Heavy Cannabis Use, Dependence and the Brain: a Clinical Perspective

Overview

Journal Addiction

Specialty Psychiatry

Date 2019 Aug 14

PMID 31408248

Citations 32

Authors

Emese Kroon

Lauren Kuhns

Eva Hoch

Janna Cousijn

Affiliations

Soon will be listed here.

Abstract

Aims: To summarize and evaluate our knowledge of the relationship between heavy cannabis use, cannabis use disorder (CUD) and the brain.

Methods: Narrative review of relevant literature identified through existing systematic reviews, meta-analyses and a PubMed search. Epidemiology, clinical representations, potential causal mechanisms, assessments, treatment and prognosis are discussed.

Results: Although causality is unclear, heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments that seem to recover after a period of abstinence. Evidence regarding other cognitive domains and neurological consequences, including cerebrovascular events, is limited and inconsistent. Abstinence after treatment is only achieved in a minority of cases; treatment targeted at reduction in use appears have some success. Potential moderators of the impact of CUD on the brain include age of onset, heaviness of use, CUD severity, the ratio of ∆9-tetrahydrocannabinol to cannabidiol and severity of comorbid disorders.

Conclusions: Current evidence of long-term effects of daily cannabis use and cannabis use disorder on brain-related outcomes is suggestive rather than conclusive, but use is associated with psychiatric morbidity and with cognitive impairments that recover after a period of abstinence.

Citing Articles

The safety and efficacy of cannabinoids for the treatment of mental health and substance use disorders: protocol for a systematic review and meta-analysis.

Wilson J, Langcake A, Bryant Z, Freeman T, Leung J, Chan G Syst Rev. 2025; 14(1):23.

PMID: 39856692 PMC: 11760101. DOI: 10.1186/s13643-024-02657-3.

Emerging trends in cannabis administration for women with chronic pain.

Cameron E, Jacquin K Mental Health Sci. 2025; 2(4.

PMID: 39816373 PMC: 11735029. DOI: 10.1002/mhs2.88.

Fatty acid binding protein 7 plays an important modulatory sex-dependent role on brain endocannabinoid levels and THC metabolism.

Penman S, Senetra A, Roeder N, Richardson B, Pareek O, Owada Y PLoS One. 2024; 19(12):e0313091.

PMID: 39621669 PMC: 11611082. DOI: 10.1371/journal.pone.0313091.

Heavy Lifetime Cannabis Use and Mortality by Sex.

Vallee A JAMA Netw Open. 2024; 7(6):e2415227.

PMID: 38842807 PMC: 11157356. DOI: 10.1001/jamanetworkopen.2024.15227.

"I Like the Vibes it Gives": Adolescent Perspectives on Cannabis Billboards and Print Advertising in Nevada.

Drake C, Sloan K, Anderson M, Clements-Nolle K, Pearson J J Drug Issues. 2024; 54(2):238-252.

PMID: 38699081 PMC: 11065432. DOI: 10.1177/00220426231159017.

References

Kandel D, Kandel E . The Gateway Hypothesis of substance abuse: developmental, biological and societal perspectives. Acta Paediatr. 2014; 104(2):130-7. DOI: 10.1111/apa.12851. View

Solowij N, Jones K, Rozman M, Davis S, Ciarrochi J, Heaven P . Verbal learning and memory in adolescent cannabis users, alcohol users and non-users. Psychopharmacology (Berl). 2011; 216(1):131-44. DOI: 10.1007/s00213-011-2203-x. View

Mokrysz C, Freeman T, Korkki S, Griffiths K, Curran H . Are adolescents more vulnerable to the harmful effects of cannabis than adults? A placebo-controlled study in human males. Transl Psychiatry. 2016; 6(11):e961. PMC: 5290352. DOI: 10.1038/tp.2016.225. View

Bhattacharyya S, Crippa J, Allen P, Martin-Santos R, Borgwardt S, Fusar-Poli P . Induction of psychosis by Δ9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Arch Gen Psychiatry. 2012; 69(1):27-36. DOI: 10.1001/archgenpsychiatry.2011.161. View

Ford T, Hayley A, Downey L, Parrott A . Cannabis: An Overview of its Adverse Acute and Chronic Effects and its Implications. Curr Drug Abuse Rev. 2017; 10(1):6-18. DOI: 10.2174/1874473710666170712113042. View

Bayrakci A, Sert E, Zorlu N, Erol A, Saricicek A, Mete L . Facial emotion recognition deficits in abstinent cannabis dependent patients. Compr Psychiatry. 2015; 58:160-4. DOI: 10.1016/j.comppsych.2014.11.008. View

Jacobus J, Taylor C, Gray K, Meredith L, Porter A, Li I . A multi-site proof-of-concept investigation of computerized approach-avoidance training in adolescent cannabis users. Drug Alcohol Depend. 2018; 187:195-204. PMC: 6053264. DOI: 10.1016/j.drugalcdep.2018.03.007. View

Mokrysz C, Landy R, Gage S, Munafo M, Roiser J, Curran H . Are IQ and educational outcomes in teenagers related to their cannabis use? A prospective cohort study. J Psychopharmacol. 2016; 30(2):159-68. PMC: 4724860. DOI: 10.1177/0269881115622241. View

Lev-Ran S, Le Foll B, McKenzie K, George T, Rehm J . Bipolar disorder and co-occurring cannabis use disorders: characteristics, co-morbidities and clinical correlates. Psychiatry Res. 2013; 209(3):459-65. DOI: 10.1016/j.psychres.2012.12.014. View

10.

DSouza D, Abi-Saab W, Madonick S, Forselius-Bielen K, Doersch A, Braley G . Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biol Psychiatry. 2005; 57(6):594-608. DOI: 10.1016/j.biopsych.2004.12.006. View

11.

Lynskey M, Agrawal A . Denise Kandel's classic work on the gateway sequence of drug acquisition. Addiction. 2018; 113(10):1927-1932. DOI: 10.1111/add.14190. View

12.

Marconi A, Di Forti M, Lewis C, Murray R, Vassos E . Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis. Schizophr Bull. 2016; 42(5):1262-9. PMC: 4988731. DOI: 10.1093/schbul/sbw003. View

13.

Budney A, Vandrey R, Hughes J, Thostenson J, Bursac Z . Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse. J Subst Abuse Treat. 2008; 35(4):362-8. PMC: 4345250. DOI: 10.1016/j.jsat.2008.01.002. View

14.

Hooper S, Woolley D, De Bellis M . Intellectual, neurocognitive, and academic achievement in abstinent adolescents with cannabis use disorder. Psychopharmacology (Berl). 2014; 231(8):1467-77. PMC: 3969383. DOI: 10.1007/s00213-014-3463-z. View

15.

Broyd S, van Hell H, Beale C, Yucel M, Solowij N . Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016; 79(7):557-67. DOI: 10.1016/j.biopsych.2015.12.002. View

16.

Chen C, Wagner F, Anthony J . Marijuana use and the risk of Major Depressive Episode. Epidemiological evidence from the United States National Comorbidity Survey. Soc Psychiatry Psychiatr Epidemiol. 2002; 37(5):199-206. DOI: 10.1007/s00127-002-0541-z. View

17.

Ganzer F, Broning S, Kraft S, Sack P, Thomasius R . Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults. Neuropsychol Rev. 2016; 26(2):186-222. DOI: 10.1007/s11065-016-9316-2. View

18.

Agrawal A, Lynskey M, Bucholz K, Martin N, Madden P, Heath A . Contrasting models of genetic co-morbidity for cannabis and other illicit drugs in adult Australian twins. Psychol Med. 2006; 37(1):49-60. DOI: 10.1017/S0033291706009287. View

19.

von Sydow K, Lieb R, Pfister H, Hofler M, Wittchen H . What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug Alcohol Depend. 2002; 68(1):49-64. DOI: 10.1016/s0376-8716(02)00102-3. View

20.

Rezkalla S, Kloner R . Cardiovascular effects of marijuana. Trends Cardiovasc Med. 2018; 29(7):403-407. DOI: 10.1016/j.tcm.2018.11.004. View