Self-Medicated but Stressed-Out: Relations between Stress and Cannabis Use in Youth at Risk for Psychosis Open Access

Espana, Roberto (Fall 2018)

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Cannabis and stress have been established as risk factors in the development of psychotic disorders. Research suggests a dose-dependent relation between cannabis use and risk of psychotic outcomes. There is also an established link between stress exposure and cannabis use in healthy and clinical samples. Recent research on psychosis etiology has focused on individuals at clinical high risk of psychosis (CHR), a stage often referred to as the prodromal period and characterized by the manifestation of attenuated psychotic symptoms. Although both cannabis and stress have been linked to poorer outcomes among CHR individuals, to date, there have been no prospective studies examining the stress antecedents, cross-sectional correlates, and subsequent stress outcomes of cannabis use in CHR youth. Thus, we do not know whether CHR cannabis users have been exposed to higher levels of previous life-event stress or experience more sensitivity to current or future stressors. Hence, the aims of the present study were to examine whether: 1) CHR cannabis users (CU) reported more exposure to life-event stress (LEtot) than CHR non-users (NU); 2) the CU group reported greater sensitivity to daily stress (DSS) at baseline than the NU group; 3) the CU group experienced greater DSS at 12-month follow-up than the NU group; and 4) LEtot predicted transitioning to cannabis use among the NU group. The present study (N=732) utilized data from the second phase of the North American Prodrome Longitudinal Study. Results indicated that the CU group had experienced more LEtot exposure at baseline and higher levels of DSS at 12-month follow-up. A significant interaction between time and cannabis group was also present, such that the CU group demonstrated less decline in DSS from baseline to follow-up than the NU group. The implications of these findings as well as study limitations are discussed.

Table of Contents

 I. Introduction. 1

Cannabis and Psychosis. 1

Relation of Trauma and Life Event Stress with Cannabis Use in Healthy and Clinical Samples. 4

Relation between Cannabis Use and Subjective (Self-Reported; Daily) Stress. 6

Effects of THC on Biological Stress Responses in CHR, Psychotic Patients, and Healthy Subjects. 9

Potential Mechanisms Involved in the Relation between Cannabis Use and Stress Sensitivity. 9

The Present Study. 11

II. Method. 13

Study Design and Procedure. 13

Participants. 13

Measures. 13

Analytic Approach. 16

III. Results. 16

Demographic Characteristics of the Groups. 16

Substance Use Characteristics of the Groups. 17

Cross-Sectional Analyses. 17

Longitudinal Analyses. 18

IV. Discussion. 19

Table 1. Demographic and Clinical Characteristics of the Groups. 24

Table 2. Alcohol and Tobacco Use at Baseline. 25

Figure 1. Total Number of Life Events by Baseline Cannabis Use. 26

Figure 2. Daily Stress-Sensitivity Scores at Baseline and Follow-up by Baseline Cannabis Use. 27

References 28

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