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Neurobiology of marijuana abuse.

Marijuana has a long history of abuse yet, as described here by Mary Abood and Billy Martin, there is little evidence that animals will self-administer the primary psychoactive constituent, tetrahydrocannabinol, or that marijuana stimulates brain reward pathways. While marked tolerance develops to marijuana, it has been difficult to demonstrate physical dependence, and until recently the mechanisms by which cannabinoids produced their behavioral effects were poorly defined. The development of new synthetic analogs played a critical role in the characterization and cloning of the cannabinoid receptor. Insight into cannabinoid receptors may lead to a better understanding of marijuana abuse in humans and provide new therapeutic strategies for several disorders.

Animals↗

Health, developmental, and nutritional status of adolescent alcohol and marijuana abusers.

The impact of alcohol and marijuana abuse on the physical health and nutritional status of adolescents has not been well documented. The health consequences of alcoholism and chemical abuse in adults may not relate to the pediatric population. Forty-nine adolescent boys (mean age 15.8 years) with varying degrees of alcohol and marijuana use by self-report were evaluated as to their general health, pubertal development and nutritional status using health and dietary history, physical examination, anthropometrics, and biochemical assays of liver function and tissue nutrients. Thirteen (27%) were alcohol and marijuana abusers, 20 (41%) marijuana abusers, and 16 (32%) nonusers. There were significant differences between alcohol and marijuana abusers and marijuana abusers compared to nonusers with respect to endorsing symptoms of nutritional deficiency (muscle weakness, bleeding gums, tiredness, etc) (P less than .001). There were no significant differences between subgroups in other nutritional measures except plasma zinc concentration which was low in marijuana abusers (mean 85 micrograms/dL). All adolescents reported consuming adequate nutrients, although alcohol and marijuana abusers reported eating more snack foods and less fruit, vegetables, and milk than other groups. There were no significant differences in hematologic status (complete blood cell count, transferrin, folate), liver function (gamma-glutamyltranspeptidase), or anthropometric and sexual maturational indices of growth. There were no chronic signs of chemical abuse by physical examinations. It appears that health and nutritional disability from chemical abuse in adolescents relates more to poor dietary habits and symptomatic deterioration in general health than to specific effects on growth or nutritional status. Studies with larger numbers of subjects need to document these findings.

Adolescent↗

Objective criteria for the diagnosis of marijuana abuse.

Among 97 chronic marijuana users, 9% were found to have had multiple life problems as a consequence of their marijuana use when evaluated during a 5-year follow-up study. Operationally defined criteria for marijuana abuse are presented which are analogous to criteria commonly used in diagnosing alcoholism. These criteria identified marijuana abusers who manifested many problems from marijuana use, including fighting, panic attacks, and traffic tickets. This was in contrast to the majority of the chronic users who did not have multiple complications from their marijuana use. The marijuana abusers had used marijuana more frequently, had used greater amounts of marijuana, and had begun using it at an earlier age than nonabusers. A high rate of alcoholism was found in the abusers but was not statistically greater than in nonabusers. The objective criteria presented here offer a method for simple, prompt evaluation of potential problems from marijuana use.

Adolescent↗

Ecology of adolescents' marijuana abuse.

Sixteen adolescent marijuana abusers reported data on the ecology of their use over a 3-month period. Abusers recorded data on the day, date, time, place, frequency, and amount of use. They also included information on their mood and functioning, and with whom they used marijuana. Peak use occurred just prior to school, at lunch, and in the early evening. Adolescents' homes, friends' houses, school, and cars represented 67% of locations in which marijuana was used. Happy, relaxed, and tired comprised 81% of moods experienced during time of use. Average core network was 5.8 individuals while casual networks averaged 15.5 adolescents. Presence of others during use was associated with abusers' increased use and decreased functioning.

Adolescent↗

The relations among personality, symptoms of alcohol and marijuana abuse, and symptoms of comorbid psychopathology: results from a community sample.

This study examined the relation of the Five-Factor Model (FFM) of personality to symptoms of alcohol and marijuana abuse before and after controlling for symptoms of antisocial personality disorder (APD) and internalizing psychopathology. The 481 participants completed a well-validated measure of the FFM and a structured diagnostic interview at age 21 years. Hierarchical regression analyses indicated that unique constellations of personality characteristics were associated with symptoms of alcohol abuse, marijuana abuse, APD, and internalizing disorders. For example, symptoms of alcohol abuse were associated with high Extraversion and low Conscientiousness, whereas symptoms of marijuana abuse were characterized by low Extraversion and high Openness to Experience. Findings have implications for models of the etiology and treatment of substance use and abuse.

Adult↗

Patient characteristics and treatment implications of marijuana abuse among bipolar alcoholics: results from a double blind, placebo-controlled study.

OBJECTIVE: Marijuana abuse, primarily a disorder of adolescents and young adults, is highly prevalent among patients with severely ill psychiatric population, especially those with bipolar disorder. Additional marijuana abuse may impact on the clinical presentation of bipolar illness and may potentially act as mediator of treatment response in this population. However, the characterization of bipolar disorder patients with additional marijuana abuse and the impact of such abuse on treatment outcome has been rarely examined. The aim of this study was to characterize bipolar alcoholic patients with comorbid marijuana abuse and test the impact of marijuana abuse on alcohol and mood outcome of patients with bipolar disorder and comorbid alcohol dependence. METHOD: We conducted secondary analyses of a randomized, double blind, placebo-controlled trial testing valproate in 52 bipolar alcoholics. Subjects had a comprehensive assessment at baseline using structured diagnostic assessments, and they were then assessed every 2 weeks for 24 weeks. RESULTS: Twenty-five subjects (48%) reported marijuana abuse. Those with co-occurring marijuana abuse were younger, had fewer years of education, and had significantly higher number of additional psychiatric comorbidity. They also had more severe alcohol and other drug use and were significantly more likely to present in the manic phase. The mixed model indicated that the placebo-treated marijuana abuse group had the worst alcohol use outcome. CONCLUSIONS: Marijuana abuse among patients with bipolar disorder and alcohol dependence is associated with higher degree of severity of alcohol and other drugs of abuse and may negatively impact on alcohol treatment outcome.

Adolescent↗

EEG deficits in chronic marijuana abusers during monitored abstinence: preliminary findings.

Cognitive, cerebrovascular, and psychiatric impairments have been documented with chronic marijuana users. To better understand the nature and duration of these neurocognitive changes in marijuana abusers, we recorded the resting EEG of 29 abstinent chronic marijuana abusers and 21 control subjects. The marijuana abusers were tested twice: the first evaluation occurred within 72 hours of admission to the inpatient research unit; the second evaluation occurred after 28 to 30 days of monitored abstinence. A three-minute period of EEG was recorded during resting eyes-closed conditions from eight electrodes (F(3), C(3), P(3), O(1), F(4), C(4), P(4), and O(2)). The artifacted EEG was converted to six frequency bands (delta, theta, alpha(1), alpha(2), beta(1), and beta(2)) using a fast Fourier transform. During early abstinence, absolute power was significantly lower (p < 0.05) for the marijuana abusers than for the control subjects for the theta and alpha(1) bands. These reductions in theta and alpha(1) power persisted for 28 days of monitored abstinence. These EEG changes, together with cerebral blood flow deficits, might underlie the cognitive alterations observed in marijuana abusers. Additional research is needed to determine how long these deficits persist during abstinence and if treatment with neuroprotective agents may reverse them.

Adult↗

Engaging young probation-referred marijuana-abusing individuals in treatment: a pilot trial.

Young marijuana abusers rarely seek treatment themselves and are difficult to engage in treatment when referred by social agencies. To evaluate treatment engagement strategies in this population, 65 young probation-referred marijuana abusers were randomly assigned to either three-session motivational enhancement therapy (MET alone) or three-session MET plus contingency management (MET/CM), with vouchers for treatment attendance. A significantly higher number of participants in the MET/CM condition completed the three-session intervention as compared with MET alone. Participants in both conditions reported significant reductions in marijuana use and improvement in legal problems. These findings suggest that young marijuana abusers benefit from scientifically validated treatments.

Adolescent↗

Comparison of problem-gambling and non-problem-gambling youths seeking treatment for marijuana abuse.

OBJECTIVE: To evaluate the prevalence and correlates of problem gambling (PG) in marijuana-abusing adolescents. METHOD: A retrospective analysis was conducted of data collected from participants entering treatment for marijuana abuse in Philadelphia, Pennsylvania, and Hartford, Connecticut, between 1998 and 2000. RESULTS: Of 255 adolescents interviewed, 22% experienced gambling problems. Compared with non-problem gamblers (NPGs), PGs were more likely to be male, of African-American ethnicity, and to live in single-parent homes. Multivariate general linear models compared the two groups with respect to psychosocial problems. After controlling for age, gender, and race, differences between the groups emerged in drug use severity, legal difficulties, psychiatric problems, and human immunodeficiency virus risk behaviors. PGs reported a greater frequency of overall drug and alcohol use and greater intensity of marijuana use than their NPG counterparts. They had more illegal activity and greater somatization and anxiety symptoms, as well as higher levels of victimization. Compared with NPGs, PGs also reported more recent sexual partners. CONCLUSIONS: These data suggest that PG is common in marijuana-abusing youths and that they have increased psychosocial problems. These data suggest the need for early identification and treatment of PG in substance-abusing adolescents.

Adolescent↗

The functions of marijuana abuse for adolescents.

Research on adolescent marijuana use has given insufficient attention to understanding the functions of marijuana in youngsters' overall adaptation, and particularly in the context of family psychodynamics. This research focused on 17 marijuana-abusing adolescents who were selected according to the "representative case method." Data obtained through unstructured psychodynamic interviews with the youngsters and their families were analyzed to identify the functions which marijuana played for these adolescents. Five key functions related to family psychodynamics-defiance and provocation, self-destructiveness, control of anger, grandiosity, and escape from competitive conflicts-are described. A case illustration is presented to show how these functions are interrelated in the adolescents' adaptation.

Adaptation, Psychological↗

Marijuana abusers are at increased risk for stroke. Preliminary evidence from cerebrovascular perfusion data.

We have recorded blood flow velocity in the anterior and middle cerebral arteries by transcranial Doppler sonography in abstinent marijuana abusers (n = 16) and control subjects (n = 19) to assess the effects of prolonged marijuana use of the cerebrovascular system. The pulsatility index, a measure of cerebrovascular resistance, and systolic velocity were significantly (p < 0.005) increased in marijuana abusers compared to the control subjects. These findings suggest that cerebral perfusion observed in 18-30 year old marijuana abusers is comparable to that of normal 60 year-olds. Thus, chronic abuse of marijuana might be a risk factor for stroke.

Adolescent↗

Demographic effects on the Trail Making Test in marijuana abusers.

Demographic effects on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, were examined in a sample of marijuana abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of marijuana abusers' scores available for analysis were 259. Data were analyzed to determine the effects of sex, ethnicity, age, and education variables on the two parts of the TMT in this large treatment sample of marijuana abusers. The variables of age and education level were statistically significantly related to TMT parts A and B, and ethnicity was statistically significant for part B of the TMT. R-Square values for overall models were moderate (A = .15, B = .18) suggesting that demographic effects on the TMT are weak.

Adolescent↗

Cholinergic syndrome following anticholinergic withdrawal in a schizophrenic patient abusing marijuana.

A 27-year-old neuroleptic-stabilised schizophrenic patient presented with a three-day history of psychomotor retardation, disturbed sleep, and social and emotional withdrawal following reduction of his anticholinergic dosage; his symptoms had intensified after an increase in neuroleptic dosage, based on a diagnosis of psychotic decompensation. Recognition of a cholinergic syndrome and institution of appropriate anticholinergic treatment resulted in rapid improvement. The clinical distinction between a cholinergic overdrive state and schizophrenic exacerbation, while sometimes difficult, can be critical in selecting appropriate management.

Adult↗

American Academy of Pediatrics. Committee on Substance Abuse. Marijuana: A continuing concern for pediatricians.

Marijuana, the common name for products derived from the plant Cannabis sativa, is the most common illicit drug used by children and adolescents in the United States.(1) Despite growing concerns by the medical profession about the physical and psychological effects of its active ingredient, Delta-9-tetrahydrocannabinol, survey data continue to show that increasing numbers of young people are using the drug as they become less concerned about its dangers.(1)

Adolescent↗

Derived trail making test indices in a sample of marijuana abusers: demographic effects.

Derived indices on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, were examined in a sample of marijuana abusers in drug abuse treatment programs. A mixed-race sample of 259 subjects was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991 to 1993 in 96 programs in 11 cities in the United States. Data were analyzed to determine the effects of demographic variables on derived indices created by adding, subtracting, multiplying, and dividing Parts A and B of the TMT in this large treatment sample of marijuana abusers. The variables of age, ethnicity, and education were statistically significant for the total (A + B), and interaction (A x B/100) derived indices of the TMT. The difference score (B - A) was significant only for ethnicity and the ratio score (B/A) was not significant for any demographic variable.

Adolescent↗

A contingency management intervention for adolescent marijuana abuse and conduct problems.

OBJECTIVE: To describe an innovative treatment for adolescent marijuana abuse and provide initial information about its feasibility, acceptability, and potential efficacy. METHOD: Provided an intervention composed of (1) a clinic-administered, abstinence-based incentive program; (2) parent-directed contingency management targeting substance use and conduct problems; (3) a clinic-administered incentive program for parent participation; and (4) individual cognitive-behavioral therapy for adolescents. Data are presented for 19 adolescents, age 15-18 years. Measures of substance use, psychopathology, and parenting were collected before and after the 14-week treatment. Substance use measures were also collected 1 month post-treatment. Substance use was monitored by twice-weekly urine and breath testing. An intent-to-treat model was used. RESULTS: Adolescents and parents attended an average of 10.3 and 10.6 of 14 sessions, respectively. Substance use, externalizing behaviors, and negative parenting behaviors decreased by treatment end. Urine testing indicated that abstinence increased from 37% at intake to 74% at treatment end (z value = 2.28, p = .02) and that 53% of adolescents were abstinent 30 days post-treatment. CONCLUSIONS: Preliminary data provide support for the feasibility and acceptability of a family-based, contingency management model to treat adolescent substance use and conduct problems. Controlled efficacy studies with larger samples are needed.

Adolescent↗

Medical symptoms associated with tobacco smoking with and without marijuana abuse among crack cocaine-dependent patients.

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling for clinical and demographic differences, the C + T + M group reported significantly more total symptoms on the MILCOM as well as on the respiratory, digestive, general, and nose/throat subscales than the C + T or C groups. The C + T group reported higher total and respiratory and nose/throat symptoms than the C group. HOwever, the C group had the highest number of mood symptoms among the three groups. The C + T and C + T + M groups were comparable in number of cigarettes smoked and ASI scores. Although tobacco smoking is associated with higher reports of medical problems in crack abusers, smoking both marijuana and tobacco seems to be associated with greater medical problems than smoking tobacco alone. Tobacco smoking was not related to changes in cocaine use. Also, marijuana smoking does not appear to be associated with a reduction in tobacco or cocaine use.

Adult↗