependent adults, as well as with other drug-dependent populations. For the most part, MET and CBT treatments have been adapted and applied to cannabis-dependent adults in the same way they have been used with alcohol and other drug problems.

  • 1 - Themes in the History of Cannabis Dependence

  • from Part I - The Nature of Cannabis Dependence
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 3-20

  • Summary

    This chapter examines the history of cannabis dependence, particularly emphasizing key themes that have contributed to how cannabis dependence has been perceived by the general public, by the scientific community, and by policy-makers. Variations in cannabis plant species, preparations, and methods of administration result in a wide range of behavioral effects associated with the regular use of this drug. Vivid and evocative imagery, often conveyed in popular literature and the media, has been among the key contributors to the public's perceptions of cannabis, its dependence liability, and the consequences of becoming dependent. In the mid-1800s, a group of French writers and artists, referring to themselves as Le Club des Hachichins, met monthly in Paris, experimented with an eaten cannabis concoction, and mused about its effects on their creative imaginations. Formal boards of inquiry have been established periodically in order to summarize existing knowledge concerning cannabis.

  • 2 - The Diagnosis of Cannabis Dependence

  • from Part I - The Nature of Cannabis Dependence
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 21-36

  • Summary

    This chapter considers the classification and diagnosis of cannabis dependence from several perspectives. It reviews the scientific evidence for the cannabis dependence syndrome, its etiology, course and natural history. The main elements of drug dependence are psychological symptoms, physiological signs and behavioral symptoms. Many patients with a history of drug dependence experience rapid reinstatement of the features of the syndrome following resumption of substance use after a period of abstinence. The chapter describes the classification of cannabis dependence within the two standard nomenclatures used both in the USA and worldwide. The first is the WHO International Classification of Diseases (ICD). The second is the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA). The purpose of diagnosis is to provide the clinician with a logical basis for planning treatment and estimating prognosis. Diagnosis also may serve a variety of administrative, statistical and scientific purposes.

  • 4 - The Epidemiology of Cannabis Dependence

  • from Part I - The Nature of Cannabis Dependence
  • Edited by Roger Roffman, University of Washington, Robert S. Stephens, Virginia College of Technology
  • Foreword by G. Alan Marlatt, University of Washington
  • Book:
    Cannabis Dependence
    Published online:
    29 October 2009
    Print publication:
    23 February 2006, pp 58-105

  • Summary

    This chapter describes selected features of cannabis epidemiology, with a focus upon recent evidence from field studies of cannabis dependence. Recent epidemiological evidence from the USA speaks to the question of how many individuals might need clinical services early in the cannabis dependence process. Among the 14 million current users, roughly 1.6-2.3 million users qualified as a recently active Diagnostic and Statistical Manual, (DSM-IV) cannabis dependence case according to the National Survey field assessment methods and DSM-IV diagnostic algorithm. Research on early-onset drug use and later increased risk of drug problems has encompassed investigations into early-onset cannabis use as a suspected determinant of later increased risk of cannabis dependence. Differences between cannabis users and non-users also complicate other inquiries into the health and social consequences of cannabis involvement. To date, epidemiology's contribution to research on prevention, intervention, amelioration, and control of cannabis dependence has been indirect.