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Cigarette smoking and cannabis use are equally strongly associated with psychotic-like experiences: a cross-sectional study in 1929 young adults

Published online by Cambridge University Press:  18 February 2013

W. A. van Gastel ,
J. H. MacCabe ,
C. D. Schubart ,
A. Vreeker ,
W. Tempelaar ,
R. S. Kahn  and
M. P. M. Boks
W. A. van Gastel*
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
J. H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
C. D. Schubart
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
A. Vreeker
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
W. Tempelaar
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
R. S. Kahn
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
M. P. M. Boks
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, The Netherlands
*
*Address for correspondence: W. A. van Gastel, M.Sc., Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, HP A01.468, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. (Email: [email protected])
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Abstract

Background

Cannabis use is associated with increased risk for psychotic-like experiences (PLEs) and psychotic disorders. It remains unclear whether this relationship is causal or due to confounding.

Method

A total of 1929 young adults aged 18–30 years participated in a nationwide internet-based survey in The Netherlands and gave information on demographics, substance use and parental psychiatric illness and completed the Community Assessment of Psychic Experiences (CAPE).

Results

Cigarette smoking and cannabis use were equally strongly associated with the frequency of PLEs in a fully adjusted model (β = 0.098 and 0.079 respectively, p < 0.05). Cannabis use was associated with distress from PLEs in a model adjusted for an elaborate set of confounders excluding smoking (β = 0.082, p < 0.05). However, when cigarette smoking was included in the model, cannabis use was not a significant predictor of distress from PLEs. Cigarette smoking remained associated with distress from PLEs in a fully adjusted model (β = 0.107, p < 0.001).

Conclusions

Smoking is an equally strong independent predictor of frequency of PLEs as monthly cannabis use. Our results suggest that the association between moderate cannabis use and PLEs is confounded by cigarette smoking.

Keywords

Cannabis useconfoundingnicotinepsychosispsychotic-like experiencesreverse causalityrisksmoking
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 11 , November 2013 , pp. 2393 - 2401
Copyright
Copyright © Cambridge University Press 2013 

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References

Agrawal, A, Budney, AJ, Lynskey, MT (2012). The co-occurring use and misuse of cannabis and tobacco: a review. Addiction 107, 1221–1233.CrossRefGoogle ScholarPubMed
Andreasson, S, Allebeck, P, Engstrom, A, Rydberg, U (1987). Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet 2, 1483–1486.CrossRefGoogle ScholarPubMed
Arseneault, L, Cannon, M, Poulton, R, Murray, R, Caspi, A, Moffitt, TE (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 1212–1213.CrossRefGoogle ScholarPubMed
Balter, KA, Balter, O, Fondell, E, Lagerros, YT (2005). Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology 16, 577–579.CrossRefGoogle ScholarPubMed
Barr, RS, Culhane, MA, Jubelt, LE, Mufti, RS, Dyer, MA, Weiss, AP, Deckersbach, T, Kelly, JF, Freudenreich, O, Goff, DC, Evins, AE (2008). The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 33, 480–490.CrossRefGoogle ScholarPubMed
Bossong, MG, Niesink, RJ (2010). Adolescent brain maturation, the endogenous cannabinoid system and the neurobiology of cannabis-induced schizophrenia. Progress in Neurobiology 92, 370–385.CrossRefGoogle ScholarPubMed
Brody, AL, Olmstead, RE, London, ED, Farahi, J, Meyer, JH, Grossman, P, Lee, GS, Huang, J, Hahn, EL, Mandelkern, MA (2004). Smoking-induced ventral striatum dopamine release. American Journal of Psychiatry 161, 1211–1218.CrossRefGoogle ScholarPubMed
Caspi, A, Moffitt, TE, Cannon, M, McClay, J, Murray, R, Harrington, H, Taylor, A, Arseneault, L, Williams, B, Braithwaite, A, Poulton, R, Craig, IW (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biological Psychiatry 57, 1117–1127.CrossRefGoogle ScholarPubMed
Compton, MT, Kelley, ME, Ramsay, CE, Pringle, M, Goulding, SM, Esterberg, ML, Stewart, T, Walker, EF (2009). Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. American Journal of Psychiatry 166, 1251–1257.CrossRefGoogle ScholarPubMed
Costas, J, Sanjuan, J, Ramos-Rios, R, Paz, E, Agra, S, Tolosa, A, Paramo, M, Brenlla, J, Arrojo, M (2011). Interaction between COMT haplotypes and cannabis in schizophrenia: a case-only study in two samples from Spain. Schizophrenia Research 127, 22–27.CrossRefGoogle ScholarPubMed
Cougnard, A, Marcelis, M, Myin-Germeys, I, de Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, C, Spauwen, J, van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model. Psychological Medicine 37, 513–527.CrossRefGoogle ScholarPubMed
Dalack, GW, Healy, DJ, Meador-Woodruff, JH (1998). Nicotine dependence in schizophrenia: clinical phenomena and laboratory findings. American Journal of Psychiatry 155, 1490–1501.CrossRefGoogle ScholarPubMed
Dalack, GW, Meador-Woodruff, JH (1996). Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. Schizophrenia Research 22, 133–141.CrossRefGoogle Scholar
Dean, B, Bymaster, FP, Scarr, E (2003). Muscarinic receptors in schizophrenia. Current Molecular Medicine 3, 419–426.CrossRefGoogle ScholarPubMed
de Beer, H, van de Glind, G (2009). Multidisciplinary directive alcohol. Disorders in use of alcohol [in Dutch]. CBO/Trimbos Instituut: Utrecht.Google Scholar
Degenhardt, L, Hall, W (2001). The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-Being. Nicotine and Tobacco Research 3, 225–234.Google ScholarPubMed
Ekman, A, Dickman, PW, Klint, A, Weiderpass, E, Litton, JE (2006). Feasibility of using web-based questionnaires in large population-based epidemiological studies. European Journal of Epidemiology 21, 103–111.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Swain-Campbell, NR (2003). Cannabis dependence and psychotic symptoms in young people. Psychological Medicine 33, 15–21.CrossRefGoogle ScholarPubMed
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, de Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P, Yung, A (2012). The psychosis high-risk state: a comprehensive state-of-the-art review. Archives of General Psychiatry 19, 1–14.Google Scholar
Gosling, SD, Vazire, S, Srivastava, S, John, OP (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. American Psychologist 59, 93–104.CrossRefGoogle ScholarPubMed
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181–191.CrossRefGoogle ScholarPubMed
Henquet, C, Murray, R, Linszen, D, van Os, J (2005). The environment and schizophrenia: the role of cannabis use. Schizophrenia Bulletin 31, 608–612.CrossRefGoogle ScholarPubMed
Henquet, C, Rosa, A, Krabbendam, L, Papiol, S, Fananas, 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.CrossRefGoogle ScholarPubMed
Johns, LC, van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 1125–1141.CrossRefGoogle ScholarPubMed
Jubelt, LE, Barr, RS, Goff, DC, Logvinenko, T, Weiss, AP, Evins, AE (2008). Effects of transdermal nicotine on episodic memory in non-smokers with and without schizophrenia. Psychopharmacology (Berlin) 199, 89–98.CrossRefGoogle ScholarPubMed
Kahn, RS, Linszen, DH, van Os, J, Wiersma, D, Bruggeman, R, Cahn, W, de Haan, L, Krabbendam, L, Myin-Germeys, I; Genetic Risk and Outcome in Psychosis (GROUP) Investigators (2011). Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient-sibling and sibling-control pairs. Archives of General Psychiatry 68, 138–147.Google Scholar
Karatekin, C, White, T, Bingham, C (2010). Shared and nonshared symptoms in youth-onset psychosis and ADHD. Journal of Attention Disorders 14, 121–131.CrossRefGoogle ScholarPubMed
Kelly, C, McCreadie, RG (1999). Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal of Psychiatry 156, 1751–1757.CrossRefGoogle ScholarPubMed
Konings, M, Bak, M, Hanssen, M, van Os, J, Krabbendam, L (2006). Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica 114, 55–61.CrossRefGoogle Scholar
Krabbendam, L, Myin-Germeys, I, Bak, M, van Os, J (2005). Explaining transitions over the hypothesized psychosis continuum. Australian and New Zealand Journal of Psychiatry 39, 180–186.CrossRefGoogle ScholarPubMed
Krishnadas, R, Jauhar, S, Telfer, S, Shivashankar, S, McCreadie, RG (2012). Nicotine dependence and illness severity in schizophrenia. British Journal of Psychiatry.CrossRefGoogle ScholarPubMed
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555–561.CrossRefGoogle ScholarPubMed
Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D, Bor, DH (2000). Smoking and mental illness: a population-based prevalence study. Journal of the American Medical Association 284, 2606–2610.CrossRefGoogle ScholarPubMed
Ledgerwood, DM, Goldberger, BA, Risk, NK, Lewis, CE, Price, RK (2008). Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men. Addictive Behaviors 33, 1131–1139.CrossRefGoogle Scholar
Lee, SS, Humphreys, KL, Flory, K, Liu, R, Glass, K (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical Psychology Review 31, 328–341.CrossRefGoogle ScholarPubMed
Lynskey, MT, Fergusson, DM, Horwood, LJ (1998). The origins of the correlations between tobacco, alcohol, and cannabis use during adolescence. Journal of Child Psychology and Psychiatry 39, 995–1005.CrossRefGoogle ScholarPubMed
Lyon, ER (1999). A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatric Services 50, 1346–1350.CrossRefGoogle ScholarPubMed
Macleod, J, Davey, SG, Hickman, M, Egger, M (2007). Cannabis and psychosis. Lancet 370, 1539–1540.CrossRefGoogle ScholarPubMed
Macleod, J, Hickman, M (2006). Commentary: understanding pathways to cannabis use and from use to harm. International Journal of Epidemiology 35, 680–682.CrossRefGoogle ScholarPubMed
Macleod, J, Oakes, R, Copello, A, Crome, I, Egger, M, Hickman, M, Oppenkowski, T, Stokes-Lampard, H, Davey, SG (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet 363, 1579–1588.CrossRefGoogle ScholarPubMed
Malcolm, CP, Picchioni, MM, DiForti, M, Sugranyes, G, Cooke, E, Joseph, C, McQueen, G, Paparelli, A, Stilo, S, O'Connor, J, Morgan, C, Murray, RM, Hodgins, S (2011). Pre-morbid conduct disorder symptoms are associated with cannabis use among individuals with a first episode of psychosis. Schizophrenia Research 126, 81–86.CrossRefGoogle ScholarPubMed
Mattejat, F, Remschmidt, H (2008). The children of mentally ill parents. Deutsches Ärzteblatt International 105, 413–418.Google ScholarPubMed
McGrath, J, Welham, J, Scott, J, Varghese, D, Degenhardt, L, Hayatbakhsh, MR, Alati, R, Williams, GM, Bor, W, Najman, JM (2010). Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Archives of General Psychiatry 67, 440–447.CrossRefGoogle Scholar
Meyerson, P, Tryon, WW (2003). Validating internet research: a test of the psychometric equivalence of internet and in-person samples. Behavior Research Methods, Instruments and Computers 35, 614–620.CrossRefGoogle ScholarPubMed
Mobascher, A, Winterer, G (2008). Mechanisms of nicotine dependence [in German]. Pneumologie 62, 553–561.CrossRefGoogle ScholarPubMed
Monshouwer, K, van Dorsselaer, S, Verdurmen, J, Bogt, TT, de Graaf, R, Vollebergh, W (2006). Cannabis use and mental health in secondary school children. Findings from a Dutch survey. British Journal of Psychiatry 188, 148–153.CrossRefGoogle ScholarPubMed
Moore, TH, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319–328.CrossRefGoogle ScholarPubMed
Mortensen, PB, Pedersen, CB, Westergaard, T, Wohlfahrt, J, Ewald, H, Mors, O, Andersen, PK, Melbye, M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603–608.CrossRefGoogle ScholarPubMed
Mullin, K, Gupta, P, Compton, MT, Nielssen, O, Harris, A, Large, M (2012). Does giving up substance use work for patients with psychosis? A systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 46, 826–839.CrossRefGoogle ScholarPubMed
Murray, RM, Morrison, PD, Henquet, C, Di Forti, M (2007). Cannabis, the mind and society: the hash realities. Nature Reviews Neuroscience 8, 885–895.CrossRefGoogle Scholar
Myles, N, Newall, H, Nielssen, O, Large, M (2012). The association between cannabis use and earlier age at onset of schizophrenia and other psychoses: meta-analysis of possible confounding factors. Current Pharmaceutical Design 18, 5055–5069.CrossRefGoogle ScholarPubMed
Obermeier, M, Mayr, A, Schennach-Wolff, R, Seemuller, F, Moller, HJ, Riedel, M (2010). Should the PANSS be rescaled? Schizophrenia Bulletin 36, 455–460.CrossRefGoogle ScholarPubMed
Punnoose, S, Belgamwar, MR (2006). Nicotine for schizophrenia. Cochrane Database of Systematic Reviews Issue 25, Art. No. CD004838.CrossRefGoogle ScholarPubMed
Ripoll, N, Bronnec, M, Bourin, M (2004). Nicotinic receptors and schizophrenia. Current Medical Research and Opinion 20, 1057–1074.CrossRefGoogle ScholarPubMed
Rossler, W, Hengartner, MP, Angst, J, Ajdacic-Gross, V (2012). Linking substance use with symptoms of subclinical psychosis in a community cohort over 30 years. Addiction 107, 1174–1184.CrossRefGoogle Scholar
Ruhrmann, S, Schultze-Lutter, F, Salokangas, RK, Heinimaa, M, Linszen, D, Dingemans, P, Birchwood, M, Patterson, P, Juckel, G, Heinz, A, Morrison, A, Lewis, S, von Reventlow, HG, Klosterkotter, J (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Archives of General Psychiatry 67, 241–251.CrossRefGoogle Scholar
Saha, S, Scott, JG, Varghese, D, Degenhardt, L, Slade, T, McGrath, JJ (2011). The association between delusional-like experiences, and tobacco, alcohol or cannabis use: a nationwide population-based survey. BMC Psychiatry 11, 202.CrossRefGoogle ScholarPubMed
Schubart, CD, van Gastel, WA, Breetvelt, EJ, Beetz, SL, Ophoff, RA, Sommer, IE, Kahn, RS, Boks, MP (2011). Cannabis use at a young age is associated with psychotic experiences. Psychological Medicine 41, 1301–1310.CrossRefGoogle Scholar
Sørensen, HJ, Mortensen, EL, Reinisch, JM, Mednick, SA (2011). A prospective study of smoking in young women and risk of later psychiatric hospitalization. Nordic Journal of Psychiatry 65, 3–8.CrossRefGoogle ScholarPubMed
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347–358.CrossRefGoogle ScholarPubMed
van Gastel, WA, Tempelaar, W, Bun, C, Schubart, CD, Kahn, RS, Plevier, C, Boks, MP (2012 a). Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools. Psychological Medicine. Published online: 3 December 2012. doi:10.1017/S0033291712002723.Google ScholarPubMed
van Gastel, WA, Wigman, JT, Monshouwer, K, Kahn, RS, van Os, J, Boks, MP, Vollebergh, WA (2012 b). Cannabis use and subclinical positive psychotic experiences in early adolescence: findings from a Dutch survey. Addiction 107, 381–387.CrossRefGoogle ScholarPubMed
van Os, J, Bak, M, Hanssen, M, Bijl, RV, de Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319–327.CrossRefGoogle ScholarPubMed
Vreeker, A, Schubart, CD, van Gastel, WA, Kahn, RS, Boks, MP (2013). Advanced paternal age and vulnerability to psychotic-like experiences in the offspring. Schizophrenia Research 143, 74–76.CrossRefGoogle ScholarPubMed
Weiser, M, Reichenberg, A, Grotto, I, Yasvitzky, R, Rabinowitz, J, Lubin, G, Nahon, D, Knobler, HY, Davidson, M (2004). Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia: a historical-prospective cohort study. American Journal of Psychiatry 161, 1219–1223.CrossRefGoogle ScholarPubMed
Wignall, ND, de Wit, H (2011). Effects of nicotine on attention and inhibitory control in healthy nonsmokers. Experimental and Clinical Psychopharmacology 19, 183–191.CrossRefGoogle ScholarPubMed
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519–526.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 21–32.CrossRefGoogle ScholarPubMed
Zaldivar, BF, Garcia Montes, JM, Flores, CP, Sanchez, SF, Lopez, RF, Molina, MA (2009). Validity of the self-report on drug use by university students: correspondence between self-reported use and use detected in urine. Psicothema. 21, 213–219.Google Scholar
Ziedonis, D, Hitsman, B, Beckham, JC, Zvolensky, M, Adler, LE, udrain-McGovern, J, Breslau, N, Brown, RA, George, TP, Williams, J, Calhoun, PS, Riley, WT (2008). Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine and Tobacco Research 10, 1691–1715.CrossRefGoogle ScholarPubMed