Towards a comprehensive developmental model of cannabis use disorders
Corresponding Author
Carlos Blanco
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Correspondence to: Carlos Blanco, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, unit 69, New York, NY 10032, USA. E-mail: [email protected]Search for more papers by this authorClaudia Rafful
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Search for more papers by this authorMelanie M. Wall
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
Search for more papers by this authorTy A. Ridenour
Department of Pharmaceutical Sciences, Center for Education and Drug Abuse Research, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorShuai Wang
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Search for more papers by this authorKenneth S. Kendler
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
Search for more papers by this authorCorresponding Author
Carlos Blanco
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Correspondence to: Carlos Blanco, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, unit 69, New York, NY 10032, USA. E-mail: [email protected]Search for more papers by this authorClaudia Rafful
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Search for more papers by this authorMelanie M. Wall
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
Search for more papers by this authorTy A. Ridenour
Department of Pharmaceutical Sciences, Center for Education and Drug Abuse Research, University of Pittsburgh, Pittsburgh, PA, USA
Search for more papers by this authorShuai Wang
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
Search for more papers by this authorKenneth S. Kendler
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
Search for more papers by this authorAbstract
Aims
To develop a comprehensive risk-factor model of cannabis use disorders (CUD) based on Kendler's development model for major depression.
Design
Risk factors were divided into five developmental tiers based on Kendler's model of depression (childhood, early adolescence, late adolescence, adulthood, past year). Hierarchical logistic regression models were used to examine the independent contribution of each risk factor. Separate models were built to predict the lifetime risk of cannabis use and the risk of CUD among those with a history of lifetime risk of cannabis use.
Setting
Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States.
Participants
Participants consisted of wave 2 of the NESARC (n = 34 653).
Measurements
Odds ratios (OR), Adjusted OR (AOR) and confidence intervals (95% CI) were used to determine the risk factors in each tier and with multiple models.
Findings
After mutually adjusting for the effect of other risk factors, lifetime history of drug use disorder (AOR = 4.78, 95% CI = 1.53–14.91), past year alcohol use disorders (AOR = 6.55, 95% CI = 2.54–16.89) and independent (AOR = 1.57, 95% CI = 1.15–2.14) and dependent (AOR = 1.25, 95% CI = 1.01–1.55) stressful life events predicted lifetime cannabis use. Impulsivity (AOR = 2.18, 95% CI = 1.34–3.53), past year alcohol use disorders (AOR = 4.09, 95% CI = 2.29–7.31), greater number of Axis I disorders (AOR = 1.56, 95% CI = 1.01–2.40) and social deviance (AOR = 1.19, 95% CI = 1.08–1.32) independently increased the risk of the development of CUD, whereas religious service attendance (AOR = 0.50, 95% CI = 0.30–0.85) decreased this risk. In both models, the effect of earlier development tiers was mediated by more proximal ones. There were few gender differences in both models.
Conclusions
A modification of Kendler's risk factor model for major depression which stratifies risk factors into five groups (childhood, early adolescence, late adolescence, adulthood, past year) provides a useful foundation for a comprehensive developmental model of cannabis use and cannabis use disorders.
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