Cannabidiol (CBD) Products: Use Patterns and Perceptions Within a Sample of Anxious Users.

INTRODUCTION: Cannabidiol (CBD) shows promise for a variety of indications, including anxiety. Prior survey work indicates anxiety ranks as a top reason for which people use cannabidiol (CBD), but no work has evaluated individuals using CBD specifically for anxiety. METHOD: The current study evaluated CBD product use patterns and perceptions within a sample of 81 participants (Mage = 32.63, SDage = 12.99) who reported using CBD products for anxiety-related concerns within the past 30 days. RESULTS: Family and friends, followed by popular and scientific literature, were the most common sources informing participants' decision to use CBD products to target anxiety. On average, participants reported using CBD products daily for at least a year and indicated it was very effective in targeting anxiety-related symptoms. The top three ranked symptoms improved by CBD products were subjective anxiety, difficulty falling asleep, and irritability. These findings were despite the fact that the most frequent dosing levels (∼50mg) were well below those empirically observed to yield anxiolytic effects. Most participants denied side effects, adding to the literature supporting CBD products' safety and tolerability. Finally, participants were generally poorly informed about the nature of CBD products (e.g., distinction from THC), suggesting a need for consumer education. CONCLUSION: Collectively, the current study extends prior survey work suggesting powerful expectancies about CBD products, particularly in terms of anxiety reduction, including among those using it to target anxiety-related symptoms. Findings also highlight the importance of addressing the gap between scientific and consumer knowledge.

A double-blind, randomized, placebo-controlled study of the safety and effects of CBN with and without CBD on sleep quality.

The present study sought to determine the effects of cannabinol (CBN) alone and in combination with cannabidiol (CBD) on sleep quality. This was a double-blind, randomized, placebo-controlled study conducted between May and November 2022. Participants were randomized to receive either (a) placebo, (b) 20 mg CBN, (c) 20 mg CBN + 10 mg CBD, (d) 20 mg CBN + 20 mg CBD, or (e) 20 mg CBN + 100 mg CBD for seven consecutive nights. Participants were 18-55 years of age who self-rated sleep quality as "very poor" or "poor." The primary endpoint was sleep quality, while secondary endpoints included sleep onset latency, number of awakenings, wake after sleep onset (WASO), overall sleep disturbance, and daytime fatigue. In a modified intent-to-treat analyses (N = 293), compared to placebo, 20 mg CBN demonstrated a nonsignificant but potentially meaningful effect on sleep quality (OR [95% CI] = 2.26 [0.93, 5.52], p = .082) and significantly reduced number of awakenings (95% CI [-0.96, -0.05], p = .025) and overall sleep disturbance (95% CI [-2.59, -0.14], p = .023). There was no difference from placebo among any group for sleep onset latency, WASO, or daytime fatigue (all p > .05). Individuals receiving 20 mg CBN demonstrated reduced nighttime awakenings and overall sleep disturbance relative to placebo, with no impact on daytime fatigue. The addition of CBD did not positively augment CBN treatment effects. No differences were observed for latency to sleep onset or WASO. Findings suggest 20 mg of CBN taken nightly may be helpful for improving overall sleep disturbance, including the number of times one wakes up throughout the night, without impacting daytime fatigue. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using the Cigarette Purchase Task to examine the relative reinforcing value of cigarettes among mothers with versus without opioid dependence.

The Cigarette Purchase Task (CPT), in which participants estimate the number of cigarettes they would smoke across increasing cigarette prices, measures the relative reinforcing value of cigarettes. Although opioid-dependent individuals are particularly vulnerable to tobacco addiction, more research is needed to elucidate whether and to what extent their motivation to smoke differs from not-opioid-dependent smokers controlling for potential sociodemographic differences. Participants were 173 women (65 opioid-dependent) in an ongoing clinical trial for smoking cessation. Baseline CPT responses were compared between opioid-dependent and not-opioid-dependent women using five demand indices: Demand Intensity; Omax; Pmax; Breakpoint (BP); and α, and two latent factors: Amplitude and Persistence. Final regression models adjusted for sociodemographic characteristics differing between the two groups. Opioid-dependent women had greater demand Intensity (i.e., number of cigarettes they would smoke if they were free) than not-opioid dependent women in the adjusted model, F(1, 156) = 6.93, p = .016. No other demand indices differed significantly. Regarding latent factors, demand Amplitude (i.e., volumetric consumption), but not Persistence (i.e., price insensitivity), was greater for opioid-dependent women in the adjusted model, F(1, 146) = 4.04, p = .046. These results further demonstrate that the CPT is a highly sensitive task that can illuminate potentially important individual and population differences in the relative reinforcing value of smoking. Greater demand Intensity and Amplitude differentiated smokers with comorbid opioid dependence; thus, decreasing smoking prevalence among opioid-dependent populations may require policies and interventions that can decrease cigarette demand Intensity and Amplitude. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Smoking prevalence among U.S. national samples of pregnant women.

Several data sources exist for estimating U.S. smoking prevalence among pregnant women, yet each differs in ways that have the potential to impact the estimates. In the present study we used the Population Assessment of Tobacco and Health (PATH), the National Survey on Drug use and Health (NSDUH), and the Pregnancy Risk Assessment Monitoring System (PRAMS), three common data sources, to evaluate the following questions about estimating U.S. smoking prevalence among pregnant women: To what extent are estimates impacted by differences in whether the samples include younger (<18 years) or older (>44 years) women, represent smoking in any trimester or only the 3rd, and use data from nationally representative or more selected national samples. Among the factors examined, inclusion of younger or older women does not appear to meaningfully alter prevalence estimates. Focusing on only the third trimester likely underestimates smoking prevalence, while the influence of basing estimates on selected national subgroups of women (i.e., only women who delivered live born infants) rather than nationally representative surveys has little discernible influence. Going forward, this research area would benefit from greater consistency in explicitly discussing the sampling methods used and how these various methods may have influenced the estimates reported.

Sensitivity of hypothetical purchase task indices when studying substance use: A systematic literature review.

Hypothetical Purchase Tasks (HPTs) simulate demand for a substance as a function of escalating price. HPTs are increasingly used to examine relationships between substance-related correlates and outcomes and demand typically characterized using a common battery of indices (Intensity, Omax, Pmax, Breakpoint, Elasticity). This review examines the relative sensitivity of the HPT indices. Reports were identified using the search term "purchase task" in PubMed and Web of Science. For inclusion, reports had to be original studies in English, examine relationships between HPT indices and substance-related correlates or outcomes, and appear in a peer-reviewed journal through December 2017. Indices were compared using effect sizes (Cohen's d) and the proportion of studies in which statistically significant relationships were observed. The search identified 1274 reports with 114 (9%) receiving full-text review and 82 (6%) meeting inclusion criteria. 41 reports examined alcohol, 34 examined cigarettes/nicotine products, and 10 examined other substances. Overall, statistically significant relationships between HPT indices and substance-related correlates and outcomes were most often reported for Intensity (88.61%, 70/79), followed by Omax (81.16%, 56/69), Elasticity (72.15%, 57/59), Breakpoint (62.12%, 41/66), and Pmax (48.08%; 25/52). The largest effect sizes were observed for Intensity (0.75 ±â€¯0.04, CI 0.67-0.84) and Omax (0.64 ±â€¯0.04, CI 0.56-0.71), followed by Elasticity (0.44 ±â€¯0.04, CI 0.37-0.51), Breakpoint (0.30 ±â€¯0.03, CI 0.25-0.36), and Pmax (0.25 ±â€¯0.04, CI 0.18-0.33). Patterns were largely consistent across substances. In conclusion, HPTs can be highly effective in revealing relationships between demand and substance-related correlates and outcomes, with Intensity and Omax exhibiting the greatest sensitivity.

Examining interrelationships between the Cigarette Purchase Task and delay discounting among pregnant women.

Two common behavioral economic simulation tasks used to study cigarette smoking are the Cigarette Purchase Task, a measure of cigarette demand, and delay discounting, a measure of the subjective value of rewards as a function of delays to delivery. Few studies have evaluated whether combining these tasks enhances understanding of smoking beyond either alone. The current study represents an initial evaluation of the intersection between cigarette demand indices and delay discounting among pregnant smokers by examining associations between these measures and whether a woman makes antepartum quit attempts before entering prenatal care (a reliable predictor of eventual quitting). Participants were 159 pregnant women enrolled in a smoking-cessation trial. Low O max and shallow discounting were each associated with antepartum quit attempts. Participants were next categorized into four subgroups (low O max , shallow discounting; low O max , steep discounting; high O max , shallow discounting; high O max , steep discounting) using median splits. Those with shallow discounting and low O max were more likely to have made quit attempts than each of the other three subgroups. That is, steep discounting appears to undermine the association of low O max and efforts to quit smoking during pregnancy while high O max overshadows any protective influence associated with shallow discounting.

Effects of Financial Incentives for Smoking Cessation on Mood and Anxiety Symptoms Among Pregnant and Newly Postpartum Women.

Introduction: Financial incentives for smoking cessation increase smoking abstinence and decrease Beck Depression Inventory (BDI) scores among depression-prone pregnant and postpartum women. The present study is a secondary analysis using the Brief Symptom Inventory (BSI) to examine whether this treatment impacts a broader array of mood and anxiety symptoms. Methods: Participants (N = 253) were pregnant cigarette smokers who participated in four controlled clinical trials examining the efficacy of financial incentives for smoking cessation. Women were assigned to an intervention wherein they earned vouchers exchangeable for retail items contingent on smoking abstinence (Contingent, n = 143) or a control condition wherein they received comparable vouchers independent of smoking status (Noncontingent, n = 110). Participants were categorized as depression-prone (n = 105) or depression-negative (n = 148) based on self-reported history of depression and BDI scores at intake. A prior study demonstrated that financial incentives decreased depressive symptoms among depression-prone women in this sample. The present study examined whether those effects extended to a broader array of mood and anxiety symptoms using the BSI. Effects of treatment, time, and depression status were examined using repeated measures analyses of covariance. Results: In addition to depressive symptoms, financial incentives reduced a multitude of BSI scores among depression-prone women, including the BSI global measure of distress and seven symptom subscales. Treatment effects were discernible by late pregnancy, peaked at 8 weeks postpartum, and dissipated by 24 weeks postpartum. Discussion: In addition to reducing smoking, this financial incentives treatment appears to reduce a range of mood and anxiety symptoms among depression-prone pregnant and postpartum women. Implications: This study adds evidence that providing financial incentives contingent on smoking cessation lowers a broad array of psychiatric symptoms, as measured by the BSI, among depression-prone pregnant and newly postpartum women during a time of heightened risk for peripartum mood disorders.

A review of the effects of very low nicotine content cigarettes on behavioral and cognitive performance.

The present systematic review examines whether very low nicotine content (VLNC) cigarettes ameliorate withdrawal-induced impairments in behavioral/cognitive performance. PubMed, PsycInfo, and Web of Science were searched for performance effects of VLNC cigarettes. For inclusion, reports had to be in English, published in a peer-reviewed journal through June 2017, examine VLNC cigarettes (<0.2mg nicotine yield), include ≥2hour smoking abstinence or reduced nicotine exposure, and examine performance. 19 of 1243 articles reviewed met inclusion criteria. Poorer performance after smoking VLNC versus normal nicotine content (NNC) cigarettes was observed across 7 of 10 domains, including reaction time (8/11), short-term memory (3/10), sustained attention (4/6), inhibitory control (1/4), long-term memory (3/3 studies), and response variability (2/2). In two studies, combining VLNC smoking with nicotine replacement therapy (NRT) resulted in performance that was comparable to performance after NNC smoking. VLNC versus NNC differences were not discerned in motor control/functioning (0/2), visuospatial processing (0/2), learning (0/1), or verbal fluency (0/1). Eleven of nineteen (58%) studies were rated of Good or Excellent quality. Overall, VLNC cigarettes may not fully ameliorate withdrawal-induced disruptions in performance, although this varies by domain, with the strongest evidence for reaction time. Importantly, combining VLNC cigarettes with NRT appears to ameliorate withdrawal that is not reduced by VLNC cigarettes alone. As only 19 studies were identified, many domains are under-investigated. A more thorough evaluation of the extent to which VLNC cigarettes affect withdrawal-impaired performance may be warranted.

Simulating demand for cigarettes among pregnant women: A Low-Risk method for studying vulnerable populations.

A substantive obstacle to experimentally studying cigarette smoking and use of other tobacco products in pregnant women is the risk of adverse effects on mother and fetus from experimenter administration of the product of interest. The purpose of this study is to investigate bypassing that obstacle by using behavioral economic simulation tasks. In the present study we used the Cigarette Purchase Task (CPT) to simulate changes in demand for hypothetical cigarettes as a function of varying cigarette prices. Participants were 95 pregnant women who completed the CPT prior to participation in a smoking-cessation trial. Aggregate and individual participant demand varied as an orderly function of price and those changes were well fitted by an exponential equation. Demand also varied in correspondence to two well-validated predictors of individual differences in smoking cessation among pregnant women (cigarettes smoked per day, pre-pregnancy quit attempts). Moreover, CPT indices were more effective than these two conventional variables in predicting individual differences in whether women made a quit attempt during the current pregnancy. Overall, these results represent a promising step in demonstrating the validity and utility of the CPT for experimentally examining demand for cigarettes, and potentially other tobacco and nicotine delivery products, among pregnant women.

Response to varying the nicotine content of cigarettes in vulnerable populations: an initial experimental examination of acute effects.

RATIONALE: The purpose of this study was to begin researching the effects of very low nicotine content cigarettes in smokers especially vulnerable to dependence to assess their potential as a less dependence-producing alternative to current commercial cigarettes. METHODS: Participants were 26 adult, daily cigarette smokers from one of three populations: economically disadvantaged women of reproductive age (n = 9), opioid-dependent individuals (n = 11), and individuals with affective disorders (n = 6). Participants completed fourteen 2-4-h experimental sessions in a within-subjects research design. Sessions were conducted following brief smoking abstinence. Four research cigarettes varying in nicotine content (0.4, 2.4, 5.2, and 15.8 mg/g) were studied under double-blind conditions, assessing smoking topography, subjective effects, and relative reinforcing effects of varying doses in concurrent choice tests. Results were collapsed across vulnerable populations and analyzed using repeated measures ANOVA. RESULTS: No significant differences between doses were discernible in smoking topography. All doses were equi-effective at reducing nicotine withdrawal. Ratings of satisfaction from smoking were lower at the 0.4 compared to 15.8 mg/g dose. Participants preferred the 15.8 mg/g dose over the 0.4 and 2.4 but not the 5.2 mg/g doses in concurrent choice testing; no differences between the two lowest doses were noted. CONCLUSIONS: All cigarettes effectively reduced nicotine withdrawal with no differences in smoking topography, suggesting minimal compensatory smoking. Dependence potential was lowest at the 0.4 mg/g dose. These initial results are promising regarding the feasibility of lowering nicotine content in cigarettes to very low levels in vulnerable populations without untoward effects.

A Review of the Literature on Remote Monitoring Technology in Incentive-Based Interventions for Health-Related Behavior Change.

Use of technology (e.g., Internet, cell phones) to allow remote implementation of incentives interventions for health-related behavior change is growing. To our knowledge, there has yet to be a systematic review of this literature reported. The present report provides a systematic review of the controlled studies where technology was used to remotely implement financial incentive interventions targeting substance use and other health behaviors published between 2004 and 2015. For inclusion in the review, studies had to use technology to remotely accomplish one of the following two aims alone or in combination: (a) monitor the target behavior, or (b) deliver incentives for achieving the target goal. Studies also had to examine financial incentives (e.g., cash, vouchers) for health-related behavior change, be published in peer-reviewed journals, and include a research design that allowed evaluation of the efficacy of the incentive intervention relative to another condition (e.g., non-contingent incentives, treatment as usual). Of the 39 reports that met inclusion criteria, 18 targeted substance use, 10 targeted medication adherence or home-based health monitoring, and 11 targeted diet, exercise, or weight loss. All 39 (100%) studies used technology to facilitate remote monitoring of the target behavior, and 26 (66.7%) studies also incorporated technology in the remote delivery of incentives. Statistically significant intervention effects were reported in 71% of studies reviewed. Overall, the results offer substantial support for the efficacy of remotely implemented incentive interventions for health-related behavior change, which have the potential to increase the cost-effectiveness and reach of this treatment approach.

Some context for understanding the place of the general educational development degree in the relationship between educational attainment and smoking prevalence.

INTRODUCTION: Individuals with a General Educational Development (GED) degree have the highest smoking prevalence of any education level, including high school dropouts without a GED. Yet little research has been reported providing a context for understanding the exception that the GED represents in the otherwise graded inverse relationship between educational attainment and smoking prevalence. We investigated whether the GED may be associated with a general riskier profile that includes but is not limited to increased smoking prevalence. METHOD: Data were obtained from three years (2011-2013) of the National Survey on Drug Use and Health ([NSDUH], N=55,940]). Prevalence of risky repertoire indicators (e.g., ever arrested, seldom/never wears a seatbelt), indicators of social instability (e.g., frequent relocations), and risky demographic characteristics (e.g., male gender) were compared among high school dropouts, GED holders, and high school graduates using Rao-Scott chi square goodness-of-fit tests and multiple logistic regression. RESULTS: Those with GEDs differed significantly between both high school dropouts and high school graduates across 19 of 27 (70.4%) risk indicators. Controlling for risky profile characteristics accounted for a significant but limited (25-30%) proportion of the variance in smoking prevalence across these three education levels. CONCLUSION: GED holders exhibit a broad high-risk profile of which smoking is just one component. Future research evaluating additional risk indicators and mechanisms that may underpin this generalized risky repertoire are likely needed for a more complete understanding of GED's place in the important relationship between educational attainment and smoking prevalence.

Depression in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): The Mediating Role of Cognitive-Behavioral Factors.

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for depressive disorders but little is known about the potential cognitive and behavioral mechanisms of risk that could shape treatment. This study evaluated the degree to which cognitive-behavioral constructs associated with depression and its treatment-dysfunctional attitudes and cognitive-behavioral avoidance-accounted for variance in depressive symptoms and disorder in adults with ADHD. 77 adults clinically diagnosed with ADHD completed self-report questionnaires, diagnostic interviews, and clinician-administered symptom rating scales. Statistical mediation analysis was employed and indirect effects assessed using bootstrap analysis and bias-corrected confidence intervals. Controlling for recent negative life events, dysfunctional attitudes and cognitive-behavioral avoidance fully accounted for the variance between ADHD symptoms and depressive symptoms. Each independent variable partially mediated the other in accounting for depression symptoms suggesting overlapping and unique variance. Cognitive-behavioral avoidance, however, was more strongly related to meeting diagnostic criteria for a depressive disorder than were dysfunctional attitudes. Processes that are targeted in cognitive behavior therapy (CBT) for depression were associated with symptoms in adults with ADHD. Current CBT approaches for ADHD incorporate active coping skills and cognitive restructuring and such approaches could be further tailored to address the ADHD-depression comorbidity.