The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical ...and psychological conditions for which it has been allowed at the state level. Common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer's disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn's disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, severe and chronic pain, and severe nausea. Post-traumatic stress disorder was also included in the review, as it is the sole psychological disorder for which medical marijuana has been allowed. Studies for this narrative review were included based on a literature search in PsycINFO, MEDLINE, and Google Scholar. Findings indicate that, for the majority of these conditions, there is insufficient evidence to support the recommendation of medical marijuana at this time. A significant amount of rigorous research is needed to definitively ascertain the potential implications of marijuana for these conditions. It is important for such work to not only examine the effects of smoked marijuana preparations, but also to compare its safety, tolerability, and efficacy in relation to existing pharmacological treatments.
Abstract Introduction Individuals report using cannabis for the promotion of sleep, and the effects of cannabis on sleep may vary by cannabis species. Little research has documented preferences for ...particular cannabis types or cannabinoid concentrations as a function of use for sleep disturbances. Methods 163 adults purchasing medical cannabis for a physical or mental health condition at a cannabis dispensary were recruited. They provided self-report of (a) whether cannabis use was intended to help with sleep problems (e.g. insomnia, nightmares), (b) sleep quality (PSQI), (c) cannabis use (including preferred type), and (d) symptoms of DSM-5 cannabis dependence. Results 81 participants reported using cannabis for the management of insomnia and 14 participants reported using cannabis to reduce nightmares. Individuals using cannabis to manage nightmares preferred sativa to indica strains (Fisher's exact test (2) = 6.83, p < 0.05), and sativa users were less likely to endorse DSM-5 cannabis dependence compared with those who preferred indica strains (χ2 (2) = 4.09, p < 0.05). Individuals with current insomnia ( t (9) = 3.30, p < 0.01) and greater sleep latency ( F (3,6) = 46.7, p < 0.001) were more likely to report using strains of cannabis with significantly higher concentrations of CBD. Individuals who reported at least weekly use of hypnotic medications used cannabis with lower THC concentrations compared to those who used sleep medications less frequently than weekly ( t (17) = 2.40, p < 0.05). Conclusions Associations between sleep characteristics and the type of cannabis used were observed in this convenience sample of individuals using cannabis for the management of sleep disturbances. Controlled prospective studies are needed to better characterize the impact that specific components of cannabis have on sleep.
Abstract
Introduction
Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for smoking cigarettes, but there is little longitudinal research on the array of smoking ...characteristics known to be prognostic of long-term smoking outcomes into adulthood. These variables were studied into early adulthood in a multisite sample diagnosed with ADHD combined type at ages 7–9.9 and followed prospectively alongside an age- and sex-matched local normative comparison group (LNCG).
Methods
Cigarette smoking quantity, quit attempts, dependence, and other characteristics were assessed in the longitudinal Multimodal Treatment Study of Children with ADHD (MTA) eight times to a mean age of 24.9 years: ADHD n = 469; LNCG n = 240.
Results
In adulthood, the ADHD group had higher rates of daily cigarette smoking, one or more quit attempts, shorter time to first cigarette of the day, and more severe withdrawal than the LNCG. The ADHD group did not appear to have better smoking cessation rates despite a higher proportion quitting at least once. Smoking quantity and nicotine dependence did not differ between groups. The ADHD group reported younger daily smoking onset and faster progression from smoking initiation to daily smoking across assessments. Finally, ADHD symptom severity in later adolescence and adulthood was associated with higher risk for daily smoking across assessments in the ADHD sample.
Conclusions
This study shows that ADHD-related smoking risk begins at a young age, progresses rapidly, and becomes resistant to cessation attempts by adulthood. Prevention efforts should acknowledge the speed of uptake; treatments should target the higher relapse risk in this vulnerable population.
Implications
Although childhood ADHD predicts later smoking, longitudinal studies of this population have yet to fully characterize smoking behaviors into adulthood that are known to be prognostic of long-term smoking outcome. The current study demonstrates earlier and faster progression to daily smoking among those with a childhood ADHD diagnosis, as well as greater risk for failed quit attempts. Prevention efforts should address speed of smoking uptake, while treatments are needed that address smoking relapse risk. The current study also demonstrates ADHD symptom severity over development increases daily smoking risk, implicating the need for continuous ADHD symptom management.
Background
Pronounced differences in drinking behavior exist between African Americans and European Americans. Disinhibited personality characteristics are widely studied risk factors for alcohol use ...outcomes. Longitudinal studies of children have not examined racial differences in these characteristics and in their rates of change or whether these changes differentially relate to adolescent alcohol use.
Methods
Latent growth curve modeling was performed on 7 annual waves of data on 447 African American and European American 8‐ and 10‐year‐old children followed into adolescence as part of the Tween to Teen Project. Both mother and child data were examined.
Results
European Americans had higher initial levels of (β = 0.22, p < 0.001) and greater growth in sensation seeking (β = 0.16, p < 0.05) compared with African Americans. However, African American children had higher initial levels of impulsivity compared with European American children (β = −0.27 and −0.16, p < 0.01). Higher initial levels of sensation seeking (β = 0.18, p < 0.01) and greater growth in both sensation seeking (β = 0.24, p < 0.01) and impulsivity (β = 0.30 to 0.34, p < 0.01) related to subsequent frequency of alcohol use. The association between race and alcohol use was partially mediated by initial levels of sensation seeking (β = 0.04, p < 0.05; 95% CI: 0.004 to 0.078). Additionally, sharper increases in sensation seeking predicted greater levels of subsequent alcohol use for European Americans (β = 0.33, p < 0.001) but not for African Americans (β = −0.15, ns).
Conclusions
This study revealed different developmental courses and important racial differences for sensation seeking and impulsivity. Findings highlight the possibility that sensation seeking at least partly drives early alcohol use for European American but not for African American adolescents.
Research in community and clinical samples has documented elevated rates of cannabis use and cannabis use disorders (CUDs) among individuals with trauma exposure and posttraumatic stress disorder ...(PTSD). However, there is a lack of research investigating relations between, and correlates of, trauma and cannabis phenotypes in epidemiologic samples. The current study examined associations between trauma (i.e., lifetime trauma exposure and PTSD) and cannabis phenotypes (i.e., lifetime cannabis use and CUD) in a nationally representative sample. Participants were individuals who participated in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,396; 52.4% women; age, M = 48.0 years, SD = 16.9). Lifetime DSM-IV Criterion A trauma exposure was significantly associated with lifetime cannabis use (OR = 1.215) but was only marginally associated with CUD (OR = 0.997). Within the trauma-exposed sample, lifetime PTSD showed a significant association with CUD (OR = 1.217) but was only marginally associated with lifetime cannabis use (OR = 0.992). Partially consistent with hypotheses, lifetime trauma was associated with greater odds of lifetime cannabis use, whereas PTSD was associated with greater odds of CUD. Longitudinal research investigating patterns of onset of these events/disorders is needed.
Aims
To examine the association between developmental trajectories of inattention, hyperactivity–impulsivity and delinquency through childhood and adolescence (ages 8–16 years) and subsequent binge ...drinking and marijuana use in early adulthood (age 21 years).
Design
Prospective naturalistic follow‐up of children with attention deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment‐phase assessments occurred at 3, 9 and 14 months after randomization; follow‐up assessments occurred at 24 months, 36 months, and 6, 8 and 12 years after randomization.
Setting
Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi‐site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care.
Participants
A total of 579 children with DSM‐IV ADHD combined type, aged 7.0 and 9.9 years at baseline (mean = 8.5, SD = 0.80).
Measurements
Ratings of inattention, hyperactivity–impulsivity and delinquency were collected from multiple informants at baseline and through the 8‐year follow‐up. Self‐reports of binge drinking and marijuana use were collected at the 12‐year follow‐up (mean age 21 years).
Findings
Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity–impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, all P‐values <0.05), even when symptom levels in stable trajectories were high.
Conclusions
Worsening inattention symptoms and delinquency during adolescence are were associated with higher levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.
Background: Familial loading for alcoholism is an important marker of risk for early‐onset alcohol problems, but the early expression of this risk in community samples of children is understudied.
...Methods: This study tested, for 452 8‐ and 10‐year‐old children, whether the density of alcohol problems in their biological relatives was associated with externalizing behaviors that are risk factors for later alcohol problems.
Results: Density of alcohol problems in first‐ and second‐degree biological relatives was associated with behavioral disinhibition (BD; e.g., poor inhibitory control, attentional shifting, β = 0.10, p = 0.04) and conduct problems (CP; i.e., defiance, aggression, delinquency, β = 0.18, p = 0.00). These relations were moderated by parenting practices (parental warmth, discipline consistency, and parental monitoring). The density‐behavior association lost statistical significance when at least 2 of 3 parenting practices were rated above median levels for the sample (p = 0.67 to 0.36). The density‐behavior association was mediated by current demographic advantage (p = 0.00 for BD, p = 0.00 for CP), current maternal mental health (p = 0.01 for BD, p = 0.00 for CP), and current maternal deviant behavior (for CP only, p = 0.01).
Conclusions: Findings support previously proposed but untested pathways in etiologic models of alcoholism and show the potentially important role of active parenting in reducing the expression of inherited vulnerability to alcoholism in childhood.
Objective: Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed ...qualitative–quantitative approach to explore this relationship. Method: Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group LNCG) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). Results: SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. Conclusion: Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related risk for cannabis use.
Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for experiencing alcohol-related problems by adulthood. However, few studies have examined contextual factors ...that may contribute to this risk. The current study examined 1 widely investigated social-contextual risk factor, friend alcohol use, in a sample of adolescents with and without a history of ADHD. One hundred and 59 adolescents (14-17 years old) with childhood ADHD and 117 demographically similar youth without ADHD were interviewed annually in the Pittsburgh ADHD Longitudinal Study. Adolescents reported the frequency of their own alcohol use in the prior 12 months and the number of friends who used alcohol regularly or occasionally (perceived friend alcohol use). Multiple-group parallel process models indicated that increases in friend alcohol use were more strongly associated with increases in adolescent alcohol use over time for individuals with ADHD (r = .15, SE = 0.04; 95% confidence interval CI = 0.08, 0.22) than for those without ADHD (r = .06, SE = 0.03; 95% CI 0.00, 0.11). These results suggest that social factors are an important part of escalating alcohol use among adolescents with ADHD histories, and they highlight the possibility that interventions focused on the peer context could be important for these at-risk youth. Additional social network research on adolescent alcohol use within the larger context of other relationships (e.g., family and romantic relationships) is indicated.
Objective: Excessive alcohol consumption increases risk of perpetrating intimate partner violence (IPV). ADHD is associated with problematic drinking and IPV, but it is unclear whether problem ...drinkers with ADHD are more likely than those without ADHD to perpetrate IPV. Method: We compared the strength of association between problem drinking trajectories and IPV perpetration among 19- to 24-year-old men with (n = 241) and without (n = 180) childhood ADHD. Results: Men with ADHD who reported higher heavy episodic drinking or alcohol use problems at age 19, and slower decreases in alcohol use problems from age 19 to 24, were more likely to perpetrate IPV than problem drinkers without ADHD, among whom the same associations were non-significant. Associations between problem drinking and IPV were not attenuated in adults with ADHD upon controlling for antisocial personality disorder. Conclusion: Study findings highlight the heightened risk of problem drinkers with ADHD perpetrating IPV.
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