UPPS-P model impulsivity and marijuana use behaviors in adolescents: A meta-analysis
Introduction
Marijuana use poses many health risks including impaired memory, decline in cognitive reasoning, decline in learning abilities, suicidal thoughts, lung cancer, and heart attack (Hall, 2009, Hall and Degenhardt, 2009, Meier et al., 2012). These negative outcomes are more likely and problematic the earlier a person begins using marijuana (Castellanos-Ryan et al., 2013; Dévieux et al., 2002; Gruber et al., 2014). Adolescents make up the largest proportion of marijuana users and over 75% of people who begin using marijuana each year are aged 12–20 (NIDA, 2014). Adolescents that use marijuana have lower grades and exam scores, are less likely to attend college, are more likely to be unemployed, and have lower life satisfaction (Cobb-Clark et al., 2015, Johnston et al., 2014). Furthermore, adolescents that use marijuana are more likely to engage in other risk taking behaviors such as stealing, using weapons in acts of violence, having risky sex, and having accidental injuries (Brook et al., 1999, Castellanos-Ryan et al., 2013, Chassin et al., 2010, Churchwell et al., 2010, Crews et al., 2007; Dévieux et al., 2002). Using marijuana can stunt brain development, including development of socio-emotional areas (i.e., amygdala, ventral striatum, orbitofrontal cortex, medial prefrontal cortex, and superior temporal sulcus) and cognitive control (i.e., lateral prefrontal, lateral parietal, and anterior cingulate cortices) (e.g., Crews et al., 2007, Chassin et al., 2010, Gruber et al., 2014), leading to the more pronounced difficulties in adulthood (e.g., Hall, 2009, Hall and Degenhardt, 2009, Meier et al., 2012).
Despite the mounting evidence of the dangers of marijuana to adolescents, marijuana use is becoming more accepted and adolescents increasingly believe that marijuana is not a risky drug (SAMHSA, 2014). The changing perception of marijuana dangers has coincided with states passing bills decriminalizing and legalizing degrees of marijuana use (NCSL, 2016). While adolescent use rates are higher in states that have passed such legislation (Harper et al., 2012, Mason et al., 2015, Wall et al., 2011), there is little evidence of causality between perception, use, and legality. These trends suggest understanding risk factors for adolescent marijuana use behaviors is of utmost importance.
Although many researchers agree that adolescence is a period of healthy experimentation, including drug use (Baker and Yardley, 2002), that is beneficial as it reflects a pattern of behavior shifting from parental control and towards autonomy (Laird et al., 2009, Loeber et al., 2000, Spear and Kulbok, 2004), problems arise when adolescents have an exaggerated inclination towards risk-taking, leading to more negative outcomes (Castellanos-Ryan et al., 2013, Stautz and Cooper, 2013). Thus, it is important to understand risk factors associated with marijuana use and negative marijuana-related consequences in order to more effectively identify and intervene on adolescents who are at greatest risk for such outcomes. We examine three main factors in the current study: separable impulsivity traits, gender, and differential relationships with marijuana use and negative marijuana-related consequences.
Impulsivity is one of the most important personality-based risk factors for marijuana use (Barrera et al., 2001, Jessor et al., 1980, Steinberg, 2008, Willoughby et al., 2014). However, despite this well-acknowledge relationship, evidence for the role of impulsivity in adolescent marijuana use behaviors is mixed (Andrucci et al., 1989; Gerra et al., 2004, Malmberg et al., 2013). One potential explanation for these inconsistencies is that impulsivity is a multidimensional trait that comprises multiple separate, though related, tendencies toward impulsive action (e.g., Evenden, 1999). The current study uses the UPPS-P framework (Whiteside and Lynam, 2001), which identifies five separate, though related, impulsivity-related traits: (1) sensation seeking, defined as the tendency to seek sensory pleasure and excitement, (2) lack of planning, the tendency to act without forethought, (3) lack of perseverance, defined as the tendency to not finish tasks, (4) negative urgency, defined as the tendency to act rashly in negative emotional states, and (5) positive urgency, defined as the tendency to act rashly in positive emotional states (Lynam et al., 2006). Previous studies have shown these traits share between 6% and 27% of their variance, with negative and positive urgency sharing the largest proportion of variance (see Cyders and Smith, 2007). The measurement of separate aspects of impulsivity can clarify discrete relationships that might be masked or watered down when such constructs are combined (Smith et al., 2003). The use of the UPPS-P model has resulted in more discrete and robust relationships with adolescent risky behaviors, including alcohol use (Stautz and Cooper, 2013), tobacco use (Bloom et al., 2014), and risky sexual behavior (Dir et al., 2014), and is key to clarifying relationships with marijuana use behaviors and consequences. Although impulsivity-related traits have been implicated in risk for a wide range of substance use behaviors, the current study focuses primarily on marijuana use behaviors and consequences.
Previous work has suggested differential patterns of relationship between separate impulsivity-related traits and marijuana use behaviors. Sensation seeking is the most widely studied impulsivity-related trait for marijuana use and there is consistent evidence that sensation seeking is a robust predictor of marijuana use in both adults (e.g., Alston, 1994, Trocki et al., 2009, Quinn and Harden, 2013) and adolescents (e.g., Andrucci et al., 1989, Arnett and Balle-Jensen, 1993, Jaffee and D’Zurilla, 2009, Castellanos-Ryan et al., 2013, Felton et al., 2015). Adolescents high in sensation seeking are more likely to use marijuana (e.g., Martin et al., 2002, Stanton et al., 2001) and use marijuana more frequently (e.g., Tercek, 2008, Felton et al., 2015). Additionally, adolescent sensation seekers are more likely to experience negative marijuana consequences, including trouble at school and at home (e.g., Hendershot et al., 2011, Stautz and Cooper, 2014), and be diagnosed with marijuana dependence (e.g., Ames et al., 2005).
Evidence for other impulsivity-related traits is less available. There is preliminary evidence that negative urgency is associated with marijuana use (e.g., Pang et al., 2014, Robinson et al., 2014) and negative marijuana consequences (e.g., Stautz and Cooper, 2014, Churchwell et al., 2010). Lack of planning has been robustly associated with adolescent marijuana use and frequency in some studies (e.g., Xiao, 2008, Castellanos-Ryan et al., 2013) but unrelated in other studies (e.g., Kong et al., 2013, Leeman et al., 2014). Furthermore, lack of planning has been strongly related to negative marijuana consequences in some studies (e.g., Caspi et al., 1995, Churchwell et al., 2010) but weakly related in others (e.g., Stautz and Cooper, 2014). While there is less available research on lack of perseverance, current findings suggest this trait has limited associations with adolescent marijuana use behaviors (e.g., Tercek, 2008, Stautz and Cooper, 2014). The inconsistencies in the relationship between these traits and adolescent marijuana use behaviors warrant a more thorough review of existing literature.
Gender plays an important role in marijuana use behaviors (e.g., Ames et al., 2005, Kong et al., 2013) and impulsivity trait levels (d’Acremont and Van der Linden, 2005, Cross et al., 2011, Cyders, 2013), such that adolescent boys tend to report higher levels of sensation seeking, positive urgency, and marijuana use (Williams et al., 2007, Schepis et al., 2011), although this gap is closing (see Johnson et al., 2015 for review). Adolescent boys begin using marijuana at an earlier age (Kosterman et al., 2000, Johnson et al., 2015) and are more likely to experience negative marijuana consequences (Ames et al., 2005). There are several possible, and likely interacting, explanations for adolescent boy’s higher propensity for marijuana use and impulsivity traits. For example, testosterone, which is higher in adolescent boys than girls, has shown to correlate with both risk-taking behaviors (i.e., marijuana use) and impulsivity traits (Archer, 2006). Adolescent boys have also been shown to positively weigh benefits of risk taking and impulsive behaviors more so than girls, particularly when in a group (Gardner and Steinberg, 2005). Additionally, protective social factors, including peer and parental disapproval of marijuana use, are less effective at reducing marijuana use (Butters, 2004). Researchers have implicated evolutionary processes in gender differences in impulsivity traits and marijuana use (e.g., Zuckerman, 2007), particularly mate competition being a significant driver in risk-taking behavior. Taken together, findings suggest there are biological, social, and cognitive factors resulting in gender differences in impulsivity traits and marijuana use. While these differences in impulsivity traits and marijuana use behaviors do not mean there are differential effects in the impulsivity and marijuana use relationship across boys and girls, they do suggest closer examination of gender as a potential moderator in this relationship.
Measurement of marijuana use behaviors has varied, including simple use behaviors (e.g., frequency and lifetime use) and the experience of negative marijuana use consequences (e.g., marijuana dependence and marijuana-related problems), leading to differences in findings and in how researchers have interpreted their results. For instance, marijuana use has been studied by asking about lifetime use with a yes or no answer (e.g., Martin et al., 2002, Stephenson and Helme, 2006), with rating scales for frequency of use (e.g., Castellanos-Ryan et al., 2013), and more recently with timeline follow-back calendars (Robinson et al., 2014). Conversely, negative marijuana consequences have been studied using self-report questionnaires asking about various types of problems experienced (e.g., Hendershot et al., 2011) and by comparing people that meet criteria for cannabis dependence according to criteria by the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2000) and people that do not (e.g., Caspi et al., 1995, Churchwell et al., 2010). It is likely that impulsivity and gender are differentially related to marijuana use and the experience of negative marijuana consequences.
Given the increasing prevalence of marijuana use and the high risk for experiencing negative marijuana consequences among adolescents, the goal of the current meta-analysis was to examine how separable impulsivity traits, based on the UPPS-P model (Lynam et al., 2006), are related to marijuana use (e.g., frequency and lifetime use) and to negative marijuana consequences (e.g., marijuana-related problems like trouble at home or at school due to marijuana use, marijuana dependence) among adolescents, and how gender affects these relationships. This review contributes to the current literature by (1) quantifying the relationship between separable impulsivity-related traits and both marijuana use and negative marijuana consequences and (2) quantifying the size of the effect of gender on these relationships. Quantifying these relationships in adolescents is imperative to developing individually tailored treatments specifically targeting marijuana use prevention and reducing negative marijuana use consequences.
Section snippets
Selection of studies
Relevant studies were identified via literature searches, using Medline, PsychInfoI PsychArticles, PubMed, and GoogleScholar (published before January, 2016), as well as reference section reviews, forward searches, and email alerts. Searches were conducted based on all keyword combinations of terms for impulsivity and marijuana-related behaviors (Term 1: impuls*; urgen*; sensation seeking; Term 2: marijuana; THC; cannabis; Term 3: adolesc*; youth; teen); as used in previous reviews (e.g.;
Sample
The final study sample consisted of 38 studies (35 peer-reviewed journal articles and 3 dissertation manuscripts) with 41 independent samples (some studies reported separate effects for multiple independent samples) conducted over the last 30 years (1986–2015). The mean sample size was 981.89 (SD = 1596.97; range 36–9600), with a mean age of 16.08 (SD = 1.19; range 12.76–18.34). On average, samples were 44.86% female (SD = 24.05; range 0–100; k = 2 female-only samples) and 57.82% Caucasian (SD = 32.06;
Discussion
Results indicate that the magnitude of the effect sizes between impulsivity-related traits and marijuana use behaviors in adolescents depends less on the specific impulsivity trait assessed and more on the type of marijuana behavior: Whereas there were primarily medium relationships between impulsivity-related traits and negative marijuana consequences, there were small effects between impulsivity-related traits and marijuana use. Gender was not a significant moderator of these relationships.
Role of funding sources
This research was not supported by any funding sources.
Contributors
VanderVeen and Cyders designed the study. VanderVeen conducted literatures searches and coded the studies for the meta-analysis. Hershberger coded a subset of 15 studies for inter-rater agreement. VanderVeen conducted statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
The authors declare that there are no conflict of interest.
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2022, Comprehensive PsychiatryCitation Excerpt :Distressful and negative affective states can be associated with limited self-regulation capacities, but attempts to regulate these affective experiences might further reduce self-control capacities which in turn can lead to dysregulation of the substance use behavior [14]. Moreover, high levels of negative urgency (NU) (i.e., impulsive behavior preference during distressful and negative affective experiences) can also account for the link between negative affectivity and diminished self-control over substance use [14,15]. Therefore, cognitive-behavioral constructs which are related to the ability to control or regulate cannabis use– such as cannabis use-related protective behavioral strategies (CPBS) and refusal self-efficacy (CRSE) – might have an important function on how anxious-depressive symptoms and rumination contribute to cannabis use outcomes.