Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T13:44:39.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Implicit and explicit affective associations towards cannabis use in patients with recent-onset schizophrenia and healthy controls

Published online by Cambridge University Press:  17 November 2009

N. Dekker ,
A. M. Smeerdijk ,
R. W. Wiers ,
J. H. Duits ,
G. van Gelder ,
K. Houben ,
G. Schippers ,
D. H. Linszen  and
L. de Haan
N. Dekker*
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
A. M. Smeerdijk
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
R. W. Wiers
Affiliation:
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
J. H. Duits
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
G. van Gelder
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
K. Houben
Affiliation:
Faculty of Psychology, Department of Experimental Psychology, Maastricht University, Maastricht, The Netherlands
G. Schippers
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
D. H. Linszen
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
L. de Haan
Affiliation:
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
*
*Address for correspondence: Dr N. Dekker, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. (Email: nienke.dekker@amc.uva.nl)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cannabis use is common in patients with recent-onset schizophrenia and this is associated with poor disease outcome. More insight in the cognitive-motivational processes related to cannabis use in schizophrenia may inform treatment strategies. The present study is the first known to compare implicit and explicit cannabis associations in individuals with and without psychotic disorder.

Method

Participants consisted of 70 patients with recent-onset psychotic disorder and 61 healthy controls with various levels of cannabis use. Three Single-Category Implicit Association Tests (SC-IAT) were used to assess ‘relaxed’, ‘active’ and ‘negative’ implicit associations towards cannabis use. Explicit expectancies of cannabis use were assessed with a questionnaire using the same words as the SC-IAT.

Results

There were no differences in implicit associations between patients and controls; however, patients scored significantly higher on explicit negative affect expectancies than controls. Both groups demonstrated strong negative implicit associations towards cannabis use. Explicit relaxed expectancies were the strongest predictors of cannabis use and craving. There was a trend for implicit active associations to predict craving.

Conclusions

The findings indicate that patients suffering from schizophrenia have associations towards cannabis similar to controls, but they have stronger negative explicit cannabis associations. The strong negative implicit associations towards cannabis could imply that users of cannabis engage in a behaviour they do not implicitly like. Explicit relaxing expectancies of cannabis might be an important mediator in the continuation of cannabis use in patients and controls.

Keywords

CannabiscravingImplicit Association Taskpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 8 , August 2010 , pp. 1325 - 1336
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Addington, D (2007). Patterns, predictors and impact of substance use in early psychosis: a longitudinal study. Acta Psychiatrica Scandinavica 115, 304–309.CrossRefGoogle ScholarPubMed
Addington, J, Duchak, V (1997). Reasons for substance use in schizophrenia. Acta Psychiatrica Scandinavica 96, 329–333.Google Scholar
Ames, SL, Grenard, JL, Thush, C, Sussman, S, Wiers, RW, Stacy, AW (2007). Comparison of indirect assessments of association as predictors of marijuana use among at-risk adolescents. Experimental and Clinical Psychopharmacology 15, 204–218.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington DC.Google Scholar
Barnes, TR, Mutsatsa, SH, Hutton, SB, Watt, HC, Joyce, EM (2006). Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry 188, 237–242.Google Scholar
Barnett, JH, Werners, U, Secher, SM, Hill, KE, Brazil, R, Masson, K, Pernet, DE, Kirkbride, JB, Murray, GK, Bullmore, ET, Jones, PB (2007). Substance use in a population-based clinical sample of people with first-episode psychosis. British Journal of Psychiatry 190, 515–520.Google Scholar
Cantwell, R, Brewin, J, Glazebrook, C, Dalkin, T, Fox, R, Medley, I, Harrison, G (1999). Prevalence of substance misuse in first-episode psychosis. British Journal Psychiatry 174, 150–153.Google Scholar
De Haan, L, Linszen, DH, Lenior, ME, De Win, ED, Gorsira, R (2003). Duration of untreated psychosis and outcome of schizophrenia: delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication. Schizophrenia Bulletin 29, 341–348.Google Scholar
De Houwer, J (2001). A structural and process analysis of the Implicit Association Test. Journal of Experimental Social Psychology 37, 443–451.Google Scholar
De Houwer, J, Crombez, G, Koster, EH, De Beul, N (2004). Implicit alcohol-related cognitions in a clinical sample of heavy drinkers. Journal of Behavior Therapy and Experimental Psychiatry 35, 275–286.Google Scholar
Dekker, N, De Haan, L, Van den Berg, S, De Gier, M, Becker, H, Linszen, DH (2008). Cessation of cannabis use by patients with recent-onset schizophrenia and related disorders. Psychopharmacology Bulletin 4, 142–153.Google Scholar
Dekker, N, Linszen, DH, De Haan, L (2009). Reasons for cannabis use and effects of cannabis use as reported by patients with psychotic disorders. Psychopathology 42, 350–360.CrossRefGoogle ScholarPubMed
Dixon, L, Haas, G, Weiden, P (1990). Acute effects of drug abuse in schizophrenic patients: clinical observations and patients' self-report. Schizophrenia Bulletin 16, 69–79.CrossRefGoogle Scholar
d'Souza, DC, Abi-Saab, WM, Madonick, S, Forselius-Bielen, K, Doersch, A, Braley, G, Gueorguieva, R, Cooper, TB, Krystal, JH (2005). Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry 57, 594–608.Google Scholar
d'Souza, DC, Perry, E, Macdougall, L, Ammerman, Y, Cooper, T, Wu, YT, Braley, G, Gueorguieva, R, Krystal, JH (2004). The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology 29, 1558–1572.Google Scholar
Field, M, Mogg, K, Bradley, BP (2004). Cognitive bias and drug craving in recreational cannabis users. Drug Alcohol Dependence 74, 105–111.CrossRefGoogle ScholarPubMed
Fowler, IL, Carr, VJ, Carter, NT, Lewin, TJ (1998). Patterns of current and lifetime substance use in schizophrenia. Schizophrenia Bulletin 24, 443–455.Google Scholar
Franken, IH (2003). Drug craving and addiction: integrating psychological and neuropsychopharmacological approaches. Progress in Neuro-psychopharmacology & Biological Psychiatry 27, 563–579.Google Scholar
Franken, IH, Hendriksen, VM, Van den Brink, W (2002). Initial validation of two opiate craving questionnaires the obsessive compulsive drug use scale and the desires for drug questionnaire. Addictive Behaviors 27, 675–685.Google Scholar
Goldman, MS, Darkes, J (2004). Alcohol expectancy multiaxial assessment: a memory network-based approach. Psychological Assessment 16, 4–15.Google Scholar
Green, B, Kavanagh, D, Young, R (2003). Being stoned: a review of self-reported cannabis effects. Drug and Alcohol Review 22, 453–460.CrossRefGoogle ScholarPubMed
Green, B, Kavanagh, DJ, Young, RM (2004). Reasons for cannabis use in men with and without psychosis. Drug and Alcohol Review 23, 445–453.CrossRefGoogle ScholarPubMed
Greenwald, AG, Banaji, MR (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychological Review 102, 4–27.Google Scholar
Greenwald, AG, McGhee, DE, Schwartz, JL (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of Personality and Social Psychology 74, 1464–1480.Google Scholar
Greenwald, AG, Nosek, BA, Banaji, MR (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology 85, 197–216.CrossRefGoogle ScholarPubMed
Hambrecht, M, Hafner, H (1996). Substance abuse and the onset of schizophrenia. Biological Psychiatry 40, 1155–1163.Google Scholar
Henquet, C, Rosa, A, Krabbendam, L, Papiol, S, Fananás, L, Drukker, M, Ramaekers, JG, Van Os, J (2006). An experimental study of catechol-o-methyltransferase Val158Met moderation of delta-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology 31, 2748–2757.Google Scholar
Hides, L, Kavanagh, DJ, Dawe, S, Young, RM (2008). The influence of cannabis use expectancies on cannabis use and psychotic symptoms in psychosis. Drug Alcohol Review, 1–7.Google Scholar
Hofmann, W, Gawronski, B, Gschwendner, T, Le, H, Schmitt, M (2005). A meta-analysis on the correlation between the implicit association test and explicit self-report measures. Personality and Social Psychology Bulletin 31, 1369–1385.Google Scholar
Holtgraves, T (2004). Social desirability and self-reports: testing models of socially desirable responding. Personality and Social Psychology Bulletin 30, 161–172.Google Scholar
Houben, K, Wiers, RW (2006 a). Assessing implicit alcohol associations with the Implicit Association Test: fact or artifact? Addictive Behaviors 31, 1346–1362.Google Scholar
Houben, K, Wiers, RW (2006 b). A test of the salience asymmetry interpretation of the alcohol-IAT. Experimental Psychology 53, 292–300.Google Scholar
Houben, K, Wiers, RW (2007 a). Are drinkers implicitly positive about drinking alcohol? Personalizing the alcohol-IAT to reduce negative extrapersonal contamination. Alcohol & Alcoholism 42, 301–307.Google Scholar
Houben, K, Wiers, RW (2007 b). Personalizing the alcohol-IAT with individualized stimuli: relationship with drinking behavior and drinking-related problems. Addictive Behaviors 32, 2852–2864.Google Scholar
Huberty, CJ, Morris, JD (1989). Multivariate analysis versus multiple univariate analysis. Psychological Bulletin 105, 302–208.CrossRefGoogle Scholar
Kahneman, D (2003). A perspective on judgment and choice: mapping bounded rationality. American Psychologist 58, 697–720.Google Scholar
Karpinski, A, Hilton, JL (2001). Attitudes and the Implicit Association Test. Journal of Personality and Social Psychology 81, 774–788.CrossRefGoogle ScholarPubMed
Karpinski, A, Steinman, RB (2006). The single category implicit association test as a measure of implicit social cognition. Journal of Personality and Social Psychology 91, 16–32.Google Scholar
Leweke, FM, Schneider, U, Radwan, M, Schmidt, E, Emrich, HM (2000). Different effects of nabilone and cannabidiol in binocular depth inversion in man. Pharmacology Biochemistry and Behaviour 66, 175–181.Google Scholar
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives General Psychiatry 51, 273–279.Google Scholar
McCusker, CG (2001). Cognitive biases and addiction: an evolution in theory and method. Addiction 96, 47–56.Google Scholar
Mueser, KT, Nishith, P, Tracy, JI, DeGirolamo, J, Molinaro, M (1995). Expectations and motives for substance use in schizophrenia. Schizophrenia Bulletin 21, 367–378.Google Scholar
Niesink, R, Rigter, S, Hoek, J, Goldschmidt, H (2007). THC-concentraties in wiet, nederwiet en hasj in Nederlandse coffeeshops (2006–2007). Trimbos-instituut, Utrecht: The Netherlands.Google Scholar
Pencer, A, Addington, J (2008). Reasons for using substances in adolescents with and without psychosis. Early Intervention in Psychiatry 2, 42–44.Google Scholar
Peters, BD, De Koning, P, Dingemans, P, Becker, H, Linszen, DH, De Haan, L (in press). Subjective effects of cannabis before the first psychotic episode. Australian and New Zealand Journal of Psychiatry.Google Scholar
Robinson, TE, Berridge, KC (1993). The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Research Reviews 18, 247–291.Google Scholar
Rothermund, K, Wentura, D (2004). Underlying processes in the implicit association test: dissociating salience from associations. Journal of Experimental Psychology: General 133, 139–165.Google Scholar
Schofield, D, Tennant, C, Nash, L, Degenhardt, L, Cornish, A, Hobbs, C, Brennan, G (2006). Reasons for cannabis use in psychosis. Australian and New Zealand Journal of Psychiatry 40, 570–574.Google Scholar
Spencer, C, Castle, D, Michie, PT (2002). Motivations that maintain substance use among individuals with psychotic disorders. Schizophrenia Bulletin 28, 233–247.Google Scholar
Stacy, AW (1997). Memory activation and expectancy as prospective predictors of alcohol and marijuana use. Journal of Abnormal Psychology 106, 61–73.Google Scholar
Swanson, JE, Rudman, LA, Greenwald, AG (2001). Using the Implicit Association Test to investigate attitude-behaviour consistency for stigmatised behaviour. Cognition and Emotion 15, 207–230.Google Scholar
Thush, C, Wiers, RW (2007). Explicit and implicit alcohol-related cognitions and the prediction of future drinking in adolescents. Addictive Behaviors 32, 1367–1383.Google Scholar
Thush, C, Wiers, RW, Ames, SL, Grenard, JL, Sussman, S, Stacy, AW (2007). Apples and oranges? Comparing indirect measures of alcohol-related cognition predicting alcohol use in at-risk adolescents. Psychology of Addictive Behaviors 21, 587–591.Google Scholar
Van Mastrigt, S, Addington, J, Addington, D (2004). Substance misuse at presentation to an early psychosis program. Social Psychiatry and Psychiatric Epidemiology 39, 69–72.Google Scholar
Wade, D, Harrigan, S, Edwards, J, Burgess, PM, Whelan, G, McGorry, PD (2006). Substance misuse in first-episode psychosis: 15-month prospective follow-up study. British Journal Psychiatry 189, 229–234.Google Scholar
WHO (1994). Composite International Diagnostic Interview: Core Version 2.1. World Health Organization: Geneva, Switzerland.Google Scholar
Wiers, RW (2008). Alcohol and drug expectancies as anticipated changes in affect: negative reinforcement is not sedation. Substance Use & Misuse 43, 429–444.Google Scholar
Wiers, RW, Bartholow, BD, Van den Wildenberg, WE, Thush, C, Engels, RC, Sher, KJ, Grenard, J, Ames, SL, Stacy, AW (2007 a). Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model. Pharmacology Biochemistry and Behavior 86, 263–283.Google Scholar
Wiers, RW, Houben, K, De Kraker, J (2007 b). Implicit cocaine associations in active cocaine users and controls. Addictive Behaviors 32, 1284–1289.Google Scholar
Wiers, RW, Schoenmakers, T, Houben, K, Thush, C, Fadardi, JS, Cox, WM (2008). Can problematic alcohol use be trained away? New behavioural treatments aimed at changing and moderating implicit cognitive processes in alcohol abuse. In Identification and Treatment of Alcohol Dependency (ed. Martin, C. R.), chapter 15, pp. 185–205. M&K Publishing: Keswick, UK.Google Scholar
Wiers, RW, Van de, Luitgaarden, Van den, Wildenberg, Smulders, FT (2005). Challenging implicit and explicit alcohol-related cognitions in young heavy drinkers. Addiction 100, 806–819.Google Scholar
Wiers, RW, Van Woerden, N, Smulders, FT, De Jong, PJ (2002). Implicit and explicit alcohol-related cognitions in heavy and light drinkers. Journal of Abnormal Psychology 111, 648–658.Google Scholar
Wilson, TD, Lindsey, S, Schooler, TY (2000). A model of dual attitudes. Psychological Review 107, 101–126.CrossRefGoogle Scholar
Zammit, S, Moore, TH, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2008). Effects of cannabis use on outcomes of psychotic disorders: systematic review, British Journal of Psychiatry 193, 357–363.Google Scholar
Zuardi, AW, Crippa, JAS, Hallak, JEC, Moreira, FA, Guimarães, FS (2006). Cannabidiol, a cannabis sativa constituent, as an antipsychotic drug. Brazilian Journal of Medical and Biological Research 39, 421–429.Google Scholar