Cannabis Use Linked To Early Drinking and Alcohol Problems Interview with:

Kathleen K. Bucholz, Ph.D. Professor, Department of Psychiatry Washington University School of Medicine St. Louis MO 63110-1547

Dr. Kathleen Bucholz

Kathleen K. Bucholz, Ph.D.
Professor, Department of Psychiatry
Washington University School of Medicine
St. Louis MO 63110-1547 What is the background for this study?

Response: We know that development of alcohol use disorder progresses through several stages of alcohol use, from beginning to drink, to engaging in problem drinking, and then to developing alcohol use disorder, but we don’t know whether the same factors are associated with each step in this progression. Stage-specific associations have implications for prevention, where targeting certain characteristics might stave off progression to the next level of alcohol involvement, potentially. That is what this particular study set out to investigate.

The data were from nearly 3600 adolescents and young adults, the majority of whom came from families with alcohol use disorder in their relatives. Thus, this sample was enriched with individuals who were at high risk for progressing to more severe stages of alcohol involvement. In studying the associations at each stage, we strengthened our analysis by defining wherever possible variables as risk factors only if they occurred before or at the same age as the particular alcohol stage. For example, we counted cannabis use as a risk factor for starting to drink only if it either preceded or occurred at the same age as taking the first drink. With this definition, we can infer that a particular factor is antecedent and not simply a correlated influence. What are the main findings?

Response: What we found was that the factors that were associated with progression to increasingly more serious and severe alcohol involvement were quite consistent across the various steps. For the most part, there did not appear to be factors that were linked with one level of involvement but not with another. We found that having parents with AUD (and especially mothers with AUD, whether or not fathers were also affected), being a cannabis users, having a diagnosis of conduct or oppositional defiant disorder, and having peers who themselves were substance users all increased the likelihood of progressing from the early stage of beginning to drink to developing problems and then going on to AUD.

In particular, cannabis use was linked with making the transition to each more severe stage – for example, those who used cannabis were nearly 10 times as likely as non cannabis users to start drinking early, and over 2 times as likely to develop alcohol problems and disorder. Although there was consistency in influences across the stages, we did find one factor that was linked only to later stages of alcohol involvement, but not to the first stage of starting to drink, and that was the characteristic of internalizing conditions (including depression, anxiety and/or suicidality.) Further, we also found that women with internalizing disorders were more likely than men with the same conditions to go on to problem alcohol use. What should readers take away from your report?

Response: The influence of cannabis ever-use on each level of alcohol involvement underscores the need to understand the underpinnings of the interplay between these substances. Linked to the cannabis results is the second message that, as has been shown in numerous past studies and in a prominent model of etiology of AUDs, externalizing disorders were a consistent influence across all stages of AUD involvement, not just for initiating drinking, but for development of problems and disorder. However, our findings also suggest that negative affect (depression, anxiety, suicidality) played a role in progression to problem drinking, particularly for women. This is especially important, since the occurrence of alcohol problems in women is increasing, and since young women with symptoms of negative affect who might not be considered at risk for problem drinking because they may not exhibit externalizing characteristics. These findings may be useful to clinicians, to assist in identifying individuals who might be likely to progress to more serious levels of alcohol involvement. What recommendations do you have for future research as a result of this study?

Response: Future studies could expand upon the link between cannabis and alcohol involvement, exploring more severe levels of cannabis involvement (regular or heavy use, problem use) for which the ever-use measure in the present report serves as a proxy. In particular, early cannabis use and its likely deleterious neurobiological consequences that may lead to more serious substance involvement should be investigated. The parental AUD influences deserve further elaboration, particularly those suggesting that maternal AUD may be a more potent factor in offspring AUD involvement. It would be helpful to examine alternative explanations for this observation, such as maternal AUD as an indicator of in utero alcohol exposure. Another possible explanation to be explored is whether maternal AUD reflects a more persistent and severe form of AUD that has adverse ramifications for the offspring rearing environment (like poor or deficient parenting practices) that contribute to offspring alcohol involvement. Linked to this latter point, our results also suggest the utility of efforts to disentangle (to the degree possible) genetic from environmental influences on progression. Is there anything else you would like to add?

Response: Our findings need to be considered in light of several limitations, chief among them being that the sample studied was a high risk sample, and findings may not generalize to a less selected, general population sample.

We would like to acknowledge the support by grants from the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.

There are several declarations of conflicts of interest. Co-author Agrawal has in the past (but not since Dec 2012) received peer-reviewed funds, travel and honorarium from the ABMRF which receives support from the brewing industry. Co-author Bierut is listed as an inventor in Issued US Patent 8,080,371, “Markers for Addiction” covering the use of certain SNPs in determining the diagnosis, prognosis and treatment of addiction. The other co-authors have no conflicts to report. Thank you for your contribution to the community.


Comparison of Parent, Peer, Psychiatric, and Cannabis Use Influences Across Stages of Offspring Alcohol Involvement: Evidence from the COGA Prospective Study
Kathleen K. Bucholz, Vivia V. McCutcheon, Arpana Agrawal, Danielle M. Dick, Victor M. Hesselbrock, John R. Kramer, Samuel Kuperman, John I. Nurnberger Jr, Jessica E. Salvatore, Marc A. Schuckit, Laura J. Bierut, Tatiana M. Foroud, Grace Chan, Michie Hesselbrock, Jacquelyn L. Meyers, Howard J. Edenberg and Bernice Porjesz
Version of Record online: 10 JAN 2017 | DOI: 10.1111/acer.13293

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Last Updated on January 17, 2017 by Marie Benz MD FAAD