Daily tobacco users who also used cannabis weekly had stronger connections between craving, depression, and failed quit attempts | Research

The takeaway

Network analysis of 1,217 weekly cannabis users found that co-use with daily tobacco strengthened the links between craving and negative psychosocial effects, and made depression and health consequences more central to the cannabis use disorder symptom network.

Addiction specialists treating patients who use both cannabis and tobacco; cessation program designers developing integrated interventions.

Craving bridges CUD and withdrawal symptoms in tobacco co-users

What the researchers found

In the overall CUD symptom network, craving, failed quit attempts, neglected responsibilities, and negative social effects were most central. Risky cannabis use was mostly independent of other CUD symptoms. Among daily tobacco co-users (n=789) compared to nondaily co-users (n=428): craving was more strongly linked to negative psychosocial effects, depression and health effects were more central, and negative health effects were more strongly connected to failed quit attempts.

Why it matters

By mapping how CUD symptoms interconnect differently in tobacco co-users, this study identifies specific targets for intervention. If craving is a bridge symptom connecting use to negative consequences, targeting craving may be more effective than addressing symptoms in isolation.

The numbers in context

1,217 weekly cannabis users total: 789 daily tobacco co-users, 428 nondaily co-users. Craving identified as bridge symptom between CUD and withdrawal symptoms. Depression and negative health effects more central in co-use network.

How the study worked

Network analysis comparing CUD symptom configurations between weekly cannabis users who also used tobacco daily (n=789) versus non-daily or never (n=428). Network centrality, bridge symptoms, and between-group differences analyzed.

What this study cannot tell us

Cross-sectional network analysis cannot determine causal relationships between symptoms. Self-reported tobacco and cannabis use. Network analysis results can vary with sample size and composition. Cannot distinguish whether tobacco use causes network differences or reflects a different subpopulation.

How to read the evidence

Novel network analysis approach with adequate sample sizes, though cross-sectional design limits causal inference.

When this study was published

2024 study

The bigger picture

The synergistic effects of tobacco and cannabis co-use on symptom networks suggest these substances should not be treated in isolation. Integrated cessation programs addressing both substances may be more effective than targeting one at a time.

Questions still open

Would targeting craving specifically in co-users improve quit outcomes? Does treating tobacco addiction first reduce CUD symptom severity?

Common questions

What is network analysis in this context?

Instead of treating a disorder as one thing, network analysis maps how individual symptoms connect to and reinforce each other. This reveals which symptoms are most central and which connections might be most important to disrupt for treatment.

Why does tobacco make cannabis harder to quit?

This study suggests tobacco co-use strengthens the connection between craving and negative consequences, and makes depression more central to the symptom network. This means co-users may experience a more interconnected, harder-to-break cycle of symptoms.

Read the original research

Cannabis Use Disorder Symptoms in Weekly Cannabis Users: A Network Comparison Between Daily Cigarette Users and Nondaily Cigarette Users.

Cannabis and cannabinoid research, 9(3), e847-e858

View on PubMed ↗Publisher’s paper ↗

Citation

Freichel, René; Kroon, Emese; Kuhns, Lauren; Filbey, Francesca; Veer, Ilya M; Wiers, Reinout; Cousijn, Janna. (2024). Cannabis Use Disorder Symptoms in Weekly Cannabis Users: A Network Comparison Between Daily Cigarette Users and Nondaily Cigarette Users.. Cannabis and cannabinoid research, 9(3), e847-e858. https://doi.org/10.1089/can.2022.0239