Trajectories of Cannabis Use Disorder: Risk and Developmental Factors, Clinical Characteristics, and Outcomes

Abstract

Efforts to objectively inform cannabis discourses include research on the epidemiology of cannabis abuse and dependence disorders or, collectively, cannabis use disorder (CUD). For my dissertation I identified classes of individuals based on intraindividual CUD trajectory patterns and contrasted trajectory classes with respect to clinical characteristics of CUD, developmental risk factors, and psychosocial outcomes.

Identifying differences between trajectory classes provides evidence for the validity of trajectory-based CUD constructs and informs the development of comprehensive models of CUD epidemiology and trajectory-specific intervention approaches. My dissertation used data from the Oregon Adolescent Depression Project, a prospective epidemiological study of the psychiatric and psychosocial functioning of a representative community-based sample randomly selected from nine high schools across western Oregon. Four waves of data collection occurred between mid-adolescence and early adulthood and included diagnostic interviews and self-report questionnaires. Onset and offset ages of all CUD episodes were recorded. The reference sample included 816 participants who completed all diagnostic interviews.

A series of latent class growth models revealed three distinct CUD trajectory classes through age 30: (1) a persistent increasing risk class; (2) a maturing out class, marked by increasing risk through age 20 and then a decreasing risk through early adulthood; and (3) a stable low risk class. Rates of cannabis dependence were similar across the persistent increasing and the maturing out classes. Trajectory classes characterized by a history of CUD were associated with a variety of childhood risk factors and measures of psychosocial functioning during early adulthood. Participants who were male, had externalizing disorders, and had psychotic experiences during early adulthood discriminated between the persistent increasing and the maturing out classes.

Future research based on more diverse samples is indicated, as are well-controlled tests of associations between risk factors, trajectory class membership, and psychosocial outcomes. A better understanding of these relationships will inform etiological theories of CUD and the development of effective intervention programs that target problematic cannabis use at specific developmental stages. Designing targeted versus undifferentiated interventions for those at greatest risk for adult psychosocial impairment could be a cost-effective way to mitigate the consequences of CUD.