What's new in cannabis?
Helping someone with problem cannabis use: Mental Health First Aid Guidelines
NCPIC and Consortium Partner, Orygen Youth Health have released a set of world first guidelines, Helping someone with problem cannabis use: Mental Health First Aid Guidelines. These guidelines were developed to help the community identify and assist users who are developing a problem with their cannabis use or are in a cannabis-related crisis. They can be downloaded from the ‘News’ section of the NCPIC website or a copy can be sent to you by emailing Clare Chenoweth on c.chenoweth@unsw.edu.au
Director’s report
Jan Copeland (PhD) (Professor/Director, NCPIC)
The annual US College of Problems of Drug Dependence is an important conference for many senior clinicians and academics internationally. This year the venue was a casino in Reno, Nevada. This posed a physical and ethical challenge for many of us (think clouds of tobacco smoke, eau de beer and the never ending bling and bells of slot machines). Leaving that aspect to one side, it was, as usual, a terrific meeting. It was particularly interesting for those working on cannabis-related issues as there was a session reporting progress on DSM-V which included discussion of cannabis withdrawal. This was perfectly timed for NCPIC as one of our new staff members, Dr David Allsop, who took up a Lecturer position with us last month, is leading our project to develop a psychometrically sound and clinically useful measure of cannabis withdrawal. David has studied meerkats in the Kalahari, sex change histories of fish and the computer-brain interface, so this challenging study requiring participants to abstain from cannabis use for two weeks will be a breeze!
There have been a number of personnel changes over the past month or so. Morag Millington has been a terrific addition to Paul’s communications team and brings marketing experience from the world of publishing. With the completion of the clinical guidelines for the management of cannabis-related problems, Dr Amie Frewen is taking a break from writing and is exploring South America and beyond. Many thanks to Amie for her important contribution to this project and we wish her bon voyage! We hope the guidelines will be published locally and internationally in the near future.
On the topic of bon voyage, this month has also seen my EA, Gem Mathieu, moving with her family to Ireland. Her husband is taking up a professorial position in Galway and we will miss her calm presence. On the positive side, we welcome Carly Harris who joined us this week as my new EA. Carly has many years experience (despite her youth) as an EA in the tertiary and other sectors here and in the UK and is settling in extremely well. A final farewell is to Dr Desiree Boughtwood who joined us last year and is moving on to pursue her passions beyond NCPIC. Des has been a fabulous team player and has established the postal intervention study in fine style. Karina Hickey from our workforce training team is going to take over the day to day running of this important project – congratulations Karina on a well deserved promotion. My report next month will include an update on even more new appointments to the Centre’s team over the next few weeks.
This next month is seeing some flagship NCPIC activities being launched. The long awaited web-based intervention is in the final stages of production. Thanks to the contribution of Dr Sally Rooke and the team from WOPR (our web providers – Al and Sam), this project has moved to another dimension of web-based interventions! We will advertise its availability when it is launched during the month. Peter Gates has also been hard at work with Melissa and Etty to finalise the telephone intervention for cannabis-related problems. The clinical training for participating counsellors is almost complete and the intervention will be available by the end of the month. Many thanks to the staff of the Cannabis Information and Helpline for their enthusiastic support of this ground breaking clinical research.
The abstracts have closed for poster presentations at the upcoming National Cannabis Conference on September 7th-8th. We have received a fascinating range of proposals from across the country on topics from genetics, epidemiology, economics, dissemination mechanisms, and interventions. Dr Nadia Solowij (University of Wollongong) will join senior NCPIC staff to review the submissions. It is shaping up to be a stellar meeting and with the venue limiting places to 300 I strongly encourage you to register now.
Jan
Research publications
Relevant publications examining issues to do with cannabis that have been published in the last month include the following:
- Caris, L., Wagner, F.A., Ríos-Bedoya, C.F., & Anthony, J.C. (2009). Opportunities to use drugs and stages of drug involvement outside the United States: Evidence from the Republic of Chile. Drug and Alcohol Dependence 102, 30-34.
- Heishman, S.J., Evans, R.J., Singleton, E.G., Levin, K.H., Copersino, M.L., & Gorelick, D.A. (2009). Reliability and validity of a short form of the Marijuana Craving Questionnaire. Drug and Alcohol Dependence 102, 35-40.
- Hjorthøj, C., Fohlmann, A. & Nordentoft, M. (2009). Treatment of cannabis use disorders in people with schizophrenia spectrum disorders - a systematic review. Addictive Behaviors 34, 520-525.
- Hyman, S.M. & Sinha, R. (2009). Stress-related factors in cannabis use and misuse: Implications for prevention and treatment. Journal of Substance Abuse Treatment 36, 400-413.
- Mason, O., Morgan, C.J., Dhiman, S.K., Patel, A., Parti, N., Patel, A., & Curran, H.V. (2009). Acute cannabis use causes increased psychotomimetic experiences in individuals prone to psychosis. Psychological Medicine 39, 951-956.
- Primack, B.A., Kraemer, K.L., Fine, M.J., & Dalton, M.A. (2009). Media exposure and marijuana and alcohol use among adolescents. Substance Use and Misuse 44, 722-739.
- Ridenour, T.A., Tarter, R.E., Reynolds, M., Mezzich, A., Kirisci, L., & Vanyukov, M. (2009). Neurobehavior disinhibition, parental substance use disorder, neighborhood quality and development of cannabis use disorder in boys. Drug and Alcohol Dependence 102, 71-77.
- Riggs, N.R. & Pentz, M.A. (2009). Long-term effects of adolescent marijuana use prevention on adult mental health services utilization: The midwestern prevention project. Substance Use and Misuse 44, 616-631.
- Sartor, C.E., Agrawal, A., Lynskey, M.T., Bucholz, K.K., Madden, P.A., & Heath, A.C. (2009). Common genetic influences on the timing of first use for alcohol, cigarettes, and cannabis in young African-American women. Drug and Alcohol Dependence 102, 49-55.
- Schwarcz, G., Karajgi, B. & McCarthy, R. (2009). Synthetic delta-9-tetrahydrocannabinol (dronabinol) can improve the symptoms of schizophrenia. Journal of Clinical Psychopharmacology 29, 255-258.
- Singh, R., Sandhu, J., Kaur, B., Juren, T., Steward, W.P., Segerbäck, D., & Farmer, P.B. (2009). Evaluation of the DNA damaging potential of cannabis cigarette smoke by the determination of acetaldehyde derived N2-ethyl-2’-deoxyguanosine adducts. Chemical Research in Toxicology 22, 1181-1188.
- Sloboda, Z., Stephens, R.C., Stephens, P.C., Grey, S.F., Teasdale, B., Hawthorne, R.D., Williams, J., & Marquette, J.F. (2009). The Adolescent Substance Abuse Prevention Study: A randomized field trial of a universal substance abuse prevention program. Drug and Alcohol Dependence 102, 1-10.
- Stephens, P.C., Sloboda, Z., Stephens, R.C., Teasdale, B., Grey, S.F., Hawthorne, R.D., & Williams, J. (2009). Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol and marijuana use. Drug and Alcohol Dependence 102, 19-29.
- Swift, W., Coffey, C., Carlin, J.B., Degenhardt, L., Calabria, B., & Patton, G.C. (2009). Are adolescents who moderate their cannabis use at lower risk of later regular and dependent cannabis use? Addiction 104, 806-814.
- Vigano, D., Guidali, C., Petrosino, S., Realini, N., Rubino, T., Di Marzo, V., & Parolaro, D. (2009). Involvement of the endocannabinoid system in phencyclidine-induced cognitive deficits modelling schizophrenia. The International Journal of Neuropsychopharmacology 12, 599-614.
- Wittchen, H.U., Behrendt, S., Höfler, M., Perkonigg, A., Rehm, J., Lieb, R., & Beesdo, K. (2009). A typology of cannabis-related problems among individuals with repeated illegal drug use in the first three decades of life: Evidence for heterogeneity and different treatment needs. Drug and Alcohol Dependence 102, 151-157.
Commentary on research
Reliability and validity of a short form of Marijuana Craving Questionnaire –
a comment on Heishman, Evans, Singleton, Levin, Copersino, and Gorelick (2009)
Most researchers define craving as a desire to use a drug and thus have relied upon one or a few items to assess cannabis craving. Such an approach has limited our understanding of how craving is related to addiction as recent research suggests that craving is a multi-dimensional construct. Using a broad range of components thought to be theoretically and clinically meaningful to cannabis withdrawal, Heishman, Singleton, and Liguori (2001) developed the Marijuana Craving Questionnaire (MCQ). The MCQ is a 47-item self-report that assesses compulsivity, emotionality, expectancy, and purposefulness. The MCQ is estimated to take seven minutes to complete, which limits its use in clinical and research settings where repeated or numerous assessments occur. Thus, Heishman and colleagues (2009) set out to develop a psychometrically sound short-form of the MCQ that maintained the factor structure of its long form.
Heishman and colleagues (2009) developed the short form by selecting 12 items from the MCQ that had significant factor loadings and high within-factor internal consistency. They had 490 individuals complete the short form by thinking about their most difficult quit attempt outside of a controlled setting. Confirmatory factor analysis demonstrated a close fit with the original four factors. The factors were more related to each other in the short form (r = 0.43-0.78) than in the long form (r = 0.12-0.58), and the factor that demonstrated the strongest internal consistency in the long form (α = 0.82 for compulsivity) demonstrated the poorest internal consistency in the short form (α = 0.61). In regards to validity, all four factors in the short form were correlated significantly with current craving intensity assessed by a visual analog scale. In addition, the factors were related to participants’ average frequency and duration of cannabis craving in the past week. Participants who reported craving cannabis three or more times per day and who craved cannabis more than 10 minutes per day scored significantly higher on the factors than participants who did not report daily cravings.
In summary, the short form appears to be moderately similar to the original MCQ. Although the MCQ fills a much needed gap in the craving literature, the poor internal consistency of the compulsivity factor suggests more work needs to be done in this area. The low internal consistency suggests that the three items included on this factor may be tapping more than one dimension. Future research also may benefit from examining the appropriateness of including an expectancy factor on cannabis cravings scales. While using cannabis regularly may lead to the creation of positive expectations about its use, it also is equally likely that expectations can be created without a use history and that expectations can exist in absence of wanting to use. As such, motives may be more relevant to craving assessment than expectations.
- Heishman, S.J., Evans, R.J., Singleton, E.G., Levin, K.H., Copersino, M.L., & Gorelick, D.A. (2009). Reliability and validity of a short form of the Marijuana Craving Questionnaire. Drug and Alcohol Dependence 102, 35-40.
- Heishman, S.J., Singleton, E.G. & Liguori, A. (2001). Marijuana Craving Questionnnaire: Development and initial validation of a self-report instrument. Addiction 96, 1023-1034.
Media stories this issue
Each issue we will examine some of the cannabis-related stories that have received media attention across the country. The headlines are listed below in bold, with a short summary and/or commentary regarding the content of the news story beneath. If you are interested in obtaining a copy of a particular story, please contact Clare Chenoweth at c.chenoweth@unsw.edu.au
Cannabis plan fails to enthuse voters
This article reports that “the majority of West Australians believe repealing the State’s cannabis laws will either have no effect or actually encourage the use of amphetamines according to the latest Westpoll”. The recently elected Liberal State Government plans to “reinstate the cautioning system for possession only, lower the threshold to 10g and scrap the two plants allowance”.
Addicts’ massive toll
The cost of drug use in Queensland is highlighted in this article, with Queensland Health spending $80 million each year for the “treatment and prevention of alcohol, tobacco and illicit drug use”. Cannabis is said to be “the drug of choice” for many Queenslanders, followed by ecstasy, according to The Illicit Drug Data 2007-2008 report. In addition, Dr Lambkin, Queensland Health’s senior director of alcohol, tobacco and illicit drug use, said that of the 12, 000 people who “sought help”, “46 per cent identified cannabis as their primary drug of concern”.
A helping hand for dealing with cannabis addiction
Widespread media coverage was achieved with the release of Helping someone with problem cannabis use: Mental Health First Aid Guidelines, a set of world first guidelines researched and produced by Orygen Youth Health for NCPIC. They have been designed to help the community identify and assist users who are developing a problem with their cannabis use or are in a cannabis-related crisis. Associate Professor Dan Lubman, of Orygen Youth Health, stresses the importance of the community having access to such guidelines, stating that many people “have been given all sorts of advice, some of it conflicting, which has confused them”. To download a copy of the guidelines, please go to the ‘News’ section of the NCPIC website or email c.chenoweth@unsw.edu.au.
Marijuana smoke much deadlier than tobacco
Research published in the journal Chemical Research in Toxicology, has found that as with tobacco smoke, cannabis smoke “could damage human DNA and increase the risk of cancer”. The researchers concluded that “the smoking of three or four cannabis cigarettes a day is associated with the same degree of damage to bronchial mucus membranes as 20 or more tobacco cigarettes a day”.
Cancer link
Cannabis smoke but not the plant itself, has recently been added to a “list of substances California regulators say cause cancer”. The Office of Environmental Health Hazard Assessment decided to add cannabis smoke to the list after it found that it “contains 33 of the same harmful chemicals as tobacco smoke”. While it is legal in California for people “suffering from certain ailments to grow, smoke and possess marijuana upon a doctor’s recommendation”, this ruling means that “pot shops with 10 or more employees” will have to “post warnings” about the risks of exposure to cannabis smoke.
Keep our kids safe
Ulladulla High School has developed, in collaboration with the community, a program aimed at year 11 students called Keeping Our Kids Safe. The program which ran in late June, involved information sessions, activities and talks from special guests including NCPIC’s National Community Training Manager, Annie Bleeker. Year 11 advisor at the high school, Mr Cris Armati stressed that “It is critical that vital accurate information is shared amongst young people and their parents and care givers”.
Drug action week tackles comorbidity
This article covers the recent Drug Action Week (DAW) 2009, with its focus on “the link between alcohol and drug misuse and the development of mental illness”. The Alcohol and other Drugs Council of Australia (ADCA), which runs the event, emphasised the link between cannabis use and mental health issues such as schizophrenia, depression and anxiety.
Focus on drugs
Findings by the Youth Substance Abuse Service in Bendigo show that the town’s young drug users “are most likely to be male, aged between 17 and 20, and using a combination of alcohol, cannabis and amphetamines”. The data collected by the centre in 2008 was released in time for Drug Action Week with the “aim of raising awareness about alcohol and other drug issues”.
High-risk drug calls on the rise
Kids Helpline has “reported an increase in the number of young people reporting drug and alcohol use at high-risk levels”. Despite calls regarding drug use declining, Wendy Protheroe, General Manager of the helpline said “contact from young people who are frequently using drugs [including cannabis] at high-risk levels had increased significantly”.
MAKINGtheLINK: promoting helpseeking for cannabis and mental health
Overview
Orygen Youth Health, in collaboration with NCPIC, has developed a curriculum-based program for schools to promote helpseeking for cannabis use and mental health problems, called MAKINGtheLINK. By seeking help early, young people are less likely to develop long-term consequences as a result of mental health and substance use issues. However, research indicates young people are reluctant to seek professional help and tend to keep their problems to themselves or turn to their friends, parents or teachers for support – people who often don’t know what to do. It is not uncommon for young people to believe that they should be able to sort out their problems on their own, or be too embarrassed to talk to someone about their problems. They are also worried about the confidentiality of information they give a professional. Existing school resources do not teach students how to overcome these barriers to helpseeking nor focus on improving helpseeking skills for substance use and mental health.
MAKINGtheLINK aims to increase staff and students’ intention and confidence to facilitate professional helpseeking for young people and reduce barriers to professional helpseeking for cannabis and mental health problems. The program has four components:
- Implementation Guide – guides the teacher through program implementation as well as provides the steps for a whole-school implementation
- Staff Professional Development Information Session – explores helpseeking in young people, how to assist a student to access professional help and explains the Student Helpseeking Program
- Parent Information Session – explores helpseeking in young people and explains the Student Helpseeking Program
- Student Helpseeking Program for senior secondary students which has four resources:
a. Teacher Manual – provides the teacher with relevant background information and instructions to facilitate the activities
b. Student classroom activities – six activities in total, each with specific context information, aims, resources required and time needed. The activities cover: recognising when a friend needs help, what types of helpers are available, professional confidentiality, barriers to raising concerns with a friend, barriers to professional helpseeking, assisting a friend to access professional help and accessing reliable helpseeking websites
c. Mates Help Mates DVD – An interactive resource modelling how to facilitate helpseeking in peers
d. Information flyer and poster
Development of MAKINGtheLINK
The development of MAKINGtheLINK was informed by the scientific literature on barriers to helpseeking among young people and the real life experiences of teachers, school psychologists, mental health and substance use specialists working with young people with these issues. A Project Team comprised of former teachers, drug education experts and mental health clinicians and trainers, met regularly to monitor progress and ensure best practice of program development for schools. A National Reference Group, encompassing education, helpseeking, substance use and mental health experts from across Australia, was consulted throughout the development of MAKINGtheLINK. Their role was to share information and provide advice on the development and dissemination of the program and recommend structures and strategies to maximise uptake in schools.
MAKINGtheLINK was specifically developed for teachers to facilitate the Student Helpseeking Program as part of the curriculum. The authors of MAKINGtheLINK subscribe to the view that teachers are the best resource in the classroom. Hence, the Teacher Manual and classroom activities were developed in consultation with teachers, education experts and young people. Multiple teaching strategies are utilised to meet the needs of different learning styles and abilities of students. The activities are interactive, providing opportunities for students to discuss helpseeking for cannabis use and mental health, and to engage with the activities.
The classroom materials and DVD script were developed and focus tested with young people. The classroom materials were amended to ensure students found the activities meaningful and relevant and understood the key messages related to helpseeking. The Mates Help Mates DVD was especially well received by students and in fact, surveys revealed it was considered one of the ‘most useful’ activities. One student reported, ‘It showed how you should approach a friend [with a cannabis use problem] and what you can say to help. And they were our age so it was like watching someone in our school’.
An evaluation of the program is well underway with a pilot study. Between April and June 2009, the program was delivered to 101 students in Year 10 at a Melbourne high school. Forty teachers received the staff professional development session. All participants completed satisfaction surveys about the feasibility and acceptability of the program, and a comprehensive dataset was also collected 2 weeks prior to the program, immediately following the program and 6 weeks later. Our findings will be reported in a later E-Zine edition, as will our dissemination strategy as we anticipate the program to be available nationally by the end of the year.
For more information on MAKINGtheLINK you are welcome to attend our workshop at the NCPIC conference on 7th September, or contact Bonnie Berridge on bonnieb@unimelb.edu.au
