Do anxiety symptoms and coping motives serially mediate the association between psychotic-like experiences and cannabis-related problems in undergraduate recent cannabis users?

Many Canadian emerging adults (ages 18-25 years) use cannabis, with 60 % of past-three-month users experiencing one or more cannabis-related problems (i.e., adverse consequences of use). While psychotic-like experiences (PLEs) and cannabis problems overlap, little is known about the mechanisms explaining this link. One hypothesis is that PLEs are distressing and give rise to anxiety, with which emerging adults attempt to cope through increased cannabis use, in turn increasing their risk for cannabis-related problems. We tested a chained-mediational model to determine if anxiety and coping-with-anxiety motives for cannabis use sequentially mediated the link between PLEs and cannabis problems in emerging adult undergraduates; a conditional process model tested for moderation by sex. Emerging adult cannabis users (N = 413; mean [SD] age = 19.1 [1.5] years; 71.9 % female) from five Canadian universities provided cross-sectional, self-report survey data in fall 2021. Validated measures of PLEs, anxiety, cannabis coping-with-anxiety motives, and cannabis-related problems were administered. Path analyses supported the hypothesized chained mediational indirect effect (b = 0.027, 95 % bootstrap CI [0.012, 0.050]). No direct effect was found (p =.698), suggesting that the PLEs-to-cannabis problems association is fully explained by anxiety and cannabis coping-with-anxiety motives. Inconsistent with hypotheses, mediation did not depend on sex (95 % CIs crossed zero); therefore, anxiety and cannabis coping-with-anxiety motives explain the link between PLEs and cannabis problems in emerging adults regardless of their sex. Results highlight anxiety and cannabis coping-with-anxiety motives as potentially important intervention targets in cannabis-using emerging adults with PLEs, possibly preventing the development/worsening of cannabis-related problems.

Do Anxiety Symptoms Mediate the Association Between Cannabis Use Frequency and Psychotic-Like Experiences in Emerging Adult Undergraduates?

OBJECTIVE: Cannabis is commonly used by Canadian emerging adults (ages 18-25 years), many of whom attend post-secondary institutions. Frequent cannabis use is linked with psychotic-like experiences (PLEs); however, the exact nature of this association remains unclear. Anxiety symptoms may mediate this association, as they are prevalent in emerging adults and have been independently linked with both cannabis use and PLEs. Past work found that anxiety mediated the association between cannabis use frequency and attenuated positive psychotic symptoms (further along the psychosis continuum than PLEs), however this research had yet to be validated in the Canadian population, and trait rather than state anxiety (frequency of anxiety symptoms) was studied. Thus, our primary objective was to examine if anxiety symptoms mediated the association between cannabis use frequency and PLEs in Canadian emerging adult undergraduates. Despite known sex differences in cannabis use, expression of anxiety, and PLEs, past work did not evaluate the potential impact of biological sex on the anxiety-mediated model, and thus is the secondary objective of the present study. METHODS: 1,266 first-/second-year emerging adult undergraduates from five Canadian universities provided cross-sectional, self-report survey data in fall 2021 semester. Validated measures of cannabis use frequency, anxiety, and PLEs were administered. RESULTS: Path analyses supported mediation from cannabis use to PLEs through anxiety (b = 0.07, P < 0.001, 95% bootstrap CI [0.03, 0.10]). No direct effect was found (P = 0.457), suggesting that the cannabis-to-PLEs association was mediated by anxiety. Mediation did not depend on biological sex (i.e., bootstrapped 95% CIs crossed zero). CONCLUSIONS: Anxiety symptoms mediated the association between cannabis use and PLEs in emerging adults regardless of their biological sex. Assuming replication in prospective research, results highlight anxiety as an important intervention target in frequent cannabis-using emerging adults, to potentially prevent development/worsening of PLEs, and in turn psychotic illness.

Cognitions mediate the influence of personality on adolescent cannabis use initiation.

Aims: Much research indicates that an individual's personality impacts the initiation and escalation of substance use and problems in youth. The acquired-preparedness model suggests that personality influences substance use by modifying learning about substances, which then affects substance use. The current study used longitudinal data to test whether automatic cannabis-related cognitions (memory associations and outcome expectancy liking) mediate the relationship between four personality traits with later cannabis use. Methods: The study focused on initiation of use in a sample of adolescents who had not previously used (n = 670). Results: A structural equation model supported a full mediation effect and the hypothesis that personality affects cannabis use in youth by influencing automatic memory associations and outcome expectancy liking. Further findings from the same model also indicated a mediation effect of these cognitions in the relationship between age and cannabis use. Conclusion: The findings of the study support the acquired-preparedness model where personality influences automatic associations in the context of dual-processing theories of substance use.

Automatic cognitions as mediators of parental influence on adolescent cannabis use.

AIMS: Multiple social influences affect cannabis use in adolescents, including parental and peer cannabis use norms. However, the mechanisms of influence underlying these social influences remain unclear. Recent studies have suggested that cognitions about cannabis use and the effects of cannabis may mediate social influences. The current study explored the relationship between automatic self-generated cognitions and their relationship with parental influences on cannabis use in a sample of n = 675 11 to 16-year-old adolescents over three years (Mean Age: 13.96, SD = 0.88, 56.4% female). METHODS: Participants reported perceptions of parental cannabis use and completed a cannabis word association task (CWAT), an open-ended cannabis outcome expectancy liking (COEL) task, and measures of cannabis use in the past year. RESULTS: Perceived parental use did not directly predict cannabis use two years later. However, a latent construct loading on both CWAT and COEL scores strongly predicted cannabis use over the following year. Structural modelling demonstrated that the association between previous cannabis use and parental cannabis use and adolescents' cannabis use over the next two years was fully mediated by cognitions. CONCLUSION: The results of the study are discussed and interpreted through the lens of dual-process theories.

Shifting patterns of variance in adolescent alcohol use: Testing consumption as a developing trait-state.

While average rates of change in adolescent alcohol consumption are frequently studied, variability arising from situational and dispositional influences on alcohol use has been comparatively neglected. We used variance decomposition to test differences in variability resulting from year-to-year fluctuations in use (i.e., state-like) and from stable individual differences (i.e., trait-like) using data from the Project on Adolescent Trajectories and Health (PATH), a cohort-sequential study spanning grades 7 to 11 using three cohorts starting in grades seven, eight, and nine, respectively. We tested variance components for alcohol volume, frequency, and quantity in the overall sample, and changes in components over time within each cohort. Sex differences were tested. Most variability in alcohol use reflected state-like variation (47-76%), with a relatively smaller proportion of trait-like variation (19-36%). These proportions shifted across cohorts as youth got older, with increases in trait-like variance from early adolescence (14-30%) to later adolescence (30-50%). Trends were similar for males and females, although females showed higher trait-like variance in alcohol frequency than males throughout development (26-43% vs. 11-25%). For alcohol volume and frequency, males showed the greatest increase in trait-like variance earlier in development (i.e., grades 8-10) compared to females (i.e., grades 9-11). The relative strength of situational and dispositional influences on adolescent alcohol use has important implications for preventative interventions. Interventions should ideally target problematic alcohol use before it becomes more ingrained and trait-like.

Childhood Maltreatment and Development of Substance Use Disorders: A Review and a Model of Cognitive Pathways.

Exposure to childhood maltreatment (CM) is associated with increased risk for developing substance use disorders (SUDs). CM exerts negative effects on cognitive abilities including intellectual performance, memory, attention, and executive function. Parallel cognitive impairments have been observed in SUDs. Hence, limited studies have examined the mediating effect of cognitive impairments in the relationship between CM and SUDs. In addition, most studies used concurrent self-report assessments in adult populations. Longitudinal studies that investigated the long-term consequences of CM on psychopathology, including SUDs, throughout childhood, adolescence, and adulthood are rare. Thus, the underlying developmental pathways between CM and SUDs are not clearly understood. In this article, we review the evidence that cognitive impairments mediate, at least in part, the relationship between CM and development of SUDs and propose a model that explains how CM increases the risk for SUDs through the development of a cognitive framework of vulnerability.

Outcome expectancy liking: a self-generated, self-coded measure predicts adolescent substance use trajectories.

This study tested the predictive validity of a novel, brief, and easy-to-use self-report measure of expectancies and their subjective values for alcohol and marijuana use. Canadian students in Grades 7 to 11 were administered paper-and-pencil questionnaires once per year for 3 consecutive years (Krank et al., 2011). As part of the questionnaire, participants completed an outcome expectancy measure where they were asked to list 3 or 4 things they expected would happen if they used a particular substance (i.e., alcohol, marijuana) and to indicate for each whether they would or would not like this outcome. "Liking" outcomes were coded as +1, "not like" as -1, and summed to obtain an outcome expectancy liking (OEL) sum for each participant and each substance. Participants also completed substance use behavior questions for alcohol and marijuana. Multilevel modeling demonstrated that OEL sum significantly predicted the intercept and slope of substance use trajectories by participants, even when demographic variables were controlled. For both alcohol and marijuana, multilevel modeling analyses indicated that a more positive OEL sum for a substance in the first year of the study were more likely to have tried that substance earlier (intercept) and were more likely to escalate their use at a greater rate over time (slope). The results complement the predictive validity found with other direct and indirect measures of substance use associations. The outcome expectancy liking task is a simple and unobtrusive method for identifying adolescents who are at risk for early substance abuse.

Self-coded indirect memory associations and alcohol and marijuana use in college students.

Indirect memory associations for substance use predict both the concurrent and prospective levels of substance use. These methods assess spontaneous, possibly implicit, and easily accessible associations that predict substance use over direct (explicit) methods of assessment (e.g., outcome expectancies). The present study tested and expanded the application of a coding method for alcohol and marijuana associations on the basis of self-coding of indirect responses (Frigon & Krank, 2009). College students generated free associates to (1) ambiguous words (e.g., draft or weed), (2) situations (e.g., at a party, hanging out with friends), and (3) emotions (having fun, feeling dreamy). Later, participants were shown their responses and were asked to code their responses according to both nonrisk and risk activities, such as alcohol and marijuana use. Self-coded scores were higher than researcher-coded scores, captured the same variance, and improved the prediction of substance use. Self-coding of indirect memory associations provides accurate and efficient prediction of the level of alcohol and marijuana. Self-coding is efficient and may be useful for reducing ambiguities in coding of many different kinds of open-ended responses.

Paradoxical effects of alcohol information on alcohol outcome expectancies.

BACKGROUND: Cognitive associations with alcohol predict both current and future use in youth and young adults. Much cognitive and social cognitive research suggests that exposure to information may have unconscious influences on thinking and behavior. The present study assessed the impact of information statements on the accessibility of alcohol outcome expectancies. METHODS: The 2 studies reported here investigated the effects of exposure to alcohol statements typical of informational approaches to prevention on the accessibility of alcohol outcome expectancies. High school and university students were presented with information statements about the effects of alcohol and other commercial products. The alcohol statements were taken from expectancy questionnaires. Some of these statements were presented as facts and others as myths. The retention of detailed information about these statements was manipulated by (i) divided attention versus focused attention or (ii) immediate versus delayed testing. Accessibility of personal alcohol outcome expectancies was subsequently measured using an open-ended question about the expected effects of alcohol. RESULTS: Participants reported more alcohol outcomes seen during the information task as personal expectations about the effects of alcohol use than similar unseen items. Paradoxically, myth statements were also more likely to be reported as expectancies than unseen items in all conditions. Additionally, myth statements were generated less often than fact statements only under the condition of immediate testing with strong content processing instructions. CONCLUSIONS: These observations are consistent with findings from cognitive research where familiarity in the absence of explicit memory can have an unconscious influence on performance. In particular, the exposure to these items in an informational format increases accessibility of the seen items even when the participants were told that they were myths. The findings have implications for the development of effective prevention materials.

Self-coded indirect memory associations in a brief school-based intervention for substance use suspensions.

This study assessed the concurrent validity of self-generated and self-coded substance use associations for marijuana and alcohol use. Grades seven to twelve students were assessed as part of a brief intervention program in lieu of suspension for substance use infractions in school. During the cognitive assessment, students generated memory associations to probes for high-risk situations and desirable outcomes. Later, the participant rated their responses according to categories including both non-risk and substance use. Three different coding methods were compared: (1) conservative codes using clearly unambiguous responses, (2) liberal scores adding ambiguous, but likely responses, and (3) self-coded. Self-coded scores were higher, had stronger correlations with substance use, and were better predictors of substance use and problems than either conservative or liberal coded scores. These findings suggest that self-coding may be used to improve concurrent validity, decrease ambiguities in coding, and reduce the cost of measuring memory associations. The present method promises a cost effective and valid measure of indirect substance use cognitions that can be readily adapted for interventions.

Goal- and signal-directed incentive: conditioned approach, seeking, and consumption established with unsweetened alcohol in rats.

RATIONALE: Many theories of addictive behavior propose that cues signaling drug administration influence the likelihood of drug-taking and drug-seeking behavior. OBJECTIVES: We investigated the behavioral impact of cues associated with unsweetened ethanol and their interaction with responding maintained by ethanol self-administration. Our goal was to establish the influence of such cues on ethanol seeking. MATERIALS AND METHODS: The experiment used a matching contingency and saccharin-fading procedure to establish equal levels of responding to two spatially distinct levers using unsweetened 10% ethanol solution. After ethanol self-administration was established, a brief cue light located alternately over each lever location was either paired or unpaired (control) with the opportunity to consume the same ethanol solution. Finally, self-administration was re-established, and the effect of the cue was measured in a transfer design. RESULTS: The reaction to lights paired with the opportunity to ingest unsweetened ethanol had three main effects: (1) induction of operant behavior reinforced by ethanol, (2) stimulation of ethanol-seeking behavior (drinker entries), and (3) cue-directed approach and contact behavior (i.e. autoshaping or sign-tracking). Cue-directed behavior to the light interacted with choice behavior in a manner predicted by the location of the cue light, enhancing responding only when the approach response did not interfere with the operant response. CONCLUSIONS: These findings replicate and extend the effects of Pavlovian conditioning on ethanol-seeking and support-conditioned incentive theories of addictive behavior. Signals for ethanol influence spatial choice behavior and may be relevant to attentional bias shown to alcohol-associated stimuli in humans.

Pavlovian conditioning with ethanol: sign-tracking (autoshaping), conditioned incentive, and ethanol self-administration.

BACKGROUND: Conditioned incentive theories of addictive behavior propose that cues signaling a drug's reinforcing effects activate a central motivational state. Incentive motivation enhances drug-taking and drug-seeking behavior. We investigated the behavioral response to cues associated with ethanol and their interaction with operant self-administration of ethanol. METHODS: In two experiments, rats received operant training to press a lever for a sweetened ethanol solution. After operant training, the animals were given Pavlovian pairings of a brief and localized cue light with the sweetened ethanol solution (no lever present). Lever pressing for ethanol was then re-established, and the behavioral effects of the cue light were tested during an ethanol self-administration session. RESULTS: The conditioned responses resulting from pairing cue lights with the opportunity to ingest ethanol had three main effects: (1) induction of operant behavior reinforced by ethanol, (2) stimulation of ethanol-seeking behavior (magazine entries), and (3) signal-directed behavior (i.e., autoshaping, or sign-tracking). Signal-directed behavior interacted with the other two effects in a manner predicted by the location of the cue light. These conditioned responses interact with operant responding for ethanol reinforcement. CONCLUSIONS: These findings demonstrate the importance of Pavlovian conditioning effects on ethanol self-administration and are consistent with conditioned incentive theories of addictive behavior.

Environmental context conditioning with ethanol reduces the aversive effects of ethanol in the acquisition of self-administration in rats.

RATIONALE: Many recent theoretical approaches to drug-taking behavior feature a role for Pavlovian conditioning. Despite growing evidence for that role, the particular contributions of Pavlovian conditioning to self-administration are not clear. For example, few studies have addressed the effects of Pavlovian conditioning on the acquisition of self-administration. OBJECTIVES: The purpose of this study was to test the effect of Pavlovian conditioning with an environmental conditioned stimulus and an ethanol unconditioned stimulus on the acquisition of self-administration reinforced by ethanol. METHODS: Rats were either given ethanol by gastric gavage in a distinctive context or in their home cage. All animals were then trained to bar press on a variable interval schedule for a sweetened ethanol solution in the distinctive context. RESULTS: Animals that had received ethanol associated with the training context maintained a higher level of bar press behavior for ethanol as the reinforcing solution. This effect developed only after the first session and resulted from differences in response rates, but did not affect the rate of reinforcement. CONCLUSIONS: This study demonstrates that an environmental context signaling the effects of ethanol maintains a higher operant response rate when ethanol is used subsequently as a reinforcer. This finding replicates previous reports of Pavlovian conditioning effects on ethanol consumption. The specific pattern of results suggests that conditioned tolerance modifies the reinforcing impact of ethanol. Context conditioning with ethanol reduces the aversive impact of initial ethanol consumption and maintains the reinforcing value of the ethanol solution.