10/16/2019 The Attraction Between ADHD & Recreational Cannabis Dr. David Teplin, C.Psych. CADDAC Conference, Toronto October 20, 2019 1 What the Numbers Say Worldwide, cannabis is one of the most widely used psychoactive substances, after tobacco and alcohol The latest 2019 Canadian figures show that about 16% of the population age 15 and older report using cannabis 3.3% use weekly, and 6.4% use daily/almost daily Males use cannabis almost twice as much as females 2 What the Numbers Say In terms of age groups, those Canadians ages 15-24 use the most cannabis (27.4%) US prevalence rates in the general population for lifetime DSM-5 cannabis use disorder is 6.27%; highest for those ages 18-29 (11%) Research shows that the risk for onset of cannabis use disorder peaks in late adolescence and early 20s, and remission often occurs within 3–4 years However, research suggest that those with ADHD may have difficulty emulating their peers' developmentally normative declines in substance use 3 1
10/16/2019 What We Know The association between ADHD and both substance use and substance use disorders is well-documented. Having ADHD has been shown to increase the risk of developing a substance use disorder, including cannabis use disorder. Those with childhood ADHD are more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine and other substances. 4 What We Know Those with childhood ADHD are more than twice as likely to meet criteria for cannabis use disorder than those without ADHD ADHD youth are nearly three times as likely to report cannabis use in later life compared to non-ADHD youth. Those with ADHD are at increased risk for early initiation of cannabis use, heavy cannabis use and developing a cannabis use disorder, compared to those persons without ADHD. 5 What We Know Some research suggests that impulsivity and oppositional problems during childhood, in particular, seem to predict increased risk of cannabis use in adulthood. Other research suggests that ADHD, alone, increases the risk of a substance use disorder. Some research suggests that comorbid oppositional defiant disorder and conduct disorder further increase the risk for a substance use disorder. 6 2
10/16/2019 What We Know Other studies suggest that ADHD, independent of comorbidity, increase the risk for substance use disorders across the lifespan. The combination of ADHD and having a substance use disorder is also associated with a worse prognosis and quality of life. 7 What We Know Substance use often modifies ADHD, worsening both the clinical picture, as well as the outcome. Comorbid ADHD and substance use produce significant and unique treatment challenges This includes less likelihood of successful treatment completion, a longer time to substance use recovery, and earlier substance use relapse. The National Epidemiological Survey on Alcohol & Related Conditions in the US has shown that adults with ADHD use cannabis 2 to 3 times more than those adults without ADHD. 8 What We Know Other research suggests those with ADHD are almost 8 times more likely to use cannabis over their lifetime compared to those without ADHD. Studies have also shown that adults with ADHD are more than 2 times likely to meet the criteria for cannabis use disorder than those adults without ADHD. Conversely, among those persons seeking treatment for cannabis use disorder, the rates of ADHD are estimated to be 34% - 46%. 9 3
10/16/2019 Does Inattention or Hyperactivity/Impulsivity Matter? Some research shows that inattentive symptoms are more predictive of substance use disorders. Other research shows that hyperactive/impulsive symptoms are more predictive of substance use disorders. Research indicates that those with ADHD who use cannabis, use all categories of substances more commonly than those with ADHD who do not use cannabis. 10 Does Inattention or Hyperactivity/Impulsivity Matter? More specifically, the rates of nicotine, alcohol and drug use are significantly greater in those who use cannabis. Rates of alcohol use disorders, nicotine dependence, and drug use disorders are significantly greater among people with ADHD who use cannabis, compared to those with ADHD who do not. The most common drug use disorders in adults with ADHD who use cannabis involve cocaine, followed by opioids, and then amphetamines. 11 Does Inattention or Hyperactivity/Impulsivity Matter? Some research found no significant differences in the prevalence of ADHD subtypes among those with ADHD who report cannabis use. Other research suggests that the average age of initiation of cannabis use is significantly younger among those with a hyperactive/impulsive presentation, compared to those with an inattentive presentation. 12 4
10/16/2019 Does Inattention or Hyperactivity/Impulsivity Matter? Research also suggests that individuals with the hyperactive/impulsive presentation tend to begin their most intensive period of cannabis use earlier than those with the inattentive presentation. The age of cannabis abuse tends to be younger among those with the combined presentation of ADHD, compared to those with the inattentive presentation. 13 Does Inattention or Hyperactivity/Impulsivity Matter? An Ontario population survey found that hyperactive and impulsive symptoms were associated with problematic cannabis use in men with adult ADHD, but not women. Conversely, inattentive symptoms predicted problems with cannabis in women with ADHD, but not men. 14 Does Inattention or Hyperactivity/Impulsivity Matter? Research suggests that men with ADHD used marijuana more frequently than women with ADHD. This is consistent with cannabis use in the general population where males use almost twice as much as females. Other research suggests that men with ADHD may be using cannabis to self-medicate inattentive symptoms, whereas women with ADHD may be using cannabis to self-medicate decreased sleep quality. 15 5
10/16/2019 What’s the Attraction? There are several possible explanations for substance use and substance use disorders in adults with ADHD. The risk is particularly striking in people whose childhood ADHD symptoms persist into adulthood, when substances are more readily available 16 What’s the Attraction? Recreational cannabis use among those with ADHD may be associated with impulsivity, sensation-seeking, poor choices in peer groups, impaired occupational and social functioning, and the desire for intoxication. Both recreational substance use and substance use disorders may be associated with efforts at self-medication of the various ADHD symptoms themselves. 17 What’s the Attraction? The co-occurrence may reflect efforts to self-medicate with respect to negative emotionality, such as feelings of demoralization or failure, anger, sadness, anxiety, frustration, and inadequate emotional regulation. Self-medication may not necessarily be specific to ADHD symptoms, but rather a way of relieving co-occurring mood and anxiety-related symptoms that are common in people with ADHD. 18 6
10/16/2019 What’s the Attraction? For some individuals, stimulant medication for the treatment for ADHD may cause adverse effects such as excessive arousal and insomnia. Cannabis use may be an attempt to try and counter those adverse effects. Dopamine neurotransmission has been shown to be involved in both ADHD and substance use. In the case of ADHD, this has to do with an underproduction of dopamine and norepinephrine. 19 What’s the Attraction? Studies show that acute use of THC (the psychoactive component of cannabis) causes increased dopamine release, while long-term THC use is associated with blunting of the dopamine system. Thus, cannabis use may also be an attempt at self-medicating, i.e., “chasing dopamine.” 20 What’s the Attraction? ADHD and cannabis use (in particular, early-onset and ongoing use) are both associated with deficits in neurocognition, including attention, memory, reward networks, and executive functions. ADHD and regular cannabis use are both associated with motivation. Familial and genetic contributions have also been shown to potentially play a role in the association between ADHD and substance use disorders 21 7
10/16/2019 It Can Be Tricky Determining a diagnosis of ADHD in those who are actively using cannabis, or in those who have recently been abstinent following active cannabis use, can be difficult. The clinician must tease out whether a person’s presentation is primarily cannabis-induced, due to a true ADHD presentation, or perhaps a combination of both. 22 Is Recreational Cannabis Therapeutic for ADHD? Perceived risks associated with regular cannabis use has decreased among adolescents and young adults in the general population. There is also an increasing perception that cannabis is therapeutic for ADHD. Anecdotally, it is commonly reported that recreational cannabis use reduces restlessness, improves focus and impulse control, and betters frustration tolerance. 23 Is Recreational Cannabis Therapeutic for ADHD? To date, though, clinical research in this realm remains scarce. A relatively recent study looked at the content of online (Internet) forum threads on ADHD and cannabis use That study found that 25% of posts indicated that cannabis was therapeutic for ADHD, as opposed to 8% that it was harmful, 5% that it was both therapeutic and harmful, and 2% that it had no effect on ADHD 24 8
Recommend
More recommend
