CANNABIS DEPENDENCE, WITHDRAWAL, AND REINFORCING EFFECTS AMONG ADOLESCENTS WITH CONDUCT SYMPTOMS AND SUBSTANCE USE DISORDERS

The prevalence of cannabis use is rising among adolescents, many of wh om perceive little risk from cannabis. However, clinicians who treat a dolescent substance users hear frequent reports of serious cannabis-us e disorders and problems. This study asked whether cannabis produced d ependence and withdrawal among such patients, and whether patients' re ports supported previous laboratory findings of reinforcing effects fr om cannabis. This was a screening and diagnostic study of serial treat ment admissions. The diagnostic standard was the DSM-III-R dependence criteria, and the setting was a university-based adolescent substance treatment program with male residential and female outpatient services . The patients were 165 males and 64, females from consecutive samples of 255 male and 85 female 13-19-year-olds referred for substance and conduct problems (usually from social service or criminal justice agen cies). Eighty-seven patients were not evaluated, usually due to early elopement. Twenty-four others did not meet study admission criteria: g reater than or equal to one dependence diagnoses and greater than or e qual to three lifetime conduct-disorder symptoms. The main measures we re items from diagnostic interview instruments for substance dependenc e, psychiatric disorders, and patterns of substance use. Diagnoses wer e substance dependence, 100%; current conduct disorder, 82.1%, major d epression, 17.5%; attention-deficit/hyperactivity disorder: 14.8%. The results show that most patients claimed serious problems from cannabi s, and 78.6% met standard adult criteria for cannabis dependence. Two- thirds of cannabis-dependent patients reported withdrawal. Progression from first to regular cannabis use was as rapid as tobacco progressio n, and more rapid than that of alcohol, suggesting that cannabis is a reinforcer. The data indicate that for adolescents with conduct proble ms cannabis use is not benign, and that the drug potently reinforces c annabis-taking, producing both dependence and withdrawal. However, fin dings from this severely affected clinical population should not be ge neralized broadly to all other adolescents. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.