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