A review of ten articles exploring determining factors and consequences of cannabis use

1. Does Cannabis Use Cause Psychological Disorders?Ray GoodsellMarch 22, 2011Advanced General Psychology PSY492Katina ClarkeArgosy University

2. Abstract Marijuana use usually begins during adolescence. The portrayal of marijuana being a harmless recreational drug by some in society is cause for concern. It is time to share what researchers have discovered about marijuana’s effects with the general population. The question ‘Does cannabis use cause psychosis?’ is one that many researchers have pondered for some time. Nine of ten articles chosen for review relate specifically to cannabis use. The Multiple Opportunities to Reach Excellence (MORE) Project study is the exception. It was designed to better understand the impact of children’s chronic exposure to community violence on their emotional behavior, substance use, and academics.

3. Discussion The first article Predictors of Treatment Contact Among Individuals with Cannabis Dependence mentioned the fact of cannabis being the number one illicit drug used in America ( Agosti & Levin, 2004). They used information from the National Comorbidity Survey (NCS) database in 2004. Data showed that 4% of the population had cannabis dependence and among those individuals they also have high rates of comorbid substance use disorders and depression. Many cannabis users also have alcohol addiction. Persons with cannabis dependence were more likely to seek professional help if they previously sought treatment having two substance dependencies (cannabis and alcohol) and having depression. Due to the small sample population it is difficult to conclude this is always the case (Agosti & Levin, 2004).

4. Community Violence and Youth: Affect, Behavior, Substance Use andAcademics, the second article reviewed, not because of cannabis use butbecause the study involved 8- to 12-year-old students who attended six urban public elementary schools located in Baltimore, Maryland who were influenced by community violence (Cooly-Strickland, et al., 2009). The Multiple Opportunities to Reach Excellence (MORE) Project study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional behavioral, substance use, and academic functioning. The researchers used the Children’s Report of Exposure to Violence (CREV; Cooley et al. 1995) a widely used self-report questionnaire developed to assess children’ lifetime exposure to community violence. Almost one-quarter (22.9%) of the 11- and 12-year olds reported having smoked tobacco and 17.1% reported drinking alcohol at least sometimes to help them ‘‘cope” (Cooly-Strickland, et al., 2009).

5. The study does not mention the use of cannabis but provides a degree of evidence that stress plays a factor in contributing to substance use. The article Cannabis Use and Later Life Outcomes examined the associations between the extent of cannabis use during adolescence and young adulthood and later education, economic, employment, relationship satisfaction and life satisfaction outcomes (Ferguson & Boden, 2008). The accumulation of data over a 25-year period made this article interesting. The conclusion the authors came up with and I agree with is that cannabis use is associated with depression. The problem with this study and others like it is that questionnaires are used. We must rely on people telling the truth when answering the questions.

6. Wayne Hall’s article titled Cannabis Use and the Mental Health of Young People used data collected from leading electronic databases such as PubMed and incorporated the information from longitudinal studies of representative samples of adolescents and young adults conducted in developed societies over the past 20 years. He concluded that cannabis is a drug of dependence. Risks increase with decreasing age of initiation. Cannabis dependence in young people predicts increased risks of using other illicit drugs, under performing in school and reporting psychotic symptoms. Evidence is growing that cannabis is a contributor of psychotic symptoms. Hall and I believe we as a society face major challenges in communicating with young people about the most probable risks of cannabis use: dependence, educational underachievement and psychosis (Hall, 2006).

7. Associations Between Psychopathic Traits and Mental Disorders Among Adolescents with Substance Use Problemswas based on a study that examined the association between psychopathic traits and mental disorders and to study associations between psychopathic traits and familial problems across gender. The study used 180 adolescents seeking help at a substance abuse treatment clinic: 99 girls, 81boys and their parents, (165 mothers, 90 fathers) were studied. It suggests that different dimensions of psychopathy predisposed substance use for girls and for boys, and that oppositional defiant disorder (ODD) is particularly important in the expression of psychopathic traits among girls (Hemphala & Tengstrom, 2010).

8. A Longitudinal Study of Cannabis Use and Mental Health from Adolescence to Early Adulthoodstudied the longitudinal association between cannabis use and mental health. It used data concerning cannabis use and mental health from 15 to 21 years of available information. Data was acquired from large sample of individuals as part of a longitudinal study from childhood to adulthood. Participants were enrolled in the Dunedin Multidisciplinary Health and Development Study, a research program on the health, development and behavior of a large group of New Zealanders born between April 1972 and March 1973.

9. Cannabis use and identification of mental disorder was based upon self-reporting in a standard diagnostic interview. The findings suggested that the primary causal direction leads from mental disorder to cannabis use among adolescents and the reverse in early adulthood. Both alcohol use and cigarette smoking had independent associations with later mental health disorder (McGee, Williams, Poulton & Moffitt, 2000).

10. Trajectories of Adolescent Alcohol and Cannabis Use into Young Adulthoodbased on a study conducted in New Zealand, studied trajectories of adolescent cannabis or alcohol use and compared the respective consequences in young adulthood. The design was a 10-year eight-wave cohort study of a state- wide community sample of 1943 Victoria, New Zealand adolescents initially aged 14–15 years. Moderate- and high-risk alcohol use was defined according to total weekly alcohol consumption. Moderate- and high-risk cannabis use were defined as weekly and daily use, respectively.

11. The article mentions how both alcohol and cannabis carry health risks and that both are commonly initiated in adolescence. The study found that around 90% of young adults used either alcohol or cannabis. There was a tendency for heavy users to use one substance predominantly at any one time. Selective heavy cannabis use in both adolescence and young adulthood was associated with greater illicit substance use and poorer social outcomes in young adulthood than selective alcohol use. One in five young adults used either alcohol or cannabis at a high- risk level. Heavier teenage cannabis users tend to continue selectively with cannabis use. Considering their poor young adult outcomes, regular adolescent cannabis users appear to be on a problematic trajectory (Patton et al., 2007).

12. The article Does Cannabis Use Lead to Depression and Suicidal Behaviors? examined relationships between cannabis use and later depression, suicidal ideation and suicide attempts in a cohort of young Norwegians. Data were gathered through the Young in Norway longitudinal study, in which a population-based sample of 2,033 Norwegians were followed up over a 13-year period, from their early teens to their late twenties. The study asked what if any relationship existed between exposure to cannabis use; and depression, suicide ideation and suicide attempts. In addition, information about possible confounding factors was included. In early adolescence, no associations with later depression or suicidal behaviors were observed. In samples of subjects in their twenties, highly significant associations with suicide ideation and suicide attempts were observed. The findings suggest that exposure to cannabis by itself does not lead to depression but that it may be associated with later suicidal thoughts and attempts (Pederson, 2008).

13. Exposure to Terrorism and Israeli Youths Cigarette, Alcohol, and Cannabis Use was an interesting article. It used anonymous self-administered questionnaires given to a random sample of 960 10th and 11th grade students (51.6% boys, 48.4% girls). Close physical exposure to acts of terrorism predicted higher levels of alcohol consumption (including binge drinking among drinkers) and cannabis use. Negative consequences of terrorism exposure among adolescents included substance abuse (Schiff, Zweig, Benbenishty & Hasin, 2007).

14. Anxiety and Mood Disorders and Cannabis Usestudied the relationship between cannabis use and Anxiety Mood Disorder (AMD). The study used data from14,531 telephone interviews between 2001 and 2006. The information came from cross-section population of adults throughout Ontario, Canada. AMD was assessed with the 12-item version of the General Health Questionnaire (GHQ12). Researchers observed that the heaviest cannabis users, defined as users who reported using cannabis almost every day or more often, were twice as likely to report an AMD as abstainers.

15. The study found a strong relationship between AMD and light and heavy cannabis use, but not moderate use. There were significant differences in AMD by gender, age group, education, and income. Women reported higher prevalence rates of AMD than men. The prevalence of AMD was highest for the age group 30–39, and lowest for the oldest group. Respondents who had not completed high school reported the highest prevalence of AMD in comparison to those with higher levels of education. Levels of AMD were highest in those in the lowest income and declined as income increased. Alcohol problems were found to be significantly associated with AMD. Levels of AMD were highest in heavy cannabis users who used cannabis almost every day or more compared to those who reported never having used cannabis (Cheung, Mann, Ialomiteanu, Stoduto, Ala-Leppilampi & Rehm, 2010).

16. Conclusion There is strong evidence of cannabis use being a gateway drug and that it also has a relationship to psychotic disorders and depression. More questions arise than answered though. Evidence indicates a link between cannabis use and other substances. It is not certain whether cannabis is the cause of psychosis or if the disorder is a determining factor for using cannabis or other substances. More research is necessary. Isolating studies on individuals in specific demographic populations could provide information based on the relationship of cannabis and psychosis. Alcoholism and other addictions combined with depression are common with cannabis use. People experiencing comorbidity are more willing to seek treatment but not for cannabis addiction alone.

17. Is cannabis more addicting, is it a more psychotic drug to one gender than the other? These are questions for future research to discover. We as a society face major challenges in communicating with young people about the most probable risks of cannabis use: dependence, educational underachievement and psychosis. If we can prove cannabis is a factor in developing psychosis then it may be possible to sway public opinion against its use.

18. References Agosti, V., & Levin, F. R. (2004). Predictors of Treatment Contact Among Individuals with Cannabis Dependence. American Journal of Drug & Alcohol Abuse, 30(1), 121-127. doi:10.1081/ADA-120029869 Cheung, J. W., Mann, R. E., Ialomiteanu, A., Stoduto, G., Chan, V., Ala-Leppilampi, K., & Rehm, J. (2010). Anxiety and Mood Disorders and Cannabis Use. American Journal of Drug & Alcohol Abuse, 36(2), 118-122. doi:10.3109/00952991003713784 Cooley-Strickland, M., Quille, T. J., Griffin, R. S., Stuart, E. A., Bradshaw, C. P., & Furr-Holden, D. (2009). Community Violence and Youth: Affect, Behavior, Substance Use, and Academics. Clinical Child & Family Psychology Review, 12(2), 127-156. doi:10.1007/s10567-009-0051-6

19. Fergusson, D. M., & Boden, J. M. (2008). Cannabis use and later life outcomes. Addiction, 103(6), 969-976. doi:10.1111/j.1360-0443.2008.02221.x Hall, W. D. (2006). Cannabis use and the mental health of young people. Australian & New Zealand Journal of Psychiatry, 40(2), 105-113. doi:10.1111/j.1440-1614.2006.01756.x Hemphälä, M., & Tengström, A. (2010). Associations between psychopathic traits and mental disorders among adolescents with substance use problems. British Journal of Clinical Psychology, 49(1), 109-122. Retrieved March 1, 2011 from EBSCOhost.

20. McGee, R., Williams, S., Poulton, R., & Moffitt, T. (2000). A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction, 95(4), 491-503. doi:10.1080/09652140031450 Patton, G. C., Coffey, C., Lynskey, M. T., Reid, S., Hemphill, S., Carlin, J. B., & Hall, W. (2007). Trajectories of adolescent alcohol and cannabis use into young adulthood. Addiction, 102(4), 607-615. doi:10.1111/j.1360-0443.2006.01728.x

21. Pedersen, W. W. (2008). Does cannabis use lead to depression and suicidal behaviours? A population-based longitudinal study. ActaPsychiatricaScandinavica, 118(5), 395-403. doi:10.1111/j.1600-0447.2008.01259.x Schiff, M., Zweig, H. H., Benbenishty, R., & Hasin, D. S. (2007). Exposure to terrorism and israeli youths' cigarette, alcohol, and cannabis use. American Journal of Public Health, 97(10), 1852. Retrieved March 1, 2011 from http://search.proquest.com/docview/215089336?accountid=34899