Cannabis Users' Recommended Warnings for Packages of Legally Sold Cannabis: An Australia-Centered Study.

Introduction: Although cannabis use creates health risks, governments have recently been legalizing either medical use or leisure use. These governments can mandate health warnings on cannabis packages. Prior research examined recommended warnings of cannabis experts. The aim of this study was to obtain suggested cannabis health and safety warnings from cannabis users. Methods: We used a media release, Facebook postings, and announcements in university classes to seek individuals who had used cannabis at least once according to their own report. Using online data collection software that keeps participants anonymous, we asked the individuals to suggest a warning that governments could mandate on cannabis packages. Results: In total, 288 users suggested warnings. Categorizing the warnings into content categories led to six warning topics: (1) risk of harm to mental health and psychological functioning; (2) risk of operating machinery while under the influence; (3) short-term physical side effects; (4) responsible use; (5) long-term negative physical effects; and (6) dependence, addiction, or abuse. The user-suggested warnings overlapped with six expert-recommended warnings identified in prior survey research and included two content areas that did not feature in expert-recommended warnings: short-term physical side effects and the importance of responsible use. Conclusions: The results are consistent with prior findings that some youths perceive cannabis use as potentially harmful. The current findings provide possible new content for warnings on cannabis packages.

Experiences of marijuana-vaporizer users.

BACKGROUND: Using a marijuana vaporizer may have potential harm-reduction advantages on smoking marijuana, in that the user does not inhale smoke. Little research has been published on use of vaporizers. METHODS: In the first study of individuals using a vaporizer on their own initiative, 96 adults anonymously answered questions about their experiences with a vaporizer and their use of marijuana with tobacco. RESULTS: Users identified 4 advantages to using a vaporizer over smoking marijuana: perceived health benefits, better taste, no smoke smell, and more effect from the same amount of marijuana. Users identified 2 disadvantages: inconvenience of setup and cleaning and the time it takes to get the device operating for each use. Only 2 individuals combined tobacco in the vaporizer mix, whereas 15 combined tobacco with marijuana when they smoked marijuana. Almost all participants intended to continue using a vaporizer. CONCLUSIONS: Vaporizers seem to have appeal to marijuana users, who perceive them as having harm-reduction and other benefits. Vaporizers are worthy of experimental research evaluating health-related effects of using them.

Applying technology to the treatment of cannabis use disorder: comparing telephone versus Internet delivery using data from two completed trials.

Technology-based interventions such as those delivered by telephone or online may assist in removing significant barriers to treatment seeking for cannabis use disorder. Little research, however, has addressed differing technology-based treatments regarding their comparative effectiveness, and how user profiles may affect compliance and treatment satisfaction. This study addressed this issue by examining these factors in online (N=225) versus telephone (N=160) delivered interventions for cannabis use, using data obtained from two previously published randomized controlled trials conducted by the current authors. Several differences emerged including stronger treatment effects (medium to large effect sizes in the telephone study versus small effect sizes in the Web study) and lower dropout in the telephone intervention (38% vs. 46%). Additionally, around half of the telephone study participants sought concurrent treatment, compared with 2% of participants in the Web study. Demographics and predictors of treatment engagement, retention and satisfaction also varied between the studies. Findings indicate that both telephone and Web-based treatments can be effective in assisting cannabis users to quit or reduce their use; however, participant characteristics may have important implications for treatment preference and outcome, with those who elect telephone-based treatment experiencing stronger outcomes. Thus, participant preference may shape study populations, adherence, and outcome.

Expert-recommended warnings for medical marijuana.

Medical marijuana is legal in some countries, including in many US states. At present, there are no government-mandated warnings on packages of marijuana, even though the substance has dangers similar to those of alcohol, tobacco, and various prescribed drugs. This article reports the results of an effort to collect marijuana warnings recommended by scientific experts on marijuana. The recommended warnings, the first ever from marijuana experts, come from 13 experts. The expert-recommended warnings pertain to risks relating to (1) safety, (2) physical health, (3) fetal harm, (4) mental health, (5) withdrawal and dependence, and (6) adolescent development. The results provide initial expert recommendations for warnings to be required on packages of medical marijuana.

Health outcomes associated with long-term regular cannabis and tobacco smoking.

This study aimed to identify patterns of health concerns associated with long-term use of cannabis and tobacco individually, as well as in combination. We recruited 350 adults aged 40 or over who smoked cannabis but not tobacco (cannabis-only group, n=59), smoked both cannabis and tobacco (cannabis/tobacco group, n=88), smoked tobacco but not cannabis (tobacco-only group, n=80), or used neither substance (control group, n=123). Participants completed a survey addressing substance use, diagnosed medical conditions, health concerns relating to smoking cannabis/tobacco, and general health (measured using the Physical Health Questionnaire and the Short Form 36). Several significant differences were found among the four groups. With regard to diagnosed medical conditions, the three smoking groups reported significantly higher rates of emphysema than did the control group (ps<.001). However, all members of the cannabis-only group diagnosed with emphysema were former regular tobacco smokers. Total general health scores, general health subscales, and items addressing smoking-related health concerns also revealed several significant group differences, and these tended to show worse outcomes for the two tobacco smoking groups. Findings suggest that using tobacco on its own and mixing it with cannabis may lead to worse physical health outcomes than using cannabis alone.

An evaluation of web-based clinical practice guidelines for managing problems associated with cannabis use.

BACKGROUND: Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs. OBJECTIVE: The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines. METHODS: Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers' (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods. RESULTS: Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46%), and editorial independence (30%). Although examination of AGREE II domain scores demonstrated that the quality of the 7 guidelines could be divided into 3 categories (high quality, acceptable to low quality, and very low quality), review of treatment providers' quality perceptions indicated all guidelines fell into 1 category (acceptable quality). Based on treatment providers' familiarity with and usage rates of the CPGs, a combination of peer/colleagues, senior professionals, workshops, and Internet dissemination was deemed to be most effective for promoting cannabis use CPGs. Lack of time, guideline length, conflicts with theoretical orientation, and prior content knowledge were identified as barriers to guideline uptake. CONCLUSIONS: Developers of CPGs should improve their reporting of development processes, conflicts of interest, and CPGs' applicability to practice, while remaining cognizant that long guidelines may deter implementation. Treatment providers need to be aware that the quality of cannabis-related CPGs varies substantially.

Effects on smokers of exposure to graphic warning images.

BACKGROUND AND OBJECTIVES: Several countries have introduced graphic warning images aimed at discouraging smoking. The objective of this study was to evaluate the impact on smokers of graphic warnings showing cosmetically important harm caused by smoking. METHODS: Fifty-six adult smokers were randomly assigned to view either written smoking warnings or the same written warnings with related graphic images. The smokers viewed the warnings at a rate of one per week for 4 weeks. The smokers were assessed before and after the warnings with regard to stage of change toward smoking cessation and level of smoking. RESULTS: The randomized control trial showed that the warnings with graphic images led to significantly more progress in stage of change toward smoking cessation than written warnings alone. However, the images did not lead to decreases in smoking rates. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The results indicate that written smoking warnings accompanied by images of cosmetically important harm caused by smoking have more potential than warnings alone in prompting changes in the direction of quitting.

Successful and unsuccessful cannabis quitters: comparing group characteristics and quitting strategies.

BACKGROUND: In order to improve treatments for cannabis use disorder, a better understanding of factors associated with successful quitting is required. METHOD: This study examined differences between successful (n=87) and unsuccessful (n=78) cannabis quitters. Participants completed a questionnaire addressing demographic, mental health, and cannabis-related variables, as well as quitting strategies during their most recent quit attempt. RESULTS: Eighteen strategies derived from cognitive behavioral therapy were entered into a principal components analysis. The analysis yielded four components, representing (1) Stimulus Removal, (2) Motivation Enhancement, (3) (lack of) Distraction, and (4) (lack of) Coping. Between groups comparisons showed that unsuccessful quitters scored significantly higher on Motivation Enhancement and (lack of) Coping. This may indicate that unsuccessful quitters focus on the desire to quit, but do not sufficiently plan strategies for coping. Unsuccessful quitters also had significantly more symptoms of depression and stress; less education; lower exposure to formal treatment; higher day-to-day exposure to other cannabis users; and higher cannabis dependence scores. CONCLUSIONS: The findings suggest that coping, environmental modification, and co-morbid mental health problems may be important factors to emphasize in treatments for cannabis use disorder.

A dual process account of adolescent and adult binge drinking.

This study adopted a dual process perspective to investigate the relative contributions of implicit and explicit cognitions to predicting binge drinking in adolescents and adults. Two hundred and seventy-two participants (136 teen-parent pairs) completed measures of alcohol memory associations (reflecting implicit cognition), expectancies about potential costs and benefits of alcohol use (reflecting explicit cognition), and self-reported binge drinking. Adolescents had stronger alcohol memory associations and perceived drinking benefits to be more probable than did adults. In turn, higher scores on the memory association and expected benefit measures were both associated with significantly higher levels of binge drinking. Moderation analyses revealed that alcohol memory associations and expected benefits of drinking were stronger predictors of binge drinking for adolescents than for adults. The findings suggest that both implicit and explicit cognitions may play important roles in alcohol use decisions, and these roles may differ for adolescents and adults.

Efficacy of written modeling and vicarious reinforcement in increasing use of problem-solving methods by distressed individuals.

The authors evaluated an application of social cognitive theory principles intended to increase adherence to a problem-solving intervention. The study included 132 adult volunteers who wanted to reduce their distress levels. All participants received group training in problem-solving methods. Before attempting to solve at least 1 distressing problem in their lives over the next 3 weeks, participants were randomly assigned to either (a) a modeling with vicarious reinforcement condition in which they received 3 personal anecdotes written by individuals who had successfully applied problem-solving methods to a real problem or (b) a control condition in which they received a fact sheet about problem solving. Word counts of problem-solving writing, self-reports of adherence, and observer ratings of adherence showed that participants in the vicarious reinforcement condition demonstrated significantly higher adherence than did those in the control condition. These results provide support for the effectiveness of symbolic modeling and vicarious reinforcement in increasing adherence to problem-solving methods by individuals who want to decrease their distress.

Implicit cognition and substance use: a meta-analysis.

A meta-analysis of 89 effect sizes based on the responses of 19,930 participants was conducted to estimate the magnitude of the relationship between substance-related implicit cognitions and the use of legal and illegal substances. The analysis produced a weighted average effect size of r=.31. Moderation analyses revealed significant heterogeneity in effect sizes related to facet of implicit cognition, measurement strategy, sample composition, and substance type. The largest effect sizes were found in studies that assessed implicit semantic associations, employed word association measures, and focused on marijuana use. The findings suggest that implicit cognition is a reliable predictor of substance use, although effect sizes vary as a function of several methodological factors.

Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis.

A meta-analysis of the efficacy of cognitive behavioral therapy (CBT) in treating chronic fatigue included 15 effect sizes for between-group outcome comparisons. Across analyses, which included a total of 1371 participants, there was a significant difference, d=0.48, in post-treatment fatigue between participants receiving CBT and those in control conditions. Results indicate that CBT for chronic fatigue syndrome tends to be moderately efficacious. Dropout rates in CBT varied from 0-42%, with a mean of 16%. In the five studies that reported the number of CBT clients who were no longer in the clinical range with regard to fatigue at the latest follow-up, the percentage varied from 33% to 73% of those assigned to CBT, with a mean of 50%. Moderator results suggest directions for future investigations.

Alcohol involvement and the Five-Factor model of personality: a meta-analysis.

The purpose of this meta-analysis was to quantify the relationship between the Five-Factor Model of personality and alcohol involvement and to identify moderators of the relationship. The meta-analysis included 20 studies, 119 effect sizes, and 7,886 participants. Possible moderators examined included: five-factor rating type (self vs. other); study time-frame (cross sectional vs. longitudinal); sample type (treatment vs. non-treatment); type of alcohol involvement measure used; gender of the participants; and age of the participants. The meta-analysis showed alcohol involvement was associated with low conscientiousness, low agreeableness, and high neuroticism, a personality profile that: a) fits on the low end of a superordinate personality dimension that has been called self-control; and b) makes treatment difficult. Several significant moderators of effect size were found, including the following: studies of individuals in treatment for alcohol problems showed a more negative pattern of personality traits than did other studies; cross-sectional studies, but not longitudinal studies, showed a significant effect for agreeableness, perhaps suggesting that low agreeableness may have a different causal link to alcohol involvement from the other factors; mixed-sex samples tended to have lower effect sizes than single-sex samples, suggesting that mixing sexes in data analysis may obscure effects.

The efficacy of symbolic modeling and vicarious reinforcement in increasing coping-method adherence.

The aim of this study was to test a method of increasing adherence to a coping method assignment in individuals interested in reducing stress. Eighty university students and 48 adult nonstudents were asked to write about their emotions for 15 minutes per day over 3 days. Participants were randomly assigned to experimental or control conditions, with the experimental manipulation being an adherence intervention involving symbolic modeling and vicarious reinforcement. A word count and self-report measures showed significantly higher adherence in the adherence intervention group. Additionally, the adherence intervention group showed significantly more reduction in distress than the writing instructions only group. Finally, the amount of adherence was significantly associated with amount of reduction in self-reported distress. The results provide the first evidence of the efficacy of symbolic modeling and vicarious reinforcement in increasing the use and clinical benefits of a recommended coping method.