Predictive impact of different acute cannabis intoxication effects with regard to abstinence motivation and cessation of use

Paranoid and dysphoric experiences during cannabis intoxication are the strongest predictors of wanting to quit or having quit cannabis use, more so than psychosis-like effects such as hallucinations. In a survey of 441 current and past users, those who had stopped using retrospectively reported more unpleasant and fewer positive intoxication effects than current users. Current users intending to stop also reported significantly more paranoia and dysphoria during intoxication than those not intending to stop. These findings suggest that different acute intoxication effects differently influence abstinence motivation and substance use behavior, pointing to a potential focus for treatment interventions.

Study at a glance

Abstract

Cannabis use is a common risk factor for psychoses. But although prevalence of consumption as well as potency of cannabis increased, the incidence of schizophrenia remained stable. The discontinuation hypothesis suggests that a potential increase of psychoses incidence may be relativized by more frequent cessation of consumption due to higher rates of adverse psychosis-like intoxication effects (PLE), caused by stronger cannabis. A mixed methods online survey was administered to 441 current and past users to analyze the predictive impact of different acute intoxication effects regarding abstinence motivation/cessation of use. Our hypothesis was that PLE would be experienced as the most aversive intoxication effect and therefore have the highest predictive significance. Possible confounds were included (craving, patterns of consumption and sociodemographics). Further analyzes compared past versus current users regarding the quality of intoxication effects, suggesting that past users retrospectively experienced more unpleasant experiences than current users. Free-text data explored subjective reasons for abstinence. We found that paranoid/dysphoric intoxication effects were most predictive for abstinence motivation. Less predictive were psychosis-like intoxication effects such as hallucinations. Group comparisons revealed significant more unpleasurable and less positive intoxication effects in past users compared with current users. Current users with the intention to stop consumption showed significantly more paranoia/dysphoria intoxication compared to users with no intention to stop use. As a conclusion, different intoxication experiences have different effects on abstinence motivation and substance use behavior. They therefore provide a focus that should be increasingly integrated into treatment concepts.