Addiction

Surprising Research on Cannabis

Photo by Rick Proctor on Unsplash

Photo by Rick Proctor on Unsplash

Much of what we think we know about cannabis may soon change as a result of new research that uncovers some surprising facts. Indeed, the topic, which can be emotionally charged, is the focus of intense scientific study. Is cannabis good for you? Is it addictive? What long-term harms can use cause? The answers to these questions are multi-layered and not always clear-cut, which is why cannabis research continues with even more urgency.

FACTS ON CANNABIS ADDICTION AND DEPENDENCE

Current estimates are that one in 10 cannabis users will develop cannabis addiction or dependence. The potency of the delta-9-tetrahydrocannabinol (THC), the main psychoactive constituent in marijuana, in today’s cannabis is much higher than in years past. Besides traditional marijuana use, designer drugs created from synthetic cannabinoids are growing in popularity – along with increased concern for their unknown addiction potential and negative health effects. According to a report from the European Monitoring Centre for Drugs and Addiction, at least 169 different synthetic cannabinoid compounds have been discovered since detection of the market’s first synthetic cannabinoid in 2008.

Using gene-based testing, four genes have been identified that are significantly associated with lifetime cannabis use:

  • Neural cell adhesion molecule 1 (NCAM1) – which is also associated with substance abuse
  • Cell adhesion molecule 2 (CADM2)
  • Potassium sodium-activated channel subfamily T member 2 (KCNT2)
  • Short coiled-coil protein (SCOC)

While vulnerability to starting cannabis use and developing cannabis use disorder (CUD) is heritable, other risk factors are believed to speed the transition. These risk factors include:

  • Age of first use of cannabis
  • Drug use by peers
  • Availability of drugs
  • Lower socioeconomic status
  • Childhood sexual abuse
  • Early adolescent smoking and/or drinking
  • Presence of pre- or comorbid psychiatric conditions — including mood disorders, psychosis, attention-deficit hyperactivity disorder (ADHD)

Other studies found certain biological and personality traits – such as impulsivity, sensation-seeking, and schizotypy – are positively correlated with youths and young adults initiating cannabis use.

CANNABIS AFFECTS WOMEN DIFFERENTLY

Comprehensive research published in Frontiers in Behavioral Science outlines some fascinating details of the differences between men and women when it comes to the effect of cannabis. The bottom line is that women are more likely to become addicted to cannabis than men. In addition to genetic background and fluctuations in hormones, here are some of the study’s findings, using animal models:

  • Men are four times more likely than women to try cannabis.
  • Men are also more likely to use cannabis more frequently than their female counterparts.

The male sex steroids (including natural sex steroid testosterone and synthetic steroids such as nandrolone) increase risk-taking and suppress the reward system in the brain. This could explain why men are more willing to experiment with drugs, including cannabis.

Women, on the other hand, seem to be more vulnerable to developing an addiction to cannabis, at least on a neurochemical level. To put it plainly, females can transition from first use to habit more rapidly than men. The rodent studies showed researchers that the female hormone estradiol affects three targets of drug-taking: control of movement, filtering of sensory input to the brain, and social behavior. This occurs through modulation of the endocannabinoid system which, in turn, influences the production of estradiol.

In addition to different levels of endocannabinoids, female rats have more sensitive receptors than males in the specific brain areas related to the three drug-taking targets – plus, significant changes along the female rats’ menstrual cycle.

Researchers noted that the result is that “the interactions between the endocannabinoid system and brain level of dopamine – the neurotransmitter of ‘pleasure’ and ‘reward’ – are sex-dependent.”

They suggest that gaining a deeper understanding of how cannabinoids and sex steroids interact is both crucial to assess the effect of increasing cannabis use and to effectively deal with the results. For example, cannabis addiction detoxification treatments and relapse prevention may be gender-tailored for better effectiveness. Still, much further research needs to be done to make evidence-based progress in this area.

MARIJUANA EXTRACT CBD OFFERS PAIN RELIEF WITHOUT THE HIGH

For the millions of Americans suffering with chronic pain, there’s promising research that shows that pinpointing an effective dose of cannabidiol (CBD), an extract from the marijuana plant can provide safe relief from chronic pain minus the adverse effects of THC from marijuana. Researchers from Canada’s McGill University Health Centre, using animal models and administering low doses of CBD over a period of seven days reduced both pain and anxiety – two symptoms commonly associated with chronic or neuropathic pain. The researchers say this is encouraging evidence for the use of CBD over THC or opioids for pain management in conditions that include sciatica, diabetic cancer, back pain, chronic pain and pain that occurs post-trauma. CBD became legal in Canada in mid-October 2018, following passage of the country’s Cannabis Act. More robust clinical trials are needed, say researchers, for the kind of evidence-based proof of CBD’s effectiveness and safety to provide pain relief for humans.

In another study published in JAMA Psychiatry, researchers from Syracuse University found that cannabinoid drugs do not reduce the intensity of chronic pain, but they do perhaps make the pain feel more tolerable and less unpleasant. Even though 30 states allow medical marijuana use, cannabis is still a Schedule 1 Controlled Substance as classified by the Drug Enforcement Agency (DEA). This presents significant challenges for research into the therapeutic effects of cannabis. As a result, there is a lack of high-quality evidence supporting the effectiveness of cannabis in treating chronic pain.

CANNABIS USE ACCELERATES BRAIN AGING

In the largest known imaging study of the brain, researchers affiliated with several California institutions, including Amen Clinics, Inc., Google, Inc., UCLA Medical Center, UCSF Medical Center, and Johns Hopkins University in Baltimore, MD, found that cannabis use is one of the drivers of accelerated brain aging. Using brain SPECT (single photon emission computer tomography) to evaluate 30,000 scans from individuals ranging in age from 9 months to 105 years, researchers say they can now track common disorders and behaviors that prematurely age the brain. Schizophrenia, for example, contributed to an average 4 year early brain aging, while cannabis abuse accelerated brain aging by 2.8 years. Other disorders found to amp up brain aging were bipolar disorder (1.6 years), attention deficit hyperactivity disorder (ADHD) (1.4 years), and alcohol abuse (0.6 years). Researchers pointed out that the results of this study should give everyone pause, especially considering the current cultural perception that cannabis use is innocuous. They added that better treatment of these disorders could slow or even halt the brain aging process.

STONED DRIVING ON THE RISE

The most prevalent detected intoxicant in drivers in the United States isn’t alcohol, it’s THC. Approximately 13 percent of drivers tested positive for marijuana, compared with about 8 percent for measurable amounts of alcohol. Despite findings that cannabis intoxication (stoned driving) while driving impairs reaction time and visual-spatial judgement, a plurality of cannabis users believe that cannabis has no effect or decreases crash risk, while only 38 percent think that driving under the influence of cannabis increases crash risk. This underestimation of risks of cannabis intoxication plus current cannabis consumption trends suggest cannabis-impaired driving may significantly contribute to highway injury and death. Alcohol and other drugs combined with cannabis use may “more than additively” increase highway risk.

TEEN CANNABIS USE PRESENTS RISKS TO COGNITIVE DEVELOPMENT

Research published in the American Journal of Psychiatry found that adolescent cannabis use is associated with concurrent and lagged effect on cognitive functioning, such as working memory, memory recall, perceptual reasoning, and inhibitory control. The lasting effects of cannabis use on inhibitory control is particularly concerning, since inhibitory control is a risk factor for other addictive behaviors. Early onset of cannabis use during adolescence results in even more pronounced cognitive and behavioral effects. Researchers highlighted the importance of protecting youth from the adverse consequences of cannabis consumption through more investment in drug-prevention programs.

CANNABIS USE MAY INCREASE HYPERTENSION RISK OF DEATH THREE-FOLD

Research published in the European Journal of Cardiology has found a three-fold increased risk of death from hypertension due to cannabis use. Compared to non-users, marijuana users had a risk of hypertension death that was 3.42 times higher – and an additional 1.04 greater risk for each year of cannabis use. Researchers pointed out that this finding is not surprising, considering that marijuana use is known to have multiple effects on the cardiovascular system, including increases in heart rate, blood pressure and oxygen demand. Cases of heart attack and angina have been reported in hospital emergency departments after cannabis use. They cautioned that the cardiovascular risk associated with marijuana use may be even greater than the risk already established for cigarette smoking.

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This article was originally published on Psych Central.

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New Research on Gambling Use Disorder

Photo by Benjamin Lambert on Unsplash

Photo by Benjamin Lambert on Unsplash

“Gambling: The sure way of getting nothing from something.” – Wilson Mizner

 

Who doesn’t enjoy a game of chance now and then? Trying your luck on an inexpensive lottery ticket can seem innocent enough, and might even net you considerable return. Spurred on by the lure of winning the big jackpot through television, radio, Internet, newspaper and other media ads may even prompt you to spend more than you intended. And it’s not just lottery tickets that people become hooked on but other forms of gambling as well: horse racing, slot machines, card games, sports betting. It should come as no surprise, then, that gambling use disorder (GUD) has steadily gained prominence as another form of addiction.

New research on gambling addiction and GUD is both illuminating, troubling, and promising with respect to prevention, treatment and recovery.

Gambling Officially Recognized in DSM-5 as Behavioral Addiction

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) took gambling out of the “Impulse Control Disorder” section and reclassified gambling disorder as part of the expanded section covering “Substance-related and Addictive Disorders.” With this action, gambling disorder is the first non-substance behavioral addiction. A 2016 review in Substance Abuse and Rehabilitation examined the similarities and differences between gambling disorder and substance use disorders (SUDs) and found many shared characteristics, some of which include diagnostic criteria, comorbidity, genetic and physiological factors, even approaches to treatment.

Suicide Rates Increasing Among Those with Gambling Disorder

While previous research found that gambling disorder appeared to be an independent risk factor for suicide, and few studies looked at all-cause mortality as it relates to gambling disorder, 2018 research published in the Journal of Behavioral Addictions explored both mortality and suicide rates in those with gambling disorder and the general population, as well as risk factors associated with mortality due to suicide and all causes. Their findings showed significantly elevated rates of mortality and suicide among those with gambling disorder. Furthermore, even though common comorbid mental health issues did not predict overall mortality, depression was found to predict suicide death. Researchers suggested that medical and mental health professionals pay attention to long-term risk of death in their patients with gambling disorder and promote effective interventions for mental health and other comorbid conditions.

Personality Disorders Consistently Associated with Pathological Gambling

In 2017 review published in Current Opinion in Psychiatry, researchers found a strong association between pathological gambling and personality disorders. They noted that studies consistently showed that the presence of a personality disorder is associated with severity of gambling and early age of onset of pathological gambling. Researchers called for further research on pathological gambling that goes beyond merely estimating rates of personality disorders and instead concentrate on longitudinal research to understand both the pathways between personality disorders and the early onset and severity of pathological gambling.

Disordered Gamblers Seeking Treatment Frequently Have Psychological Distress

What used to be called problem gambling or pathological gambling is now generally referred to as disordered gambling, according to several sources, including the New York Council on Problem Gambling. A 2017 study published in the Journal on Gambling Studies examined psychological distress as an indicator of co-occurring psychopathology among disordered gamblers seeking treatment. They found evidence of severe gambling pathology among those with greater levels of psychological distress. Furthermore, greater scores of psychological distress was found to significantly predict anxiety, depression, and deviancy. Researchers suggested that clinicians treating disordered gamblers may want to conduct a brief screening to check for the presence of co-occurring psychopathology, especially with reference to measures of psychological distress. The results could greatly aid clinicians in determining effective treatment approaches for disordered gamblers with psychological distress.

Co-morbid PTSD and Gambling-Related Cognitions: How They Affect Treatment

A 2018 study published in Addictive Behaviors looked at the association of post-traumatic stress disorder (PTSD) and gambling disorder in individuals with both conditions. Researchers sought to determine how PTSD might be related to specific gambling-related cognitions in terms of expression and experience. Hypothesizing that those with symptoms of PTSD (or symptoms of PTSD, even if undiagnosed) would show greater erroneous beliefs and cognitive distortions about gambling, researchers found the study participants consistently reported greater gambling-related cognitions. This led researchers to suggest that PTSD is uniquely associated with increased levels of cognitive distortions and erroneous beliefs about gambling and, further, that the findings both add to current understanding about the relation of PTSD and gambling to each other and to treatment of those diagnosed with the co-morbid conditions.

Other 2018 research published in Psychology of Addictive Behaviors postulated that PTSD symptoms were likely to be associated with unique beliefs about types of gambling behavior and unique motivations to gamble. Researchers studying two groups, an inpatient group of U.S. Armed Forces veterans in treatment for gambling disorder and an online sample of gambling adults found that symptoms of PTSD were related to positive expectancies for gambling and consistently associated with greater coping mechanisms for gambling for both sample groups. Researchers said that the high co-morbidity of symptoms of PTSD and gambling disorder are likely of interest for clinicians treating individuals for either PTSD or gambling disorder (or both).

Flashing Casino Lights/Sounds: Influence Risky Decision-making and Promote Problem Gambling?

Research published in the Journal of Neuroscience indicates a possible connection between the sensory cues of flashing lights and sounds in casinos and increased risky decision-making, potentially even promoting problem gambling behavior. Researchers from the University of British Columbia found that individual choices were less influenced by the odds of winning when the gambling environment featured the audio and visual sensory cues. In other words, they took more risks in gambling despite the odds. Researchers suggested that the findings might help explain why individuals continue to gamble even though the odds of winning are against them. In addition, they said that gambling sights and sounds are far from innocuous and may form an important piece of the puzzle surrounding gambling addiction in that such environmental cues encourage risky decision-making and bias attention.

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This article was originally published on Psych Central.

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