Skip to main content

Advertisement

SpringerLink
Log in

Intellectual, neurocognitive, and academic achievement in abstinent adolescents with cannabis use disorder

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

The active component of cannabis, delta-9 tetrahydrocannabinol (THC), has a long half-life and widespread neurocognitive effects. There are inconsistent reports of neurocognitive deficits in adults and adolescents with cannabis use disorders (CUD), particularly after a period of abstinence.

Objectives

This study aims to examine neurocognitive measures (IQ, academic achievement, attention, memory, executive functions) in abstinent adolescents with CUD, while controlling for demographic, psychopathology, and poly-substance confounders.

Methods

We investigated neurocognitive performance in three groups: adolescents with CUD after successful first treatment and in full remission (n = 33); controls with psychiatric disorders without substance use disorder history (n = 37); and healthy adolescents (n = 43).

Results

Adolescents with psychiatric disorders, regardless of CUD status, performed significantly worse than the healthy adolescents in academic achievement. No group differences were seen in IQ, attention, memory, or executive functions. Lower academic achievement was positively associated with younger age of CUD onset, regular cannabis use, and maximum daily use. In the CUD group, lifetime nicotine use episodes were negatively associated with IQ. Lower overall neurocognitive function was associated with younger age of onset of regular cannabis use and relapse within the 1 year follow-up.

Conclusions

Verifiably, abstinent adolescents with CUD history did not differ from the two comparison groups, suggesting that previously reported neurocognitive deficits may be related to other factors, including residual drug effects, preexisting cognitive deficits, concurrent use of other substances (e.g., nicotine), or psychopathology. Adolescents with CUD may not be vulnerable to THC neuropsychological deficits once they achieve remission from all drugs for at least 30 days.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Armstrong TD, Costello EJ (2002) Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. J Consult Clin Psychol 70:1224–1239

    Article  PubMed  Google Scholar 

  • Ashton CH (2001) Pharmacology and effects of cannabis: a brief review. Br J Psychiatry 178:101–106

    Article  PubMed  CAS  Google Scholar 

  • Block RI, Ghoneim MM (1993) Effects of chronic marijuana use on human cognition. Psychopharm 110:219–228

    Article  CAS  Google Scholar 

  • Bolla KI, Brown K, Eldreth D, Tate BA, Cadet JL (2002) Does-related neurocognitive effects of marijuana use. Neurol 59:1337–1342

    Article  CAS  Google Scholar 

  • Brody AL, Mandelkern MA, Jarvik ME, Lee GS, Smith EC, Huang JC, Bota RG, Bartzokis G, London ED (2004) Differences between smokers and nonsmokers in regional gray matter volumes and densities. Biol Psychiatry 55:77–84

    Article  PubMed  Google Scholar 

  • Chung T, Martin CS, Winters KC, Cornelius JR, Langenbucher JW (2004) Limitations in the assessment of DSM–IV cannabis tolerance as an indicator of dependence in adolescents. Exp Clin Psychopharmacol 12:136–146

    Article  PubMed  Google Scholar 

  • Clark DB (1999) Psychiatric Assessment. In: Ott PJ, Tarter RE, Ammerman RT (eds) Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment. Allyn & Bacon, Needham Heights MA, pp 197–211

    Google Scholar 

  • Clark DB (2004) The natural history of adolescent alcohol use disorders. Addiction 99(Suppl. 2):5–22

    Article  PubMed  Google Scholar 

  • Clark DB, Lesnick L, Hegedus A (1997) Trauma and other stressors in adolescent alcohol dependence and abuse. J Am Acad Child Adolesc Psychiatry 36:1744–1751

    Article  PubMed  CAS  Google Scholar 

  • Clark DB, Pollock NK, Mezzich A, Cornelius J, Martin C (2001) Diachronic assessment and the emergence of substance use disorders. J Child Adolesc Subst Abus 10:13–22

    Article  Google Scholar 

  • Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale NJ

    Google Scholar 

  • Conners C K, MHS Staff (2000) Conners’ Continuous performance test II: computer program for windows technical guide and software manual north Tonawanda. Multi-Health Systems, NY

  • Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatr 60(8):837–844

    Article  PubMed  Google Scholar 

  • Crews F, He J, Hodge C (2007) Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol Biochem Behav 86:189–199

    Article  PubMed  CAS  Google Scholar 

  • De Bellis MD, Hooper SDPW, Shenk CE (2009) Demographic, maltreatment, and neurobiological correlates of PTSD symptoms in children and adolescents. J Pediatric Psychol 35(5):570–577

    Article  Google Scholar 

  • De Bellis MD, Wang L, Bergman SR, Yaxley RY, Hooper SR, Huettel SA (2013) Neural mechanisms of risky decision-making and reward response in adolescent onset cannabis use disorder drug and alcohol dependence 133:134–145

  • Degenhardt L, Hall W, Lynskey M (2003) Exploring the association between cannabis use and depression. Addiction 98:1493–1504

    Article  PubMed  Google Scholar 

  • Delis DC, Kaplan E, Kramer JH (2001) Delis-Kaplan executive function system. The Psychological Corporation, San Antonio TX

    Google Scholar 

  • Delis DC, Kaplan E, Kramer JH, Ober BA (1994) California Verbal Learning Test-Children’s Version. The Psychological Corporation, San Antonio TX

    Google Scholar 

  • Delis DC, Kaplan E, Kramer JH, Ober BA (2000) California Verbal Learning Test-Second Edition. The Psychological Corporation, San Antonio TX

    Google Scholar 

  • Dembo R, Dertke M, Borders S, Washburn M, Schmeidler J (1988) The relationship between physical and sexual abuse and tobacco, alcohol, and illicit drug use among youths in a juvenile detention center. Int J Addict 23:351–378

    PubMed  CAS  Google Scholar 

  • Duley JF, Wilkins JW, Hamby SL, Hopkins DG, Burwell RD, Barry NS (1993) Explicit scoring criteria for the Rey-osterrieth complex figure and taylor complex figure. Clin Neuropsych 7:29–38

    Article  Google Scholar 

  • Fontes MA, Bolla KI, Cunha PJ, Almeida PP, Jungerman F, Laranjeira RR, Bressan RA, Lacerda ALT (2011) Frontal assessment battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users. J Clin Exp Neuropsychol 33(5):523–531. doi:10.1080/13803395.2010.535505

    Article  PubMed  Google Scholar 

  • Fried PA, Watkinson B, Gray R (2005) Neurocognitive consequences of marijuana—a comparison with predrug performance. Neurotoxicol Teratol 27:231–239

    Article  PubMed  CAS  Google Scholar 

  • Fried PA, Watkinson B, James D, Gray R (2002) Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults. Can Med Assoc J Med 166:887–891

    Google Scholar 

  • Gonzalez R, Carey C, Grant I (2002) Nonacute (residual) neuropsychological effects of cannabis use: a qualitative analysis and systematic review. J Clin Pharm 42:48S–57S

    Article  CAS  Google Scholar 

  • Grant JE, Chamberlain SR, Schreiber L, Odlaug BL (2012) Neuropsychological deficits associated with cannabis use in young adults. Drug Alcohol Depend 121:159–162

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Hanson KL, Winward JL, Schweinsburg AD, Medina KL, Brown SA, Tapert SF (2010) Longitudinal study of cognition among adolescent marijuana users over three weeks of abstinence. Addict Behav 35:970–976

    Article  PubMed Central  PubMed  Google Scholar 

  • Harvey MA, Sellman JD, Porter RJ, Frampton CM (2007) The relationship between non-acute adolescent cannabis use and cognition. Drug Alcohol Rev 26:309–319

    Article  PubMed  Google Scholar 

  • Heaton RK (1981) Wisconsin Card Sorting Test. Psychological Assessment Resources Inc., Odessa Florida

    Google Scholar 

  • Iversen L (2005) Long-term effects of exposure to cannabis. Curr Op Pharm 5:69–72

    Article  CAS  Google Scholar 

  • Jacobsen LK, Pugh KR, Constable RT, Westerveld M, Menci WE (2007) Functional correlations of verbal memory deficits emerging during nicotine withdrawal in abstinent adolescent cannabis users. Bio Psych 61:31–40

    Article  CAS  Google Scholar 

  • Jager G, Kahn RS, Van Den Brink W, Van Ree JM, Ramsey NF (2006) Long-term effects of frequent cannabis use on working memory and attention: an fMRI study. Psychopharm 185:358–368

    Article  CAS  Google Scholar 

  • Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE (2012) Monitoring the future national results on adolescent drug use: overview of key findings 2011. Institute for Social Research at the University of Michigan, Ann Arbor Michigan

    Google Scholar 

  • Kaminer Y, Bukstein OG (eds) (2008) Adolescent substance abuse: dual diagnosis and high risk behaviors. Routledge/Taylor & Francis, NY NY

    Google Scholar 

  • Kanayama G, Rogowska J, Pope HG, Gruber SA, Yurgelun-Todd DA (2004) Spatial working memory in heavy cannabis users: a functional magnetic resonance imaging study. Psychopharm 176:239–247

    Article  CAS  Google Scholar 

  • Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective Disorders and Schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988

    Article  PubMed  CAS  Google Scholar 

  • Kosten TA, Rounsaville BJ (1992) Sensitivity of psychiatric diagnosis based on the best estimate procedure. Am J Psychiatry 149:1225–1227

    PubMed  CAS  Google Scholar 

  • Lane SD, Cherek DR, Tcheremissine OV, Steinberg JL, Sharon JL (2007) Response perseveration and adaptation in heavy marijuana-smoking adolescents. Addict Behav 32:977–990

    Article  PubMed  Google Scholar 

  • Lisdahl KM, Price JS (2012) Increased marijuana Use and gender predict poorer cognitive functioning in adolescents and emerging adults. J Int Neuropsychol Soc 18:678–688. doi:10.1017/S1355617712000276

    Article  PubMed Central  PubMed  Google Scholar 

  • Lynskey MT, Heath AC, Bucholz KK, Slutske WS, Madden PA, Nelson EC, Statham DJ, Martin NG (2003) Escalation of drug use in early-onset cannabis users vs co-twin controls. J Am Med Assoc 289:427–433

    Article  Google Scholar 

  • Lyons MJ, Bar JL, Panizzon MS, Toomey R, Eisen S, Xian H, Tsuang MT (2004) Neuropsychological consequences of regular marijuana use: a twin study. Psych Med 34:1239–1250

    Article  CAS  Google Scholar 

  • McHale S, Hunt N (2008) Executive function deficits in short-term abstinent cannabis users Hum Psychopharm. Clin Exp 23:409–415

    Google Scholar 

  • Medina KL, Hanson KL, Schweinsburg AD, Cohen-Zion M, Nagel BJ, Tapert SF (2007) Neuropsychological functioning in adolescent marijuana users: subtle deficits detectable after a month of abstinence. J Int Neuropsychol Soc 13:807–820

    Article  PubMed Central  PubMed  Google Scholar 

  • Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RSE, McDonald K, Ward A, Poulton R, Moffitt TE (2012) Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A 109:2657–2664

    Article  Google Scholar 

  • Millsaps CL, Azrin RL, Mittenberg W (1994) Neuropsychological effects of chronic cannabis use on the memory and intelligence of adolescents. J Child Adolesc Subst Abus 3:47–55

    Article  Google Scholar 

  • Musshoff F, Madea B (2006) Review of biologic matrices (urine, blood, hair) as indicators of recent or ongoing cannabis use. Ther Drug Monit 28(2):155–163

    Article  PubMed  CAS  Google Scholar 

  • Nelson JR, Benner GJ, Lane K, Smith BW (2004) Academic achievement of K-12 students with emotional and behavioral disorders. Except Child 71:59–73

    Article  Google Scholar 

  • Padula CB, Schweinsburg AD, Tapert SF (2007) Spatial working memory performance and fMRI activation interaction in abstinent adolescent marijuana users. Psychol Addict Behav 21:478–487

    Article  PubMed Central  PubMed  Google Scholar 

  • Pope HG, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D (2001) Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry 58:909–915

    Article  PubMed  Google Scholar 

  • Pope HG, Yurgelun-Todd D (2001) The residual cognitive effects of heavy marijuana Use in college students. J Am Med Assoc 275:521–527

    Article  Google Scholar 

  • Parolaro D, Bartesaghi R, Sala M, Printer A, Guidali C, Vigano D, Capurro V, Guidi S, Braida D, Realini N, Rubino T (2009) Changes in hippocampal morphology and neuroplasticity induced by adolescent THC treatment are associated with cognitive impairment in adulthood. Hippocampus 19(8):763–772

    Article  PubMed  CAS  Google Scholar 

  • Schwartz RH, Gruenewald PJ, Klitzner M, Fedio P (1989) Short-term memory impairment in cannabis-dependent adolescents. Am J Dis Child 143:1214–1219

    PubMed  CAS  Google Scholar 

  • Schweinsburg AD, Brown SA, Tapert SF (2008a) The influence of marijuana Use on neurocognitive functioning in adolescents. Current Drug Abuse Rev 1(1):99–111

    Article  Google Scholar 

  • Schweinsburg AD, Nagel BJ, Schweinsburg BC, Park A, Theilmann RJ, Tapert SF (2008b) Abstinent adolescent marijuana users show altered fMRI response during spatial working memory. Psychiatry Res Neuroimaging 163:40–51

    Article  Google Scholar 

  • Skinner H (1982) Development and validation of a lifetime alcohol consumption assessment procedure. Addiction Research Foundation, Toronto

    Google Scholar 

  • Solowij N, Sephens RS, Roffman RA, Babor T, Kadden R, Miller M, Christiansen K, McRee B, Vendetti J (2002) Cognitive functioning of long-term heavy cannabis users seeking treatment. J Am Med Assoc 287:1123–1131

    Article  Google Scholar 

  • Spear SF, Ciesla JR, Skala SY (1999) Relapse patterns among adolescents treated for chemical dependency. Subst Use Misuse 34(13):1795–1815

    Article  PubMed  CAS  Google Scholar 

  • Stinson FS, Ruan WJ, Pickering R, Grant BF (2006) Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med 36:1447–1460

    Article  PubMed  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 national survey on drug use and health: volume I. Summary of national findings: office of applied studies, NSDUH Series H-38A, HHS Publication No. SMA 10–4586Findings Rockville MD.

  • Tapert SF, Schweinsburg AD, Drummond SPA, Paulus MP, Brown SA, Yang TT, Frank LR (2007) Functional MRI of inhibitory processing in abstinent adolescent marijuana users. Psychopharmacology 194:173–183

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Wechsler (1997) Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation, San Antonio TX

    Google Scholar 

  • Whalley LJ, Fox HC, Deary IJ, Starr JM (2005) Childhood IQ, smoking, and cognitive change from age 11 to 64 years. Addict Behav 30:77–88

    Article  PubMed  Google Scholar 

  • Williams RJ, Chang SY, AdditionCentreAdolescentResearchGroup (2000) A comprehensive and comparative review of adolescent substance abuse treatment outcome. Clin Psychol Sci Pract 7:138–166

    Article  Google Scholar 

  • Woodcock RW, McGrew KS, & Mather N, (2001). Woodcock-Johnson III. Itasca IL

Download references

Acknowledgments

The authors thank the staff of the Duke Healthy Childhood Brain Development Developmental Traumatology Research Program and the participants and their families for making this work possible.

This research was supported by grants from the National Institute of Drug Abuse (R01DA020989 and K24DA028773) and the National Institute of Mental Health (MH063407, K24MH071434) to De Bellis. NIDA and NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Disclosures

Dr. Hooper has received research and travel funding from Eli Lilly not related to this work; Dr. Woolley and Dr. De Bellis report no competing interests.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Stephen R. Hooper

  2. Healthy Childhood Brain Development Developmental Traumatology Research Program, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Donald Woolley

  3. Director Healthy Childhood Brain Development Developmental Traumatology Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 104360, 27710, Durham, NC, USA

    Michael D. De Bellis

Authors
  1. Stephen R. Hooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald Woolley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael D. De Bellis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael D. De Bellis.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hooper, S.R., Woolley, D. & De Bellis, M.D. Intellectual, neurocognitive, and academic achievement in abstinent adolescents with cannabis use disorder. Psychopharmacology 231, 1467–1477 (2014). https://doi.org/10.1007/s00213-014-3463-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-014-3463-z

Keywords

Search

Navigation