The role of decision-making in cannabis-related problems among young adults
Introduction
Deficits in neurocognitive functioning are a well-documented negative consequence of frequent cannabis use (Gonzalez, 2007, Grant et al., 2003, Lisdahl et al., 2014, Pope et al., 2001, Schreiner and Dunn, 2012, Solowij et al., 2002). Meta-analyses on studies of non-intoxicated cannabis users reveal deficits in learning, recall, executive functions, attention, motor abilities, and language (Grant et al., 2003, Schreiner and Dunn, 2012), with deficits in episodic memory (i.e., memory for personally experienced information, as opposed to facts; Tulving, 1984) being one of the most consistently reported (Gonzalez, 2007, Ranganathan and D'Souza, 2006, Solowij and Battisti, 2008). Although several studies document that recovery of most neurocognitive functions may occur after about 1 month of abstinence (Fried et al., 2005, Hanson et al., 2010, Pope et al., 2001, Schreiner and Dunn, 2012), others have shown that some deficits (e.g., attention and decision-making) persist, especially among very heavy users, those using during early adolescence, and individuals with persistent cannabis use disorders (Bolla et al., 2002, Bolla et al., 2005, Hanson et al., 2010, Meier et al., 2012, Pope et al., 2003). However, as with most drugs of abuse, the majority of cannabis users (approximately 91%) do not go on to develop a cannabis use disorder (Anthony et al., 1994, Lopez-Quintero et al., 2011). Although myriad factors may make some cannabis users more vulnerable to cannabis use disorders and to experience more problems from their cannabis use (Kirisci et al., 2013, von Sydow et al., 2002), the role of neurocognitive performance has been relatively understudied, as it is typically examined as a consequence of use in studies of cannabis and neurocognition. A notable exception is a recent study by Day et al. (2013) that reported poorer “working memory” (as assessed by the Trail-Making Test B) was associated with more problems from cannabis use among an adult sample of frequent cannabis users.
Decision-making is a neurocognitive construct that may play an important role in the magnitude of problems experienced from cannabis use. It has been defined in numerous ways (Bechara et al., 2001, Paulus et al., 2003), but essentially refers to making the most advantageous choice under uncertain outcomes that may result in reward or punishment. The Iowa Gambling Task (IGT) is one of the most commonly used measures of decision-making among many available (Monterosso et al., 2001) and requires participants to make choices under conditions of uncertain risk with the goal of obtaining the most advantageous outcome over 100 trials. A seemingly advantageous choice on one trial may be a losing strategy over many trials. Poor overall performance on this task is thought to reflect a preference for immediate rewards even if they are at the expense of longer-term negative outcomes – sometimes referred to as “myopia for the future,” which is observed among patients with lesions affecting the orbitofrontal cortex (OFC; Bechara et al., 1994, Bechara et al., 2002). This mirrors to some extent the behavior of individuals with cannabis use disorders, who by definition continue to use cannabis despite experiencing significant negative consequences. Not surprisingly, individuals with various substance use disorders perform poorly on measures of decision-making, including those with alcohol, cocaine, and methamphetamine addiction (e.g., Barry and Petry, 2008, Gonzalez et al., 2007, Grant et al., 2000, van der Plas et al., 2009, Verdejo-Garcia et al., 2007). Similarly, poorer performance on the IGT has also been reported among cannabis users (Bolla et al., 2002, Bolla et al., 2005, Fernandez-Serrano et al., 2009, Hermann et al., 2009, Lamers et al., 2006, Verdejo-Garcia et al., 2007, Whitlow et al., 2004). Oftentimes, this is thought to reflect adverse effects of the drug on brain structure, function, or development.
However, emerging evidence lends support to decision-making as an important predictor and moderator in substance use outcomes. For example, poor decision-making performance has been associated with attrition in a weight-management program (Koritzky et al., 2014) and relapse for cocaine (Verdejo-Garcia et al., 2014), methamphetamine (Paulus et al., 2005), alcohol (Bowden-Jones et al., 2005), and opiates (Passetti et al., 2008). With regards to problems from cannabis use, neuroimaging studies have revealed relationships between OFC gray matter volume and more self-reported problems from cannabis (Filbey et al., 2014) and OFC activation with cannabis use relapse (De Bellis et al., 2013), further substantiating the potential role of decision-making deficits in the problems experienced from cannabis use. We recently reported no significant differences between cannabis users and non-users on several measures of inhibitory control (including decision-making), despite finding deficits in episodic memory; (Gonzalez et al., 2012). Despite the lack of differences between groups on measures of decision-making and inhibitory control, we found that poorer decision-making performance alone was significantly associated with more DSM-IV symptoms of cannabis use disorder. In a subsequent manuscript with the same sample, decision-making was found to moderate the relationship between amount of cannabis use and engagement in risky sexual behaviors, with greater cannabis use being associated with more risky sexual behaviors, but only among participants with poorer decision-making (Schuster et al., 2012).
In the current study, we set out to examine in more detail how decision-making influences the problems that individuals report experiencing from their cannabis use by using a more fine-grained and well-established measure of cannabis use problems: the Marijuana Problems Scale (Stephens et al., 2000), as well as specifically looking at amount of use across three different time frames (30-day, 12-month, and lifetime). The Marijuana Problems Scale allows for rating the severity of numerous problems that may be experienced by cannabis users as a consequence of their cannabis use. Based on our prior findings, we sought to test the role of decision-making as a potential moderator of the relationship between amount of cannabis use and problems experienced from cannabis use in a sample of young adult cannabis users who identified cannabis as their drug of choice. Contrary to the fairly consistent finding of acute and non-acute cannabis use on episodic-memory that some have reported to resolve with abstinence (noted above), studies on cannabis effects on decision-making have been less consistent, oftentimes showing no acute effects (reviewed in Crean et al. 2011) and a lack of recovery with abstinence (e.g., Bolla et al., 2002, Bolla et al., 2005, Crean et al., 2011). Therefore, for comparison and to test for a simple dissociation, in the present study we also examined whether episodic memory performance also served as a moderator of cannabis use and problems from cannabis use. We hypothesized that poorer decision-making and more cannabis use would be related to more cannabis-related problems as measured by the Marijuana Problems Scale (Stephens et al., 2000). More importantly, we anticipated that decision-making performance would moderate the relationship between amount of cannabis use and problems experienced from cannabis use, such that the association between amount of cannabis use and problems from use would be strongest for those with poorer decision-making. We hypothesized that similar relationships would not be observed with measures of episodic memory. Finally, we explored if the moderating effects of decision-making were more relevant for measures of current (30 day) or more distal (12 month and lifetime cumulative use) cannabis use.
Section snippets
Participants
Participants were a subset (n = 52) of cannabis users from a larger study on inhibitory control and cannabis use among young adults (K23DA023560; PI: Gonzalez) who completed the Marijuana Problems Scale. The Marijuana Problems Scale was introduced after the onset of the larger study and the current sample consists of all eligible participants from the larger study who completed the Marijuana Problems Scale. Participants were recruited from the Chicago area through word-of-mouth and printed flyers
Participant characteristics
The sample consisted of young adult cannabis users with exposure to cannabis, alcohol, and nicotine, but no history of dependence for alcohol or other drugs of abuse (Table 1). The sample was demographically diverse with participants in their early twenties and with some college education. Scores on the BDI-II, BAI, and WURS suggested minimal mental health complaints, with median scores well below clinical cut-points. Table 1 provides detailed information on use of alcohol, nicotine, and
Discussion
In the current study, decision-making performance (as assessed by the IGT) was a significant moderator of the relationship between amount of cannabis use and problems reported from its use among young adult cannabis users. Amount of cannabis consumed was associated with problems experienced from use only among those participants demonstrating the poorest (impaired) decision-making performance. Among those with better decision-making performance, amount of cannabis use was uncorrelated with
Role of funding source
Research reported in this article was supported by National Institute on Drug Abuse and the National Cancer Institute of the National Institutes of Health under grant number K23 DA023560, R01 DA031176, R01 DA033156 to Dr. Gonzalez, F31 DA032244 to Dr. Schuster, and P01 CA098262 to Dr. Mermelstein. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Contributors
All authors have materially participated in the research and article preparation. Dr. Gonzalez, participated in conceptualizing the study, conducting data analyses, and writing the manuscript. Dr. Schuster participated in study recruitment, assessment, data analysis, and editing of the manuscript. Dr. Mermelstein is the PI of a study from which a subset of participants were recruited. She assisted with conceptualizing the current study, reviewing results, and contributing to the initial
Conflicts of interest
Research reported in this article was supported by National Institute on Drug Abuse and the National Cancer Institute of the National Institutes of Health. The authors have no other conflicts of interest to declare.
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Results of a pilot study examining the effect of positive psychology interventions on cannabis use and related consequences
2023, Contemporary Clinical TrialsClueless about cues: the impact of reward-paired cues on decision making under uncertainty
2021, Current Opinion in Behavioral SciencesCitation Excerpt :During relapse, the benefits of use are judged to outweigh the costs, and multiple addicted populations perform poorly on cost/benefit decision-making tasks [4–13]. Furthermore, the degree to which choice is impaired predicts treatment failure and addiction severity [6,10,14,15]. Stimuli that drive risky choice may thus be pro-addictive, whereas interventions that restore optimal decision making could help break the cycle of addiction [16,17,9,18–20].
Residual effects of cannabis-use on neuropsychological functioning
2021, Cognitive DevelopmentCitation Excerpt :Moreover, found results are consistent with those of Becker et al. (2018) who in a longitudinal study found improved decision-making skills in young adult cannabis users compared to controls at their follow-up examination after two years. Further, Duperrouzel et al. (2019) failed to find negative longitudinal associations between cannabis use and decision-making and Gonzalez, Schuster, Mermelstein, and Diviak (2015) found no significant differences in cannabis use patterns of young adults across varying levels of decision-making performance. Taken together, our study provides evidence that decreased consumption as well as delayed initiation is advantageous as it could possibly lead to a recovery of cognitive deficits (Becker et al., 2018; Fried et al., 2005; Jacobus et al., 2015).
Gender-based differential item functioning in the Cannabis-Associated Problems Questionnaire: A replication and extension
2021, Addictive BehaviorsCitation Excerpt :Items were developed based on existing scales of other substance problems and adapting items for cannabis users in treatment (Stephens, Roffman, & Simpson, 1993, Stephens, Roffman, & Simpson, 1994). Data support the strong internal reliability of this measure and MPS scores covary expectedly with cannabis use (Blevins, Banes, Walker, Stephens, & Roffman, 2016; Buckner & Schmidt, 2008; Gonzalez, Schuster, Mermelstein, & Diviak, 2015). An adaptation to the MPS yielded the Cannabis-Associated Problems Questionnaire, measuring lifetime cannabis problems across a larger response scale (CAPQ; Lavender et al., 2008).