Impulsivity Was Linked to Earlier Cannabis Use and Compulsive Craving but Did Not Predict Quit Outcomes in Veterans | Research

The takeaway

Among 72 cannabis-dependent veterans attempting to quit, delay discounting (a measure of impulsivity) correlated with compulsive craving and earlier age of first use, but did not predict who would successfully quit over 6 months.

Read this if you consider yourself impulsive and wonder whether that affects your ability to quit cannabis.

Impulsivity predicted craving and earlier use but not quit outcomes over 6 months

What the researchers found

Seventy-two cannabis-dependent US veterans (95% male) interested in quitting completed a delay discounting task before making self-guided quit attempts and were followed for 6 months. Higher delay discounting (preferring smaller immediate rewards over larger delayed ones) correlated with greater compulsive craving for cannabis, younger age of first cannabis use, earlier start of regular smoking, and having previously sought professional help to quit.

However, delay discounting did not predict any cessation outcomes, either in the first week after quitting or during the 6-month follow-up. This contrasts with findings for tobacco, alcohol, and opioids, where delay discounting does predict cessation outcomes.

Why it matters

The finding that impulsivity relates to how cannabis dependence develops (earlier onset, more craving) but not to whether quitting succeeds suggests that cannabis cessation may depend on different factors than cessation from other substances. Treatment approaches may need to target different mechanisms than those used for tobacco or alcohol.

The numbers in context

72 veterans, 95% male. Higher DD correlated with: compulsive craving (rho=0.29), younger first use (r=-0.32), earlier regular use (r=-0.25), prior professional help (rho=0.27). DD did not predict: 1-week outcomes, 6-month abstinence, time to relapse.

How the study worked

Prospective cohort study of 72 cannabis-dependent veterans (95% male) making self-guided quit attempts. Computerized delay discounting task at baseline. Follow-up at 1 week and monthly for 6 months. Cessation outcomes included point-prevalence abstinence, continuous abstinence, and time to relapse.

What this study cannot tell us

Almost exclusively male veteran sample limits generalizability. Self-guided quit attempts may differ from formal treatment. Only one measure of impulsivity was used. The 6-month follow-up may be insufficient to detect long-term effects. Sample size may be underpowered for some analyses.

How to read the evidence

Prospective cohort with 6-month follow-up; moderate evidence for a null finding on cessation prediction.

When this study was published

Published in 2013. Research on predictors of cannabis cessation success has expanded.

The bigger picture

This study challenges the assumption that impulsivity universally predicts substance use treatment outcomes. Cannabis may be distinct from tobacco, alcohol, opioids, and cocaine in how impulsivity relates to cessation. This suggests cannabis dependence may involve different maintenance mechanisms.

Questions still open

Why does impulsivity predict cessation for other substances but not cannabis? What factors do predict cannabis quit success? Would behavioral interventions targeting impulsivity improve cannabis outcomes anyway?

Common questions

Does being impulsive mean you cannot quit cannabis?

No. This study found that impulsivity was linked to starting cannabis use earlier and experiencing stronger cravings, but it did not predict who actually succeeded or failed at quitting over 6 months. Whatever determines cannabis quit success, impulsivity alone does not appear to be the deciding factor.

Why is cannabis different from other drugs in this regard?

For tobacco, alcohol, opioids, and cocaine, impulsivity does predict cessation outcomes. This study found that cannabis was different. The reasons are not clear, but cannabis withdrawal is generally less acute than withdrawal from other substances, and the decision to use or not use cannabis may be driven more by social context, habit, and motivation than by impulsive decisions in the moment.

Read the original research

A comprehensive examination of delay discounting in a clinical sample of Cannabis-dependent military veterans making a self-guided quit attempt.

Experimental and clinical psychopharmacology, 21(1), 55-65

View on PubMed ↗Publisher’s paper ↗

Citation

Heinz, Adrienne J; Peters, Erica N; Boden, Matthew T; Bonn-Miller, Marcel O. (2013). A comprehensive examination of delay discounting in a clinical sample of Cannabis-dependent military veterans making a self-guided quit attempt.. Experimental and clinical psychopharmacology, 21(1), 55-65. https://doi.org/10.1037/a0031192