Sosiaalisten tilanteiden pelko altistaa kannabiksen käytölle

Kannabiksen käyttäjillä on ahdistuneisuushäiriö: sosiaalisten tilanteiden pelko edeltää  kannabiksen käyttöä.
Mielialalääkkeet ja ahdistuksen altistusterapia olisivat tehokkaampia hoitoja kuin kannabiksen pössyttäminen

Individuals with cannabis use disorders (CUD) often struggle with anxiety. People with cannabis dependence are over five times more likely to have an anxiety disorder (Stinson et al., 2006), and
73.1% of cannabis dependent adults meet criteria for a primary anxiety disorder (Agosti et al., 2002).

Social anxiety disorder (SAD) appears particularly related to CUD. In the National Comorbidity
 Survey, 29% of individuals with lifetime cannabis dependence had lifetime SAD, whereas rates of other lifetime anxiety disorders ranged from 6.9% to 18.5% (Agosti et al., 2002). Also, adolescents with SAD are seven times more likely to develop cannabis dependence as young adults (Buckner et al., 2008a).

SAD to be prospectively related to onset of cannabis dependence but not abuse (Buckner et al., 2008a) and that social anxiety tends to be related to more and/or more severe cannabis-related problems
(Buckner et al., 2006a,b, 2007, 2011, in press; Buckner and Schmidt, 2008, 2009).

These data, in conjunction with past research (Buckner et al., 2008a), support the contention that
SAD is robustly related to cannabis dependence and that this effect does not seem to be attributable to gender, race, or other co-occurring psychiatric disorders. In fact, no other anxiety disorder was significantly related to cannabis dependence after controlling for race and gender, suggesting that SAD may be uniquely related to cannabis dependence (Buckner et al., 2008a) among the anxiety disorders.

The vast majority of respondents with CUD–SAD reported the onset of SAD prior to CUD onset. In light of the finding that SAD in adolescence prospectively predicts development of cannabis dependence in adulthood (Buckner et al., 2008a), our data, relying on retrospective account of age of onset, are consistent
with the notion that persons with SAD use substances in an attempt to cope in social situations (Buckner et al., in press). In fact, respondents with CUD–SAD were more likely to report using cannabis to help them manage social fears.

Thus, it could be some persons with SAD come to rely on cannabis to help them cope in social situations, continuing to use cannabis despite experiencing negative consequences related to its use, thereby developing CUD.

They may also develop cannabis-induced paranoia that others are negatively evaluating them.
For instance, social avoidance was found to be more related to cannabis-related problems among men
than women (Buckner et al., 2011).

SAD is associated with a variety of negative features in those with CUD. The co-occurrence of SAD was
related to lower educational attainment, lower income, greater financial aid, and lower perceived health. The relation to health status is especially important given the clear link between cannabis use and health problems such as lung cancer, sexually transmitted disease, and impaired reproduction capacity (Berthiller et al., 2008; Hall et al., 1994; Han et al., 2010).

SAD was also related to higher rates of mood disorders, other anxiety disorders, psychotic disorders, and Axis II disorders. It is especially noteworthy that the co-occurrence of SAD was related to other substance dependence, but not other substance abuse, suggesting that people with SAD appear vulnerable to more severe substance-related problems when they use other (non-cannabis) substances as well. This is consistent with prior work finding SAD to be related to alcohol dependence but not alcohol abuse (Buckner et al., 2008a,b) and extends this finding to other types of substance dependence.

Among those with SAD, co-occurring CUD was associated with less educational attainment, less likelihood of being married, greater reliance on financial assistance, and greater use of other substances. Further, co-occurring CUD was related to greater likelihood of experiencing other SUDs, bipolar I disorder, other anxiety disorders, psychotic disorders, and Axis II disorders. This is not surprising given that CUD tends to be related to some of these disorders (Agosti et al., 2002). However, CUD was not related to unipolar
depressive disorders, suggesting that the observed relationship between CUD and SAD does not appear to be due to co-occurring depression.

Clinicians should be encouraged to assess for and attend to co-occurring SAD during CUD treatment. Similarly, cannabis use and cannabis-related problems should be assessed during SAD treatment. Further, given that respondents with CUD–SAD reported using alcohol as well as cannabis to manage their social fears, these patients may benefit from monitoring of alcohol use and acquiring skills to help them more effectively manage their social anxiety.

In fact, greater anxiety at termination of treatment for CUD predicts greater post treatment cannabis use and cannabis-related problems (Buckner and Carroll, 2010), suggesting that these patients may especially benefit from skills to help them better manage negative affect to prevent relapse.

ref: J.D. Buckner et al. / Drug and Alcohol Dependence 124 (2012) 128– 134