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Cannabis use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community study in adolescents
Open accessAbstract
Background Whereas the role of externalizing disorders is relatively well established in predicting the onset of cannabis use (CU) or cannabis use disorder (CUD), the status of anxiety and mood disorders in predicting CU and CUD remains controversial.Objective (1) To examine cross-sectional and prospective associations of CU and CUD with a range of mental disorders and whether anxiety and mood disorders are associated with CU/CUD after adjusting for externalizing disorders.Methods N=1395 community subjects aged 14-17 at baseline were followed-up at three waves prospectively over 10 years. Substance use, substance disorders and mental disorders were assessed using the DSM-IV/M-CIDI.Results (1) The baseline prevalence rates where 19.3% at t(0) for CU and 2.6% for CUD. Cumulative incidence rates at t(3) were 54.3% for CU and 13.7% for CUD. (2) In cross-sectional and prospective analyses other substance use disorders, mood and anxiety disorders were associated with CU and CUD. (3) Associations of panic-anxiety with CU and of depressive and bipolar disorders with CU and CUD were significant after controlling for externalizing disorders.Conclusion A range of psychopathological conditions, including depressive, bipolar and less consistently anxiety disorders as well as the degree of their comorbidity are significantly associated with incident CU and progression to CUD, even when controlling for externalising disorders. A better understanding of this complex interplay may result in better aetiological models and intervention strategies.
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“another found the highest risk in childhood internalizing disorders, 9”
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“The disorders included in anxiety disorders appear to have a differential risk for substance-related disorders.”
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“Similarly, results from investigations which tested a unidirectional hypothesis about the nature of this association in their sample are equivocal, with some suggesting that depression is a risk factor of subsequent cannabis use (Wittchen et al. 2007), while a larger number suggest that cannabis use is a risk factor f…”
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“Previous research indicates that the progression from cannabis experimentation or use to CUD is comparatively rare (Chen et al. 2005; Wittchen et al. 2007).”
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“Indeed, depression has been suggested to exert a causal influence on marijuana use among adolescents even after controlling for sociodemographics, familial factors and externalizing disorders (McGee et al.2000; King et al. 2004; Wittchen et al. 2007).”
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“Wittchen et al. (2007) found that even after controlling for externalizing disorders, internalizing disorders (depressive and bipolar disorders, and anxiety less consistently) predicted subsequent marijuana use.”
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Spechler, P. A., Orr, C., Chaarani, B., Kan, K., Mackey, S., Morton, A., Snowe, M. P., Hudson, K. E., Althoff, R. R., Higgins, S. T., et al. (2015) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2015.08.007 · Cited by 77
“52, Hamburg, Germany Department of Psychiatry, Universite de Montreal, CHU Ste Justine Hospital, Canada Neurospin, Commissariat à l’Energie Atomique, CEA-Saclay Center, Paris, France Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany…”
BackgroundInfluentialGriffith‐Lendering, M. F. H., Huijbregts, S. C. J., Mooijaart, A., Vollebergh, W., & Swaab, H. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.11.024 · Cited by 67
“Nonetheless, there are some studies hat have found evidence for the self-medication hypothesis, with nternalizing behaviour problems preceding cannabis use at later ge (King et al., 2004; Wittchen et al., 2007).”
BackgroundThe association between adolescent cannabis use and anxiety: A parallel process analysis
Duperrouzel, J. C., Hawes, S. W., Lopez‐Quintero, C., Pacheco‐Colón, I., Comer, J. S., & González, R. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.11.005 · Cited by 66
Towards a comprehensive developmental model of cannabis use disorders
Blanco, C., Rafful, C., Wall, M. M., Ridenour, T. A., Wang, S., & Kendler, K. S. (2014) · Addiction · doi:10.1111/add.12382 · Cited by 114
“In accord with prior studies [37,38], we found that when examined individually, a broad range of variables increased the likelihood of cannabis use.”
Ransing, R. S., de la Rosa, P. A., Pereira-Sánchez, V., Handuleh, J. I. M., Jerotić, S., Gupta, A. K., Karaliūnienė, R., de Filippis, R., Peyron, E., Güngör, E. S., et al. (2021) · Trends in Psychiatry and Psychotherapy · doi:10.47626/2237-6089-2021-0263 · Cited by 75
Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana
Richter, L., Pugh, B., & Ball, S. A. (2016) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2016.1164711 · Cited by 70
Goldstein, B. I., Strober, M., Axelson, D., Goldstein, T. R., Gill, M. K., Hower, H., Dickstein, D., Hunt, J., Yen, S., Kim, E., et al. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.07.009 · Cited by 65
The association between social phobia, social anxiety cognitions and paranoid symptoms
Schutters, S. I. J., Dominguez, M.-D.-G., Knappe, S., Lieb, R., van Os, J., Schruers, K. R. J., & Wïttchen, H. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01787.x · Cited by 66
“The temporal order of the association, however, seems to differ in that anxiety disorders tend to precede cannabis use (51, 53), whereas psychosis is preceded by cannabis use (49, 50, 54).”
BackgroundSelf-citationEfficacy of a targeted cognitive–behavioral treatment program for cannabis use disorders (CANDIS*)
Hoch, E., Noack, R., Henker, J., Pixa, A., Höfler, M., Behrendt, S., Bühringer, G., & Wïttchen, H. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.07.014 · Cited by 60
“For example, epidemiological data suggest that the main incidence phases of CU, CUD, and associated psychosocial problems are primarily in adolescence and early adulthood (Behrendt et al., 2009; Georgiades and Boyle, 2007; Monshouwer et al., 2005; Perkonigg et al., 2008; von Sydow et al., 2002; Wittchen et al., 2009;…”
Self-citationPathways from Acculturation Stress to Substance Use Among Latino Adolescents
Buchanan, R. L., & Smokowski, P. R. (2009) · Substance Use & Misuse · doi:10.1080/10826080802544216 · Cited by 61
“However, there have been inconsistent associations between internalizing problems and reported substance use depending upon the specific type of internalizing problem (Wittchen et al., 2007), substance used, and gender (King et al., 2004).”
BackgroundPollard, J., Reardon, T. C., Williams, C., Creswell, C., Ford, T. J., Gray, A. M., Roberts, N. W., Stallard, P. N., Ukoumunne, O. C., & Violato, M. (2023) · JCPP Advances · doi:10.1002/jcv2.12149 · Cited by 70
Xue, S., Husain, M. I., Zhao, H., & Ravindran, A. V. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720952251 · Cited by 65
“This issue is particularly salient as cannabis is commonly regarded as an anxiolytic agent and is often used for self-medication, in spite of the lack of systematic evaluations of its long-term impact on the onset and cause of anxiety disorders.(7,8) Published literature on cannabis use and prospective development of…”
BackgroundHeron, J., Barker, E. D., Joinson, C. J., Lewis, G., Hickman, M., Munafo, M. R., & Macleod, J. (2013) · Addiction · doi:10.1111/add.12268 · Cited by 58
Euser, A. S., Evans, B., Greaves-Lord, K., Huizink, A., & Franken, I. (2013) · Addiction Biology · doi:10.1111/adb.12002 · Cited by 60
“…are highly co-morbid and there is plenty of existing data arguing that internalizing problems, such as anxiety, precede cannabis use at a later age and can be considered a risk factor for cannabis dependence (e.g. King, Iacono & McGue 2004; Buckner et al. 2006; Wittchen et al. 2007; Pasche 2012).”
BackgroundBehrendt, S., Wïttchen, H., Höfler, M., Lieb, R., Low, N. C. P., Rehm, J. T., & Beesdo‐Baum, K. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02324.x · Cited by 62
Self-citationGrella, C. E., Rodriguez, L., & Kim, T. (2014) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2014.944960 · Cited by 58
“2012), depression (Wittchen et al. 2007), problems with cognitive processing and memory (Indlekofer et al.”
BackgroundReligiosity and Behavioral Health Outcomes of Adolescents Living in Disaster-Vulnerable Areas
Rose, T., Shields, J. J., Tueller, S., & Larson, S. L. (2014) · Journal of Religion and Health · doi:10.1007/s10943-014-9828-0 · Cited by 57
Cannabis use and first manic episode
Bally, N., ZULLINO, D. F., & Aubry, J. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.038 · Cited by 59
“It has been suggested that having any mental disorder originally is associated with increased rates of cannabis abuse (Wittchen et al., 2007).”
BackgroundEnglund, M. M., & Siebenbruner, J. (2012) · Journal of Adolescence · doi:10.1016/j.adolescence.2012.03.004 · Cited by 57
“Then again, Wittchen et al. (2007) investigating German youth found, after controlling for externalizing disorders, age, and gender, that early adolescents with major depression/ dysthymia and panic-anxiety disorders had higher levels of cannabis use ten years later J Adolesc.”
BackgroundCannabis Use and Hypomania in Young People: A Prospective Analysis
Marwaha, S., Winsper, C., Bebbington, P., & Smıth, D. J. (2017) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx158 · Cited by 58
Emerging adult outcomes of adolescent psychiatric and substance use disorders
Vida, R., Brownlie, E. B., Beitchman, J. H., Adlaf, E. M., Atkinson, L., Escobar, M., Johnson, C. J., Jiang, H., Koyama, E., & Bender, D. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.03.035 · Cited by 53
Patterns of use, sequence of onsets and correlates of tobacco and cannabis
Arpana Agrawal, A., Scherrer, J. F., Lynskey, M. T., Sartor, C. E., Grant, J. D., Haber, J. R., Madden, P. A. F., Jacob, T., Bucholz, K. K., & Xian, H. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.07.005 · Cited by 53
Lankenau, S. E., Ataiants, J., Mohanty, S., Schrager, S. M., Iverson, E., & Wong, C. F. (2017) · Drug and Alcohol Review · doi:10.1111/dar.12534 · Cited by 52
Dellazizzo, L., Potvin, S., Dou, B. Y., Beaudoin, M., Luigi, M., Giguère, C.-É., & Dumais, A. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.19101008 · Cited by 55
Screening for Substance Abuse Among Adolescents Validity of the CAGE-AID in Youth Mental Health Care
Couwenbergh, C., van der Gaag, R. J., Koeter, M. W. J., de Ruiter, C., & van den Brink, W. (2009) · Substance Use & Misuse · doi:10.1080/10826080802484264 · Cited by 51
“This early-onset substance use and abuse1 is often preceded by mental disorders (Boden, Fergusson, and Horwood, 2007; Huizink, Ferdinand, van der, and Verhulst, 2006; Wittchen et al., 2007).”
BackgroundCannabis use and mood disorders: a systematic review
Sorkhou, M., Dent, E. L., & George, T. P. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1346207 · Cited by 61
Sanchez, Z. M., Valente, J. Y., Galvão, P. P. D. O., Gubert, F. D. A., Melo, M. H. D. S., Caetano, S. C., Mari, J. D. J., & Cogo‐Moreira, H. (2020) · Addiction · doi:10.1111/add.15358 · Cited by 49
Psychosocial factors associated with adolescent substance use: a longitudinal investigation
Champion, K. E., Barrett, E. L., Slade, T. N., Teesson, M., & Newton, N. C. (2017) · Advances in Dual Diagnosis · doi:10.1108/add-07-2017-0007 · Cited by 49
Goodman, A. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.02981.x · Cited by 52
“Far fewer look for evidence of a dose-response relationship, and while some suggest such effects (6, 43) others do not (10).”
BackgroundInfluentialPreuss, U. W., Watzke, A.-B., Zimmermann, J., Wong, J., & Schmidt, C. O. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.08.008 · Cited by 48
Piechatzek, M., Indlekofer, F., Daamen, M., Glasmacher, C., Lieb, R., Pfister, H., Tucha, O. M., Lange, K. W., Wïttchen, H., & Schütz, C. G. (2009) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.1069 · Cited by 52
“The cumulative incidence of alcohol use was 95.1% in a group of young adults between 21 and 27 years of age (Wittchen et al., 2007).”
BackgroundInfluentialSelf-citationOh, S., Salas‐Wright, C. P., Vaughn, M. G., & DiNitto, D. M. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.09.036 · Cited by 48
“Moreover, longitudinal research has helped to clarify the ways in which marijuana use is related to increased risk of anxiety, depression, and other psychiatric disorders (Caspi et al., 2005; Wittchen et al., 2007).”
BackgroundLin, S. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.100 · Cited by 51
Cannabis controversies: how genetics can inform the study of comorbidity
Arpana Agrawal, A., & Lynskey, M. T. (2014) · Addiction · doi:10.1111/add.12436 · Cited by 45
“The links between cannabis and depression as well as suicide have been noted in both crosssectional and longitudinal studies (22; 73; 74) – for instance, a recent meta-analysis notes an odds-ratio of 1.”
BackgroundPsychosocial Factors Related to Cannabis Use Disorders
Brook, J. S., Lee, J. Y., Finch, S. J., Koppel, J., & Brook, D. W. (2011) · Substance Abuse · doi:10.1080/08897077.2011.605696 · Cited by 46
“Additionally, both anxiety and depressive disorders (12, 13), as well as subclinical symptoms of anxiety and depression (14–16), are associated with an increased risk of CUDs.”
BackgroundParental transmission of risk for cannabis use disorders to offspring
Kosty, D. B., Farmer, R. F., Seeley, J. R., Gau, J. M., Duncan, S. C., & Lewinsohn, P. M. (2015) · Addiction · doi:10.1111/add.12914 · Cited by 45
Stapinski, L. A., Montgomery, A. A., & Araya, R. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.06.032 · Cited by 42
Metadata
- Authors
- Wittchen, H.-U., Fröhlich, C., Behrendt, S., Günther, A., Rehm, J., Zimmermann, P., Lieb, R., & Perkonigg, A.
- Affiliations
- Technische Universität Dresden (DE)
- Centre for Addiction and Mental Health (CA)
- Max Planck Society (DE)
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2007-04
- Volume
- 88
- Pages
- S60-S70
- ISSN
- 0376-8716 (ISSN-L)
- OpenAlex
- W2103849723
- Cited by
- 311
- References
- 50
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 12 · 2023: 13 · 2022: 10 · 2021: 16 · 2020: 20 · 2019: 22 · 2018: 14 · 2017: 23 · 2016: 18 · 2015: 15 · 2014: 17 · 2013: 24 · 2012: 21
- FWCI
- 11.96
- Type
- journal article
- Language
- en
- Open access
- green
- tud.qucosa.de
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
- Max Planck Institute for Plasma Physics (submittedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (WI 709/8-1, WI 709/7-1, WI2246/1‐1, LA1148/1‐1)
- Bundesministerium für Bildung und Forschung (LA1148/1-1, 01EB9901/6, EB 0142, WI2246/1-1, WI 709/7-1, 01EB0140, WI 709/8-1, 01EB9405/6, EB01016200, 01EB0440)
- National Institutes of Health
- U.S. Public Health Service (303-7028)
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- cannabis use, cannabis use disorder, adolescents, anxiety disorders, mood disorders, depressive disorders, bipolar disorder, externalizing disorders, substance use disorders, comorbidities, substance use onset, substance use progression
- MeSH terms
- Adolescent, Mental Disorders, Cannabis, Marijuana Abuse, Humans, Internal-External Control, Prospective Studies, Residence Characteristics
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