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CORK Bibliography: Marijuana

98 citations. June 2011 to present

Prepared: December 2011

Abadi MH; Shamblen SR; Thompson K; Collins DA; Johnson K. Influence of risk and protective factors on substance use outcomes across developmental periods: A comparison of youth and young adults. Substance Use & Misuse 46(13): 1604-1612, 2011. (47 refs.)

Data were collected from samples of youth (ages 11-18; N = 38,268) and young 10 adults (ages 18-24; N = 602) across 30 Tennessee counties using surveys and telephone interviews conducted in 2006-2008. Data were analyzed using hierarchical nonlinear modeling to determine: (1) which risk and protective factors predicted alcohol and marijuana use, and (2) whether predictors differed as a function of developmental period. Findings provide preliminary evidence that prevention efforts need to take into consideration the changing environment and related influences as youth age, especially as they move from a more protected community environment to one where they live somewhat independently. Implications and limitations are discussed.

Agrawal A; Scherrer JF; Lynskey MT; Sartor CE; Grant JD; Haber JR et al. Patterns of of use, sequence of onsets and correlates of tobacco and cannabis. Addictive Behaviors 36(12): 1141-1147, 2011. (48 refs.)

Background: While most individuals initiate their use of tobacco prior to onset of cannabis use, recent reports have identified a smaller subset of youth who report onset of cannabis use prior to tobacco use. In this study, we characterize patterns of cannabis and tobacco use (tobacco but not cannabis, cannabis but not tobacco or both) and compare the factors associated with onset of tobacco before cannabis and cannabis before tobacco. Methods: Data on 1812 offspring aged 12-32 years, drawn from two related offspring of Vietnam Era twin studies, were used. Individuals were divided into tobacco but not cannabis (T), cannabis but not tobacco (C) and users of both substances (CT). Those who used both could be further classified by the timing of onset of tobacco and cannabis use. Multinomial logistic regression was used to characterize the groups using socio-demographic and psychiatric covariates. Furthermore, data on parental smoking and drug use was used to identify whether certain groups represented greater genetic or environmental vulnerability. Results: 22% (N = 398) reported T, 3% (N = 55) reported C and 44% reported CT (N = 801). Of the 801 CT individuals, 72.8% (N = 583), 9.9% (N = 77) and 17.3% (N = 139) reported onset of tobacco before cannabis, cannabis before tobacco and onsets at the same age. C users were as likely as CT users to report peer drug use and psychopathology, such as conduct problems while CT was associated with increased tobacco use relative to T. Onset of tobacco prior to cannabis, when compared onset of cannabis before tobacco or reporting initiation at the same age was associated with greater cigarettes smoked per day, however no distinct factors distinguished the group with onset of cannabis before tobacco from those with initiation at the same age. Conclusion: A small subset of individuals report cannabis without tobacco use. Of those who use both cannabis and tobacco, a small group report cannabis use prior to tobacco use. Follow-up analyses that chart the trajectories of these individuals will be required to delineate their course of substance involvement.

Alessi SM; Rash C; Petry NM. Contingency management is efficacious and improves outcomes in cocaine patients with pretreatment marijuana use. Drug and Alcohol Dependence 118(1): 62-67, 2011. (41 refs.)

Background: Marijuana use is common in patients seeking treatment for cocaine use. Nevertheless, few studies have examined effects of marijuana use on treatment outcomes in general, and even fewer with respect to contingency management (CM) treatment, which has been criticized for potentially increasing non-reinforced drug use. Methods: Data from three randomized clinical trials of CM versus standard treatment (ST) in cocaine-abusing patients were examined (Petty et al., 2004, 2005a, 2006a; N = 393) to assess effects of pretreatment marijuana use on outcomes. Patients were divided into two groups: (1) no self-reported marijuana use (No Pre-M; n = 315) and (2) any self-reported marijuana use (Pre-M; n = 78) in the 30 days pretreatment. Results: CM was especially efficacious in enhancing retention in Pre-M patients such that retention nearly doubled among Pre-M patients assigned to CM versus those assigned to ST. In contrast, CM exerted only modest benefits on retention in No Pre-M patients. Pretreatment marijuana use was not related to during-treatment abstinence from cocaine, opioids, and alcohol, or abstinence at a Month 9 follow-up. However, CM treatment and longest duration of abstinence achieved during treatment were significant predictors of Month 9 abstinence. Pre-M patients also evidenced more improvements in drug problems over time when randomized to CM. Conclusions: CM was especially efficacious in facilitating retention and improving severity of drug-related problems in those who used marijuana in the month before initiating treatment.

Alexander D; Leung P. The DSM Guided Cannabis Screen (DSM-G-CS): Description, reliability, factor structure and empirical scoring with a clinical sample. Addictive Behaviors 36(11): 1095-1100, 2011. (35 refs.)

Clinicians need cannabis-specific diagnostic screens compatible with DSM-IV-TR and proposed DSM-5. A clinical sample (n = 174) completed the DSM-Guided-Cannabis Screen (DSM-G-CS) 21 and 11 criteria versions and three drug comparison measures. DSM-G-CS descriptive statistics, reliabilities, three factor analyses, and eight ROC and discriminant analyses evaluated construct validity and empirical scoring. DSM-G-CS reliabilities are .88 (21-items) and .85 (11-criteria). Factor analyses (FA) with varimax rotation derived six and three factors explaining 62% to 60% of variances for the DSM-G-CS 21 and 11 respectively, with >= 400 loadings supporting retention of all items. Cannabis withdrawal subscale reliability .952 (10-items) and FA supported one factor composite item. ROC and discriminant analyses supports DSM-G-CS 1.5 to 2.5 scoring cutoffs as empirically sound, based upon sensitivity-specificity maximums, accuracy probabilities, confidence levels and correctly classified percentages, optimal with Marijuana Screening Inventory (MSI) comparisons. Results support DSM-G-CS construct validity, empirical scoring and compatibility with DSM-IV-TR cannabis abuse or dependence and proposed DSM-5 cannabis use disorder diagnostic models. Clinically, DSM-G-CS scores of two to three (or more) suggest probable cannabis-use disorder, deserving assessment to determine diagnostic accuracy.

Alwan H; Viswanathan B; Rousson V; Paccaud F; Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Pediatrics 11: 85, 2011. (42 refs.)

Background: We examined the associations between substance use (cigarette smoking, alcohol drinking, and cannabis use) and psychosocial characteristics at the individual and family levels among adolescents of the Seychelles, a rapidly developing small island state in the African region. Methods: A school survey was conducted in a representative sample of 1432 students aged 11-17 years from all secondary schools. Data came from a self-administered anonymous questionnaire conducted along a standard methodology (Global School-based Health Survey, GSHS). Risk behaviors and psychosocial characteristics were dichotomized. Association analyses were adjusted for a possible classroom effect. Results: The prevalence of cigarette smoking, alcohol drinking and cannabis use was higher in boys than in girls and increased with age. Age-adjusted and multivariate analyses showed that several individual level characteristics (e. g. suicidal ideation and truancy) and family level characteristics (e. g. poor parental monitoring) were associated with substance use among students. Conclusions: Our results suggest that health promotion programs should simultaneously address multiple risk behaviors and take into account a wide range of psychosocial characteristics of the students at the individual and family levels.

Alwan H; Viswanathan B; Rousson V; Paccaud F; Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Pediatrics 11: 85, 2011. (42 refs.)

Andrade T; Santiago L; Amari E; Fischer B. 'What a pity!' - Exploring the use of 'pitilho' as harm reduction among crack users in Salvador, Brazil. Drugs: Education, Prevention and Policy 18(5): 382-386, 2011. (34 refs.)

Aims: The aim of this study was to explore the use of 'pitilho' (the co-smoking of crack and marijuana in a cigarette-like form) among crack users in Salvador, Brazil as a potential harm reduction measure. Methods: In-depth interviews were conducted with two outreach workers who frequently encountered the use of 'pitilho' as part of their community outreach programme work, as well as four 'pitilho' users who were clients of the programme. Daily field notes were also collected. Transcribed data were analysed for common reasons for 'pitilho' use. Findings: Several key reasons crack users have adopted the 'pitilho' as a harm reduction tool were uncovered: it was reported to reduce the negative pharmaco-behavioural and physical effects of crack use, is more economical, provides users with better control over their behaviours, and decreases their vulnerability for violence and betters their subcultural position. Conclusions: 'Pitilho' may offer several relevant short-term benefits to users and therefore may constitute a potentially important 'harm reduction' tool in an area where little other targeted prevention measures exist. Our exploratory data need to be investigated in depth by appropriate and rigorous methods.

Armentia A; Castrodeza J; Ruiz-Munoz P; Martinez-Quesada J; Postigo I; Herrero M et al. Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users. Allergologia et Immunopathologia 39(5): 271-279, 2011. (21 refs.)

Background: Cannabis is the illicit drug most widely used by young people in high-income countries. Allergy symptoms have only occasionally been reported as one of the adverse health effects of cannabis use. Objectives: To study IgE-mediated response to cannabis in drug users, atopic patients, and healthy controls. Methods: Asthmatic patients sensitised to pollen, and all patients sensitised to tobacco, tomato and latex, considered as cross-reacting allergens, were selected from a data base of 21,582 patients. Drug users attending a drug-rehabilitation clinic were also included. Controls were 200 non-atopic blood donors. Specific IgE determination, prick tests and specific challenge with cannabis extracts were performed in patients and controls. Results: Overall, 340 patients, mean age 26.9 +/- 10.7 years, were included. Males (61.4%) were the most sensitised to cannabis (p < 0.001). All cannabis-sensitised patients were alcohol users. Eighteen (72%) of the patients allergic to tomato were sensitised to cannabis, but a positive specific challenge to cannabis was highest in patients sensitised to tobacco (13/21, 61.9%), (p < 0.001). Pollen allergy was not a risk factor for cannabis sensitisation. Prick tests and IgE for cannabis had a good sensitivity (92 and 88.1%, respectively) and specificity (87.1 and 96%) for cannabis sensitisation. Conclusions: Cannabis may be an important allergen in young people. Patients previously sensitised to tobacco or tomato are at risk. Cannabis prick tests and IgE were useful in detecting sensitisation.

Bogstrand ST; Normann PT; Rossow I; Larsen M; Morland J; Ekeberg O. Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department. Drug and Alcohol Dependence 117(2-3): 132-138, 2011. (28 refs.)

Background: Studies have found a high prevalence of both alcohol and other impairing psychoactive drugs in injured patient populations. The aim of this study was to assess the prevalence of potentially impairing psychoactive substances in all patients admitted to a hospital emergency department with injuries from accidents, assault or deliberate self harm. Methods: A total of 1272 patients over 18 years of age, admitted to the hospital within 12 h of injury, were included. Presence of alcohol was determined by an enzymatic method and other drugs by liquid chromatography-mass spectrometry (LC-MS) or gas chromatography-mass spectrometry (GC-MS), both highly specific analytical methods for determining recent intake. Results: There were 510(40%) women in the sample. Of the patients, 38% of the women and 48% of the men had a positive blood sample for psychoactive substances on admission. The most prevalent psychoactive substance was alcohol (27%) with an average concentration of 1.5 g/kg. A further 21% of patients tested showed use of medicinal drugs, and 9% showed use of illicit substances. Cannabis was the most prevalent illicit drug (6.2%). Diazepam (7.4%) and zopiclone (5.3%) were the most prevalent medicinal drugs. In road traffic accidents, 25% of the car drivers had positive findings, about half of them for alcohol. Conclusion: Psychoactive substances were found in nearly half the patients admitted with injuries. The most common substance was alcohol. Alcohol was particularly related to violence, whereas medicinal drugs were most prevalent in accidents at home.

Boleda MR; Huerta-Fontela M; Ventura F; Galceran MT. Evaluation of the presence of drugs of abuse in tap waters. Chemosphere 84(11): 1601-1607, 2011. (44 refs.)

A total of seventy samples of drinking water were tested for non-controlled and illicit drugs. Of these, 43 were from Spanish cities, 15 from seven other European countries, three from Japan and nine from seven different Latin American countries. The most frequently detected compounds were caffeine, nicotine, cotinine, cocaine and its metabolite benzoylecgonine, methadone and its metabolite EDDP. The mean concentrations of non-controlled drugs were: for caffeine 50 and 19 ng L(-1), in Spanish and worldwide drinking water respectively and for nicotine 13 and 19 ng L. Illicit drugs were sparsely present and usually at ultratrace level (<1 ng L(-1)). For example, cocaine has mean values of 0.4 (Spain) and 0.3 ng L(-1) (worldwide), whereas for benzoylecgonine, these mean values were 0.4 and 1.8 ng L(-1), respectively. Higher concentrations of benzoylecgonine were found in Latin American samples (up to 15 ng L(-1)). No opiates were identified in any sample but the presence of methadone and EDDP was frequently detected. Total mean values for EDDP were 0.4 ng L(-1) (Spain) and 0.3 ng L(-1) (worldwide). Very few samples tested positive for amphetamines, in line with the reactivity of chlorine with these compounds. No cannabinoids, LSD, ketamine, fentanyl and PCP were detected.

Bonn-Miller MO; Vujanovic AA; Drescher KD. Cannabis use among military veterans after residential treatment for posttraumatic stress disorder. Psychology of Addictive Behaviors 25(3): 485-491, 2011. (40 refs.)

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (M(age) = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p < .05), even after accounting for the effects of length of treatment stay and frequency of cannabis use during the 2 months before treatment intake. Furthermore, post hoc analyses revealed that less change in PTSD avoidance/numbing and hyperarousal symptom severity during treatment was significantly predictive of a greater frequency of cannabis use at 4-month follow-up, after controlling for relevant covariates. Notably, these effects were specific to cannabis and were not found for the other substances examined among this sample, including alcohol and opiates. Implications of the findings are discussed with regard to the extant literature and future directions.

Brook JS; Lee JY; Finch SJ; Koppel J; Brook DW. Psychosocial factors related to cannabis use disorders. Substance Abuse 32(4): 242-251, 2011. (24 refs.)

The objective of this study was to explore the association between psychosocial risk and protective factors and cannabis use disorders (CUDs) in a cohort of African American and Puerto Rican young adults. A representative sample (N = 838) from the East Harlem area of New York City was assessed at 4 points in time (at mean ages 14.1, 19.2, 24.5, and 29.2). The psychosocial measures came from 6 domains: personality attributes, family, peer, work, neighborhood, and substance use. The psychosocial measures were assessed at each of the first 3 waves of the study, and CUDs were assessed at the fourth and final wave of the study. Multivariate logistic regression and a cumulative risk analysis were conducted. Increased psychological symptoms (odds ratio [OR] = 1.21; 95% confidence interval [CI], 1.05-1.39; P < .01), problems resulting from cannabis use (OR = 2.69; 95% CI, 1.33-5.46; P < .01), frequent arguments with one's partner (OR = 1.84; 95% CI, 1.09-3.10; P < .05), high levels of deviance (OR = 1.81; 95% CI, 1.21-2.71; P < .01), and frequent acts of violence directed toward the participant (OR = 1.19; 95% CI, 1.01-1.42; P < .05) were all associated with an increased risk for CUDs. An increase in the number of risks was associated with an increase in the probability of having CUDs at the fourth wave (again, at a mean age of 29.2). A decrease in the number of risk factors may lead to a decrease in CUDs.

Brook JS; Rubenstone E; Zhang C; Brook DW. Maternal predictors of comorbid trajectories of cigarette smoking and marijuana use from early adolescence to adulthood. Addictive Behaviors 37(1): 139-143, 2012. (24 refs.)

This is the first study to examine maternal predictors of comorbid trajectories of cigarette smoking and marijuana use from adolescence to adulthood. Participants (N=806) are part of an on-going longitudinal psychosocial study of mothers and their children. Mothers were administered structured interviews when participants were adolescents, and participants were interviewed at six time waves, from adolescence to adulthood. Mothers and participants independently reported on their relationships when participants were age 14.1 years. At each time wave, participants answered questions about their cigarette and marijuana use from the previous wave to the present. Latent growth mixture modeling determined the participants' membership in trajectory groups of comorbid smoking and marijuana use, from ages 14.1 to 36.6 years. Multivariate logistic regression was used to assess the association of maternal factors (when participants were adolescents) with participants' comorbid trajectory group membership. Findings showed that most maternal risk (e.g., mother-child conflict, maternal smoking) and protective (e.g., maternal affection) factors predicted participants' membership in trajectory groups of greater and lesser comorbid substance use, respectively. Clinical implications include the importance of addressing the mother-child relationship in prevention and treatment programs for comorbid cigarette smoking and marijuana use.

Bujarski SJ; Feldner MT; Lewis SF; Babson KA; Trainor CD; Leen-Feldner Ellen et al. Marijuana use among traumatic event-exposed adolescents: Posttraumatic stress symptom frequency predicts coping motivations for use. Addictive Behaviors 37(1): 53-59, 2012. (49 refs.)

Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age)=15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.

Casadio P; Fernandes C; Murray RM; Di Forti M. Cannabis use in young people: The risk for schizophrenia. (review). Neuroscience and Biobehavioral Reviews 35(8, special isssue): 1779-1787, 2011. (131 refs.)

Cannabis is one of the most commonly used illicit drugs, and despite the widely held belief that it is a safe drug, its long-term use has potentially harmful consequences. To date, the research on the impact of its use has largely been epidemiological in nature and has consistently found that cannabis use is associated with schizophrenia outcomes later in life, even after controlling for several confounding factors. While the majority of users can continue their use without adverse effects, it is clear from studies of psychosis that some individuals are more vulnerable to its effects than others. In addiction, evidence from both epidemiological and animal studies indicates that cannabis use during adolescence carries particular risk. Further studies are warranted given the increase in the concentration of the main active ingredient (Delta(9)-tetrahydrocannabinol) in street preparations of cannabis and a decreasing age of first-time exposure to cannabis.

Cascone P; Zimmermann G; Auckenthaler B; Robert-Tissot C. Cannabis dependence in Swiss adolescents: Exploration of the role of anxiety, coping styles, and psychosocial difficulties. Swiss Journal of Psychology 70(3): 129-139, 2011. (71 refs.)

This naturalistic cross-sectional study explores how and to what extent cannabis dependence was associated with intrapersonal aspects (anxiety, coping styles) and interpersonal aspects of adolescent functioning (school status, family relationships, peer relationships, social life). A convenience sample of 110 adolescents (aged 12 to 19) was recruited and subdivided into two groups (38 with a cannabis dependence and 72 nondependent) according to DSM-IV-TR criteria for cannabis dependence. Participants completed the State-Trait Anxiety Inventory (STAI-Y), the Coping Across Situations Questionnaire (CASQ), and the Adolescent Drug Abuse Diagnosis (ADAD) interview investigating psychosocial and interpersonal problems in an adolescent's life. Factors associated with cannabis dependence were explored with logistic regression analyses. The results indicated that severity of problems in social life and peer relationships (OR = 1.68, 95% CI = 1.21 - 2.33) and avoidant coping (OR = 4.22, 95% CI = 1.01 - 17.73) were the only discriminatory factors for cannabis dependence. This model correctly classified 84.5% of the adolescents. These findings are partially consistent with the "self-medication hypothesis" and underlined the importance of peer relationships and dysfunctional coping strategies in cannabis dependence in adolescence. Limitations of the study and implications for clinical work with adolescents are discussed.

Chalmers J; Ritter A. The business cycle and drug use in Australia: Evidence from repeated cross-sections of individual level data. International Journal of Drug Policy 22(5): 341-352, 2011. (32 refs.)

Background: This paper examined the implications of the business cycle for cannabis and alcohol use. What little we know about cannabis use suggests that young Americans (teenagers and adults in their early 20s) seem more inclined to use illicit drugs and to use them more frequently with rises in the unemployment rate. In contrast, a more fulsome alcohol literature suggests that participation in drinking is unaffected by the business cycle. Heavy drinkers drink less during economic downturns and their reduced use counteracts the fact that light drinkers might drink a little more. Method: Using individual level data from repeated cross-sections of Australia's National Drug Strategy Household Survey (NDSHS), spanning 1991-2007, this study examined the relationship between cannabis and alcohol use of Australians aged 14-49 years and the unemployment rate and real income per capita, two indicators of the business cycle. Results: Australians in their late 20s, 30s and 40s drink less frequently during economic downturns. If unemployment rate rises are accompanied by falls in income per capita, younger Australians will also drink less frequently. Recent participation in cannabis use (within the last year) increases with falls in income per capita regardless of age, although the increase is less marked for young people (14-24 years). Whereas the participation rate of people aged 25-49 years also falls with rising unemployment rates, the participation of younger people increases. Cannabis users younger than 35 will use more frequently as the unemployment rate rises. In contrast, older Australians will use less frequently. Conclusion: Australia's recent economic slowdown has been characterised by rising unemployment rates without accompanying falls in income per capita. Based on our findings this slowdown should have encouraged young Australians aged 14-24 years to both drink and use cannabis more frequently. The slowdown would have had little impact on the frequency of drinking of older Australians. However it should have discouraged older Australians from using cannabis, and encouraged people in their late 30s and 40s to use less frequently, whilst encouraging those aged 25-34 years to use more frequently.

Chaplin E; Gilvarry C; Tsakanikos E. Recreational substance use patterns and co-morbid psychopathology in adults with intellectual disability. Research In Developmental Disabilities 32(6): 2981-2986, 2011. (14 refs.)

There is very limited evidence on the patterns of recreational substance use among adults with Intellectual Disabilities (ID) who have co-morbid mental health problems. In this study we collected clinical and socio-demographic information as well as data on substance use patterns for consecutive new referrals (N = 115) to specialist mental health services for adults with ID in South-East London. The data were recorded from active clinical case notes. About 15% of patients had a history of substance use, however only 8% were currently using substances. Alcohol was the most frequently used substance (80%) followed by cannabis (28%) and cocaine (12%). Overall, substance use was significantly more likely among male patients, those with a mild level of ID and those with a forensic history. Substance use was less likely among patients with autism and more likely among those with schizophrenia spectrum disorders. Logistic regression analyses revealed that those with a forensic history were about five times more likely to have current substance use problems. Male gender was the only predictor for legal substance (alcohol) use. Illicit substance use was about three times more likely among patients with schizophrenia spectrum disorders. The present results highlight the role of illicit substance use as a health risk factor for adults with ID as well as the need to increase awareness within specialist mental health services.

Cheng TC; Lo CC. A longitudinal analysis of some risk and protective factors in marijuana use by adolescents receiving child welfare services. Children and Youth Services Review 33(9): 1667-1672, 2011. (32 refs.)

The present study sought to identify risk and protective factors in marijuana use by adolescents involved in child welfare services. Longitudinal records of 1797 adolescents were extracted from the National Survey of Child and Adolescent Well-Being data set. The obtained multivariate results from generalized estimating equations showed that an adolescent's likelihood of being a current marijuana user rose with prior lifetime use of the drug and was also associated with out-of-home child welfare services, perceived parental monitoring, perceived closeness to parent, engagement with school environment, and age. Implications for child welfare services are discussed.

Ciorciari J; Marotte A. Implications of MDMA use for prospective memory function and substance use patterns in an Australian sample: A web-based pilot study. Australian Journal of Psychology 63(3): 142-149, 2011. (30 refs.)

The use of amphetamine type stimulants, particularly MDMA, is a global concern. Little research has been conducted on the association between MDMA use and everyday memory function-prospective memory. Twenty-five MDMA users, 37 cannabis users, and 43 illicit substance-naive controls were assessed on their substance use history and reported prospective memory performance as measured by the Prospective Memory Questionnaire (PMQ) using a web-based survey. There were significant differences between MDMA users and controls and cannabis users and controls on long-term episodic subscale of the PMQ. However, given the high prevalence of cannabis co-use by MDMA users, it was not possible to determine if MDMA use alone is associated with prospective memory performance. The substance use patterns of the sample were evaluated. Alcohol was the most used substance followed by tobacco, cannabis, and MDMA. The incidence of polydrug use was high, with all illicit substance use reporting having used at least two substances in their lifetime. The present study supports previous research into prospective memory deficits associated with substance use, and provides a basis for future research, particularly for elucidation of prospective memory deficits specific to MDMA use and further evaluation of substance use patterns.

Cougle JR; Bonn-Miller MO; Vujanovic AA; Zvolensky MJ; Hawkins KA. Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychology of Addictive Behaviors 25(3): 554-558, 2011. (20 refs.)

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use.

Cucciare MA; Ghaus S; Weingardt KR; Frayne SM. Sexual assault and substance use in male veterans receiving a brief alcohol intervention. Journal of Studies on Alcohol and Drugs 72(5): 693-700, 2011. (31 refs.)

Objective: Many studies have documented the link between substance use and a history of sexual assault in women; however, few studies have examined this relationship in men. The purpose of this study was to explore the rates of sexual assault in a sample of male veterans reporting alcohol misuse and to further explore potential differences in alcohol use patterns and alcohol-related characteristics in those with and without a history of sexual assault. We also explored the types of illicit drugs being used in the past 90 days and whether a clinical sample of male veterans reporting sexual assault are at greater odds of using these substances when compared with their peers with no history of sexual assault. Method: Data were collected on a nationwide sample (N = 880) of male veterans receiving care in Veterans Administration outpatient mental health clinics. Results: We found that 9.5% of our sample reported a history of sexual assault, and those with this history reported increased alcohol consumption, a greater number of alcohol-related consequences, and an increased likelihood of using an illicit substance in the past 90 days. The most commonly used illicit substances were cannabis, cocaine, and opiates. Those with sexual assault histories were also more likely to report risk factors that may exacerbate the negative effects of any level of alcohol consumption. Conclusions: Our findings highlight the burden of alcohol and illicit drug use among male veterans and suggest that substance use disorder treatment settings may be a context in which prevalence of a history of sexual assault is high. Our findings further support prior call for universal screening for sexual assault among this population.

Curcio F; Villano G; Masucci S; Plenzik M; Veneruso C; De Rosa G. Epidemiological survey of hepatitis C virus infection in a cohort of patients from a Ser.T [addiction treatment program] in Naples, Italy. Journal of Addiction Medicine 5(1): 43-49, 2011. (28 refs.)

Hepatitis C virus (HCV) has infected an estimated 170 million people worldwide, most of whom are chronically infected (60% to 80%). In Italy, the estimate of anti-HCV antibody (Ab) prevalence, in the general population of Northern Italy, is 3.2%; in Central and Southern Italy, it is 8.4% to 22.4%. Highest prevalence of infection (70% to 90%) is found among intravenous drug users. Our purpose is to monitor HCV infection among drug users treated in a Drug Addiction Centre (Ser.T) in Naples and to gain a better understanding of that relationship with the abused substance(s). Epidemiological data are shown for viral coinfections. Finally, the authors investigate access to specific HCV therapy in an Italian Ser.T. The study analyzed a group of 1753 consecutive subjects treated from 1988 to 2008 in the O.U. Ser. T D. S. 31 (Gesu e Maria Hospital), ASL Napoli 1 Centre. HCV Abs were detected by enzyme immune assay method and confirmed by recombinant immunoblot assay III method. During the entire period, we performed real-time polymerase chain reaction at random for 312 patients. The incidence (per year) of HCV infection showed a rapid spread decrease from 49.5% in 2003 to 14.5% in 2008. The overall prevalence of HCV was 48.1%. We tested 312 randomly selected patients for viral replication. Our study showed active viral replication in 201 (64.4%) patients as follows: 97 of 201 (31.1%) resulted infected by genotype (gt) 1; 3 of 201 (1.0%) gt 2; 84 of 201 (26.9%) gt 3; and 4 of 201 (1.3%) gt 4. Coinfection data showed that HCV Ab prevalence was 58.5% (48 of 82) in hepatitis B virus chronically infected patients. Human immunodeficiency virus (HIV)/HCV coinfection resulted in 95.2% (80 of 84) HIV patients. The prevalence of HIV Abs in HCV-infected patients was 8.99% (80 of 889). Analysis of drug abuse showed high prevalence of opiate addicted, multiabusers, and with high-risk factors. Cocaine abuser prevalence was 14.4%, and incidence, during past 4 years of the study, rose to 42.6%. Alcohol abuser prevalence represented 5.8% of patients and incidence rose to 17.7% in final 4 years of the study. In those opiate addicted, HCV infection was 61.0% (805 of 1320). HCV infection in cocaine-addicted patients was 9.5% (24 of 253). In 78 delta-9-tetra-hydrocannabinol addicted patients, 5.1% of tests were positive (4 of 78). In alcohol abusers, HCV infection was 9.8% (10 of 102). Access to HCV treatment in our cohort from 2000 to 2008 resulted low (15.4%). Enhancing the Ser.Ts efficiency can result in health and financial benefits.

Dakwar E; Nunes EV; Bisaga A; Carpenter KC; Mariani JP; Sullivan MA et al. A comparison of independent depression and substance-induced depression in cannabis-, cocaine-, and opioid-dependent treatment seekers. American Journal on Addictions 20(5): 441-446, 2011. (16 refs.)

Depressive symptoms often coexist with substance use disorders (SUDs). The DSM-IV has identified two distinct categories for depression coexisting with SUDs-independent depression and substance-induced depression. While this distinction has important therapeutic and prognostic implications, it remains difficult to make in clinical practice; the differentiation is often guided by chronological and symptom severity criteria that patients may be unable to precisely provide. Furthermore, it is unclear whether the various substances commonly abused-cannabis, cocaine, and opioids-are equally associated with the two types of depression. Predictors, associations, and other markers may be helpful in guiding the diagnostic process. We, therefore, examined the differences between cannabis-, cocaine-, and opioid-dependent individuals contending with independent depression and those contending with substance-induced depression in regard to several variables, hypothesizing that independent depression is more commonly found in females, and that it is associated with higher symptom severity and psychiatric comorbidity. Cocaine-, cannabis-, and/or opioid-dependent, treatment-seeking individuals underwent a structured clinical interview for DSM-IV-TR disorders after providing consent at our clinical research site; those with coexisting primary depression or substance-induced depression diagnoses were provided with further questionnaires and were entered into this analysis (n = 242). Pair-wise comparisons were conducted between the groups classified as independent versus substance-induced depression with 2-by-2 tables and chi-square tests for dichotomous independent variables, and t-tests for continuous variables. Binomial logistic regression was performed in order to ascertain which of the variables were significant predictors. Women were more likely than men to have independent depression (p < .005). Cannabis dependence was highly associated with independent depression (p < .001), while cocaine dependence was highly associated with substance-induced depression (p < .05). Independent depression was associated with higher Hamilton depression scale scores (16 vs. 10, p < .005), and was more highly associated with the comorbid diagnosis of posttraumatic stress disorder (p < .05). Cannabis dependence (p < .001) and female gender (p < .05) were highly significant predictors of major depression specifically. Gender, cannabis dependence, psychiatric severity, and psychiatric comorbidity have variable, statistically significant associations with independent and substance-induced depression, and may be helpful in guiding the diagnostic process.

Dawes GM; Sitharthan T; Conigrave KM; Phung N; Weltman M. Patients admitted for inpatient cannabis detoxification: Withdrawal symptoms and impacts of common comorbidities. Journal of Substance Use 16(5): 392-405, 2011. (31 refs.)

Introduction: There is clinical impetus to accurately monitor cannabis withdrawal symptoms. In doing this the impact of other drug and mental health comorbidities should be considered. Aims: To report patient demographics, psychiatric and substance use comorbidities and symptoms of cannabis withdrawal in the first 5 days of hospital admission for detoxification. Design: Daily self-reported symptom severity ratings were analysed as functions of gender, secondary drug use and recent mental health history. Setting: Specialised inpatient hospital unit for withdrawal management (detoxification) at a University of Sydney teaching hospital, Sydney, Australia. Participants: Total 193 consecutive patients admitted for routine inpatient cannabis withdrawal management over a 9-month period. Measurements: Patients screened via daily self-reported subjective ratings of cannabis withdrawal. Findings: Average cannabis used per day was 2.6 g. Most patients smoked tobacco daily (91%) and half of the sample (53%) reported other drug use. Alcohol was the main secondary drug used (29%). Half of the patients (51%) reported recent contact or interventions for mental health concerns. We were able to delineate principal withdrawal features to include "anxiety" (physical tension, hypermentation, palpitations and excessive worry), dysphoria (+ anergia, anhedonia, lethargy and somnolence) and irritability/agitation. Additional features identified included mood swings and cravings for cannabis. These features all significantly declined over a 5-day admission. Recent mental health concerns, but not gender or secondary drug use, correspond to greater global symptom severity over the course of admission. Conclusions: This study underscores a need to be alert to the impacts of comorbidities that are common in this treatment-seeking population, especially secondary drug use and the potential for mental health issues which add dimensions of complexity.

Degenhardt L; Bucello C; Calabria B; Nelson P; Roberts A; Hall W et al. What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. (review). Drug and Alcohol Dependence 117(2-3): 85-101, 2011. (92 refs.)

Background: We systematically reviewed availability and quality of data on the prevalence of use and dependence on meth/amphetamine, cannabis, cocaine and opioids. Methods: Multiple search strategies: (a) peer-reviewed literature searches (1990-2008) using methods recommended by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group; (b) systematic searches of online databases; (c) Internet searches to find other published evidence of drug use; (d) repeated consultation and feedback from experts around the globe; (e) a viral email sent to lists of researchers in the illicit drug and HIV fields. Data were extracted and graded according to predefined variables reflecting quality of data source. Results: Qualitative evidence of illicit drug use and dependence was found for most countries, which hold over 98% of the world's population aged 15-64 years. Countries where use was identified but prevalence estimates had not been made (evidence of drug supply, trafficking, reports of use, treatment data) were mainly from Asia, Africa, the Middle East, and Oceania. Estimates of the prevalence of use were located in 77 countries for meth/amphetamine, 95 for cannabis, 86 for cocaine and 89 for opioids. Dependence prevalence estimates existed in very few countries; 9 meth/amphetamine dependence estimates, 7 cannabis dependence estimates, 5 cocaine dependence estimates, and 25 opioid dependence estimates were located. Conclusions: Data on the extent of meth/amphetamine, cannabis, cocaine and opioid use and dependence must be improved in quality and coverage. Dependence estimates are lacking even in high income countries that have required resources. Responses to illicit drug dependence require better estimates of its scale.

Dermengiu D; Radu D; Aciu F; Broscauceanu A; Sereteanu L; Gorun G et al. Drugs of abuse identified in the National Institute of Legal Medicine Mina Minovici Bucharest 2010. Romanian Journal of Legal Medicine 19(3): 229-232, 2011. (10 refs.)

In the last few years in Romania a modern system of drug detection has been developed in the legal medicine system, increasing the detection rate and the sensitivity of DRD detection. In this short report we will present a general profile of drug abuse in Bucharest in 2010. The study was conducted in 2010 when a total number of 208 toxicology tests were conducted in the National Institute of Legal Medicine, 105 on cadavers and 103 on living persons. As main results, in living the most frequently identified drugs of abuse were THC and opiates whilst in cadavers opiates were the most frequent, followed by benzodiazepines. Conclusions. Opiate consumption has a tendency to decrease compared with 2009. Legal highs seems to shift the pattern of drug consumption in Bucharest and surrounding areas, but a definite results can only be obtained using test results from 2011.

Di Cosmo C; Milfont TL; Robinson E; Denny SJ; Ward C; Crengle S et al. Immigrant status and acculturation influence substance use among New Zealand youth. Australian and New Zealand Journal of Public Health 35(5): 434-441, 2011. (24 refs.)

Objective: To investigate the associations between generational status, acculturation and substance use among immigrant and non-immigrant secondary school students in New Zealand. Methods: A nationally representative sample of secondary school students in New Zealand was selected using a two-stage cluster sample design. Of the 8,999 students in the sample, 23.81% were first-generation immigrants and 20.90% were second-generation immigrants; the remaining 55.29% students are collectively referred to as 'non-immigrant' peers. Logistic regression models adjusted the associations of interest for age, gender, ethnicity, socioeconomic status and experience of ethnic discrimination. Results: First and second-generation immigrants showed significantly lower risks of smoking cigarettes compared with their non-immigrant peers. Similar trends were apparent for consuming alcohol and marijuana weekly. The inclusion of some characteristics suggestive of acculturation in multivariable models did not influence the relationship between generational status and smoking cigarettes, but attenuated the apparent protective effect of being a first-generation immigrant with regard to alcohol and marijuana use. Conclusions and implications: The study shows the lower likelihood of substance use among newer immigrants in a nationally representative sample of New Zealand youth. Policies and health programs that build on this positive profile and reduce the risk of adverse changes over time require attention.

Diep F. Pharmaceuticals: Clearing the smoke. Marijuana remains tightly controlled, even though its compounds show promise. (editorial). Scientific American 305(4): 21, 2011. (0 refs.)

Erickson PG. Lower risk cannabis use guidelines: For whom? (editorial). Canadian Journal of Public Health 102(5): 328-329, 2011. (14 refs.)

Every-Palmer S. Synthetic cannabinoid JWH-018 and psychosis: An explorative study. Drug and Alcohol Dependence 117(2-3): 152-157, 2011. (53 refs.)

Background: Aroma, Spice, K2 and Dream are examples of a class of new and increasingly popular recreational drugs. Ostensibly branded "herbal incense", they have been intentionally adulterated with synthetic cannabinoids such as JWH-018 in order to confer on them cannabimimetic psychoactive properties while circumventing drug legislation. JWH-018 is a potent cannabinoid receptor agonist. Little is known about its pharmacology and toxicology in humans. This is the first research considering the effects of JWH-018 on a psychiatric population and exploring the relationship between JWH-018 and psychotic symptoms. Method: This paper presents the results of semi-structured interviews regarding the use and effects of JWH-018 in 15 patients with serious mental illness in a New Zealand forensic and rehabilitative service. Results: All 15 subjects were familiar with a locally available JWH-018 containing product called "Aroma" and 86% reported having used it. They credited the product's potent psychoactivity, legality, ready availability and non-detection in drug testing as reasons for its popularity, with most reporting it had replaced cannabis as their drug of choice. Most patients had assumed the product was "natural" and "safe". Anxiety and psychotic symptoms were common after use, with 69% of users experiencing or exhibiting symptoms consistent with psychotic relapse after smoking JWH-018. Although psychological side effects were common, no one reported becoming physically unwell after using JWH-018. Three subjects described developing some tolerance to the product, but no one reported withdrawal symptoms. Conclusion: It seems likely that JWH-018 can precipitate psychosis in vulnerable individuals. People with risk factors for psychosis should be counseled against using synthetic cannabinoids.

Fakier N; Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. Journal of Adolescence 34(4): 717-726, 2011. (68 refs.)

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.

Fattore L; Fratta W. Beyond THC: The new generation of cannabinoid designer drugs. Frontiers In Behavioral Neuroscience 5: 60, 2011

Synthetic cannabinoids are functionally similar to delta9-tetrahydrocannabinol (THC), the psychoactive principle of cannabis, and bind to the same cannabinoid receptors in the brain and peripheral organs. From 2008, synthetic cannabinoids were detected in herbal smoking mixtures sold on websites and in "head shops" under the brand name of Spice Gold, Yucatan Fire, Aroma, and others. Although these products (also known as "Spice drugs" or "legal highs") do not contain tobacco or cannabis, when smoked they produce effects similar to THC. Intoxication, withdrawal, psychosis, and death have been recently reported after consumption, posing difficult social, political, and health challenges. More than 140 different Spice products have been identified to date. The ability to induce strong cannabis-like psychoactive effects, along with the fact that they are readily available on the Internet, still legal in many countries, marketed as natural safe substances, and undetectable by conventional drug screening tests, has rendered these drugs very popular and particularly appealing to young and drug-naive individuals seeking new experiences. An escalating number of compounds with cannabinoid receptor activity are currently being found as ingredients of Spice, of which almost nothing is known in terms of pharmacology, toxicology, and safety. Since legislation started to control the synthetic cannabinoids identified in these herbal mixtures, many new analogs have appeared on the market. New cannabimimetic compounds are likely to be synthesized in the near future to replace banned synthetic cannabinoids, leading to a "dog chasing its tail" situation. Spice smokers are exposed to drugs that are extremely variable in composition and potency, and are at risk of serious, if not lethal, outcomes. Social and health professionals should maintain a high degree of alertness for Spice use and its possible psychiatric effects in vulnerable people.

Fischer B; Jeffries V; Hall W; Room R; Goldner E; Rehm J. Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A narrative review of evidence and recommendations. (review). Canadian Journal of Public Health 102(5): 324-327, 2011. (49 refs.)

Objectives: More than one in ten adults - and about one in three young adults - report past year cannabis use in Canada. While cannabis use is associated with a variety of health risks, current policy prohibits all use, rather than adopting a public health approach focusing on interventions to address specific risks and harms as do policies for alcohol. The objective of this paper was to develop 'Lower Risk Cannabis Use Guidelines' (LRCUG) based on research evidence on the adverse health effects of cannabis and factors that appear to modify the risk of these harms. Methods: Relevant English-language peer-reviewed publications on health harms of cannabis use were reviewed and LRCUG were drafted by the authors on the basis of a consensus process. Synthesis: The review suggested that health harms related to cannabis use increase with intensity of use although the risk curve is not well characterized. These harms are associated with a number of potentially modifiable factors related to: frequency of use; early onset of use; driving after using cannabis; methods and practices of use and substance potency; and characteristics of specific populations. LRCUG recommending ways to reduce risks related to cannabis use on an individual and population level - analogous to 'Low Risk Drinking Guidelines' for alcohol - are presented. Conclusions: Given the prevalence and age distribution of cannabis use in Canada, a public health approach to cannabis use is overdue. LRCUG constitute a potentially valuable tool in facilitating a reduction of health harms from cannabis use on a population level.

Fox CL; Towe SL; Stephens RS; Walker DD; Roffman RA. Motives for cannabis use in high-risk adolescent users. Psychology of Addictive Behaviors 25(3): 492-500, 2011. (51 refs.)

The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use.

Franelic IP; Kuzman M; Simetin IP; Kern J. Impact of environmental factors on marijuana use in 11 European countries. Croatian Medical Journal 52(4): 446-457, 2011. (22 refs.)

Aim To investigate the association between environmental factors (perceived availability of marijuana, perceived use among friends and siblings, use of alcohol and tobacco, family structure, parental control, school performance) and lifetime prevalence and frequent and early marijuana use in high school students. Methods We used self-reported data from 15-16 years old participants of the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 11 countries: Denmark, Estonia, Norway, Croatia, Slovenia, Germany, Switzerland, Bulgaria, Czech Republic, Russian Federation, and Ukraine. Multivariate logistic regression was used for data analysis. Results Countries varied according to lifetime prevalence (8.7%-47.8%) and frequent (8.7%-23.9%) and early (3.0%13.0%) marijuana use. Daily tobacco smoking was most strongly associated with lifetime marijuana use for boys in 7 and for girls in 5 countries, with highest odds ratio (OR, 95% and confidence interval -CI) for boys in Denmark (OR, 13.52; 95% CI, 8.16-22.4), and for girls in the Czech Republic (OR, 21.21; 95% CI, 12.99-34.62). Perceived marijuana availability was most strongly associated with frequent marijuana use for boys in 4 countries (highest in Slovenia: OR, 19.28; 95% CI, 6.52-57.02) and girls in 5 (highest in Slovenia: OR, 19.05; 95% CI, 5.18-70.04). Perceived use of marijuana among friends was most strongly associated with frequent marijuana use in 5 countries, both for boys (highest in Norway: OR, 23.91; 95% CI, 4.16-137.48) and girls (highest in Denmark: OR, 75.42; 95% CI, 13.11-433.90). Perceived use of marijuana among friends was most strongly associated with early marijuana use in 8 countries for boys (highest in Norway: OR, 54.03; 95% CI, 3.34-875.19) and 3 countries for girls (highest in Denmark: OR, 7.29; 95% CI, 1.77-30.12). Conclusion: In each country, marijuana use was associated with similar factors, regardless of marijuana use prevalence in that country. The influence of peer group and perceived availability of marijuana seemed more important than parental control and family structure.

Gadit AAM. Medical marijuana: Can we think about it? (editorial). Journal of the Pakistan Medical Association 61(9): 932-933, 2011. (9 refs.)

Gerbi GB; Davis CG; Habtemariam T; Tameru B; Nganwa D; Robnett V. The association between substance use and risky sexual behaviors among middle school children. Journal of Substance Use 16(5): 339-347, 2011. (36 refs.)

Objective: The objective of the study was to determine if there was a significant association between substance use and risky sexual behaviors among middle school children. Methods: Data were collected in May 2002 using a questionnaire. A chi-square test was used for data analysis. Results: The results showed that alcohol, cocaine, marijuana, and tobacco use are strong predictors of risky sexual behaviors. Conclusions: These findings will be of use to healthcare practitioners and health educators seeking to reduce the risk of infection with HIV and other sexually transmitted diseases among the middle school children.

Gorelick DA; Goodwin RS; Schwilke E; Schwope DM; Darwin WD; Kelly DL et al. Antagonist-elicited cannabis withdrawal in humans. Journal of Clinical Psychopharmacology 31(5): 603-612, 2011. (35 refs.)

Cannabinoid CB1 receptor antagonists have potential therapeutic benefits, but antagonist-elicited cannabis withdrawal has not been reported in humans. Ten male daily cannabis smokers received 8 days of increasingly frequent 20-mg oral Delta(9)-tetrahydrocannabinol (THC) dosages (40-120 mg/d) around-the-clock to standardize cannabis dependence while residing on a closed research unit. On the ninth day, double-blind placebo or 20- (suggested therapeutic dose) or 40-mg oral rimonabant, a CB1-cannabinoid receptor antagonist, was administered. Cannabis withdrawal signs and symptoms were assessed before and for 23.5 hours after rimonabant. Rimonabant, THC, and 11-hydroxy-THC plasma concentrations were quantified by mass spectrometry. The first 6 subjects received 20-mg rimonabant (1 placebo); the remaining 4 subjects received 40-mg rimonabant (1 placebo). Fourteen subjects enrolled; 10 completed before premature termination because of withdrawal of rimonabant from clinical development. Three of 5 subjects in the 20-mg group, 1 of 3 in the 40-mg group, and none of 2 in the placebo group met the prespecified withdrawal criterion of 150% increase or higher in at least 3 visual analog scales for cannabis withdrawal symptoms within 3 hours of rimonabant dosing. There were no significant associations between visual analog scale, heart rate, or blood pressure changes and peak rimonabant plasma concentration, area-under-the-rimonabant-concentration-by-time curve (0-8 hours), or peak rimonabant/THC or rimonabant/(THC + 11-hydroxy-THC) plasma concentration ratios. In summary, prespecified criteria for antagonist-elicited cannabis withdrawal were not observed at the 20- or 40-mg rimonabant doses. These data do not preclude antagonist-elicited withdrawal at higher rimonabant doses.

Gorman D. Does the Life Skills Training program reduce use of marijuana? (review). Addiction Research & Theory 19(5): 470-481, 2011. (50 refs.)

The Life Skills Training (LST) program is one of the most widely disseminated drug prevention programs developed during the past 30 years. It is estimated that 50,000 teachers and 3 million students in the USA have participated in the program since 1995, and the program has been used in more than 30 other countries worldwide. This article reviews the evaluation studies that have assessed the effects of the LST program on the use of marijuana. Evaluations conducted by both the program developer and other research teams are reviewed. Most of the available evidence, especially coming from the analysis of data from full samples and not subgroup analysis, indicates that the program is unlikely to reduce use or abuse of marijuana among adolescents. The reason that the program has come to be considered so efficacious in preventing marijuana use is that those who promote the program pay little attention to the preponderance of evidence which supports the null hypothesis of no effect.

Gray KM; Riggs PD; Min SJ; Mikulich-Gilbertson SK; Bandyopadhyay D; Winhusen T. Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders. Drug and Alcohol Dependence 117(2-3): 242-247, 2011. (52 refs.)

Background: Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n = 303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. Methods: Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). Results: Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8 +/- 1.1 to 6.2 +/- 1.1 cigarettes per day). Conclusions: Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

Harrington M; Baird J; Lee C; Nirenberg T; Longabaugh R; Mello M et al. Identifying subtypes of dual alcohol and marijuana users: A methodological approach using cluster analysis. Addictive Behaviors 37(1): 119-123, 2012. (19 refs.)

Alcohol is the most common psychoactive substance used with marijuana. However, little is known about the potential impact of different levels of use of both alcohol and marijuana and their influence on risky behaviors, injuries and psychosocial functioning. A systematic approach to identifying patterns of alcohol and marijuana use associated with increased risks has not yet been identified in the literature. We report on the secondary analysis of data collected from a RCT conducted in a busy urban emergency department. Cluster analysis was performed on the patterns of past 30-day alcohol and marijuana use in two random subsamples N(1)=210 and N(2)=217. Four distinct subtypes of those who use both alcohol and marijuana were identified: (1) Daily Marijuana and Weekly Alcohol users; (2) Weekly Alcohol and Weekly Marijuana users; (3) Daily Alcohol and Daily Marijuana users; and (4) Daily Alcohol, Weekly Marijuana users. The four subtypes were replicated in both subsamples and examination of the external validity using ANOVA to determine cluster differences on psychosocial and behavioral variables confirmed the theoretical relevance of different patterns of alcohol and marijuana use. There were significantly different psychosocial negative consequences and related risky behaviors among subtypes. We found that Daily Alcohol and Daily Marijuana users are at the highest risk to experience more negative consequences and engage in a broader spectrum of risky behaviors related to both substances, than the other three types of alcohol and marijuana users.

Hauli KA; Ndetei DM; Jande MB; Kabangila R. The prevalence of substance use among psychiatric patients: The case study of Bugando Medical Centre, Mwanza (Northern Tanzania). Substance Abuse 32(4): 238-241, 2011

World Health Organization (2004) documented that substance use or abuse and mental disorders are important causes of disease burden accounting for 8.8% and 16.6% of the total burden of disease in low income and lower middle-income countries, respectively. Alcohol use/abuse disorders alone contribute to 0.6%-2.6% of the total burden of disease in these countries. This cross-sectional descriptive study recruited 184 psychiatric patients seen at Bugando Medical centre and assessed them for substance involvement using the WHO Alcohol, Smoking and Substance Involvement Screening Test. The most frequently used substances among respondents were alcohol (59.3%), tobacco (38.6%), and cannabis (29.3%), while heroin and cocaine were least used (2.1% and 1.6%, respectively). Statistical significant difference existed between substance use and participants: level of education, formal employment, marital status, gender, family history of mental illness, and family history of substance use. About a third attributed their involvement into substance exclusively to peer pressure, 8.7 to both peer pressure and curiosity while 7.1% exclusively to curiosity. This result represents one of the most important risks to mental health, and is a leading factor that causes high rates of admission or reason to be seen by a psychiatrist, this cannot be ignored when managing psychiatric disorders and therefore calls for routing screening for substance involvement among clients seeking psychiatric treatment. It also calls for appropriate standard operation policy procedures that can be operationlized as a matter of clinical practice by mental health workers in their routine medical practice.

Hemphill SA; Heerde JA; Herrenkohl TI; Patton GC; Toumbourou JW; Catalano RF. Risk and protective factors for adolescent substance use in Washington State, the United States and Victoria, Australia: A longitudinal study. Journal of Adolescent Health 49(3): 312-320, 2011. (40 refs.)

Purpose: To compare the levels of risk and protective factors and the predictive influence of these factors on alcohol, tobacco, and cannabis use over a 12-month follow-up period in Washington State in the United States and in Victoria, Australia. Method: The study involved a longitudinal school-based survey of students drawn as a two-stage cluster sample recruited through schools, and administered in the years 2002 and 2003 in both states. The study used statewide representative samples of students in the seventh and ninth grades (n = 3,876) in Washington State and Victoria. Results: Washington State students, relative to Victorian students, had higher rates of cannabis use but lower rates of alcohol and tobacco use at time 1. Levels of risk and protective factors showed few but important differences that contribute to the explanation of differences in substance use; Washington State students, relative to Victorian students, reported higher religiosity (odds ratio, .96 vs. .79) and availability of handguns (odds ratio, 1.23 vs. 1.18), but less favorable peer, community, and parental attitudes to substance use. The associations with substance use at follow-up are generally comparable, but in many instances were weaker in Washington State. Conclusions: Levels of risk and protective factors and their associations with substance use at follow-up were mostly similar in the two states. Further high-quality longitudinal studies to establish invariance in the relations between risk and protective factors and substance use in adolescence across diverse countries are warranted.

Hesse M; Tutenges S. Dependent cannabis users at a music festival: Prevalence and correlates. Drugs: Education, Prevention and Policy 18(6, special issue): 433-437, 2011. (19 refs.)

Aim: In western countries, the most prevalent type of illicit substance-use dependence is cannabis dependence. This study aimed at estimating the prevalence of cannabis dependence among music festival visitors. Methods: Based on a survey of 380 music festival guests, we estimated the prevalence of cannabis dependence, as defined by a score of 3 or more on the Severity of Dependence Scale (SDS), as well as characteristics of cannabis dependent visitors. Results: 143 (38%) reported having used cannabis within the past year (past year cannabis users), and of these respondents, 21 (15%) screened positive for cannabis dependence. Compared to other cannabis users, the dependent respondents were more likely to be daily smokers, and they scored higher on self-reported sensation seeking. Compared with past-year non-users, both dependent users and non-dependent users were more likely to be men, weekly heavy drinkers, daily smokers and to score high on sensation seeking. Conclusions: Out of the past-year cannabis users recruited at a music festival, one in seven of those respondents showed indication of cannabis dependence. This suggests a need for both available treatment options and primary prevention of dependence.

Hodder RK; Daly J; Freund M; Bowman J; Hazell T; Wiggers J. A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students. BMC Public Health 11: 722, 2011. (77 refs.)

Background: Despite schools theoretically being an ideal setting for accessing adolescents and preventing initiation of substance use, there is limited evidence of effective interventions in this setting. Resilience theory provides one approach to achieving such an outcome through improving adolescent mental well-being and resilience. A study was undertaken to examine the potential effectiveness of such an intervention approach in improving adolescent resilience and protective factor scores; and reducing the prevalence of adolescent tobacco, alcohol and marijuana use in three high schools. Methods: A non-controlled before and after study was undertaken. Data regarding student resilience and protective factors, and measures of tobacco, alcohol and marijuana use were collected from grade 7 to 10 students at baseline (n = 1449) and one year following a three year intervention (n = 1205). Results: Significantly higher resilience and protective factors scores, and significantly lower prevalence of substance use were evident at follow up. Conclusions: The results suggest that the intervention has the potential to increase resilience and protective factors, and to decrease the use of tobacco, alcohol and marijuana by adolescents. Further more rigorous research is required to confirm this potential.

Houston JE; Murphy J; Shevlin M; Adamson G. Cannabis use and psychosis: Re-visiting the role of childhood trauma. Psychological Medicine 41(11): 2339-2348, 2011. (54 refs.)

Background. Cannabis consumption continues to be identified as a causal agent in the onset and development of psychosis. However, recent findings have shown that the effect of cannabis on psychosis may be moderated by childhood traumatic experiences. Method. Using hierarchical multivariate logistic analyses the current study examined both the independent effect of cannabis consumption on psychosis diagnosis and the combined effect of cannabis consumption and childhood sexual abuse on psychosis diagnosis using data from the Adult Psychiatric Morbidity Survey 2007 (n=7403). Results. Findings suggested that cannabis consumption was predictive of psychosis diagnosis in a bivariate model; however, when estimated within a multivariate model that included childhood sexual abuse, the effect of cannabis use was attenuated and was not statistically significant. The multivariate analysis revealed that those who had experienced non-consensual sex in childhood were over six times [odds ratio (OR) 6.10] more likely to have had a diagnosis of psychosis compared with those who had not experienced this trauma. There was also a significant interaction. Individuals with a history of non-consensual sexual experience and cannabis consumption were over seven times more likely (OR 7.84) to have been diagnosed with psychosis compared with those without these experiences; however, this finding must be interpreted with caution as it emerged within an overall analytical step which was non-significant. Conclusions. Future studies examining the effect of cannabis consumption on psychosis should adjust analyses for childhood trauma. Childhood trauma may advance existing gene-environment conceptualisations of the cannabis-psychosis link.

Hudson S; Ramsey J. The emergence and analysis of synthetic cannabinoids. Drug Testing and Analysis 3(7-8, special issue): 466-478, 2011. (35 refs.)

In late 2008, several synthetic cannabinoids were detected in herbal smoking mixtures. Typical of these products were 'Spice Gold', 'Spice Silver' and 'Yucatan Fire', but many other products have since appeared. The analytes detected, such as JWH-018 and CP47,497 are experimental compounds, some of which were never designed for human use. Both scientific and anecdotal evidence suggest that these compounds are more potent than traditional cannabis and are being widely used. As a result, authorities around the world are now beginning to control them by either naming individual compounds or using generic legislation. This, however, is easier said than done as the synthetic cannabinoids detected are constantly changing in attempts by manufacturers to evade legislation. This paper includes background information in the style of a brief monograph, as an aid to rapidly understanding the pharmacological aspects of these compounds in the forensic context, and then presents a comprehensive set of data, obtained from analysis of purchased products by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Huepe D; Roca M; Salas N; Canales-Johnson A; Rivera-Rei AA; Zamorano L et al. Fluid intelligence and psychosocial outcome: From logical problem solving to social adaptation. PLoS ONE 6(9): e-24858, 2011. (118 refs.)

Background: While fluid intelligence has proved to be central to executive functioning, logical reasoning and other frontal functions, the role of this ability in psychosocial adaptation has not been well characterized. Methodology/Principal Findings: A random-probabilistic sample of 2370 secondary school students completed measures of fluid intelligence (Raven's Progressive Matrices, RPM) and several measures of psychological adaptation: bullying (Delaware Bullying Questionnaire), domestic abuse of adolescents (Conflict Tactic Scale), drug intake (ONUDD), self-esteem (Rosenberg's Self Esteem Scale) and the Perceived Mental Health Scale (Spanish adaptation). Lower fluid intelligence scores were associated with physical violence, both in the role of victim and victimizer. Drug intake, especially cannabis, cocaine and inhalants and lower self-esteem were also associated with lower fluid intelligence. Finally, scores on the perceived mental health assessment were better when fluid intelligence scores were higher. Conclusions/Significance: Our results show evidence of a strong association between psychosocial adaptation and fluid intelligence, suggesting that the latter is not only central to executive functioning but also forms part of a more general capacity for adaptation to social contexts.

Ilgen MA; Schulenberg J; Kloska DD; Czyz E; Johnston L; O'Malley P. Prevalence and characteristics of substance abuse treatment utilization by US adolescents: National data from 1987 to 2008. Addictive Behaviors 36(12): 1349-1352, 2011. (16 refs.)

Objective: Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services. Method: Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N = 25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization. Results: The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services. Conclusion: Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.

Inoue K; Fukunaga T; Okazaki Y; Fujita Y; Ono Y. An analysis of drug-related offenses in Japan: Focusing on a discussion of future preventive measures. Journal of Forensic and Legal Medicine 18(7): 317-319, 2011. (14 refs.)

Recently, drug use has become a major social problem in Japan. Therefore, this study examined recent trends of drug use in detail. Specifically, this report researched the number of people arrested for drug-related offenses in the 8 years since 2001 and it discusses measures to prevent drug use. During the period studied, the proportion of drug-related offenses related to 'stimulants' has decreased, despite those drugs accounting for the highest proportion of such offenses, and the proportion of offenses related to 'cannabis' has increased markedly. Therefore, organizations implementing measures to prevent drug-related offenses should be aware of the recent increase in the number of people arrested for 'cannabis' and the high proportion of arrests for 'stimulants'.

Kaltiala-Heino R; Koivisto AM; Marttunen M; Frojd S. Pubertal timing and substance use in middle adolescence: A 2-year follow-up study. Journal of Youth and Adolescence 40(10, special issue): 1288-1301, 2011. (45 refs.)

Earlier research has associated early puberty with emotional and behavioral symptoms particularly among girls, while among boys, findings have been contradictory as to whether risks are associated with early or late pubertal timing. We studied the association between pubertal timing and substance use behaviors in middle adolescence in a 2-year follow up study of 2,070 (mean age 15.5 years, SD 0.36; 56.4% females) Finnish adolescents. Pubertal timing was measured by age at menarche/oigarche. Eleven years or less was classified as early, 12-13 years as normative and 14 years or later as late pubertal timing. Substance use behaviors were elicited by a number of questions related to alcohol use patterns, smoking and cannabis use. As factors that could explain the association between pubertal timing and substance use, we studied depressive symptoms, delinquency and aggression, and parental monitoring. In boys, all these substance use behaviors were the more common the earlier the puberty and the associations persisted at age 17. Among girls, early pubertal timing was similarly associated with substance use behaviors at age 15, but no longer at age 17. The associations between pubertal timing and substance use behaviors persisted when symptom dimensions and parental monitoring were added into the models. Early puberty is a risk factor for substance use particularly among boys. Among girls, the impact of pubertal timing already tempers off during adolescence.

Kelly TM; Daley DC; Douaihy AB. Treatment of substance abusing patients with comorbid psychiatric disorders. (review). Addictive Behaviors 37(1): 11-24, 2012. (148 refs.)

To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients. Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity. Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions. Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.

Keyes KM; Schulenberg JE; O'Malley PM; Johnston LD; Bachman JG; Li GH et al. The social norms of birth cohorts and adolescent marijuana use in the United States, 1976-2007. Addiction 106(10): 1790-1800, 2011. (83 refs.)

Aims: Studies of the relationship between social norms and marijuana use have generally focused on individual attitudes, leaving the influence of larger societal-level attitudes unknown. The present study investigated societal-level disapproval of marijuana use defined by birth cohort or by time-period. Design: Combined analysis of nationally representative annual surveys of secondary school students in the United States conducted from 1976 to 2007 as part of the Monitoring the Future study. Setting: In-school surveys completed by adolescents in the United States. Participants A total of 986,003 adolescents in grades 8, 10 and 12. Measurements Main predictors included the percentage of students who disapproved of marijuana in each birth cohort and time-period. Multi-level models with individuals clustered in time-periods of observation and birth cohorts were modeled, with past-year marijuana use as the outcome. Findings: Results indicated a significant and strong effect of birth cohort disapproval of marijuana use in predicting individual risk of marijuana use, after controlling for individual-level disapproval, perceived norms towards marijuana and other characteristics. Compared to birth cohorts in which most (87-90.9%) adolescents disapproved of marijuana use, odds of marijuana use were 3.53 times higher in cohorts where fewer than half (42-46.9%) disapproved (99% confidence interval: 2.75, 4.53). Conclusions: Individuals in birth cohorts that are more disapproving of marijuana use are less likely to use, independent of their personal attitudes towards marijuana use. Social norms and attitudes regarding marijuana use cluster in birth cohorts, and this clustering has a direct effect on marijuana use even after controlling for individual attitudes and perceptions of norms.

Kuepper R; van Os J; Lieb R; Wittchen HU; Henquet C. Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study. Psychological Medicine 41(10): 2121-2129, 2011. (49 refs.)

Background. Cannabis use is considered a component cause of psychotic illness, interacting with genetic and other environmental risk factors. Little is known, however, about these putative interactions. The present study investigated whether an urban environment plays a role in moderating the effects of adolescent cannabis use on psychosis risk. Method. Prospective data (n = 1923, aged 14-24 years at baseline) from the longitudinal population-based German Early Developmental Stages of Psychopathology cohort study were analysed. Urbanicity was assessed at baseline and defined as living in the city of Munich (1562 persons per km(2); 4061 individuals per square mile) or in the rural surroundings (213 persons per km(2); 553 individuals per square mile). Cannabis use and psychotic symptoms were assessed three times over a 10-year follow-up period using the Munich version of the Composite International Diagnostic Interview. Results. Analyses revealed a significant interaction between cannabis and urbanicity [10.9% adjusted difference in risk, 95% confidence interval (CI) 3.2-18.6, p = 0.005]. The effect of cannabis use on follow-up incident psychotic symptoms was much stronger in individuals who grew up in an urban environment (adjusted risk difference 6.8%, 95% CI 1.0-12.5, p = 0.021) compared with individuals from rural surroundings (adjusted risk difference -4.1%, 95% CI -9.8 to 1.6, p = 0.159). The statistical interaction was compatible with substantial underlying biological synergism. Conclusions. Exposure to environmental influences associated with urban upbringing may increase vulnerability to the psychotomimetic effects of cannabis use later in life.

Kuras MJ; Wachowicz MJ. Cannabis profiling based on its elemental composition: Is it possible? Journal of Forensic Sciences 56(5): 1250-1255, 2011. (19 refs.)

Elemental composition of 85 cannabis samples was established using GF AAS and ICP OES methods. The robustness of the method was determined by analyzing eight independently prepared replicates from a single cannabis plant. The accuracy of the method was established by analyzing four plant certified reference material samples. The ability of discriminant analysis using elemental compositions to distinguish between fiber cannabis samples collected from four different regions of Poland was evaluated. Then, a classification model was developed that correctly classified selected samples of known origin. Cannabis samples confiscated by law enforcement agencies have also been subjected to discriminant analysis. A classification model has been developed for four locations in Poland (Bialystok, Koscierzyna, the environs of Skarzysko Kamienna, and Bydgoszcz), to help determine where samples of unknown origin could have been grown.

Lapoint J; James LP; Moran CL; Nelson LS; Hoffman RS; Moran JH. Severe toxicity following synthetic cannabinoid ingestion. Clinical Toxicology 49(8): 760-764, 2011. (35 refs.)

Objective. To report a case of seizures and supraventricular tachycardia (SVT) following confirmed synthetic cannabinoid ingestion. Background. Despite widespread use of legal synthetic cannabinoids, reports of serious toxicity following confirmed use of synthetic cannabinoids are rare. We report severe toxicity including seizures following intentional ingestion of the synthetic cannabinoid JWH-018 and detail confirmation by laboratory analysis. Case Report. A healthy 48 year old man had a generalized seizure within thirty minutes of ingesting an ethanol mixture containing a white powder he purchased from the Internet in an attempt to get high. Seizures recurred and abated with lorazepam. Initial vital signs were: pulse, 106/min; BP, 140/88 mmHg; respirations, 22/min; temperature, 37.7 degrees C. A noncontrast computed tomography of the brain and EEG were negative, and serum chemistry values were normal. The blood ethanol concentration was 3.8 mg/dL and the CPK 2,649 U/L. Urine drug screening by EMIT was negative for common drugs of abuse, including tetrahydrocannabinol. On hospital day 1, he developed medically refractory SVT. The patient had no further complications and was discharged in his normal state of health 10 days after admission. The original powder was confirmed by gas chromatography mass spectrometry to be JWH-018, and a primary JWH-018 metabolite was detected in the patient's urine (200 nM) using liquid chromatography tandem mass spectrometry. Discussion. Synthetic cannabinoids are legal in many parts of the world and easily obtained over the Internet. Data on human toxicity are limited and real-time confirmatory testing is unavailable to clinicians. The potential for toxicity exists for users mistakenly associating the dose and side effect profiles of synthetic cannabinoids to those of marijuana. Conclusion. Ingestion of JWH-018 can produce seizures and tachyarrhythmias. Clinicians, lawmakers, and the general public need to be aware of the potential for toxicity associated with synthetic cannabinoid use.

Latt N; Jurd S; Tennant C; Lewis J; Macken L; Joseph A et al. Alcohol and substance use by patients with psychosis presenting to an emergency department: Changing patterns. Australasian Psychiatry 19(4): 354-359, 2011. (14 refs.)

Objectives: The aim of this study was to determine the incidence of alcohol and other substance use in patients presenting to an emergency department with acute psychiatric illnesses and to clarify the role of urine drug screens. Method: This was an unblinded prospective (observational) cohort study incorporating retrospective review of patient medical records, history of alcohol and substance use, results of urine drug screens and blood alcohol concentrations. Results: Of 196 acute psychotic patients, 104 were diagnosed with schizophrenia and 92 with "other psychosis". Results of urine drug screens were consistent with self-reported use of substances and only identified an additional 5% of substance users. Cannabis was the commonest illicit substance used by both groups of patients, followed by psychostimulants, mainly amphetamines. Younger males were more likely to use psychostimulants and to present with violence. Conclusions: Patients with co-existing mental health problems and substance use present a major problem for our emergency departments. Cannabis was the most common substance used. Youth, male gender and psychostimulant use are associated with violent presentations. A comprehensive history of alcohol and substance use is important to implement appropriate dual diagnosis treatment. Urine drug screening is recommended for patients who do not admit to substance use.

Le Strat Y; Le Foll B. Obesity and cannabis use: Results from 2 representative national surveys. American Journal of Epidemiology 174(8): 929-933, 2011. (30 refs.)

The role of cannabis and endocannabinoids in appetite regulation has been extensively studied, but the association of cannabis use with weight in the general population is not known. The authors used data from 2 representative epidemiologic studies of US adults aged 18 years or older, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002) and the National Comorbidity Survey-Replication (NCS-R; 2001-2003), to estimate the prevalence of obesity as a function of cannabis use. The adjusted prevalences of obesity in the NESARC and the NCS-R were 22.0% and 25.3%, respectively, among participants reporting no use of cannabis in the past 12 months and 14.3% and 17.2%, respectively, among participants reporting the use of cannabis at least 3 days per week. These differences were not accounted for by tobacco smoking status. Additionally, after adjustment for sex and age, the use of cannabis was associated with body mass index differences in both samples. The authors conclude that the prevalence of obesity is lower in cannabis users than in nonusers.

Legleye S; Janssen E; Beck F; Chau N; Khlat M. Social gradient in initiation and transition to daily use of tobacco and cannabis during adolescence: A retrospective cohort study. Addiction 106(8): 1520-1531, 2011. (81 refs.)

Aims: This study explores whether the family socio-economic status (F-SES) and school situation could have an impact on tobacco and cannabis initiation and transition to daily use during adolescence. Design and setting A French cross-sectional nation-wide survey conducted in 2005 containing retrospective data. Participants French teenagers aged 17 (n = 29 393). Measurement The F-SES was defined by the highest occupational category of either parent, with seven categories ranging from unemployed/inactive to managers/professionals. Ages at repeat school years, at leaving school, at the first episode of drunkenness and at initiation of illicit drug use were used to model tobacco and cannabis initiation and transition to daily use with time-discrete logistic regressions. Findings The risk for tobacco initiation was almost equally distributed across F-SES groups, but the risk of a progression to daily use was higher in every F-SES category compared to managers/professionals [ odds ratio (OR) from 1.17 to 1.90]. Compared to managers/professionals, risk of cannabis initiation was lower in all F-SES categories (OR from 0.63 to 0.87), but all categories except farmers were at increased risk of transition to daily use: the OR range between 1.29 (intermediate) and 1.98 (unemployed/inactive). Repeating school years and leaving school predicted daily use of tobacco (OR = 2.00 and 2.37) and cannabis (4.58 and 2.07). Conclusions: Adolescents from the highest family socio-economic status categories are at risk for tobacco and cannabis experimentation but are less prone to engage in daily use. Psychological and social mechanisms that inhibit transition to daily use should be investigated, including school attainment and performance.

Lewis P; O'Connor C. My war on drug laws. Forbes 188(6): 181-181, 2011. (0 refs.)

The government has a marijuana problem it-doesn't realize the benefits or the harm caused policing it. I'm devoting my time and money to making it legal.

Li GH; Baker SP; Zhao Q; Brady JE; Lang BH; Rebok GW et al. Drug violations and aviation accidents: Findings from the US mandatory drug testing programs. Addiction 106(7): 1287-1292, 2011. (26 refs.)

Aims: To assess the role of drug violations in aviation accidents. Design: Case-control analysis. Setting: Commercial aviation in the United States. Participants: Aviation employees who were tested for drugs during 1995-2005 under the post-accident testing program (cases, n = 4977) or under the random testing program (controls, n = 1 129 922). Measurements Point prevalence of drug violations, odds ratio of accident involvement and attributable risk in the population. A drug violation was defined as a confirmed positive test for marijuana (>= 50 ng/ml), cocaine (>= 300 ng/ml), amphetamines (>= 1000 ng/ml), opiates (>= 2000 ng/ml) or phencyclidine (>= 25 ng/ml). Findings The prevalence of drug violations was 0.64% [95% confidence interval (CI): 0.62-0.65%] in random drug tests and 1.82% (95% CI: 1.47-2.24%) in post-accident tests. The odds of accident involvement for employees who tested positive for drugs was almost three times the odds for those who tested negative (odds ratio 2.90, 95% CI: 2.35-3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for 67.3% of the illicit drugs detected. The proportion of illicit drugs represented by amphetamines increased progressively during the study period, from 3.4% in 1995 to 10.3% in 2005 (P < 0.0001). Conclusions: Use of illicit drugs by aviation employees is associated with a significantly increased risk of accident involvement. Due to the very low prevalence, drug violations contribute to only a small fraction of aviation accidents.

Lorencova R. Religiosity and spirituality of alcohol and marijuana users. Journal of Psychoactive Drugs 43(3): 180-187, 2011. (34 refs.)

This study focuses on measuring the spirituality of alcohol and marijuana users, using the new and exclusively Czech measuring tool, the Prague Spiritual Questionnaire (PSQ). The data from 155 respondents shows that users of both marijuana and alcohol scored significantly higher in the mysticism dimension of spirituality than those who only drank alcohol. People who mentioned that the specified spiritual feelings resulted from drug use are significantly more spiritual than those who do not associate their experiences with any drugs. The gender, age, education and professions of respondents show no significant effect on spirituality, while there is a significant difference between religious and nonreligious drug users in the specific dimensions of spirituality. Various implications of these findings, as well as the limitations of the PSQ, are further discussed.

Marco EM; Garcia-Gutierrez MS; Bermudez-Silva FJ; Moreira FA; Guimaraes F; Manzanares J et al. Endocannabinoid system and psychiatry: In search of a neurobiological basis for detrimental and potential therapeutic effects. Frontiers in Behavioral Neuroscience 5: e-63, 2011

Public concern on mental health has noticeably increased given the high prevalence of neuropsychiatric disorders. Cognition and emotionality are the most affected functions in neuropsychiatric disorders, i.e., anxiety disorders, depression, and schizophrenia. In this review, most relevant literature on the role of the endocannabinoid (eCB) system in neuropsychiatric disorders will be presented. Evidence from clinical and animal studies is provided for the participation of CB1 and CB2 receptors (CB1R and CB2R) in the above mentioned neuropsychiatric disorders. CBRs are crucial in some of the emotional and cognitive impairments reported, although more research is required to understand the specific role of the eCB system in neuropsychiatric disorders. Cannabidiol (CBD), the main non-psychotropic component of the Cannabis sativa plant, has shown therapeutic potential in several neuropsychiatric disorders. Although further studies are needed, recent studies indicate that CBD therapeutic effects may partially depend on facilitation of eCB-mediated neurotransmission. Last but not least, this review includes recent findings on the role of the eCB system in eating disorders. A deregulation of the eCB system has been proposed to be in the bases of several neuropsychiatric disorders, including eating disorders. Cannabis consumption has been related to the appearance of psychotic symptoms and schizophrenia. In contrast, the pharmacological manipulation of this eCB system has been proposed as a potential strategy for the treatment of anxiety disorders, depression, and anorexia nervosa. In conclusion, the eCB system plays a critical role in psychiatry; however, detrimental consequences of manipulating this endogenous system cannot be underestimated over the potential and promising perspectives of its therapeutic manipulation.

Marsiglia FF; Kulis S; Hoffman S; Calderon-Tena CO; Becerra D; Alvarez D. Migration intentions and illicit substance use among youth in central Mexico. Substance Use & Misuse 46(13): 1619-1627, 2011. (54 refs.)

This study explored intentions to emigrate and substance use among youth (ages 14-24) from a central Mexico state with high emigration rates. Questionnaires were completed in 2007 by 702 students attending a probability sample of alternative secondary schools serving remote or poor communities. Linear and logistic regression analyses indicated that stronger intentions to emigrate predicted greater access to drugs, drug offers, and use of illicit drugs (marijuana, cocaine, inhalants), but not alcohol or cigarettes. Results are related to the healthy migrant theory and its applicability to youth with limited educational opportunities. The study's limitations are noted.

Mayet A; Legleye S; Chau N; Falissard B. Transitions between tobacco and cannabis use among adolescents: A multi-state modeling of progression from onset to daily use. Addictive Behaviors 36(11): 1101-1105, 2011. (24 refs.)

Use of a given substance may follow a stage process leading from onset to regular use, and use of one substance can be strongly associated with use of another. The aim of this study was to describe the transitions between tobacco and cannabis use. Data was derived from a French nationwide survey involving 29,393 teenagers. A homogenous Markov multi-state model (MSM) was fitted. The substance use pattern modeled was: no lifetime use -> 1 (2) substance(s) initiation -> 1 (2) daily substance(s) use, with pathways between tobacco and cannabis. The likelihood of first initiating tobacco appeared 17.6 times greater than the likelihood of initiating cannabis. Once a subject has experimented with one substance, the risk of another substance experiment was much greater. Transition intensity from tobacco initiation to daily use was 4.8 times higher than that from cannabis. Our results are compatible with a process mixing the gateway theory, the reverse gateway theory and the route of administration model, but do not explore a common liability to addictions, which could be explored by using a MSM on a prospective cohort with initial collection of some explanatory factors.

Mohamed WMY; Ben Hamida S; Cassel JC; de Vasconcelos AP; Jones BC. MDMA: Interactions with other psychoactive drugs. (review). Pharmacology, Biochemistry And Behavior 99(4): 759-774, 2011. (335 refs.)

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is one of the most widely abused illegal drugs. Some users self-report euphoria and an increased perception and feeling of closeness to others. When taken in warm environments. MDMA users may develop acute complications with potential fatal consequences. In rodents, MDMA increases locomotor activity and, depending on ambient temperature, may produce a dose-dependent, potentially lethal hyperthermia. Like most other recreational drugs, MDMA is frequently taken in combination with other substances including tobacco, EtOH, marijuana, amphetamines, cocaine and, caffeine. Although polydrug use is very common, the understanding of the effects of this multiple substance use, as well as the analysis of consequences of different drug-drug associations, received rather little attention. The purpose of this review is to summarize our current knowledge about the changes on MDMA-related behavior, pharmacology, and neurotoxicity associated with co-consumption of other drugs of abuse and psychoactive agents.

Nussbaum AM; Boyer JA; Kondrad EC. "But my doctor recommended pot": Medical marijuana and the patient-physician relationship. Journal of General Internal Medicine 26(11): 1364-1367, 2011. (16 refs.)

As the use of medical marijuana expands, it is important to consider its implications for the patient-physician relationship. In Colorado, a small cohort of physicians is recommending marijuana, with 15 physicians registering 49% of all medical marijuana patients and a single physician registering 10% of all patients. Together, they have registered more than 2% of the state to use medical marijuana in the last three years. We are concerned that this dramatic expansion is occurring in a setting rife with conflicts of interest despite insufficient scientific knowledge about marijuana. This system diminishes the patient-physician relationship to the recommendation of a single substance while unburdening physicians of their usual responsibilities to the welfare of their patients.

Nyan O; Mendy AM; Moraru D; Berger C; Thome J. Diagnostic characteristics of inpatients in a Western African psychiatric hospital. World Journal of Biological Psychiatry 12(Supplement 1): 85-88, 2011. (7 refs.)

Little is known about psychiatric patients and psychiatric service delivery in non-Western developing countries. Therefore, this naturalistic pilot study aimed at analysing and describing the patient population treated in the Tanka Tanka Psychiatric Hospital, the mental health inpatient facility of The Gambia. Most patients were male and exhibited a wide age range of over 40 years. There were also indicators that the hospital population consisted of two distinguished groups: a large group of chronically ill patients and a smaller group of psychiatric patients with very acute symptoms. Psychotic/mood disorders and substance dependence/abuse were the most common diagnoses. In many patients problematic cannabis use was prevalent. Such research can contribute to better understand the needs of psychiatric patients, and help to develop continuously improved service delivery and optimise therapeutic options.

Oesterle S; Hawkins JD; Hill KG. Men's and women's pathways to adulthood and associated substance misuse. Journal of Studies on Alcohol and Drugs 72(5): 763-773, 2011. (62 refs.)

Objective: Social role transitions have been linked to changes in substance use and misuse during young adulthood. This study examined how commonly observed pathways to adulthood, defined by education, employment, marriage, and parenthood, were associated with alcohol, tobacco, and marijuana misuse from ages 18 to 33. Method: Data came from a longitudinal panel of 412 men and 396 women recruited when they were in fifth grade in Seattle public schools in 1985. Participants were followed through age 33 in 2008, with 92% retention. Results: Young adults who had little postsecondary education and remained unmarried through age 30 generally had the highest rates of substance misuse. Those who were involved in postsecondary education and postponed family formation had the lowest rates, particularly with respect to daily smoking and nicotine dependence. Parenting during the young adult years was associated with lower rates of substance misuse for both men and women. However, taking on parenting responsibilities early, during the late teen years and early 20s (observed mostly for women), was associated with higher rates of tobacco misuse. Differences in substance misuse by pathways to adulthood were fairly constant across the young adulthood years and were already observed at age 18, suggesting that substance misuse patterns are established early. Conclusions: Young adults may change their substance use only partially in response to new freedoms and responsibilities in young adulthood. Preventive efforts should include a focus on early initiation of substance use and educational experiences that move people into life trajectories and associated substance misuse patterns.

Palamar JJ; Kiang MV; Halkitis PN. Development and psychometric evaluation of scales that assess stigma associated with illicit drug users. Substance Use & Misuse 46(12): 1457-1467, 2011. (36 refs.)

This study established validity evidence for scales that assess perceived public stigma and stigmatization of illicit drug use. These concepts were measured with respect to five commonly used drugs: marijuana, powder cocaine, ecstasy, and nonmedical use of opioids and amphetamine. Data were collected from a diverse sample of 1,048 emerging adults in New York City in 2009. Exploratory and confirmatory factor analyses suggested two distinct factors, which were inversely related to exposure to users and recent use of each drug. These measures demonstrated good criterion, construct, and incremental validity and effectiveness in analyzing predictors of use. Study limitations were discussed.

Rubino T; Parolaro D. Sexually dimorphic effects of cannabinoid compounds on emotion and cognition. Frontiers In Behavioral Neuroscience 5: 64, 2011. (37 refs.)

This review addresses the issue of sex differences in the response to cannabinoid compunds focusing mainly on behavious belonging to the congnitive and emotional sphere. Sexual dimorphism exists in the different components of the endocannabinoid system. Males seem to have higher CB1 receptor binding sites than females, but females seem to possess more efficient CB1 recptors. Differences between sexess have been also observed in the metabolic processing of THC, the main psychoactive ingredient of marijuana. The consistent dimorphism in the endocannabinoid system and THC metabolism may justify at least in part the ifferent sensitivity observed between male and female animals in different behavioral paradigms concerning emotion and cognition after treatment with cannabinoid compunds. On the basis of these observation, we would like to emphasize the need of including females in basic research and to analyze results for sex differences in epidemiological studies.

Sarne Y; Asaf F; Fishbein M; Gafni M; Keren O. The dual neuroprotective-neurotoxic profile of cannabinoid drugs. (review). British Journal of Pharmacology 163(7, special issue): 1391-1401, 2011. (137 refs.)

Extensive in vitro and in vivo studies have shown that cannabinoid drugs have neuroprotective properties and suggested that the endocannabinoid system may be involved in endogenous neuroprotective mechanisms. On the other hand, neurotoxic effects of cannabinoids in vitro and in vivo were also described. Several possible explanations for these dual, opposite effects of cannabinoids on cellular fate were suggested, and it is conceivable that various factors may determine the final outcome of the cannabinoid effect in vivo. In the current review, we focus on one of the possible reasons for the dual neuroprotective/neurotoxic effects of cannabinoids in vivo, namely, the opposite effects of low versus high doses of cannabinoids. While many studies reported neuroprotective effects of the conventional doses of cannabinoids in various experimental models for acute brain injuries, we have shown that a single administration of an extremely low dose of Delta(9)-tetrahydrocannabinol (THC) (3-4 orders of magnitude lower than the conventional doses) to mice induced long-lasting mild cognitive deficits that affected various aspects of memory and learning. These findings led to the idea that this low dose of THC, which induces minor damage to the brain, may activate preconditioning and/or postconditioning mechanisms and thus will protect the brain from more severe insults. Indeed, our recent findings support this assumption and show that a pre- or a postconditioning treatment with extremely low doses of THC, several days before or after brain injury, provides effective long-term cognitive neuroprotection. The future therapeutical potential of these findings is discussed.

Scholes-Balog KE; Martin-Iverson MT. Cannabis use and sensorimotor gating in patients with schizophrenia and healthy controls. Human Psychopharmacology: Clinical and Experimental 26(6): 373-385, 2011. (31 refs.)

Objective: Schizophrenia patients and healthy cannabis users show different attention-dependant alterations in prepulse inhibition (PPI). It is of interest then to examine PPI in patients with schizophrenia who use cannabis, given the hypothesized association between cannabis use and schizophrenia. Methods: Prepulse inhibition was measured in 34 healthy cannabis users, 32 healthy non-using controls, 20 patients with schizophrenia who were current cannabis users, and 44 non-using patients with schizophrenia. PPI was measured across a range of startling stimulus intensities, during two attention set conditions. Curves of best fit were fitted to the startle magnitudes, across the stimulus intensities. A number of reflex parameters were extracted from these logistic functions. Results: Similar to healthy cannabis users, cannabis-using patients showed altered PPI of Threshold, only when instructed to sustain attention to the auditory stimuli. Conversely, non-using patients with schizophrenia showed reduced PP of R(MAX) only when instructed to ignore the auditory stimuli. Conclusion Cannabis use in patients with schizophrenia is associated with a similar pattern of attention-dependant alterations in PPI to that observed in healthy cannabis users. This is different to those observed in patients with schizophrenia who do not use cannabis and may be as a result of a dysfunction of sustained attention.

Sevy S; Robinson DG; Sunday S; Napolitano B; Miller R et al. Olanzapine vs. risperidone in patients with first-episode schizophrenia and a lifetime history of cannabis use disorders: 16-week clinical and substance use outcomes. Psychiatry Research 188(3): 310-314, 2011. (24 refs.)

The purpose of this study is to compare the efficacy of olanzapine and risperidone for the acute treatment of first-episode schizophrenia patients with cannabis use disorders. This secondary analysis of a previously published study included 49 first-episode patients with a diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a co-occurring lifetime diagnosis of cannabis use disorders randomly assigned to treatment with either olanzapine (n = 28) or risperidone (n = 21) for 16 weeks. The olanzapine group did not differ significantly from the risperidone group for initial response rates of positive symptoms, and rates of cannabis use or alcohol use during the study. Positive symptoms and the Scale for Assessment of Negative Symptoms (SANS) global asociality-anhedonia scores improved over time but did not differ between study medications. In both groups, cannabis use during the study was higher in patients who used cannabis within three months of the admission. Thus, our results suggest that olanzapine and risperidone had a similar initial efficacy on psychotic symptoms and substance use in first-episode patients with co-occurring cannabis use disorders. If clinicians are choosing between olanzapine versus risperidone treatment for this population, their decision should be based upon factors other than symptom response and short-term substance misuse.

Shield KD; Ialomiteanu A; Fischer B; Mann RE; Rehm J. Non-medical use of prescription opioids among Ontario adults: Data From the 2008/2009 CAMH Monitor. Canadian Journal of Public Health 102(5): 330-335, 2011. (34 refs.)

Objective: There are indications that non-medical prescription opioid analgesics use (NMPOU) in the general population has increased in Canada in recent years; however, existing estimates have limitations. Thus our objectives are to determine prevalence and associated demographics of 1) prescription opioid analgesics (PO) use, 2) NMPOU, and 3) use of PO for intoxication purposes in the adult population in Ontario. Methods: Prevalence and the associations between sex, age, region, income, cigarette smoking, binge drinking, cannabis use and psychological distress with the above-noted types of PO use were assessed using data from the 2008 and 2009 samples (n=2030) of the CAMH Monitor. The statistical significance of the associations for all types of PO use was tested through bivariate associations using chi-square tests, and a two-step logistic regression was performed to test if demographics are associated with NMPOU. Results: The prevalence of PO use was 21.3% (95% CI 19.1-23.4), and the prevalence of NMPOU was 2.0% (95% CI 1.2-2.8) of Ontario adults. There were no significant differences between men and women for either PO use or NMPOU. Bivariate associations indicated that NMPOU was associated with tobacco and cannabis use and psychological distress in men. Logistic regression showed a significant association between NMPOU and each of age, cannabis use, and psychological distress in men. Discussion: NMPOU is an emerging epidemic in Canada across all income and age groups, and is associated with other substance use and mental health problems. Improved survey designs are required for more accurate population estimates of NMPOU.

Sidhpura N; Parsons LH. Endocannabinoid-mediated synaptic plasticity and addiction-related behavior. (review). Neuropharmacology 61(7, special issue): 1070-1087, 2011. (403 refs.)

Endogenous cannabinoids (eCBs) are retrograde messengers that provide feedback inhibition of both excitatory and inhibitory transmission in brain through the activation of presynaptic CBI receptors. Substantial evidence indicates that eCBs mediate various forms of short- and long-term plasticity in brain regions involved in the etiology of addiction. The present review provides an overview of the mechanisms through which eCBs mediate various forms of synaptic plasticity and discusses evidence that eCB-mediated plasticity is disrupted following exposure to a variety of abused substances that differ substantially in pharmacodynamic mechanism including alcohol, psychostimulants and cannabinoids. The possible involvement of dysregulated eCB signaling in maladaptive behaviors that evolve over long-term drug exposure is also discussed, with a particular focus on altered behavioral responses to drug exposure, deficient extinction of drug-related memories, increased drug craving and relapse, heightened stress sensitivity and persistent affective disruption (anxiety and depression).

Smith JR; Edland SD; Novotny TE; Hofstetter CR; White MM; Lindsay SP et al. Increasing hookah use in California. American Journal of Public Health 101(10): 1876-1879, 2011. (37 refs.)

Hookah use is gaining popularity nationwide. We determined the correlates and trends for hookah use from the California Tobacco Survey. Between 2005 and 2008 hookah use increased more than 40%, and in 2008, 24.5% of young men reported ever using a hookah. Hookah use was more common among the young (18-24 years), the educated, the non-Hispanic Whites, and the cigarette smokers. Hookah use is increasing in California, especially among young adults, and in 2008 reached the highest prevalence ever reported for both genders.

Solowij N; Yucel M; Respondek C; Whittle S; Lindsay E; Pantelis C et al. Cerebellar white-matter changes in cannabis users with and without schizophrenia. Psychological Medicine 41(11): 2349-2359, 2011. (49 refs.)

Background. The cerebellum is rich in cannabinoid receptors and implicated in the neuropathology of schizophrenia. Long-term cannabis use is associated with functional and structural brain changes similar to those evident in schizophrenia, yet its impact on cerebellar structure has not been determined. We examined cerebellar grey and white matter in cannabis users with and without schizophrenia. Method. Seventeen patients with schizophrenia and 31 healthy controls were recruited; 48% of the healthy group and 47% of the patients were long-term heavy cannabis users (mean 19.7 and 17.9 years near daily use respectively). Cerebellar measures were extracted from structural 3-T magnetic resonance imaging (MRI) scans using semi-automated methods, and examined using analysis of covariance (ANCOVA) and correlational analyses. Results. Cerebellar white-matter volume was reduced in cannabis users with and without schizophrenia compared to healthy non-users, by 29.7% and 23.9% respectively, and by 17.7% in patients without cannabis use. Healthy cannabis users did not differ in white-matter volume from either of the schizophrenia groups. There were no group differences in cerebellar grey matter or total volumes. Total cerebellar volume decreased as a function of duration of cannabis use in the healthy users. Psychotic symptoms and illness duration correlated with cerebellar measures differentially between patients with and without cannabis use. Conclusions. Long-term heavy cannabis use in healthy individuals is associated with smaller cerebellar white-matter volume similar to that observed in schizophrenia. Reduced volumes were even more pronounced in patients with schizophrenia who use cannabis. Cannabis use may alter the course of brain maturational processes associated with schizophrenia.

Spronk D; Dumont GJH; Verkes RJ; de Bruijn ERA. Acute effects of delta-9-tetrahydrocannabinol on performance monitoring in healthy volunteers. Frontiers In Behavioral Neuroscience 5: 59, 2011. (81 refs.)

The error-related negativity (ERN) is a negative event-related potential that occurs immediately after an erroneous response and is thought to reflect human performance monitoring. Delta-9-Tetrahydrocannabinol (THC) administration in healthy volunteers has been linked to impaired performance monitoring in behavioral studies, but to date no studies have examined the effects of cannabinoids on the ERN. Methods: EEG data from 10 healthy volunteers was recorded during execution of a speeded choice-reaction time task (Flankers task) after administration of THC or placebo vapor in a double-blind randomized crossover design. Results: The findings of this study show that the ERN was significantly reduced after administration of THC. The behavioral outcomes on the Flankers task showed no indications of drug induced impairments. Discussion: The diminished ERN reflects impairments in the process of performance monitoring. The task design was not optimized to find behavioral effects. The study shows that cannabinoids impair performance monitoring.

Tarter RE; Fishbein D; Kirisci L; Mezzich A; Ridenour T; Vanyukov M. Deviant socialization mediates transmissible and contextual risk on cannabis use disorder development: A prospective study. Addiction 106(7): 1301-1308, 2011. (49 refs.)

Aims: This study examined the contribution of transmissible risk, in conjunction with family and peer contextual factors during childhood and adolescence, on the development of cannabis use disorder in adulthood. Design: The family high-risk design was used to recruit proband fathers with and without substance use disorder and track their sons longitudinally from late childhood to adulthood. Setting: The families were recruited under the aegis of the Center for Education and Drug Abuse Research in Pittsburgh, Pennsylvania. Participants: The oldest son in the family was studied at ages 10-12, 16, 19 and 22 years. Measurements: The transmissible liability index (TLI), along with measures of quality of the parent-child relationship, cooperative behavior at home, social attitudes and peer milieu were administered to model the developmental pathway to cannabis use disorder. Findings Affiliation with socially deviant peers and harboring non-normative attitudes (age 16) mediate the association between transmissible risk for substance use disorder (SUD) (age 10-12) and use of illegal drugs (age 19), leading to cannabis use disorder (age 22). Conclusions: Deviant socialization resulting from transmissible risk and poor parent-child relationship is integral to development of cannabis use disorder in young adulthood.

Tebes JK; Cook EC; Vanderploeg JJ; Feinn R; Chinman MJ; Shepard JK et al. Parental knowledge and substance use among African American adolescents: Influence of gender and grade level. Journal of Child and Family Studies 20(4): 406-413, 2011. (42 refs.)

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use 1 year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across 1 year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

Temple Jeff R; van den Berg P; Thomas JF; Northcutt J; Thomas C; Freeman DH Jr. Teen dating violence and substance use following a natural disaster: Does evacuation status matter? American Journal of Disaster Medicine 6(4): 201-206, 2011

In September 2008, the Texas coast was directly hit by Hurricane Ike. Galveston Island was flooded by 4.25 m of storm surge, affecting most of the island's housing and infrastructure. The purpose of this study is to examine whether youth who did not evacuate (11 percent), and subsequently were exposed to Hurricane Ike, exhibit higher rates of substance use and physical and sexual teen dating violence (TDV; both perpetration and victimization) when compared with adolescents who did evacuate. Public high school in southeast Texas that was in the direct path of Hurricane Ike. An anonymous survey was conducted in March 2009 to 1,048 high school students who returned to the Galveston Island post-storm (41 percent Hispanic, 23 percent African American, and 27 percent White). For teen dating violence and substance use, Mantel-Haenszel odds ratios, adjusting for age and ethnicity, were computed. When compared with boys who evacuated, nonevacuating boys were more likely to perpetrate physical dating violence and sexual assault and to be a victim of sexual assault. Nonevacuating boys and girls were more likely to report recent use of excessive alcohol, marijuana, and cocaine than those who did evacuate. School personnel, medical personnel, and mental health service providers should consider screening for evacuation status in seeking to identify those adolescents who most need services after a natural disaster. In addition to addressing internalized emotions and psychological symptoms associated with experiencing trauma, intervention programs should focus on reducing externalized behavior such as substance use and TDV.

Thake J; Davis CG. Assessing problematic cannabis use. Addiction Research & Theory 19(5): 448-458, 2011. (50 refs.)

Many cannabis users do not report experiencing harm from use, suggesting that not all use is cause for concern. The objective of this research is to establish a threshold beyond which cannabis use becomes problematic. Thresholds from the cannabis portion of the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) and the Cannabis Use Disorders Identification Test (CUDIT) were compared against a simple frequency of use question (daily use) for their ability to identify problematic users. Data are drawn from the 2008 Canadian Alcohol and Drug Use Monitoring Survey (n = 16,674). Effectiveness of the thresholds for predicting signs of problematic use was assessed in terms of sensitivity and specificity and in terms of positive and negative predictive values (NPV). The ASSIST (threshold of 8) and the CUDIT (thresholds of 6 and 8) outperformed the frequency measure with regards to sensitivity and specificity; the CUDIT with a threshold of 6 struck the best balance. With regards to positive predictive values, the CUDIT with a threshold of 8 revealed the highest value, whereas the daily use threshold, the CUDIT (threshold of 6 and 8) and the ASSIST (threshold of 8) revealed approximately the same NPV. Rates of harm were low for those using less than daily. Findings suggest that the CUDIT with a threshold of 6 may be best for use in population surveys when there is typically no reason to favor either sensitivity or specificity. Health care professionals may achieve greater precision using a threshold of 8 on the CUDIT.

van der Pol P; Liebregts N; de Graaf R; Korf DJ; van den Brink W; van Laar M. The Dutch Cannabis Dependence (CanDep) study on the course of frequent cannabis use and dependence: Objectives, methods and sample characteristics. International Journal of Methods in Psychiatric Research 20(3): 169-181, 2011. (71 refs.)

This paper presents an overview of the prospective cohort design of the Dutch Cannabis Dependence (CanDep) study, which investigates (i) the three-year natural course of frequent cannabis use (>= three days per week in the past 12 months) and cannabis dependence; and (ii) the factors involved in the transition from frequent non-dependent cannabis use to cannabis dependence, and remission from dependence. Besides its scientific relevance, this knowledge may contribute to improve selective and indicated prevention, early detection, treatment and cannabis policies. The secondary objectives are the identification of factors related to treatment seeking and the validation of self report measures of cannabis use. Between September 2008 and April 2009, baseline data were collected from 600 frequent cannabis users with an average age of 22.1 years, predominantly male (79.3%) and an average cannabis use history of 7.1 years; 42.0% fulfilled a (12-month DSM-IV) diagnosis of cannabis dependence. The response rate was 83.7% after the first follow up at 18 months. The second and last follow-up is planned at 36 months. Computer assisted personal interviews (CAPI) were conducted which covered: cannabis use (including detailed assessments of exposure, motives for use and potency preference); use of other substances; DSM-IV internalizing and externalizing mental disorders; treatment seeking; personality; life events; social support and social functioning.

Van Havere T; Vanderplasschen W; Lammertyn J; Broekaert E; Bellis M. Drug use and nightlife: More than just dance music. Substance Abuse Treatment, Prevention and Policy 6: e-article 18, 2011. (58 refs.)

Background: Research over the last decade has focused almost exclusively on the association between electronic music and MDMA (3,4-Methylenedioxymethamphetamine or "ecstasy") or other stimulant drug use in clubs. Less attention has been given to other nightlife venues and music preferences, such as rock music or southern/funky music. This study aims to examine a broader spectrum of nightlife, beyond dance music. It looks at whether certain factors influence the frequency of illegal drug and alcohol use: the frequency of going to certain nightlife venues in the previous month (such as, pubs, clubs or goa parties); listening to rock music, dance music or southern and funky music; or sampling venues (such as, clubs, dance events or rock festivals). The question of how these nightlife variables influence the use of popular drugs like alcohol, MDMA, cannabis, cocaine and amphetamines is addressed. Methods: The study sample consisted of 775 visitors of dance events, clubs and rock festivals in Belgium. Study participants answered a survey on patterns of going out, music preferences and drug use. Odds ratios were used to determine whether the odds of being an illegal substance user are higher for certain nightlife-related variables. Furthermore, five separate ordinal regression analyses were used to investigate drug use in relation to music preference, venues visited during the last month and sampling venue. Results: Respondents who used illegal drugs were 2.5 times more likely to report that they prefer dance music. Goa party visitors were nearly 5 times more likely to use illegal drugs. For those who reported visiting clubs, the odds of using illegal drugs were nearly 2 times higher. Having gone to a pub in the last month was associated with both more frequent alcohol use and more frequent illegal substance use. People who reported liking rock music and attendees of rock festivals used drugs less frequently. Conclusions: It was concluded that a more extended recreational environment, beyond dance clubs, is associated with frequent drug use. This stresses the importance of targeted prevention in various recreational venues tailored to the specific needs of the setting and its visitors.

van Leeuwen AP; Creemers HE; Greaves-Lord K; Verhulst FC; Ormel J; Huizink AC. Hypothalamic-pituitary-adrenal axis reactivity to social stress and adolescent cannabis use: The TRAILS study. Addiction 106(8): 1484-1492, 2011. (38 refs.)

Aims: To investigate the relationship of life-time and repeated cannabis use with hypothalamic-pituitary-adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents. Design: Adolescents who reported life-time or repeated cannabis use, life-time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), which was based on the Trier Social Stress Task. Setting A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study]. Participants A total of 591 adolescents (51% male) who participated in the GSST, which was an additional measurement during the third assessment wave. Measurements HPA axis stress-reactivity was indexed by four cortisol samples collected before, during and after the GSST. Furthermore, all adolescents in our study completed self-reported questionnaires on life-time and repeated cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, experimental session risk status, socio-economic status, mood and time of the experimental session. Findings Life-time cannabis users had significantly lower stress-reactivity levels when compared to abstainers [odds ratio (OR) = 0.68, confidence interval (CI) = 0.55-0.85, P < 0.01] and life-time tobacco users (OR = 0.79, CI = 0.64-0.98, P < 0.05). In addition, repeated cannabis users also exhibited lower stress-reactivity levels when compared to life-time ever users of either tobacco or cannabis (OR = 0.74, CI = 0.53-0.98, P < 0.05). Conclusions: Lower hypothalamic-pituitary-adrenal-axis stress-reactivity in adolescents is related specifically to life-time and repeated cannabis use.

van Nuijs ALN; Castiglioni S; Tarcomnicu I; Postigo C; de Alda ML; Neels H et al. Illicit drug consumption estimations derived from wastewater analysis: A critical review. (review). Science of the Total Environment 409(19): 3564-3577, 2011. (52 refs.)

The consumption of illicit drugs causes indisputable societal and economic damage. Therefore it is necessary to know their usage levels and trends for undertaking targeted actions to reduce their use. Recently, a new approach (namely sewage epidemiology) was developed for the estimation of illicit drug use based on measurements of urinary excreted illicit drugs and their metabolites in untreated wastewater. This review aims at critically evaluating the published literature and identifying research gaps of sewage epidemiology. Firstly, the existing analytical procedures for the determination of the four most used classes of illicit drugs worldwide (cannabis, cocaine, opiates and amphetamine-like stimulants) and their metabolites in wastewater are summarized and discussed. The focus lies on the sample preparation and on the analysis with chromatographic techniques coupled to mass spectrometry. Secondly, back-calculations used to transform measured concentrations in wastewater (in ng/L) into an amount of used illicit drug (in g/day per 1000 inhabitants or doses/day per 1000 inhabitants) are discussed in detail for the four groups of illicit drugs. Sewage epidemiology data from Spain, Belgium, UK, Italy, Switzerland and. are summarized and compared with data from international organisations, such as the European Monitoring Centre for Drug and Drug Addiction (EMCDDA) and the United Nations Office on Drugs and Crime (UNODC). The results derived from wastewater analysis show in general good agreement with existing prevalence data (percentage of a population that uses illicit drugs at a given time) and demonstrate the potential of sewage epidemiology. However, this review confirms that future work should focus on further optimisation and standardisation of various important parameters (e.g. sample collection and back-calculations). In the future, sewage epidemiology could be used in routine drug monitoring campaigns as a valuable tool in addition to the classical socio-epidemiological studies for the determination of local, national and international illicit drug use.

VanDerNagel J; Kiewik M; Buitelaar J; DeJong C. Staff perspectives of substance use and misuse among adults with intellectual disabilities enrolled in Dutch disability services. Journal of Policy and Practice in Intellectual Disabilities 8(3): 143-149, 2011. (15 refs.)

Although the use of psychoactive substances seems to be a growing problem among clients of intellectual disability services (IDS) in the Netherlands, rates of such substance use are unknown, and it is unclear how the services deal with substance-related problems. This study explored the perspectives of staff with respect to the occurrence of substance use and abuse, as well as users' profiles, and service organization policies regarding substance use. A semi-structured questionnaire asked staff to comment on lifetime, current, and problematic substance use among their clients, provide illustrative case reports, and describe policies within their service regarding substance-related problems. Data from 39 IDS were included. Estimations of occurrence of substance use varied greatly across services. Alcohol was reported to be used most often but at lower rates than reported in the general population. Cannabis and other drugs were reported to be used relatively often when compared with the rates noted in the general population. Case reports on 86 substance users were analyzed, and subgroups of users were identified, including younger clients who used both cannabis and alcohol, and older clients with mild ID who used only alcohol. Psychiatric comorbidity and lack of daytime activities were highly prevalent among users. Of the interventions the services reported using to address abuse, psychosocial and restrictive measures were rated as most effective and collaboration with addiction facilities and rewarding abstinence as least effective. Most services reported to have inadequate expertise with substance use. According to respondents, users with both borderline and mild ID used substances, but there were different patterns of use across age groups and level of ID. Respondents noted that substance users face a number of psychosocial problems but that they were poorly equipped to meet the users' needs and to affect functional policies. The authors concluded that the low effectiveness of mainstream addiction treatment or consultation suggests that there is a need for more cross-system collaboration to address this problem.

Vandrey R; Umbricht A; Strain EC. Increased blood pressure after abrupt cessation of daily cannabis use. Journal of Addiction Medicine 5(1): 16-20, 2011. (26 refs.)

Objective: Cannabis is the most widely used illicit drug. Acute cannabis administration increases blood pressure (BP) and heart rate and tolerance develops to these effects with heavy use. A valid and reliable withdrawal syndrome occurs in most daily users, but few studies have assessed the cardiovascular effects of withdrawal. The objective of this report is to describe unexpected changes in cardiovascular function during brief periods of supervised cannabis use and abstinence in daily cannabis users. Methods: A within-subjects ABAC crossover study in which inpatient volunteers smoked cannabis ad libitum (A), and abstained from cannabis (B/C). Vital signs were obtained 3 times daily during 11 inpatient days for 13 daily cannabis users (11 men, 8 African American). Results: BP increased significantly during periods of cannabis abstinence compared with periods of cannabis use. The magnitude of increase was substantial in a subset (N = 6) of participants, with mean increases of up to 22.8 mm Hg systolic and 12.3 mm Hg diastolic BP observed. A main effect of heart rate was not observed. Secondary analysis limited to morning assessments suggested that resting heart rate increased during abstinence, but the magnitude of this effect was not clinically significant. Conclusions: Abrupt cessation of heavy cannabis use may cause clinically significant increases in BP in a subset of users. BP should be monitored among those attempting to reduce or quit frequent cannabis use, particularly those with preexisting hypertension. The time course of this effect is currently unknown and requires further study.

Walker DD; Stephens R; Roffman R; DeMarce J; Lozano B; Towe S et al. Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the Teen Marijuana Check-Up. Psychology of Addictive Behaviors 25(3): 474-484, 2011. (44 refs.)

Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control. Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC), or Delayed Feedback Control (DFC). Those who were assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to four optional individual treatment sessions aimed at cessation of cannabis use. The research was conducted in high schools in Seattle, Washington. The participant s included 310 self-referred adolescents who smoked cannabis regularly. The main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment. At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to those in the DFC. The frequency of cannabis use was less in MET relative to EFC at 3 months, but it did not translate to differences in negative consequences. Reductions in use and problems were sustained at 12 months, but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and did not differ by condition. Brief interventions can attract adolescent cannabis users and have positive impacts on them, but the mechanisms of the effects are yet to be identified.

Wall MM; Poh E; Cerda M; Keyes KM; Galea S; Hasin DS. Adolescent marijuana use from 2002 to 2008: Higher in states with medical marijuana laws, cause still unclear. Annals of Epidemiology 21(9): 714-716, 2011. (10 refs.)

PURPOSE: Since 1996, 16 states have legalized marijuana use for medical purposes. The current study provides a scientific assessment of the association of medical marijuana laws (MML) and adolescent marijuana use using national data. METHOD: State representative survey data on approximately 23,000 12-17 year olds were collected by the National Survey on Drug, Use and Health annually from 2002-2008. Yearly state-specific estimates of prevalence of past-month marijuana use and perception of its riskiness were statistically tested for differences between states with and without MML by year and across years. RESULTS: States with MML had higher average adolescent marijuana use, 8.68% (95% Cl: 7.95-9.42) and lower perception of riskiness, during the period 2002-2008 compared to states without MML, 6.94% (95% Cl: 6.60-7.28%). In the eight states that passed MML since 2004, in the years prior to MML passage, there Was already a higher prevalence of use and lower perceptions of risk in those states compared to states that have not passed MML. CONCLUSIONS: While the most likely of several possible explanations for higher adolescent marijuana use and lower perceptions of risk in MML states cannot be determined from the current study, results clearly suggest the need for more empirically-based research on this topic.

Wang GS; Narang SK; Wells K; Chuang R. A case series of marijuana exposures in pediatric patients less than 5 years of age. Child Abuse & Neglect 35(7): 563-565, 2011. (6 refs.)

This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 6 years of age. A total of 5 patients were identified between November 2009 through March 2010. The age range was 10 months to 4 years, all were male. They all presented to the ED with abnormal neurologic physical exams consisting of lethargy and somnolence. One patient also had bradycardia. All the patients had extensive laboratory and radiographic work ups in the ED; ultimately, the urine toxicology screen confirmed THC ingestions in all the patients. Two patients were admitted, 1 to the intensive care unit ; the remaining 3 were observed in the emergency department . It was determined that 4 of the 5 patients had household members with confirmed medical marijuana cards, and these children were explosed to medical marijuana. Exposures in such young patients may be from ingestion, passive inhalation or both. Prior case reports have demonstrated significant symptoms from ingestions, including coma resulting from airway obstruction though there have been no reported fatalities to poison control centers from exposures solely from marijuana, this case series highlights the significant morbidity of this increasing environmental exposure to marijuana in children.

Weinstein AM; Gorelick DA. Pharmacological treatment of cannabis dependence. (review). Current Pharmaceutical Design 17(14): 1351-1358, 2011. (86 refs.)

Cannabis is the most frequently used illegal psychoactive substance in the world. There is a significant increase in the number of treatment admissions for cannabis use disorders in the past few years, and the majority of cannabis-dependent individuals who enter treatment have difficulty in achieving and maintaining abstinence. Thus, there is increased need for medications that can be used to treat this population. So far, no medication has been shown broadly and consistently effective; none has been approved by any national regulatory authority. Medications studied have included those that alleviate symptoms of cannabis withdrawal (e.g., dysphoric mood, irritability), those that directly affect endogenous cannabinoid receptor function, and those that have shown efficacy in treatment of other drugs of abuse or psychiatric conditions. Buspirone is the only medication to date that has shown efficacy for cannabis dependence in a controlled clinical trial. Results from controlled human laboratory studies and small open-label clinical trials suggest that dronabinol, the COMT inhibitor entacapone, and lithium may warrant further study. Recent pre-clinical studies suggest the potential of fatty acid amide hydrolase (FAAH) inhibitors such as URB597, endocannabinoid-metabolizing enzymes, and nicotinic alpha7 receptor antagonists such as methyllycaconitine (MLA). Controlled clinical trials are needed to evaluate the clinical efficacy of these medications and to validate the laboratory models being used to study candidate medications.

Welch KA; McIntosh AM; Job DE; Whalley HC; Moorhead TW; Hall J et al. The impact of substance use on brain structure in people at high risk of developing schizophrenia. Schizophrenia Bulletin 37(5): 1066-1076, 2011. (49 refs.)

Ventricular enlargement and reduced prefrontal volume are consistent findings in schizophrenia. Both are present in first episode subjects and may be detectable before the onset of clinical disorder. Substance misuse is more common in people with schizophrenia and is associated with similar brain abnormalities. We employ a prospective cohort study with nested case control comparison design to investigate the association between substance misuse, brain abnormality, and subsequent schizophrenia. Substance misuse history, imaging data, and clinical information were collected on 147 subjects at high risk of schizophrenia and 36 controls. Regions exhibiting a significant relationship between level of use of alcohol, cannabis or tobacco, and structure volume were identified. Multivariate regression then elucidated the relationship between level of substance use and structure volumes while accounting for correlations between these variables and correcting for potential confounders. Finally, we established whether substance misuse was associated with later risk of schizophrenia. Increased ventricular volume was associated with alcohol and cannabis use in a dose-dependent manner. Alcohol consumption was associated with reduced frontal lobe volume. Multiple regression analyses found both alcohol and cannabis were significant predictors of these abnormalities when simultaneously entered into the statistical model. Alcohol and cannabis misuse were associated with an increased subsequent risk of schizophrenia. We provide prospective evidence that use of cannabis or alcohol by people at high genetic risk of schizophrenia is associated with brain abnormalities and later risk of psychosis. A family history of schizophrenia may render the brain particularly sensitive to the risk-modifying effects of these substances.

Wisdom JP; Manuel JI; Drake RE. Substance use disorder among people with first-episode psychosis: A systematic review of course and treatment. Psychiatric Services 62(9): 1007-1012, 2011. (54 refs.)

Objective: People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments. Methods: The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? Results: Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction. Conclusions: Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.

Yang WS; Leatherdale ST; Ahmed R. Smoking susceptibility among never-smokers: Data from the 2006-07 National Youth Smoking Survey. Canadian Journal of Public Health 102(4): 254-257, 2011. (25 refs.)

Objectives: The purpose of this study was to explore school and individual characteristics associated with smoking susceptibility among a nationally representative sample of Canadian youth who were never-smokers. Methods: Using data from the 2006-07 Youth Smoking Survey, multi-level logistic regression modeling was used to examine if student-level and school-level characteristics were associated with smoking susceptibility among grade 9 to 12 never-smokers. Results: In 2006, 88.2% of Canadian youth in grades 9 to 12 were considered never-smokers, of whom 28.2% (n=255,840) were considered to be susceptible to future smoking. Significant between-school random variation in smoking susceptibility was identified, although the school-level smoking rate was not significantly associated with the risk of an individual student being susceptible. At the student level, smoking susceptibility was associated with having a sibling who smokes, having 1 or 2 close friends who smoke, having ever used alcohol or marijuana, being female and being in grade 9. Parental smoking and exposure to smoking in a car or in the home were not significantly associated with smoking susceptibility. Conclusion: One way to prevent smoking onset among youth is to interfere with the development of susceptibility to smoking in non-smoking youth population. We found that over 1 in 4 Canadian youth who were never-smokers in 2006 were considered susceptible to smoking in the future. Ongoing tobacco control prevention initiatives are crucial for reducing the prevalence of smoking susceptibility among non-smoking Canadian youth.

Yonkers KA; Howell HB; Gotman N; Rounsaville BJ. Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women. Journal of Substance Use 16(5): 372-380, 2011. (36 refs.)

Introduction: Many factors comprise a patient's decision to disclose use of drugs. Pregnant women may report drug use because they would like help with their addiction but the stigma associated with drug use may dampen their willingness to disclose. Knowledge about the accuracy of self-reported drug use as compared to urine toxicology screens can assist clinicians in the management of substance use in pregnancy. Method: We compared the urine toxicology screens and self-reported use of marijuana or cocaine for 168 women enrolled in an integrated obstetrical/substance abuse treatment program. We stratified by various periods of self-reported use and race and utilized Cohen's kappa to measure overall agreement between self-report and toxicology tests. Results: Most women with a positive toxicology screen reported use in the past 28 days (78% for marijuana, 86% for cocaine). However, many women reported their most recent use to be outside of the assays' detection window (14% for marijuana, 57% for cocaine). We did not find differences in self-report for women with positive urine between Whites and non-Whites (p = 1.00). Agreement over the previous month was good (Kappa = 0.74 and 0.70 for marijuana and cocaine, respectively.) Summary: A question about use of marijuana or cocaine during the preceding month rather than the prior few days may be a better indicator of use.