Lisa dedicates her life to studying the behaviours of others. She is currently completing her MA in Counselling Psychology.
Cannabis use within the adolescent population is concerningly high, especially within Canadian youth. There is a growing concern surrounding the actions of teenagers accessing cannabis and using it to a degree which can produce ill effects. Yasgur (2019) presents an article published by Psychiatry Advisor suggesting the secondary responses of adopting habitual cannabis use. Yasgur (2019) discusses the misconceptions pertaining to cannabis being understood as a cure-all for certain conditions and discusses treatment options by means of pharmacotherapy and psychosocial interventions. She examines how to collaborate with an adolescent cannabis user to manage their substance use through various modes of remedial efforts (Yasgur, 2019).
This paper will examine the media’s portrayal of cannabis use among adolescents by analyzing the effects of cannabis on individuals with ADHD, recognizing how parental cannabis use and parenting supervision impacts their child’s perceptions of cannabis, cannabis-induced psychosis, and pharmacotherapeutic research with respect to reducing cannabis utilization.
Cannabis Use and ADHD
A study completed by Rasmussen et al. (2016) used functional Magnetic Resonance Imaging (fMRI) to examine the brain activity within young adults who were diagnosed with childhood ADHD who did (n = 25) and did not (n = 25) use cannabis greater than or equal to on a monthly basis within the past year. This group was compared with a local normative comparison group (LNCG) where there was (n = 11) and was not (n = 12) cannabis use occurring. A Go/NoGo task was used to measure inhibitory control between all groups, with Rasmussen et al.’s (2016) findings stating that participants with ADHD made more errors during the test (mean accuracy = 89.1 ± 7.6% for LNCG; 84.4 ± 9.8% for ADHD; p<0.05). The LNCG cannabis users showed more activation (NoGo>Go) within the right hippocampus and the cerebellar vermis (two regions of the endocannabinoid system) than did LNCG non-users, whereas ADHD cannabis users showed minorly lower activation in these areas. These results indicate that cannabis use by those without ADHD leads to an increase in activity within the hippocampus and the cerebellar vermis whereas this is not observed in the ADHD subjects, illustrating that the altered brain circuitry of those with ADHD face a sizable impact on their brain activity when using cannabis (Rasmussen et al., 2016).
Yasgur’s (2019) article articulates the common perception that cannabis is beneficial for those with ADHD as it can help relieve symptoms such as inability to concentrate or hyperactivity, as it is believed by some that cannabis could temporarily revoke some of these adversities that are associated with ADHD. Yasgur (2019) rebuttals this claim by elaborating on how cannabis can cause agitation and excitatory effects among anybody, let alone individuals who have ADHD and already have hyperactive tendencies. She expands on this by stating how most adolescents who have ADHD are likely taking stimulants, and when tetrahydrocannabinol (THC) is taken in combination with a stimulant, there is an excessive glutamate release within the brain which can lead to episodes of cognitive disturbances (Yasgur, 2019).
Largely, it seems as though both Yasgur (2019) and Rasmussen et al. (2016) note that cannabis use among adolescents who have ADHD is not a favourable treatment method. It is implied as though cannabis’ effect on a hyperactive brain does not provide an appropriate enough solution for those with ADHD due to the interactions between under-activation of the endocannabinoid system while using cannabis and having ADHD.
Parental Guidance and Parental Cannabis Use Vis-à-vis Adolescent Cannabis Use
A study conducted by Hill et al. (2018) recalled participants from a third generational longitudinal study, focusing on assessing youth (n = 363) who have parents with cannabis use disorder (CUD), or have a history of cannabis use over a period of four waves between the years of 2000 – 2012. The historical parental cannabis use was categorized into three different measures: neither parent ever used cannabis (n = 107), at least one parent used cannabis but no parent ever met full criteria for CUD (n = 157), and at least one parent had history of CUD (n = 99) (Hill et al., 2018). These youth then reported on what they believed to be a proper reflection of the levels of their parents’ support, monitoring, and discipline. Hill et al. (2018) analyzed the affiliation between parental cannabis use history and adolescent cannabis use using logistic regression. Their results signal a statistically significant correlation between parental cannabis use and adolescent cannabis use, with the parental CUD group showing the highest rates of adolescent cannabis use and lowest rates of satisfactory parenting, conclusively stating that the quality of parenting acts as a mechanism of the intergenerational conveyance of cannabis use (Hill et al., 2018).
Similarly, Leos-Toro et al. (2019) examines trends of cannabis use within Canadian youth between the years of 2004 – 2014. Using a self-report measure, Leos-Toro et al. (2019) randomly surveyed school boards (n = 292 414) in each Canadian province (all territories were omitted from the study), limited to students in grades 7 – 12. Leos-Toro et al.’s (2019) survey consisted of questions pertaining to both the respondent’s level of cannabis use and their accessibility level to obtaining cannabis by indicating on a numerical scale. Their results show that a notable decrease occurred in cannabis use among Canadian youth between the years 2007 – 2015, the higher the grade level of the student the more likely they are to engage in cannabis-related activities, and that ease of access to cannabis peaked in 2006/2007 and reached its lowest in 2014/2015 (Leos-Toro et al., 2019).
Yasgur’s (2019) article particularizes psychosocial intervention options, including those pertaining to parental support for the adolescent such as helping parents to understand addiction and psychosis, and teaching the parents how to properly support their child with suggestions on how to properly communicate with them regarding their cannabis use. “Most young people have no clue, and it can be hard for them to link cause and effect because the onset of longer-term effects [is] usually insidious and gradual” (Yasgur, 2019). Yet, most adolescents who use cannabis have parents who are either also cannabis users, have below satisfactory parenting, or both (Hill et al., 2018), so this prospect of relying on parental approaches is lacking. Granting, Leos-Toro et al.’s (2019) findings with respect to cannabis use among adolescents showing a decline in rates in recent years indicates that something is working concerning therapeutic motions and/or accessibility.
Shakoor et al. (2015) published a study where they recruited a group of families (n = 327) who have a child(ren) within the preadolescent age range and gauged their cannabis use by means of a self-report measure. When the participants reached the age of 16, Shakoor et al. (2015) assessed any psychotic experiences (PEs) undergone by the participants with five self-report subscales: paranoia, hallucinations, cognitive disorganization, grandiosity, and anhedonia. The adolescent participants who reported “yes” to having used cannabis during early adolescence had significantly higher rates of PEs than did their non-using counterparts, with the largest effect being paranoia (d = 0.38) and the smallest being grandiosity (d = 0.13) (Shakoor et al., 2015). Their study established that because adolescence is a “window of vulnerability” with reference to neurodevelopment that it is largely possible that cannabis use during adolescence is leading to an increase in PEs by virtue of the altercations in brain chemistry deriving from cannabis use (Shakoor et al., 2015).
Yasgur (2019) extensively elaborates on the effects that cannabis use during adolescence can have on the chances of experiencing psychosis, stating how cannabis use can impair blood flow and glucose metabolism in regions of the brain associated with neuronal maturation and rearrangement processes, yet can cause increased glucose metabolism in the regions of the brain associated with executive dysfunction, psychosis, and hallucinations. She also articulates how such disruptions during brain development can unquestionably alter neurodevelopmental trajectories for the adolescent, leading to cannabis being found to be involved in as many as 50% of cases of psychosis, schizophrenia, and schizophreniform episodes (Yasgur, 2019). Accordingly, it seems evident that there is a known correlation between cannabis use during adolescence and enduring PEs as a result. The levels of neurotoxicity in the brain of a developing teenager who casually or frequently uses cannabis are concerning and essential to both psychological research and understanding the impacts it has on the overall health and future success of adolescents.
Pharmacotherapeutics as Treatment for Cannabis Dependencies
Cannabis-dependent adolescents between the ages of 15 – 21 were recruited by Gray et al. (2012) to examine the effects that N-acetylcysteine, a glutathione-inducing drug, has on assisting adolescents who have a cannabis dependence on overcoming their reliance on the substance. Gray et al. (2012) completed a double-blind randomized placebo-controlled trial, where cannabis-dependent adolescents (n = 116) where placed in either the experimental group (received a 1200mg N-acetylcysteine pill twice daily) or the control group (received a placebo pill twice daily) over the course of 8 weeks, alongside completion of a weekly urine test to examine the chances of producing a negative cannabinoid sample. Their results indicate that participants who were apart of the experimental group had more than double the chance of producing a negative cannabinoid urine sample compared to those apart of the control group, alongside very minimal reported side effects within the experimental group (Gray et al., 2012).
Yasgur (2019) notes several different pharmaceutical drugs that have been studied to try and find a treatment for cannabis dependence in adolescents, including N-acetylcysteine as well as bupropion, buspirone, atomoxetine, gabapentin, oxytocin, nabilone, naltrexone, quetiapine, clonidine, and prazosin. She states that all 11 listed drugs have “little value in treating cannabis dependence” and that “the evidence for their use is weak” (Yasgur, 2019).
Research in pharmacotherapy regarding cannabis dependence seems to target N-acetylcysteine the most, evidently with the American Journal of Psychiatry publishing Gray et al.’s (2012) study displaying a strong correlation between intake of N-acetylcysteine and decreased cannabis dependence in adolescents. There are noticeably conflicting results between Gray et al.’s (2012) study and Yasgur’s (2019) article, indicating that there is much more research needed to be done within the field of pharmacotherapeutics and identifying possible treatments for cannabis dependence, especially in adolescents whose neurodevelopment is at considerable risk of permanent impairment if their cannabis use does not become under control, or if there is simply no established evidence to back up the correct treatment method for the particular individual.
Conclusion and Directions for Future Research
Exploring the effects that cannabis use during adolescence can have on the amount of grey matter found in the brain during or following adolescent development could be imperative to understanding how detrimental cannabis use at such a young age can be on the body’s central nervous system as a whole. This expands research possibilities within adolescent cannabis use beyond solely psychological impacts and further considers how it can create an even wider array of repercussions on the adolescent’s prosperity and growth. There is also a need for research to be conducted to survey ill effects from cannabis use during adolescence that exist alongside co-use of other substances, such as tobacco, alcohol, or vaping, and if the levels of ailment within participants are generally higher or not depending on if they co-use alongside cannabis or if they use cannabis exclusively on its own.
Yasgur’s (2019) article published per a psychiatric news source seems to be substantially supported by multiple academic research studies over a variety of different topics. Although, it remains distressing that such a consequential issue being presented in public access media does not manage to express the ramifications in an explicit enough manner. Albeit her articulation surrounding both pharmacotherapy and psychosocial interventions were lacking, her material is still applicable to and seems to be, for the most part, decently established.
Gray, K. M., Carpenter, M. J., Baker, N. L., DeSantis, S. M., Kryway, E., Hartwell, K. J., McRae-Clark, A. L., & Brady, K. T. (2012). A double-blind randomized controlled trial of N-Acetylcysteine in cannabis-dependent adolescents. American Journal of Psychiatry, 169(8), 805–812. https://doi.org/10.1176/appi.ajp.2012.12010055
Hill, M., Sternberg, A., Suk, H. W., Meier, M. H., & Chassin, L. (2018). The intergenerational transmission of cannabis use: Associations between parental history of cannabis use and cannabis use disorder, low positive parenting, and offspring cannabis use. Psychology of Addictive Behaviors, 32(1), 93–103. https://doi.org/10.1037/adb0000333
Leos-Toro, C., Rynard, V., Murnaghan, D., MacDonald, J.-A., & Hammond, D. (2019). Trends in cannabis use over time among Canadian youth: 2004–2014. Preventive Medicine, 118, 30–37. https://doi.org/10.1016/j.ypmed.2018.10.002
Rasmussen, J., Casey, B. J., van Erp, T. G. M., Tamm, L., Epstein, J. N., Buss, C., Bjork, J. M., Molina, B. S. G., Velanova, K., Mathalon, D. H., Somerville, L., Swanson, J. M., Wigal, T., Arnold, L. E., & Potkin, S. G. (2016). ADHD and cannabis use in young adults examined using fMRI of a Go/NoGo task. Brain Imaging and Behavior, 10(3), 761–771. https://doi.org/10.1007/s11682-015-9438-9
Shakoor, S., Zavos, H. M. S., McGuire, P., Cardno, A. G., Freeman, D., & Ronald, A. (2015). Psychotic experiences are linked to cannabis use in adolescents in the community because of common underlying environmental risk factors. Psychiatry Research, 227(2-3), 144–151. https://doi.org/10.1016/j.psychres.2015.03.041
Yasgur, B. S. (2019, June 25). Cannabis-Induced psychosis in teenagers and young adults: Risk factors, detection, management. Psychiatry Advisor. https://www.psychiatryadvisor.com/home/topics/addiction/cannabis-use-disorder/cannabis-induced-psychosis-in-teenagers-and-young-adults-risk-factors-detection-management/
© 2021 Lisa Hallam