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Etiology of Cannabis-Related Disorders Hans-Ulrich Wittchen* Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Max-Planck-Institute.

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Präsentation zum Thema: "Etiology of Cannabis-Related Disorders Hans-Ulrich Wittchen* Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Max-Planck-Institute."—  Präsentation transkript:

1 Etiology of Cannabis-Related Disorders Hans-Ulrich Wittchen* Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Max-Planck-Institute of Psychiatry * Speaker BMBF-Addiction Research Network ASAT Das Forschungsvorhaben „Vulnerabilitäts- und Protektionsfaktoren bei Frühstadien von Substanzmissbrauch und Abhängigkeit“ (EDSP und ANEPSA-Verbunddaten) sowie das Anschlussvorhaben wurden gefördert vom Bundesministerium für Bildung und Forschung (BMBF) Förderkennzeichen: BMBF 01 EB 9405/6 und 01 EB 9901/6 als Teilpojekte des BMBF Suchtforschungsverbunds ASAT gefördert.

2 Why are we interested in the etiology of CUD?   Prevalence and incidence   Cannabis use can result in dependence syndromes (Nocon et al JPR 2002)   Increased neuropsychological and psychopathological risks (Henquet et al 2004, Perkonigg et al 2006, Wittchen et al 2006)   Negative effects on development and social functioning (von Niekerk et al 2002)   Increased risk for other drug use disorders („gateway drug“ von Niekerk et al 2002)   To understand and describe its development in order to:   predict onset of problematic and use disorders,   to prevent effectively use and transitions to CUD and   to design appropriate strategies for early interventions and effective therapy and rehabilitation

3 Critical issues   There is a wide spectrum of „cannabis-related disorders“ (CUD)   The heterogeneity of CUDs implies heterogenous „etiologies“ (even for dependence)   Even restricting CUD to „dependence“ it is unlikely to find……   One single etiological model   simple (causal) etiological pathways   It is more likely to find highly complex vulnerability – stress/risk models

4 Problem resolved! Vulnerability factors + Increased incidence of cannabis- related disorders = time Exposition with drug increasing availability Easier access permissiveness Life style Potency of drug Acute effects Chronic effects Distal & proximal risk- factors … partially!

5 Why only a partial resolution?   Sampling and design of etiological studies   Diffusion of constructs and variables   Lack of integration of research findings   Lack of appropriate vulnerability and risks modeling   Lack on research on mediators and moderators   Lack of clinically useful predictive models

6 Problem 1: Etiological research results are dependent on sampling frames Community/general population or fractions thereof Drug Use Experience (lifetime user) Current Users Problematic Drug Users* SUD ( Substance Abuse/ and Dependence) Persons in contact with services For treatment and intervention *Problem drug use: i.e social or physical harm

7 Problem 2 - An incomplete summary of factors Sociodemographic factors: - Adoescent age - male - Low socio-economic status - Urbanicity Developmental: - birth complications - neglect - Divorce/separation/death - bonding - traumatic, critical life events - Genetic/family genetic: - genes - Anxiety and depressive disorders - bipolar disorders - substance use disorders - other (somatoform, personality dis, etc) Familiar factors: - Rejection - emotional warmth and overprotection - family styple and attitudes - substance use Intrapersonel factors: - behavioral inhibition - conduct disorders - antisocial Personlyity dis. - self-esteem, confidence - regulation of cognition and affect - impulsivity - daily hazzles Interpersonel factors: - peer group - social network and support - interpersonel life events– and conditions Mental disorders - conduct and dissocial disorders - ADHD - anxiety disorders - mood diosrders - nicotine dependence Substance-related factors - access and availability - type and frequency of consumption - potency