Elsevier

Drug and Alcohol Dependence

Volume 168, 1 November 2016, Pages 181-190
Drug and Alcohol Dependence

UPPS-P model impulsivity and marijuana use behaviors in adolescents: A meta-analysis

https://doi.org/10.1016/j.drugalcdep.2016.09.016Get rights and content

Highlights

  • We studied the impulsivity-marijuana behavior relationship across trait and gender.

  • Multiple impulsivity traits were related to marijuana use behaviors.

  • Impulsivity was more strongly related to negative marijuana consequences.

  • Relationships were stronger in males.

Abstract

Background

Impulsivity is often included as a risk factor in models of adolescent marijuana use behaviors; however, the magnitude of the association between impulsivity and marijuana use behaviors is variable across studies. The present study reviewed existent literature to 1) quantify the relationship between separable impulsivity-related traits and both marijuana use and negative marijuana consequences and 2) quantify the size of the effect of gender on these relationships.

Method

Thirty-eight studies (41 independent samples) were meta-analyzed using a random effects model to examine the relationship between impulsivity traits and marijuana use behaviors.

Results

Marijuana use was significantly related to all impulsivity-related traits except lack of perseverance (r’s ranging from 0.13–0.23, p’s < 0.01). Negative marijuana consequences were only significantly related to sensation seeking, lack of planning, and positive urgency (r’s ranging from 0.37–0.39, p’s < 0.01). Effects were small for marijuana use, but medium for negative marijuana consequences. Gender was not a significant moderator of any relationships.

Conclusions

Impulsivity-related traits had more robust relationships with negative marijuana consequences than marijuana use, suggesting impulsivity-related traits are important in differentiating adolescents most likely to experience negative consequences from marijuana use. Few relationships examined gender and many of the impulsivity-related traits, other than sensation seeking. Data and trends suggest a more multi-dimensional approach to marijuana use and consequences is warranted.

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.

References (110)

  • W.B. Jaffee et al.

    Personality, problem solving, and adolescent substance use

    Behav. Ther.

    (2009)
  • R.M. Johnson et al.

    Past 15-year trends in adolescent marijuana use: differences by race/ethnicity and sex

    Drug Alcohol Depend.

    (2015)
  • K.A. Karyadi et al.

    A meta-analysis of the relationship between trait mindfulness and substance use behaviors

    Drug Alcohol Depend.

    (2014)
  • A.N. Kopstein et al.

    Sensation seeking needs among 8th and 11th graders: characteristics associated with cigarette and marijuana use

    Drug Alcohol Depend.

    (2001)
  • R.F. Leeman et al.

    Impulsivity, sensation-seeking, and part-time job status in relation to substance use and gambling in adolescents

    J. Adolesc. Health

    (2014)
  • M. Malmberg et al.

    Are there reciprocal relationships between substance use risk personality profiles and alcohol or tobacco use in early adolescence?

    Addict. Behav

    (2013)
  • C.A. Martin et al.

    Sensation seeking, puberty, and nicotine, alcohol, and marijuana use in adolescence

    J. Am. Acad. Child Adolesc. Psychiatry

    (2002)
  • S.S. Martins et al.

    Adolescent ecstasy and other drug use in the national survey of parents and youth: the role of sensation-seeking, parental monitoring and peer's drug use

    Addict. Behav.

    (2008)
  • H.B. Moss et al.

    Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample

    Drug Alcohol Depend.

    (2014)
  • R.D. Pang et al.

    Depressive symptoms, negative urgency and substance use initiation in adolescents

    Drug Alcohol Depend.

    (2014)
  • J.M. Robinson et al.

    When you see it, let it be: urgency, mindfulness and adolescent substance use

    Addict. Behav.

    (2014)
  • K. Serafini et al.

    Motivation and substance use outcomes among adolescents in a school-based intervention

    Addict. Behav.

    (2016)
  • T.R. Simon et al.

    Sensation seeking and drug use among high risk Latino and Anglo adolescents

    Pers. Individ. Diff.

    (1994)
  • S.H. Sperry et al.

    Examining the multidimensional structure of impulsivity in daily life

    Pers. Individ. Diff.

    (2016)
  • K. Stautz et al.

    Impulsivity-related personality traits and adolescent alcohol use: a meta-analytic review

    Clin. Psychol. Rev.

    (2013)
  • L. Steinberg

    A social neuroscience perspective on adolescent risk-taking

    Dev. Rev.

    (2008)
  • American Psychiatric Association

    DSM-IV-TR: Diagnostic And Statistical Manual Of Mental Disorders, Text Revision

    (2000)
  • R.J. Alston

    Sensation seeking as a psychological trait of drug abuse among persons with spinal cord injury

    Rehabil. Couns. Bull.

    (1994)
  • S.L. Ames et al.

    Implicit cognition and dissocative experiences as predictors of adolescent substance use

    Am. J. Drug Alcohol Abuse

    (2005)
  • S.L. Ames et al.

    Comparison of indirect assessments of association as predictors of marijuana use among at-risk adolescents

    Exp. Clin. Psychopharmacol.

    (2007)
  • G.L. Andrucci et al.

    The relationship of MMPI and sensation seeking scales to adolescent drug use

    J. Pers. Assess.

    (1989)
  • J. Archer

    Testosterone and human aggression: an evaluation of the challenge hypothesis

    Neurosci. Biobehav. Rev.

    (2006)
  • J. Arnett et al.

    Cultural bases of risk behavior: danish adolescents

    Child Dev. Perspect.

    (1993)
  • M. Barrera et al.

    Replication of a problem behavior model with American Indian, Hispanic, and Caucasian youth

    J. Early Adolesc.

    (2001)
  • M.E. Bates et al.

    The effect of sensation seeking needs on alcohol and marijuana use in adolescence

    Psychol. Addict. Behav.

    (1986)
  • E.L. Bloom et al.

    The relationship between cigarette smoking and impulsivity: a review of personality, behavioral, and neurobiological assessment

    Addict. Res. Theory

    (2014)
  • Introduction to Meta-Analysis

  • J.S. Brook et al.

    The risks for late adolescence of early adolescent marijuana use

    Am. J. Public Health

    (1999)
  • J.E. Butters

    The impact of peers and social disapproval on high-risk cannabis use: gender differences and implications for drug education

    Drugs Educat. Prev. Policy

    (2004)
  • A. Caspi et al.

    Identification of personality types at risk for poor health and injury in late adolescence

    Crim. Behav. Ment. Health

    (1995)
  • N. Castellanos-Ryan et al.

    Pubertal development, personality, and substance use: a 10-year longitudinal study from childhood to adolescence

    J. Abnorm. Psychol.

    (2013)
  • L. Chassin et al.

    Does adolescent alcohol and marijuana use predict suppressed growth in psychosocial maturity among male juvenile offenders?

    Psychol. Addict. Behav.

    (2010)
  • M.W.L. Cheung

    Modeling dependent effect sizes with three-level meta-analyses: a structural equation modeling approach

    Psychol. Methods

    (2014)
  • J.C. Churchwell et al.

    Altered frontal cortical volume and decision making in adolescent cannabis users

    Front. Psychol.

    (2010)
  • D.A. Cobb-Clark et al.

    ‘High’-school: the relationship between early marijuana use and educational outcomes

    Econ. Rec.

    (2015)
  • J. Cohen

    A power primer

    Psychol. Bull.

    (1992)
  • P.J. Conrod et al.

    Personality-targeted interventions delay the growth of adolescent drinking and binge drinking

    J. Child Psychol. Psychiatr.

    (2008)
  • P.J. Conrod et al.

    Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence

    Arch. Gen. Psychiatry

    (2010)
  • Synthesizing Research: A Guide For Literature Reviews (Vol. 2)

  • A. Coskunpinar et al.

    Multidimensionality in impulsivity and alcohol use: a meta-analysis using the UPPS model of impulsivity

    Alcohol. Clin. Exp. Res.

    (2013)
  • Cited by (105)

    • The relationship between anxious-depressive symptoms and harmful cannabis use: Multiple mediation models via rumination, negative urgency, protective behavioral strategies and refusal self-efficacy

      2022, Comprehensive Psychiatry
      Citation 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.

    View all citing articles on Scopus
    View full text