Elsevier

Drug and Alcohol Dependence

Volume 147, 1 February 2015, Pages 20-25
Drug and Alcohol Dependence

Antecedents and consequences of cannabis use among racially diverse cannabis users: An analysis from Ecological Momentary Assessment

https://doi.org/10.1016/j.drugalcdep.2014.12.022Get rights and content

Highlights

  • Predictors and consequences of cannabis use were examined in racially diverse sample.

  • Withdrawal and craving were robustly related to cannabis use.

  • Withdrawal, craving, and negative affect were higher prior to and lower after use.

  • Enhancement and coping motives were the most common reasons cited for use.

  • Withdrawal and craving were greater in social situations when others were using.

Abstract

Background

Cannabis remains the most commonly used illicit substance and use rates are rising. Notably, the prevalence of cannabis use disorders (CUD) nearly equals that of other illicit substance use disorders combined. Thus, the present study aimed to identify cognitive, affective, and situational predictors and consequences of ad-lib cannabis use in a racially diverse sample.

Methods

The sample consisted of 93 current cannabis users (34.4% female; 57.1% non-Hispanic Caucasian), 87.1% of whom evinced a current CUD. Ecological Momentary Assessment was used to collect frequent ratings of cannabis withdrawal, craving, affect, cannabis use motives, and peer cannabis use over two weeks. Mixed effects linear models examined within- and between-day correlates and consequences of cannabis use.

Results

Withdrawal and craving were higher on cannabis use days than non-use days. Withdrawal, craving, and positive and negative affect were higher immediately prior to cannabis use compared to non-use episodes. Withdrawal and craving were higher among those who subsequently used cannabis than those who did not. Cannabis use resulted in less subsequent withdrawal, craving, and negative affect. Enhancement and coping motives were the most common reasons cited for use. Withdrawal and negative affect were related to using cannabis for coping motives and social motives. Participants were most likely to use cannabis if others were using, and withdrawal and craving were greater in social situations when others were using.

Conclusions

Data support the contention that cannabis withdrawal and craving and affect and peer use play important roles in the maintenance of cannabis use.

Introduction

Cannabis is the most commonly used illicit drug and nearly one-fourth of users meets criteria for a cannabis use disorder (CUD; Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). Rates of CUD nearly equal that of other illicit substance use disorders combined (SAMHSA, 2013). Further, cannabis use is on the rise (SAMHSA, 2013). It is therefore important to determine whether putative proximal ‘high-risk’ cannabis vulnerability factors are in fact related to use. Tension-reduction-based models of substance use (e.g., Conger, 1956) propose that substances may be used in an attempt to relieve unpleasant physical and/or emotional states such as withdrawal, craving, and negative affect. Consistent with these models (e.g., Khantzian, 1997), substance use is maintained if the desired effect is achieved (i.e., substance produces alleviation of negative state). The incorporation of Ecological Momentary Assessment (EMA) into prospective designs is one way to test the utility of tension-reduction-based models. Benefits include: collection of data in real-world environments; minimization of retrospective recall bias; and aggregation of observations over multiple assessments facilitating within-subject assessments across time and context, permitting the examination of both predictors and consequences of use (Shiffman et al., 2008).

There is some evidence that withdrawal, craving, and negative affect are ‘high-risk’ cannabis use factors. Withdrawal is related to cannabis relapse (Cornelius et al., 2008) and was cross-sectionally related to cannabis use following a self-quit (i.e., no treatment) attempt in a pilot EMA study of 30 cannabis users (Buckner et al., 2013). Craving does not only occur in the context of withdrawal (see American Psychiatric Association [APA], 2013). Thus, it is important to assess whether craving specifically is related to use and extant data suggest it may be. THC administration decreases craving (Haney et al., 2008) and in a pilot study of 49 Florida State University (FSU) undergraduates, craving was higher prior to cannabis use and lower following use (Buckner et al., 2012a). Similarly, cannabis users report using cannabis to cope with stress and anxiety (Hathaway, 2003, Ogborne et al., 2000). Further, although both positive and negative affect were higher during cannabis use than non-use episodes in our pilot study of self-quitters, only negative affect was uniquely related to use (Buckner et al., 2013).

There remain several gaps in our understanding of putative high-risk cannabis use maintenance factors. First, no known studies assessed momentary motives for cannabis use among users not undergoing a quit attempt. Thus, although coping, enhancement, and expansion motives tend to be most strongly related to cannabis use when assessed via retrospective assessments (e.g., Buckner et al., 2007, Simons et al., 2000), it is unknown whether these motives proximally predict use. Second, although tension-reduction-based models posit that cannabis use should result in decreases in unpleasant states, we know of no EMA studies testing whether cannabis use results in decreases in withdrawal and/or negative affect. Third, the majority of research on withdrawal has concerned individuals undergoing quit attempts, limiting information about the role of withdrawal among non-treatment seekers. Fourth, although the majority of cannabis use occurs when others are also using (Buckner et al., 2012a, Buckner et al., 2013), it is unknown whether greater use in social situations is for social reasons and/or due to increases in cannabis withdrawal or craving in response to cannabis-related cues (e.g., peers’ paraphernalia). Fifth, the vast majority of work has relied on data from predominantly Caucasian samples (e.g., Buckner et al., 2007, Buckner et al., 2012a, Buckner et al., 2013, Simons et al., 1998, Simons et al., 2000) or relatively small samples of diverse participants (e.g., n = 8; Haney et al., 2008). It is unknown whether results generalize to more racially/ethnically diverse samples.

The present study sought to further understanding of factors that maintain cannabis use in a racially diverse sample of community-recruited adult cannabis users using EMA to collect real-world data about ad-lib cannabis use episodes over a two-week period. The cross-sectional and prospective relationships between putative cannabis use vulnerability factors (e.g., cannabis withdrawal, craving, affect) and cannabis use were examined. It was predicted that these factors would be cross-sectionally and prospectively related to use. Specifically, it was predicted that (1) these symptoms would be greater on cannabis use days than non-use days, (2) these symptoms would be positively related to cannabis use at each assessment point, and (3) these symptoms at one assessment point would predict cannabis use at the next assessment point. Consistent with tension-reduction-based models, it was also predicted that cannabis use would result in subsequent reduction in the severity of these symptoms. Further, per prior work (Buckner et al., 2007, Simons et al., 2000), it was hypothesized that coping, enhancement, and expansion motives would be the most commonly reported motives for use. We also tested whether withdrawal and negative affect were significantly related to coping motivated use. Finally, we sought to extend prior EMA work (Buckner et al., 2012a, Buckner et al., 2013) by testing whether use of cannabis by others was related to greater cannabis withdrawal, craving, and negative affect.

Section snippets

Participants

Participants were recruited via community advertisements (e.g., flyers, newspaper ads). Interested participants completed a screening (on-line or telephone) and baseline appointment to determine eligibility. Participants were asked to refrain from cannabis use the day of their appointment. Eligibility criteria included being between 18 and 45 years old, past-month cannabis use (confirmed via urine sample using a 50 ng/ml positive cutoff), cannabis as drug of choice, and no interest in, or

Patterns of cannabis use

Participants recorded 1934 cannabis use entries (M = 22.1, SD = 14.3 per participant), suggesting some cannabis use was recorded during signal and interval contingent assessments. Participants reported an average of 2.1 (SD = 2.3) cannabis use episodes per day and 71% of all entries occurred on cannabis use days. Fig. 1 graphically presents percent of days on which cannabis use occurred (A), time of day use occurred (B), and number of times cannabis was used on cannabis use days (C). Cannabis use was

Discussion

The current study tested tension-reduction-based models of cannabis use (Conger, 1956) by simultaneously examining predictors and consequences of cannabis use in a racially diverse sample of cannabis users. Findings contribute to our understanding of cannabis use in several substantial ways. First, withdrawal, craving, and affect were robustly related to cannabis use. Second, use resulted in decreases in withdrawal, craving, and negative affect. Third, participants were especially vulnerable to

Role of funding source

Funding for this study was provided in part by grants from the National Institute of Drug Abuse (5R21DA029811-02, 1R34DA031937-01A1). NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

Contributors

All authors contributed to and approve of the final manuscript.

Conflict of interest

No conflict declared.

Acknowledgements

The authors thank Katherine Welch for her assistance with data collection.

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