Evidence Lacking for Cannabis Users Slacking: A Longitudinal Analysis of Escalating Cannabis Use and Motivation among Adolescents.

OBJECTIVE: Reduced motivation is often noted as a consequence of cannabis use. However, previous work has yielded mixed results and focused largely on adults. To address these limitations, this study examined longitudinal associations between cannabis use and self-reported motivation in a large adolescent sample. METHOD: Participants were 401 adolescents aged 14-17 at baseline who completed five bi-annual assessments. We assessed motivation at three timepoints using two self-report questionnaires: the Apathy Evaluation Scale and the Motivation and Engagement Scale (disengagement, persistence, planning, self-efficacy, and valuing school subscales). Controlling for relevant covariates, we used latent growth curve modeling to characterize patterns of cannabis use and motivation over time, examining bidirectional influences between these processes. RESULTS: On average, adolescent cannabis use frequency increased significantly over time. The disengagement and planning facets of motivation also increased significantly over time, whereas other aspects of motivation remained stable. At baseline, greater cannabis use was associated with greater disengagement, lower planning, and lower valuing of school. Greater baseline cannabis use also predicted lesser increases in disengagement over time. After controlling for the effect of sex, age, depression, and use of alcohol and nicotine, only the baseline association between cannabis use and valuing school remained significant. CONCLUSIONS: Our results do not support a prospective link between cannabis use and reduced motivation among adolescents. Although most observed associations were accounted for by covariates, greater cannabis use was cross-sectionally associated with lower perceived value of school, which may contribute to poorer educational and later life outcomes.

Adverse Effects of Cannabis Use on Neurocognitive Functioning: A Systematic Review of Meta- Analytic Studies.

Objective: As the perceived risk of cannabis use continues to decline among youths and access continues to increase, it has become more important to synthesize the rapidly growing literature on the effects of cannabis on neurocognition. Hundreds of studies examining associations between cannabis use and neurocognitive functioning have been published in recent decades. However, results often differ across individual studies, particularly when sample sizes are small. Meta-analytic methods help to make sense of this literature and have been increasingly applied to studies on cannabis use and neurocognition. Methods: A systematic literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify peer-reviewed meta-analyses of neurocognitive or functional neuroimaging data that examined associations between cannabis use and non-acute effects on neurocognitive functioning (n = 8). Results: Current findings suggest that regular healthy cannabis users, regardless of age, display poorer neurocognitive functioning relative to nonusers of small to medium effect sizes across many neurocognitive domains, as well as functional brain alterations when compared to non-users. Adverse effects are not uniform across neurocognitive domains and evidence for adolescent-onset users having poorer neurocognitive outcomes remains equivocal based on these studies. However, less is known about cannabis effects on neurocognition among clinical samples, as findings from specific clinical samples revealed mixed results. Conclusions: Meta-analyses have played an important role in helping to grasp the totality of results from a large body of literature on cannabis effects on neurocognition, yet more research (particularly large-scale longitudinal studies) is needed to identify critical periods or patterns of use that are more likely to result in negative outcomes.

Decision-Making as a Latent Construct and its Measurement Invariance in a Large Sample of Adolescent Cannabis Users.

OBJECTIVE: Relative to the vast literature that employs measures of decision-making (DM), rigorous examination of their psychometric properties is sparse. This study aimed to determine whether three measures of DM assess the same construct, and to measure invariance of this construct across relevant covariates. METHOD: Participants were 372 adolescents at risk of escalation in cannabis use. DM was assessed via four indices from the Cups Task, Game of Dice Task (GDT), and Iowa Gambling Task (IGT). We used confirmatory factor analysis to assess unidimensionality of the DM construct, and moderated nonlinear factor analysis (MNLFA) to examine its measurement invariance. RESULTS: The unidimensional model of DM demonstrated good fit. MNLFA results revealed that sex influenced mean DM scores, such that boys had lower risk-taking behaviors. There was evidence of differential item functioning (DIF), such that IQ and age moderated the IGT intercept and GDT factor loading, respectively. Significant effects were retained in the final model, which produced participant-specific DM factor scores. These scores showed moderate stability over time. CONCLUSIONS: Indices from three DM tasks loaded significantly onto a single factor, suggesting that these DM tasks assess a single underlying construct. We suggest that this construct represents the ability to make optimal choices that maximize rewards in the presence of risk. Our final DM factor accounts for DIF caused by covariates, making it comparable across adolescents with different characteristics. (JINS, 2019, 25, 661-667).

Developmental pathways of adolescent cannabis use: Risk factors, outcomes and sex-specific differences.

BACKGROUND: Characterizing patterns of adolescent cannabis use (CU), as well as risk factors and outcomes uniquely associated with these pathways is essential for informing treatment and prevention efforts. Yet, few studies have examined these issues among youth at-risk of engaging in problematic cannabis use. Further, research accounting for use of other substances or sex differences in patterns of CU remains exceedingly sparse. METHODS: Trajectory-based modeling was used to identify underlying CU pathways among a predominantly Hispanic (90%) sample of at-risk youth (n = 401; 46% female) across adolescence (ages∼14-18), controlling for baseline substance use and participant demographics. Adolescent psychopathology (i.e., conduct disorder, attention deficit hyperactivity disorder, anxiety, and depression) was examined as a predictor and outcome of CU. RESULTS: Three trajectories of adolescent CU were identified, with most youth (74%) engaging in relatively "low" levels of use, followed by ∼12% exhibiting an early-initiating "chronic" course, and 14% "escalating" in use. Although boys and girls both experienced increased levels of CU across adolescence, boys were more likely to exhibit escalating and chronic patterns of use. Findings revealed unique associations between adolescent CU pathways and facets of psychopathology; most notably, the relatively robust and bidirectional association between CU trajectories and conduct problem symptoms. CONCLUSIONS: Specific facets of psychopathology may confer unique associations with CU across development, including the initiation and exacerbation of CU during adolescence.

Is Cannabis Use Associated with Various Indices of Motivation among Adolescents?

Decreased motivation is often noted as a consequence of cannabis use (CU). Previous work has yielded mixed findings, relied mostly on adult samples, and varied to the extent that it accounted for potential confounds. This study examines associations between CU and several motivation indices among adolescents. We hypothesized that regular cannabis users would report lower motivation than light users, and that greater lifetime and past 30-day CU amounts would be associated with decreased motivation. Participants were 79 adolescents, ages 14-18, classified as recent regular cannabis users (n = 36) or light users (n = 43). Frequency and amount of substance use were assessed across participants' lifetime and during the past 30 days. Motivation was measured through the Apathy Evaluation Scale and Motivation and Engagement Scale. To examine associations between CU and our motivation indices, we conducted a series of two-step hierarchical multiple regressions. Variables found to correlate with any motivation measure were entered on step 1 (e.g., mental health, other substance use) and the relevant CU variable was entered on step 2. After controlling for confounds, no significant differences were observed between regular and light users on any motivation index, p > .01. Similarly, no associations between motivation and lifetime or past 30-day CU amount were observed, p > .01. Our findings do not support a link between reduced motivation and CU among adolescents after controlling for relevant confounds. Future studies will examine the levels of CU which influence motivation in adolescents, and the conditions under which this link becomes manifest.

Does Cannabis Use Cause Declines in Neuropsychological Functioning? A Review of Longitudinal Studies.

Cannabis use has been linked to impairments in neuropsychological functioning across a large and continually expanding body of research. Yet insight into underlying causal relations remains limited due to the historically cross-sectional nature of studies in this area. Recently, however, studies have begun to use more informative design strategies to delineate these associations. The aim of this article is to provide a critical evaluation and review of research that uses longitudinal designs to examine the link between cannabis use and neuropsychological functioning. In summarizing the primary findings across these studies, this review suggests that cannabis use leads to neuropsychological decline. However, across most studies, these associations were modest, were present only for the group with the heaviest cannabis use, and were often attenuated (or no longer significant) after controlling for potential confounding variables. Future studies with neuropsychological data before and after initiation of cannabis use, along with careful measurement and control of "shared risk factors" between cannabis use and poorer neuropsychological outcomes, are needed to better understand who, and under what conditions, is most vulnerable to cannabis-associated neuropsychological decline. (JINS, 2017, 23, 893-902).

An exploratory follow-up study of cannabis use and decision-making under various risk conditions within adolescence.

OBJECTIVE: Studies examining the associations between decision-making (DM) and cannabis use (CU) often use cross-sectional, adult samples, and composite scores or single tasks to assess DM. The present study explored differential associations between tasks assessing DM under various risk conditions (i.e., ambiguous vs. explicit; gain vs. loss) and CU frequency, CU-related problems, and CU disorder (CUD) onset across a 2-year period within adolescence. METHOD: Adolescents (n = 401, 90% Hispanic) aged 14-17 at baseline participated in five biannual assessments. CU frequency, CU-related problems, and CUD were assessed using the Drug Use History Questionnaire, Marijuana Problems Scale, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, respectively. DM was assessed using the Iowa gambling task (IGT), Game of Dice Task (GDT), and Cups Task. We used latent growth curve modeling to examine bidirectional associations between DM and escalation in CU frequency and CU-related problems, and discrete time survival analyses to determine whether baseline performance across DM tasks predicted CUD onset. RESULTS: Baseline performance on the GDT predicted greater escalation in CU (ß = .200, p = .008) and CU-related problems (ß = .388, p = .035). No other significant associations were found. CONCLUSIONS: DM under explicit risk may be a more salient risk factor for escalating CU and CU-related problems than DM under ambiguous risk. Deficits in executive functioning could partially explain the results. Findings suggest that neurocognitive development should inform prevention and intervention efforts focused on reducing CU. Given the exploratory nature of the present study, replication of findings is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risky decision-making as an antecedent or consequence of adolescent cannabis use: findings from a 2-year longitudinal study.

BACKGROUND AND AIMS: Although poor decision-making (DM) has been correlated with problematic cannabis use (CU), cross-sectional designs make it difficult to determine whether poor DM represents an antecedent and/or consequence of CU. The current study measured bidirectional associations between CU and DM among adolescents over 2 years and compared these findings to those observed with episodic memory, which is consistently reported as a consequence of CU. We also measured the role of DM as a risk factor for cannabis use disorder (CUD) onset. DESIGN: Two-year longitudinal study with five bi-annual assessments. PARTICIPANTS: Participants were 401 adolescents aged 14-17 years at baseline. SETTING: Miami, Florida, USA. MEASUREMENTS: CU frequency and CUDs were assessed at each time-point through the Drug Use History Questionnaire and Structured Clinical Interview for DSM-IV, respectively. Neurocognition was assessed at odd time-points throughout the Iowa Gambling Task, Game of Dice Task and Cups Task [decision-making (DM)] and the Wechsler Memory Scale IV and California Verbal Learning Test II (episodic memory). We used latent growth curve modeling to examine bidirectional influences between CU and neurocognition over time. We applied discrete time survival analyses to determine whether baseline DM predicted CUD onset. FINDINGS: Greater lifetime CU frequency was associated with poorer episodic memory at baseline (bs = -14.84, -16.44, Ps = 0.038, 0.021). Greater CU escalation predicted lesser gains in immediate episodic memory (b = -0.05, P = 0.020). Baseline DM did not predict CU escalation (b = 0.07, P = 0.421), nor did escalation in CU predict changes in DM (b = 0.02, P = 0.352). Baseline DM also did not predict CUD onset (adjusted OR = 1.01, 95% confidence interval = 0.98-1.06). CONCLUSIONS: This study replicates findings that poorer episodic memory in adolescents appears to be a consequence of cannabis use, even among adolescents at earlier stages of use. Poor decision-making does not appear to be either a consequence of or a risk factor for escalating cannabis use or onset of cannabis use disorder among adolescents.

Nicotine treatment buffers negative behavioral consequences induced by exposure to physical and emotional stress in adolescent male mice.

Early life stress influences adult psychopathology and is associated with an increase in the propensity for drug use/seeking throughout the lifespan. Animal models corroborate that stress exposure exacerbates maladaptive reactivity to stressful stimuli while also shifting the rewarding properties of many drugs of abuse, including nicotine (NIC), a stimulant commonly misused by adolescents. Interestingly, NIC treatment can also normalize some stress-induced behavioral deficits in adult rodents; however, little is known about NIC's therapeutic efficacy following stress experienced during adolescence. The goal of the following experiments was to elucidate NIC's ability to buffer the negative consequences of stress exposure, and to further assess behavioral responsivity while on the drug. Given that stress often occurs in both physical and non-physical forms, we employed the vicarious social defeat stress (VSDS) model which allows for investigation of both physical (PS) and emotional stress (ES) exposure. After 10 days, exposure to PS and ES decreased interaction with a social target in the social interaction test (SIT), confirming social avoidance. Groups were further divided and given NIC (0.0 or 160 mg/L) in their drinking water. After 1 month of NIC consumption, the mice were exposed to the SIT, elevated plus maze (EPM), and the forced swim test (FST), respectively. NIC-treated mice showed a reversal of stress-induced deficits in the EPM and FST. Surprisingly, the mice did not show improvement in the SIT regardless of treatment condition. Together, these data confirm NIC's ability to normalize some stress-induced behavioral deficits; however, NIC's effects on social behavior need further investigation.

Risky sexual behavior among adolescents: The role of decision-making, problems from cannabis use and externalizing disorder symptoms.

INTRODUCTION: Previous research has demonstrated that externalizing symptoms, cannabis use problems, and poor decision-making abilities are each independently related to risky sexual behavior (RSB). However, few studies have examined the joint effect of these factors on RSB among a sample of adolescents. METHODS: The current study addresses this gap in the literature by examining how externalizing disorder symptoms, cannabis use, and decision-making abilities interact to predict RSB among a sample of adolescents (n = 204; Mage = 15.5) at-risk for escalation in cannabis use. Poisson regression was used for all analyses, and simple slope difference tests were used for all post-hoc analyses. RESULTS: A greater number of externalizing symptoms, more problems from cannabis use, and more risk disadvantageous choices on the Cups Task (CT) total trials and more risk disadvantageous choices on the CT-gain trials predicted greater RSB endorsement. Findings also highlight significant interactions between cannabis use problems and CT-total and -gain trial performance, as well as between cannabis use problems and externalizing symptoms in predicting RSB. CONCLUSION: Current treatment and prevention approaches to reduce RSB among adolescents may benefit from incorporating techniques that improve decision-making skills.

Adolescent cannabis use and its associations with decision-making and episodic memory: Preliminary results from a longitudinal study.

OBJECTIVE: Impairments in neurocognitive functioning, including memory and executive functions, have been identified among adult cannabis users; however, less is known about the effects of cannabis use (CU) among adolescent users. Delineating the directionality of associations between CU and neurocognition has been restricted due to the relatively few longitudinal studies examining this question. As such, we examined whether decision-making prospectively predicted CU, and whether increases in CU were associated with changes in decision-making and episodic memory among a sample consisting predominantly of adolescent cannabis users. METHOD: Adolescents (n = 401), aged 14-17 at baseline, completed 3 (biannual) assessments across a 1-year period. Latent growth curve analyses in structural equation models were conducted to examine potential associations between decision-making and growth in CU, and associations between change in CU and change in decision-making or episodic memory performance. RESULTS: Significant cross-sectional associations were observed between greater CU and poorer decision-making and episodic memory performance (p < .05), consistent with our hypotheses and prior findings. However, decision-making performance did not predict change in CU frequency across 1 year. Neither was change in decision-making associated with changes in CU. However, increasing cannabis use was associated with worsening immediate (but not delayed) episodic memory. CONCLUSIONS: Our findings suggest that poorer decision-making does not put teens at relatively early stages of cannabis use at risk for further escalation in use over one year. However, increasing cannabis use over the same period was associated with declines in immediate memory. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transition to drug co-use among adolescent cannabis users: The role of decision-making and mental health.

BACKGROUND: Co-use of cannabis and drugs other than cannabis (DOTC) influences the risk of experiencing cannabis disorders. Accordingly, we explored whether speed of transition to drug co-use, the number of DOTC used, and/or being an experimental cannabis-only user, a regular cannabis-only user, or a regular cannabis user who co-uses DOTC (i.e., cannabis-plus user) were associated with decision-making (DM), mental health disorder symptoms, or cannabis use-related characteristics. METHODS: We analyzed baseline data from a sub-sample of 266 adolescent (ages 14 to 16) cannabis users (CU) participating in an ongoing longitudinal study. Assessments included semi-structured interviews, self-report questionnaires, and measures of drug use, DM (measured via the Iowa Gambling Task), mental health disorders, and cannabis use-related problems. RESULTS: Endorsing a larger number of mood disorders symptoms was associated with being a regular cannabis-plus user rather than a regular cannabis-only user (AOR = 1.08, C.I.95% 1.01, 1.15). Poorer DM was associated with a faster transition to co-use, such that for each one unit increase in DM performance, the years to onset of drug co-use increased by 1% (p = 0.032). Endorsing a larger number of cannabis use-related problems was positively associated with endorsing a larger number of DOTC used (p = 0.001). CONCLUSIONS: This study provides new evidence on the process of drug co-use among CU. Specifically, mood disorder symptoms were associated with use of DOTC among regular CU. Furthermore, poorer DM was associated with a faster transition to drug co-use. Poorer DM and mood disorder symptoms may aggravate or accelerate the onset of adverse consequences among adolescent CU.