Cannabis use and trauma

Individuals who have traumatic experiences have been found to have increased overall cannabis use and higher instances of cannabis use disorder (CUD), suggestive of problematic cannabis use.{{cite journal|vauthors=Browne KC, Dolan M, Simpson TL, Fortney JC, Lehavot K|date=September 2018|title=Regular past year cannabis use in women veterans and associations with sexual trauma|journal=Addictive Behaviors|volume=84|pages=144–150|doi=10.1016/j.addbeh.2018.04.007|pmc=6716375|pmid=29684763}}  For example, veterans who identify as medicinal users have been shown to have a higher association with combat exposure, trauma related symptoms, and arousal when cued to situations, as well as overall cannabis use.{{cite journal|vauthors=Loflin M, Earleywine M, Bonn-Miller M|date=May 2017|title=Medicinal versus recreational cannabis use: Patterns of cannabis use, alcohol use, and cued-arousal among veterans who screen positive for PTSD|journal=Addictive Behaviors|volume=68|pages=18–23|doi=10.1016/j.addbeh.2017.01.008|pmid=28088054}}

Despite increased cannabis use in those with PTSD symptoms, a National Epidemiological Study with thousands of  participants based in the United States indicated lifetime PTSD was a weak predictor of lifetime cannabis use.{{cite journal|vauthors=Kevorkian S, Bonn-Miller MO, Belendiuk K, Carney DM, Roberson-Nay R, Berenz EC|date=September 2015|title=Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample|journal=Psychology of Addictive Behaviors|volume=29|issue=3|pages=633–8|doi=10.1037/adb0000110|pmc=4699174|pmid=26415060}}{{cite journal|vauthors=Buckner JD, Zvolensky MJ, Schmidt NB|date=November 2012|title=Cannabis-related impairment and social anxiety: the roles of gender and cannabis use motives|journal=Addictive Behaviors|volume=37|issue=11|pages=1294–7|doi=10.1016/j.addbeh.2012.06.013|pmid=22766487}}{{cite journal|vauthors=Buckner JD, Schmidt NB|date=November 2008|title=Marijuana effect expectancies: relations to social anxiety and marijuana use problems|journal=Addictive Behaviors|volume=33|issue=11|pages=1477–1483|doi=10.1016/j.addbeh.2008.06.017|pmc=2556243|pmid=18694625}} However, this study affirmed that for individuals who endorse cannabis use and trauma exposure, they are likely to have concurrent PTSD and CUD symptoms.{{cite book|last1=Zvolensky|first1=Michael J.|title=Marijuana: An Overview of the Empirical Literature|last2=Bonn-Miller|first2=Marcel O.|last3=Leyro|first3=Teresa M.|last4=Johnson|first4=Kirsten A.|last5=Bernstein|first5=Amit|date=2010|work=Addiction Medicine|publisher=Springer New York|isbn=978-1-4419-0337-2|place=New York, NY|pages=445–461|name-list-style=vanc}} The strength of the association between heavy PTSD symptoms and CUD was stronger than that of CUD and other psychological disorders, namely depression, general and social anxiety, panic disorder, alcohol dependence, and personality disorders. It is worth noting that this was done with older DSM-IV criteria, rather than the most current DSM-V, suggestive of possible shifts in diagnostic criteria used to gauge psychological and substance-related disorders.

High use of cannabis has been associated with coping motives in medicinal cannabis users with PTSD symptoms. In a longitudinal study of American female twins, trauma and psychological symptoms were significant predictors for cannabis initiation and cannabis use disorder (CUD).{{Cite book|url=https://www.worldcat.org/oclc/847226928|title=Diagnostic and statistical manual of mental disorders : DSM-5.|others=American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force.|year=2013|isbn=978-0-89042-559-6|edition=Fifth|location=Arlington, VA|oclc=847226928}}{{cite journal | vauthors = Werner KB, McCutcheon VV, Agrawal A, Sartor CE, Nelson EC, Heath AC, Bucholz KK | title = The association of specific traumatic experiences with cannabis initiation and transition to problem use: Differences between African-American and European-American women | journal = Drug and Alcohol Dependence | volume = 162 | pages = 162–9 | date = May 2016 | pmid = 27012434 | doi = 10.1016/j.drugalcdep.2016.03.003 | pmc = 4833569 }} Individuals with higher levels of life-threatening events, injury, or experiences of death were also more likely to initiate cannabis use during the emerging adulthood phase, with sexual abuse predicting cannabis use initiation before the age of 15 in African American women. In European-American women, sexual and physical abuse, as well as major depressive disorder (MDD) predicted age of cannabis initiation, with development of a CUD being predicting more specifically by MDD and physical abuse. Those with sexual trauma who initiate cannabis use prior to the age of 16, are also more likely to develop psychosis.{{cite journal | vauthors = Houston JE, Murphy J, Shevlin M, Adamson G | title = Cannabis use and psychosis: re-visiting the role of childhood trauma | journal = Psychological Medicine | volume = 41 | issue = 11 | pages = 2339–48 | date = November 2011 | pmid = 21557896 | doi = 10.1017/S0033291711000559 | s2cid = 32270892 }}

In women military veterans, a higher proportion of cannabis users who had experienced childhood and adult sexual trauma, had higher levels Post-Traumatic Stress Disorder (PTSD) diagnosis when compared to those with no drug use.{{cite journal | vauthors = Browne KC, Dolan M, Simpson TL, Fortney JC, Lehavot K | title = Regular past year cannabis use in women veterans and associations with sexual trauma | journal = Addictive Behaviors | volume = 84 | pages = 144–150 | date = September 2018 | pmid = 29684763 | doi = 10.1016/j.addbeh.2018.04.007 | pmc = 6716375 }}   When controlling for PTSD symptoms and demographic factors, regular cannabis use was still significantly related to sexual trauma. For sexual minority women, have indicated higher cannabis use, coping motives, and post-traumatic stress symptoms than heterosexual women.{{cite journal | vauthors = Walukevich-Dienst K, Dylanne Twitty T, Buckner JD | title = Sexual minority women and Cannabis use: The serial impact of PTSD symptom severity and coping motives | journal = Addictive Behaviors | volume = 92 | pages = 1–5 | date = May 2019 | pmid = 30553032 | doi = 10.1016/j.addbeh.2018.12.012 | s2cid = 56172257 }}{{cite journal | vauthors = Dworkin ER, Kaysen D, Bedard-Gilligan M, Rhew IC, Lee CM | title = Daily-level associations between PTSD and cannabis use among young sexual minority women | journal = Addictive Behaviors | volume = 74 | pages = 118–121 | date = November 2017 | pmid = 28618391 | pmc = 5538382 | doi = 10.1016/j.addbeh.2017.06.007 }} This may suggest that for women, trauma symptoms may be more severe for those who belong to a minority status, and the necessity to cope is often met by increasing cannabis use. These findings corroborate the idea that increased cannabis use can also be driven by minority stress, which has also been related to increased trauma.{{cite journal | vauthors = Gonzalez CA, Gallego JD, Bockting WO | title = Demographic Characteristics, Components of Sexuality and Gender, and Minority Stress and Their Associations to Excessive Alcohol, Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States | journal = The Journal of Primary Prevention | volume = 38 | issue = 4 | pages = 419–445 | date = August 2017 | pmid = 28405831 | pmc = 5516932 | doi = 10.1007/s10935-017-0469-4 }}{{cite journal | vauthors = Goldbach JT, Schrager SM, Dunlap SL, Holloway IW | title = The application of minority stress theory to marijuana use among sexual minority adolescents | journal = Substance Use & Misuse | volume = 50 | issue = 3 | pages = 366–75 | date = February 2015 | pmid = 25493644 | doi = 10.3109/10826084.2014.980958 | s2cid = 23419207 }}

The psychoactive component of cannabis, tetrahydrocannabinol (THC) is not effective in treating emotion-regulation and anxiety-related symptoms.{{cite journal | vauthors = Crippa JA, Zuardi AW, Martín-Santos R, Bhattacharyya S, Atakan Z, McGuire P, Fusar-Poli P | title = Cannabis and anxiety: a critical review of the evidence | journal = Human Psychopharmacology | volume = 24 | issue = 7 | pages = 515–23 | date = October 2009 | pmid = 19693792 | doi = 10.1002/hup.1048 | s2cid = 13544234 | doi-access = free }} Conversely, THC has been empirically related to an increase anxiety symptoms through impacts on neurological areas impacting serotonin, noradrenalin, GABA and glutamate.{{cite journal | vauthors = Braida D, Limonta V, Malabarba L, Zani A, Sala M | title = 5-HT1A receptors are involved in the anxiolytic effect of Delta9-tetrahydrocannabinol and AM 404, the anandamide transport inhibitor, in Sprague-Dawley rats | journal = European Journal of Pharmacology | volume = 555 | issue = 2–3 | pages = 156–63 | date = January 2007 | pmid = 17116299 | doi = 10.1016/j.ejphar.2006.10.038 }}{{cite journal | vauthors = Degenhardt L, Hall W, Lynskey M | title = Exploring the association between cannabis use and depression | journal = Addiction | volume = 98 | issue = 11 | pages = 1493–504 | date = November 2003 | pmid = 14616175 | doi = 10.1046/j.1360-0443.2003.00437.x }}{{cite journal | vauthors = Pertwee RG | title = The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin | journal = British Journal of Pharmacology | volume = 153 | issue = 2 | pages = 199–215 | date = January 2008 | pmid = 17828291 | pmc = 2219532 | doi = 10.1038/sj.bjp.0707442 }}

When using cannabidiol (CBD) results have indicated a weakened emotional response to traumatic memories.{{cite journal | vauthors = Passie T, Emrich HM, Karst M, Brandt SD, Halpern JH | title = Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence | journal = Drug Testing and Analysis | volume = 4 | issue = 7–8 | pages = 649–59 | date = 2012-06-26 | pmid = 22736575 | doi = 10.1002/dta.1377 }} This effect is attributed to the presence of endocannabinoid receptors in the limbic system, including the amygdala, and the hypothalamus that CBD may impact.{{cite journal | vauthors = Katona I, Rancz EA, Acsady L, Ledent C, Mackie K, Hajos N, Freund TF | title = Distribution of CB1 cannabinoid receptors in the amygdala and their role in the control of GABAergic transmission | journal = The Journal of Neuroscience | volume = 21 | issue = 23 | pages = 9506–18 | date = December 2001 | pmid = 11717385 | doi = 10.1523/jneurosci.21-23-09506.2001 | pmc = 6763903 }}{{Cite journal| vauthors = Walker JM, Huang SM |date=2002|title=Cannabinoid analgesia |journal=Pharmacology & Therapeutics|volume=95|issue=2|pages=127–135|doi=10.1016/S0163-7258(02)00252-8|pmid=12182960}}{{cite journal | vauthors = Lorenzetti V, Lubman DI, Whittle S, Solowij N, Yücel M | title = Structural MRI findings in long-term cannabis users: what do we know? | journal = Substance Use & Misuse | volume = 45 | issue = 11 | pages = 1787–808 | date = September 2010 | pmid = 20590400 | doi = 10.3109/10826084.2010.482443 | s2cid = 22127231 }} These components' effect likely leads to the reduction of neuroendocrine and behavioral stress responses.{{cite journal | vauthors = Jacobson L, Sapolsky R | title = The role of the hippocampus in feedback regulation of the hypothalamic-pituitary-adrenocortical axis | journal = Endocrine Reviews | volume = 12 | issue = 2 | pages = 118–34 | date = May 1991 | pmid = 2070776 | doi = 10.1210/edrv-12-2-118 }} Altogether, a cumulation of research indicates cannabinoids can help with fear extinction and combating depression. However, further studies are needed to validate the therapeutic potential of cannabinoids for emotion dysregulation and anxiety symptoms associated with trauma.

While the psychoactive component THC, has been shown to reduce time to get to sleep, studies indicate disrupted circadian rhythms when using THC.{{cite journal | vauthors = Perron RR, Tyson RL, Sutherland GR | authorlink3=Grant Robert Sutherland | title = Delta9 -tetrahydrocannabinol increases brain temperature and inverts circadian rhythms | journal = NeuroReport | volume = 12 | issue = 17 | pages = 3791–4 | date = December 2001 | pmid = 11726796 | doi = 10.1097/00001756-200112040-00038 | s2cid = 25466602 }}{{cite journal | vauthors = Babson KA, Sottile J, Morabito D | title = Cannabis, Cannabinoids, and Sleep: a Review of the Literature | journal = Current Psychiatry Reports | volume = 19 | issue = 4 | pages = 23 | date = April 2017 | pmid = 28349316 | doi = 10.1007/s11920-017-0775-9 | s2cid = 7429763 }} Furthermore, THC is shown to have a quicker development of tolerance to sleep-inducing effects.{{cite journal | vauthors = Vaughn S, Cirino PT, Wanzek J, Wexler J, Fletcher JM, Denton CD, Barth A, Romain M, Francis DJ | display-authors = 6 | title = Response to Intervention for Middle School Students With Reading Difficulties: Effects of a Primary and Secondary Intervention | journal = School Psychology Review | volume = 39 | issue = 1 | pages = 3–21 | date = 2010-03-01 | pmid = 21479079 | doi = 10.1080/02796015.2010.12087786 | pmc = 3072689 }} It is worth noting that synthetic THC has also shown the same effects of developed tolerance to sleep latency effects.{{cite journal | vauthors = Gorelick DA, Goodwin RS, Schwilke E, Schwope DM, Darwin WD, Kelly DL, McMahon RP, Liu F, Ortemann-Renon C, Bonnet D, Huestis MA | display-authors = 6 | title = Tolerance to effects of high-dose oral δ9-tetrahydrocannabinol and plasma cannabinoid concentrations in male daily cannabis smokers | journal = Journal of Analytical Toxicology | volume = 37 | issue = 1 | pages = 11–6 | date = 2013-01-01 | pmid = 23074216 | pmc = 3584989 | doi = 10.1093/jat/bks081 }}

However, individuals diagnosed with high PTSD scores have endorsed the use of medical cannabis for sleeping.{{cite journal | vauthors = Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA | title = Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users | journal = The American Journal of Drug and Alcohol Abuse | volume = 40 | issue = 1 | pages = 23–30 | date = January 2014 | pmid = 24205805 | doi = 10.3109/00952990.2013.821477 | s2cid = 8988512 }}{{cite journal | vauthors = Metrik J, Jackson K, Bassett SS, Zvolensky MJ, Seal K, Borsari B | title = The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD | journal = Psychology of Addictive Behaviors | volume = 30 | issue = 7 | pages = 743–754 | date = November 2016 | pmid = 27786514 | doi = 10.1037/adb0000210 | pmc = 5218528 }} Studies have found some evidence for using Naboline, a synthetic version of THC, has proven effective for decreasing the frequency of PTSD related nightmares without developing long-term tolerance.{{cite journal | vauthors = Cameron C, Watson D, Robinson J | title = Use of a synthetic cannabinoid in a correctional population for posttraumatic stress disorder-related insomnia and nightmares, chronic pain, harm reduction, and other indications: a retrospective evaluation | journal = Journal of Clinical Psychopharmacology | volume = 34 | issue = 5 | pages = 559–64 | date = October 2014 | pmid = 24987795 | doi = 10.1097/jcp.0000000000000180 | pmc = 4165471 }}{{cite journal | vauthors = Fraser GA | title = The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD) | journal = CNS Neuroscience & Therapeutics | volume = 15 | issue = 1 | pages = 84–8 | date = 2009 | pmid = 19228182 | doi = 10.1111/j.1755-5949.2008.00071.x | pmc = 6494011 }}{{cite journal | vauthors = Jetly R, Heber A, Fraser G, Boisvert D | title = The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study | journal = Psychoneuroendocrinology | volume = 51 | pages = 585–8 | date = January 2015 | pmid = 25467221 | doi = 10.1016/j.psyneuen.2014.11.002 | s2cid = 29692607 }}{{cite journal | vauthors = Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A | title = Preliminary, open-label, pilot study of add-on oral Δ9-tetrahydrocannabinol in chronic post-traumatic stress disorder | journal = Clinical Drug Investigation | volume = 34 | issue = 8 | pages = 587–91 | date = August 2014 | pmid = 24935052 | doi = 10.1007/s40261-014-0212-3 | s2cid = 4881658 }}

Novel research into cannabis suggests potential therapeutic effects of cannabinoids, specifically with higher doses of CBD, as opposed to lower doses, which can have an energizing effect.{{cite journal | vauthors = Carlini EA, Cunha JM | title = Hypnotic and antiepileptic effects of cannabidiol | journal = Journal of Clinical Pharmacology | volume = 21 | issue = S1 | pages = 417S–427S | date = 1981-08-09 | pmid = 7028792 | doi = 10.1002/j.1552-4604.1981.tb02622.x | s2cid = 7372390 }}{{cite journal | vauthors = Nicholson AN, Turner C, Stone BM, Robson PJ | title = Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults | journal = Journal of Clinical Psychopharmacology | volume = 24 | issue = 3 | pages = 305–13 | date = June 2004 | pmid = 15118485 | doi = 10.1097/01.jcp.0000125688.05091.8f | s2cid = 4846127 }} In laboratory studies with rats, CBD has been shown to reduce sleep latency due to anxiety in REM sleep, with no negative changes to other aspects of sleep.{{cite journal | vauthors = Hsiao YT, Yi PL, Li CL, Chang FC | title = Effect of cannabidiol on sleep disruption induced by the repeated combination tests consisting of open field and elevated plus-maze in rats | journal = Neuropharmacology | volume = 62 | issue = 1 | pages = 373–84 | date = January 2012 | pmid = 21867717 | doi = 10.1016/j.neuropharm.2011.08.013 | series = Anxiety and Depression | s2cid = 20340120 | url = http://ntur.lib.ntu.edu.tw/bitstream/246246/245704/-1/index.html | url-access = subscription }}{{cite journal | vauthors = Chagas MH, Crippa JA, Zuardi AW, Hallak JE, Machado-de-Sousa JP, Hirotsu C, Maia L, Tufik S, Andersen ML | display-authors = 6 | title = Effects of acute systemic administration of cannabidiol on sleep-wake cycle in rats | journal = Journal of Psychopharmacology | volume = 27 | issue = 3 | pages = 312–6 | date = March 2013 | pmid = 23343597 | doi = 10.1177/0269881112474524 | s2cid = 5125324 }}

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Category:Cannabis

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