Towards a comprehensive developmental model of cannabis use disorders

Abstract

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.

Keywords: Cannabis use disorders; development; epidemiology; risk factors.