Previous research has consistently demonstrated that cannabis use among adolescents contributes to symptoms of psychosis, but the exact reasons have remained unclear.
Researchers have now identified that external factors and self-medication likelihood play a part in increased psychotic symptoms, according to a new study published in JAMA Psychiatry. The study’s authors recommend that their findings inform inventions and educational efforts that aim to reduce cannabis use during childhood and adolescence.
The study highlighted three hypotheses that attempt to explain increased psychotic symptoms in adolescents who use cannabis.
The first of these, called the contributing risk hypothesis, suggests that cannabis use causes psychosis symptoms. The shared vulnerability hypothesis suggests that genetic, gestational or environmental factors increase the likelihood of both cannabis use and psychosis. The self-medication hypothesis suggests that adolescents with psychosis symptoms or symptoms like anxiety and dysphoria may begin using cannabis in an attempt to self-medicate.
Researchers found evidence consistent with both the shared vulnerability hypothesis and the self-medication hypothesis but found only mixed evidence for the contributing risk hypothesis.
Adolescents who used cannabis at any point reported a greater number of psychosis symptoms and distress from psychosis-related symptoms compared to adolescents who never used cannabis, which researchers said supported the shared vulnerability hypothesis.
But the study also found that the number of psychotic symptoms increased in the time leading up to when children began using cannabis, adding fodder to the self-medication hypothesis.
“The findings underscore the importance of accounting for shared vulnerability and self-medication effects when modeling cannabis-psychosis risk associations,” the study’s authors wrote.
While evidence for the contributing risk hypothesis was mixed in this specific study, researchers noted that there could still be a dose-dependent relationship between cannabis use and psychosis, in which using more cannabis more frequently may increase psychotic symptoms.
The findings were gleaned from the Adolescent Brain Cognitive Development study (ABCD), which collected information on the brain development and mental and physical health of 11,868 U.S.-based children aged 9 to 10 years at the beginning of the study. Researchers used data spanning four years beginning in 2016 to track psychosis spectrum symptoms before and after children began using cannabis.
Across the data set, researchers found that the number of psychosis symptoms decreased as children aged. They controlled for this age-related decrease when analyzing relative increases in psychotic symptoms before or after children begin using cannabis.
As rates of cannabis use disorder (CUD) increase across the U.S., several behavioral health providers have begun to offer treatment for this condition.
In September, workforce behavioral health provider Lyra launched treatment programs for cannabis, opioid, stimulant and nicotine use. Lyra previously operated an alcohol treatment program.
In April, digital SUD treatment provider Pelago rolled out a new CUD treatment program. The provider also offers care for tobacco, alcohol and opioid use.
