Research Article: Reaching out towards cannabis: approach-bias in heavy cannabis users predicts changes in cannabis use

Date Published: September , 2011

Publisher: Blackwell Publishing Ltd

Author(s): Janna Cousijn, Anna E Goudriaan, Reinout W Wiers.


Repeated drug exposure can lead to an approach-bias, i.e. the relatively automatically triggered tendencies to approach rather that avoid drug-related stimuli. Our main aim was to study this approach-bias in heavy cannabis users with the newly developed cannabis Approach Avoidance Task (cannabis-AAT) and to investigate the predictive relationship between an approach-bias for cannabis-related materials and levels of cannabis use, craving, and the course of cannabis use.

Cross-sectional assessment and six-month follow-up in 32 heavy cannabis users and 39 non-using controls.

Approach and avoidance action-tendencies towards cannabis and neutral images were assessed with the cannabis AAT. During the AAT, participants pulled or pushed a joystick in response to image orientation. To generate additional sense of approach or avoidance, pulling the joystick increased picture size while pushing decreased it. Craving was measured pre- and post-test with the multi-factorial Marijuana Craving Questionnaire (MCQ). Cannabis use frequencies and levels of dependence were measured at baseline and after a six-month follow-up.

Heavy cannabis users demonstrated an approach-bias for cannabis images, as compared to controls. The approach-bias predicted changes in cannabis use at six-month follow-up. The pre-test MCQ emotionality and expectancy factor were associated negatively with the approach-bias. No effects were found on levels of cannabis dependence.

Heavy cannabis users with a strong approach-bias for cannabis are more likely to increase their cannabis use. This approach-bias could be used as a predictor of the course of cannabis use to identify individuals at risk from increasing cannabis use.

Partial Text

Cannabis is the most commonly used illegal drug in most countries and treatment demands have increased strongly over the last decades [1–3]. Growing awareness of the addictive properties of cannabis is accompanied by a growing need for research investigating cannabis abuse and dependence. A key question in research on addiction is why some individuals escalate from recreational use to problematic use, while others do not. From all heavy cannabis users (defined as using cannabis on at least 10 occasions per month), an estimated 7–8% meet DSM-IV criteria of dependence [1–3]. Identifying predictors of the course of cannabis use is crucial for the development of effective prevention strategies.

This study showed that heavy cannabis users, but not controls, have an approach-bias specifically for cannabis-related images (not for neutral images), as measured with the AAT [9,29,30]. In line with our hypothesis, the approach-bias predicted changes in cannabis use 6 months later in heavy cannabis users: stronger approach-biases were related to increases in weekly cannabis use. In contrast to our hypothesis, the approach-bias was related negatively to craving for relief from negative affect and anticipation of positive outcome (i.e. MCQ emotionality and expectancy factor). No associations were found between the approach-bias and measures of cannabis-related problems and dependence.




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