www.ccsa.ca • www.cclt.

ca Report in Short

The Effects of Cannabis Use during Adolescence

The Issue
Cannabis use, a prominent political, health and law enforcement issue in Canada, is currently
receiving a great deal of attention. Policy developments in different parts of the world and ongoing
public debate in Canada may be influencing the views held by youth about the drug. They are
especially vulnerable to the negative effects of cannabis use, since the adolescent brain undergoes
rapid and extensive development until a person reaches his or her mid-twenties. Brain development
during this time helps to lay the foundation for success or, conversely, challenges later in life.
About one quarter of Canadian youth aged 15–24 reported using cannabis in 2013, making it the
most commonly used illegal drug among this age group.1 Of great concern is the 27.4% of youth who
used cannabis daily or almost daily during the past three months.1 Youth may not be concerned
about this pattern of use as many view cannabis to be natural, safe and not addictive.2 Indeed,
research has noted that youth who do not think using cannabis presents risks are more likely to
report using the drug (see Figure 1).3 In fact, some youth have said that using cannabis could
enhance their focus while driving, improve their health and even prevent or cure cancer.2

Purpose of this Report in Short

This report in short summarizes the research evidence on the health, psychological and social
effects of adolescent cannabis use that is covered more comprehensively in the technical report on
which it is based. * It focuses on youth who use cannabis daily or almost daily, as this is the age
group in which severe and potentially irreversible effects that can seriously limit future success can

* The Effects of Cannabis Use during Adolescence is part of the Substance Abuse in Canada series, which covers key substance abuse
issues and highlights areas for action in both policy and practice. All volumes in the series are available on the CCSA website.

Page 1
Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies
 The Effects of Cannabis Use during Adolescence

be observed. This report cuts through the abundance of information circulating about cannabis from
various perspectives to clearly identify what we know, what we do not yet know and what evidence is
emerging about the effects of cannabis use during adolescence.
The evidence reviewed in the report supports efforts to reduce harm to youth by decreasing the
number who use cannabis or delaying the start of use for those who choose to use it. By situating the
relevant neuroscience in the broader behavioural and social contexts of youth cannabis use, the
report provides a much-needed resource for developing youth policies, programs and practices
related to cannabis. Finally, the report identifies areas where future studies are needed to clarify the
relationships between cannabis use and outcomes for youth to reduce cannabis-related harms.

Cannabis Impacts the Brain

Humans are born with an endocannabinoid system that responds to chemicals (cannabinoids) that
are developed in the brain and that are similar to the psychoactive components of cannabis.4 The
endocannabinoid system aids the extensive brain development that occurs during youth, regulating
activity and communication in the brain and affecting memory, learning, coordination, appetite, pain,
mood, pleasure and motivation.4–6 Consuming cannabis regularly during adolescence interferes with
the function and development of this brain system.7,8 As a result, youth who use cannabis regularly
are at risk for harmful effects on their mental health and cognitive functioning, as well as for
developing cannabis dependence, which are discussed in more detail in the following sections.
Cannabis Use Negatively Affects Cognition and Behaviour
Accumulating research indicates that regular cannabis use initiated early in life can result in
behavioural and cognitive impairments, including poor academic performance, and deficits in
attention, information processing and memory.9–19 These deficits have been shown to persist after
an individual stops using cannabis;13 however, the exact duration of impairment is still unknown.
Brain imaging of adolescents who used cannabis has revealed differences in the size (both increases and
decreases),20–31 connectivity32,33 and quality9,26,34–38 of various brain structures, as compared to non-users.
The earlier that individuals started regular use, the more impaired the nerve connections were in the
brain,38 and in those who began using cannabis at a later age some of these negative effects were not
seen.26 It remains unclear as to whether these differences were the result of cannabis use, or if they were
present before a youth began using cannabis and might have been a motivating factor for use. Still, the
finding are significant as they represent a brain that is not as efficient or healthy as it could be.
When looking at brain function, imaging of the brains of youth who use cannabis showed greater
activity while completing tasks, as compared to those who did not use cannabis.12,17,18 This
increased activity indicates the brain was working harder to perform a task and used more resources
to respond. In these cases, the brain may have been compensating for structural changes, which can
lead to fatigue over time and might ultimately result in cognitive efficiency problems.18 These
differences were observed in brain regions critical for executive functioning (e.g., planning and
decision making, and establishing and completing goals), which are necessary for future success.
Similarly, the apathy that can be observed among youth who use cannabis39 might be related to a
reduction of volume in the front of the brain,24 which acts as a network hub for many behaviours
involved in reward processing, motivation, self-awareness and decision making, and that also has a
great quantity of cannabinoid receptors. This front portion is one of the latest brain regions to
complete development and so is particularly vulnerable to the disruptive effects of cannabis use
during this period when it is not fully formed. These negative effects appear to be related to early

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 2
 The Effects of Cannabis Use during Adolescence

onset and chronic use. Thus, delaying the age of use onset might protect the brain, as there are
fewer cannabinoid receptors present in the mature brain than in the developing brain.38
Cannabis Impairs Driving Abilities
Cannabis can produce deficits in attentional focus, information processing, motor coordination and
reaction time, making it unsafe to operate a motor vehicle while impaired.11 People who drive under
the influence of cannabis are at a significantly increased risk of motor vehicle collisions compared to
drivers who have not used cannabis, alcohol or other drugs.40,41 This risk is further increased when
cannabis is consumed together with alcohol.11 Drivers who use cannabis have been shown to
attempt to compensate by driving slower, but have reduced control when more complex tasks are
involved. This impairment results in more lane weaving, slower reaction times, difficulties paying
attention to multiple things at once, and flawed eye–hand coordination and reaction times.42–45
Cannabis is Linked to Mental Health Concerns
It is well established that regular cannabis use is associated with experiencing psychotic symptoms
and developing schizophrenia, especially among those who have a personal or family history of
psychotic disorders.46–50 Whether drug use induces psychosis and schizophrenia, or whether these
illnesses put people at risk for drug use is still unknown.
The connections between cannabis use and other mental illnesses, especially anxiety, are less clear.
Some studies have found that regular cannabis use by adolescents is associated with an increased
risk of depression,51,52 worsening symptoms of depression, anxiety53 and bipolar disorder,54–57
suicidal thoughts and attempts,58 eating disorders,59 and childhood disorders.60
It was once thought that adolescents with anxiety and mood disorders self-medicated with cannabis
to improve their symptoms.61,62 However, longitudinal studies have found that this theory does not
account for the pattern of cannabis use among adolescents and young adults with depression,
anxiety or bipolar disorder.53,63 Nonetheless, social anxiety and post-traumatic stress disorder are
risks for the onset of problematic cannabis use among adolescents and young adults,64,65 as people
living with these conditions may use cannabis for its anxiety-inhibiting properties.66 Indeed, some
studies have shown that activation of the endocannabinoid system can reduce symptoms of
anxiety.67,68 There is a complex relationship between cannabis and anxiety such that anxiety may
either be enhanced or reduced after use of cannabis. Further research, taking into account biological
and environmental factors, is needed to achieve a better understanding of this relationship.
Regardless of which occurs first, symptoms of mental illness or cannabis use, the detrimental effects
of consuming cannabis could be related to malfunctioning of the cannabinoid system in the brain. A
gene might make individuals vulnerable to both cannabis use and developing schizophrenia,69,70 or
might interact with early cannabis exposure to increase the risk of developing schizophrenia or
psychosis.71,72 Alternatively, cannabis might lead to dysregulation of the body’s stress response
system, which has implications for developing mood and anxiety disorders.73 Further research is
needed to completely understand the interrelations between genes, experiences and poor outcomes.74

Cannabis Can Be Addictive

It is estimated that one in six individuals who use cannabis during adolescence will develop a cannabis
use disorder,75 defined as a problematic pattern of cannabis use leading to clinically significant
impairment or distress.76 (See the technical report for additional diagnostic criteria.) Compared to
alcohol and tobacco, cannabis use can develop more quickly into a substance use disorder among
adolescents.77 Problems are typically observed among “heavy users” or those who use daily or almost

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 3
 The Effects of Cannabis Use during Adolescence

daily.11 More than one in 20 Canadians ages 15–24 met the criteria for cannabis abuse or dependence
in 2012.78 Among those with a cannabis use disorder, withdrawal can occur, with individuals
experiencing irritability, anxiety, restlessness, appetite changes and sleep disturbances.79
How can we recognize who will develop dependence? The influence of genes might contribute to how
an individual responds to their first exposure to cannabis, yet the exact genes and the pathways
through which they exert their influences are still unclear. Genes may account for 51–59% of
determining problematic cannabis use, whereas shared environments, such as being raised in the
same household, account for 15–20%, and unshared environments, such as having different peer
groups, account for 26–29%, depending on gender.80 Psychosocial factors found to contribute to risk
of cannabis dependence were early initiation (by age 15), low socioeconomic status, use of other
drugs, male gender, regular cannabis use, anti-social behaviour, persistent tobacco use, living alone,
using cannabis as a coping mechanism, and number and type of recent negative life events.81–84
Though studies have shown that cannabis use can be associated with an increased risk of using
other illegal drugs,85,86 there are many factors influencing an individual’s drug use trajectory. It might
be that risk factors for using additional drugs are the same factors that led an individual to use
cannabis in the first place, as opposed to cannabis being the cause of subsequent drug use.

Interventions for Problematic Cannabis Use

Given the findings that cannabis use is related to negative effects on multiple aspects of a youth’s
life, the importance of prevention, early identification and intervention cannot be overstated. The
best preventive education programs delivered in schools or healthcare facilities can delay initiation
of use by 20–40% compared to the outcome in groups not exposed to such programs. Primary
healthcare providers are optimally placed to screen for all substance use concerns when interacting
with young patients. Among those who indicate potentially problematic behaviour, brief motivational
interviewing, a type of counselling that prepares people to change their behaviours,87 has resulted in
improvements in cannabis-related measures as compared to those in control conditions.88–90
Healthcare providers must recognize when the severity of a youth’s cannabis use exceeds their
expertise, and when to refer a patient to specialized treatment. Specialized treatments have mainly
involved therapies focused on psychological well-being, such as cognitive behavioural therapy (CBT),
motivational enhancement therapy (MET), and multidimensional family therapy (MDFT), all of which
have resulted in reductions in cannabis use among youth.91–94 Contingency management (CM),
where participants receive a reward if they meet pre-established criteria such as drug abstinence,95
has resulted in improvements in treatment retention and cannabis-free urine samples;96 though the
results are mixed as to whether CM can enhance other therapeutic interventions.97
There are also medications that can diminish withdrawal symptoms, but have not yet demonstrated
improved clinical outcomes, nor were they tested primarily among adolescents.98–101 Similarly, one
drug, N-acetylcysteine, has shown promise in reducing cannabis craving and use among youth aged
18–21 years old,102 and has proven even more effective when combined with brief counselling and
CM,103 but clinical trials of this medication are still needed.
Emerging research has outlined the potential of novel areas for treatment, including mobile
technology, internet and computer-based interventions. These have shown promise as they are
accessible and might meet youth’s needs for immediate support in high-risk situations.104,105

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 4
 The Effects of Cannabis Use during Adolescence

Call to Action
The evidence summarized in this report indicates that cannabis is not a harmless drug. The negative
effects of regular use by the large percentage of youth, combined with misperceptions of this drug,
have the potential to impact society as a whole, as youth represent the future of our country. We
have a strong knowledge base about the risks and harms associated with cannabis use, and we can
use this information to inform effective programs, policy and practice.
The knowledge in this report can inform prevention programs that need to be comprehensive, factual
and multi-faceted to be effective. These programs should involve family members, schools and the
community, and speak to youth about their misperceptions of cannabis being a benign substance.
The findings reveal that the youth brain might be particularly vulnerable to the effects of cannabis,
and thus education and prevention programs that encourage delaying cannabis use could be
paramount.
Healthcare providers are well placed to identify and intervene early when cannabis use concerns are
observed. The development of a youth-focused screening tool for cannabis use may be beneficial to
increase the capacity of frontline clinicians to identify youth in need of help, and to provide an
entryway into educating youth about the harmful effects of cannabis use.
Similarly, youth need to know the potentially fatal dangers of driving after using cannabis. Greater
education and public awareness of this issue is critical. The development and implementation of
improved roadside screening for cannabis is needed to begin to address these acute harms.
Continuing to learn about factors leading to initiation, patterns and impacts of use, to concretely
identify cause and effects of use will provide a clearer picture of where to focus prevention and
treatment efforts. An opportunity exists to develop pilot programs using the evidence within this
report, including comparing longer-term interventions against brief, technology-based or assisted
interventions. Investments in young people, such as these research studies and others listed in the
technical report, can yield long-term improvements in health and socioeconomic outcomes for
individuals and families.

Additional Resources
• The Effects of Cannabis Use during Adolescence
• Clearing the Smoke on Cannabis Series
• Canadian Drug Summary: Cannabis
• Marijuana for Non-Therapeutic Purposes: Policy Brief
• Marijuana for Non-Therapeutic Purposes: Policy Considerations
• What Canadian Youth Think About Cannabis

ISBN 978-1-77178-265-4 © Canadian Centre on Substance Abuse 2015

The Canadian Centre on Substance Abuse changes lives by bringing people and
knowledge together to reduce the harm of alcohol and other drugs on society. We partner
with public, private and non-governmental organizations to improve the health and safety
of Canadians.
CCSA activities and products are made possible through a financial contribution from
Health Canada. The views of CCSA do not necessarily represent the views of the
Government of Canada.

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 5
 The Effects of Cannabis Use during Adolescence

1 Analysis based on the Statistics Canada 2013 Canadian Tobacco, Alcohol and Drugs Survey. Computation and
interpretation of these data are entirely that of the Canadian Centre on Substance Abuse.
2 Porath-Waller, A.J., Brown, J.E., Frigon, A.P., & Clark, H. (2013). What Canadian youth think about cannabis. Ottawa, ON:

Canadian Centre on Substance Abuse.

3 Volkow, N.D., Baler, R.D., Compton, W.M., & Weiss, S.R. (2014). Adverse health effects of marijuana use. New England

Journal of Medicine, 370, 2219–2227. Figure reproduced with permission, Massachusetts Medical Society.
4 Breivogel, C. S., & Sim-Selley, L. J. (2009). Basic neuroanatomy and neuropharmacology of cannabinoids. International

Review of Psychiatry, 21(2), 113–121.

5 Gray, K.M. (2013). New developments in understanding and treating adolescent marijuana dependence. Adolescent
Psychiatry, 3(4), 297–306.
6 Pope, C., Mechoulam, R., & Parson, L. (2010). Endocannabinoid signaling in neurotoxicity and neuroprotection.

Neurotoxicology, 31(5), 562–571.

7 Batalla, A., Bhattacharyya, S., Yucel, M., Fusar-Poli, P., Crippa, J.A., Nogue, S., … Marin-Santos, R. (2013). Structural and

functional imaging studies in chronic cannabis users: A systematic review of adolescent and adult findings. PLoS One, 8(2),
e55821.
8 Bossong, M.G., Jansma, J.M., van Hell, H.H., Jager, G., Oudman, E., Sliasi, E., … Ramsey, N.F. (2012). Effects of delta 9-

tetrahydrocannabinol on human working memory function. Biological Psychiatry, 71, 693–699.

9 Bava, S., Jacobus, J., Thayer, R.E., & Tapert, S.F. (2013). Longitudinal changes in white matter integrity among adolescent

substance users. Alcoholism: Clinical and Experimental Research, 37(1), E181–189.

10 Crane, N.A., Schuster, R.M., Fusar-Poli, P., & Gonzalez, R. (2013). Effects of cannabis on neurocognitive functioning:

Recent advances, neurodevelopmental influences, and sex differences. Neuropsychological Review, 23, 117–137.
11 Hall, W. (2014). What has research over the past two decades revealed about the adverse health effects of recreational

cannabis use? Addiction, 110(1), 19–35.

12 Hatchard, T., Fried, P.A., Hogan, M.J., Cameron, I., & Smith, A.M. (2014). Does regular cannabis use impact cognitive

interference? An fMRI investigation in young adults using the Counting Stroop task. Journal of Addiction Research and
Therapy, 5(4), 197–203.
13 Meier, M.H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keffe, R.S., & Moffitt, T.E. (2012). Persistent cannabis users

show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the USA,
109(40), e2657–2664.
14 Mokrysz, C., Gage, S., Landy, R., Munafo, M.R., Roiser, J.P., & Curran, H.V. (2014). Neuropsychological and educational

outcomes related to adolescent cannabis use, a prospective cohort study. European Neuropsychopharmacology, 24, S695–696.
15 Porath-Waller, A.J. (2009). Clearing the smoke on cannabis: Chronic use and cognitive functioning and mental health.

Ottawa, ON: Canadian Centre on Substance Abuse.

16 Silins, E., Horwood, L.J., Patton, G.C., Olsson, C.A., Hutchinson, D.M., … Mattick, R. (2014). Young adult sequelae of

adolescent cannabis use: An integrative analysis. Lancet Psychiatry, 1, 286–293.

17 Smith, A.M., Longo, C.A., Fried, P.A., Hogan, M.J., & Cameron, I. (2010). Effects of cannabis on visuospatial working

memory: An fMRI study in young adults. Psychopharmacology, 210(3), 429–438.

18 Smith, A.M., Zunini, R.A., Anderson, C.D., Longo, C.A., Cameron, I., Hogan, M.J., & Fried, P.A. (2011). Impact of cannabis

on response inhibition: An fMRI study in young adults. Journal of Behavioural and Brain Sciences, 1, 24–33.
19 Solowij, N., & Battisti, R. (2008). The chronic effects of cannabis on memory in humans: A review. Current Drug Abuse

Review, 1, 81–98.
20 Ashtari, M., Avants, B., Cyckowski, L., Cervellione, K.L., Roofeh, D., Cook, P., … Kumra, S. (2011). Medial temporal structures

and memory functions in adolescents with heavy cannabis use. Journal of Psychiatric Research, 45(8), 1055–1066.
21 Battistella, G., Forari, E., Annoni, J., Chtioui, H., Dao, K., Fabritius, M., … Giroud, C. (2014). Long-term effects of cannabis

on brain structure. Neuropsychopharmacology, 39, 2041–2048.

22 Churchwell, J.C., Carey, P.D., Ferrett, H.L., Stein, D.J., & Yurgelun-Todd, D.A. (2012). Abnormal striatal circuitry and

intensified novelty seeking among adolescents that abuse methamphetamine and cannabis. Developmental Neuroscience,
34(4), 310–317.
23 Cousijn, J., Wiers, R.W., Ridderinkhof, K.R., Brink, W.V., Veltman, D.J., & Goudriaan, A.E. (2012). Grey matter alterations

associated with cannabis use: Results of a VBM study in heavy cannabis users and healthy controls. NeuroImage, 59,
3845–3851.
24 Filbey, F.M., Aslan, S., Calhoun, V.D., Spence, J.S., Damaraju, E., Caprihan, A., & Segall, J. (2014). Long-term effects of

marijuana use on the brain. Proceedings of the National Academy of Sciences of the USA, 111(47), 16913–16918.
25 Gilman, J.M., Kuster, J.K., Lee, S., Lee, M.J., Kim, B.W., Makris, N., … Breiter, H.C. (2014). Cannabis use is quantitatively

associated with nucleus accumbens and amygdala abnormalities in young adult recreational users. Journal of
Neuroscience, 34(16), 5529–5538.
26 Gruber, S. A., Dahlgren, M., Sagar, K.A., Gonenc, A., & Lukas, S.E. (2014). Worth the wait: Effects of age of onset of

marijuana use on white matter and impulsivity. Psychopharmacology, 231(8), 1455–1465.

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 6
 The Effects of Cannabis Use during Adolescence

27 McQueeny, T., Padula, C.B., Price, J., Medina, K.L., Logan, P., & Tapert, S.F. (2011). Gender effects on amygdala

morphometry in adolescent marijuana users. Behavioural Brain Research, 224(1), 128–134.

28 Medina, K.L., McQueeny, T., Nagel, B.J., Hanson, K.L., Yang, T.T., & Tapert, S.F. (2009). Prefrontal cortex morphometry in

abstinent adolescent marijuana users: Subtle gender effects. Addiction Biology, 14(4), 457–468.
29 Medina, K.L., Nagel, B.J., & Tapert, S.F. (2010). Abnormal cerebellar morphometry in abstinent adolescent marijuana

users. Psychiatry Research: Neuroimaging, 182(2), 152–159.

30 Medina, K.L., Schweinsburg, A.D., Cohen-Zion, M., Nagel, B.J., & Tapert, S.F. (2007). Effects of alcohol and combined

marijuana and alcohol use during adolescence on hippocampal volume and asymmetry. Neurotoxicology and Teratology,
29, 141–152.
31 Schacht,J.P., Hutchison, K.E., & Filbey, F.M. (2012). Associations between cannabinoid receptor-1 (CNR1) variation and

hippocampus and amygdala volumes in heavy cannabis users. Neuropsychopharmacology, 37, 2368–2376.
32 Houck, J. M., Bryan, A. D., & Feldstein Ewing, S. W. (2013). Functional connectivity and cannabis use in high-risk

adolescents.The American Journal of Drug and Alcohol Dependence, 39(6), 414–423.

33 Orr, C., Morioka, R., Behan, B., Datwani, S., Doucet, M., Ivanovic, J., … Garavan, H. (2013). Altered resting-state

connectivity in adolescent cannabis users. American Journal of Drug and Alcohol Abuse, 39(6), 372–381.
34 Arnone, D., Barrick, T. R., Chengappa, S., Mackay, C. E., Clark, C. A., & Abou-Saleh, M. T. (2008). Corpus callosum

damage in heavy cannabis use: Preliminary evidence from diffusion tensor tractography and tract-based spatial statistics.
NeuroImage, 41(3), 1067-1074.
35 Ashtari, M., Cervellione, K., Cottone, J., Ardekani, B.A., & Kumra, S. (2009). Diffusion abnormalities in adolescents and

young adults with a history of heavy cannabis use. Journal of Psychiatric Research, 43(3), 189–204.
36 Bava, S., Frank, L.R., McQueeny, T., Schweinsburg, B.C., Schweinsburg, A.D., & Tapert, S.F. (2009). Altered white matter

microstructure in adolescent substance users. Psychiatry Research: Neuroimaging, 173(3), 228–237.

37 Jacobus, J., Squeglia, L.M., Infante, M.A., Bava, S., & Tapert, S. F. (2013). White matter integrity pre- and post-marijuana

and alcohol initiation in adolescence. Brain Science, 3, 396–414.

38 Zalewsky, A., Solowij, N., Yucel, M., Lubman, D., Takagi, M., Harding, H., … Seal, M. (2012). Effect of long-term cannabis

use on axonal fibre connectivity. Brain: A Journal of Neurology, 135, 2245–2255.

39 Lynskey, M., & Hall, W. (2000). The effects of adolescent cannabis use on educational attainment: A review. Addiction,

95(11), 433–443.
40 Asbridge, M., Hayden, J.A., & Cartwright, J. (2012). Acute cannabis consumption and motor vehicle collision risk:

Systematic review of observational studies and meta-analysis. BMJ, 344, e536.

41 Gerberich, S., Sidney, S., Braun, B., Tekawa, I., Tolan, K., & Quesenberry, C. (2003). Marijuana use and injury events

resulting in hospitalization. Annals of Epidemiology, 13, 230–237.

42 Anderson, B.M., Rizzo, M., Block, R.I., Pearlson, G.D., & O’Leary, D.S. (2010). Sex differences in the effects of marijuana

on simulated driving performance. Journal of Psychoactive Drugs, 42, 19–30.

43 Downey, L.A., King, R., Papafotiou, K., Swann, P., Ogden, E., Boorman, M., & Stough, C. (2013). The effects of cannabis

and alcohol on simulated driving: Influences of dose and experience. Accident Analysis and Prevention, 50, 879–886.
44 Hartman, R. L., & Huestis, M. A. (2013). Cannabis effects on driving skills. Clinical Chemistry, 59(3), 478–492.
45 Lenne, M.G., Dietze, P.M., Triggs, T.J., Walmsley, S., Murphy, B., & Redman, J.R. (2010). The effects of cannabis and

alcohol on simulated arterial driving: Influences of driving experience and task demand. Accident Analysis and Prevention,
42, 859–866.
46 Andréasson, S., Engström, A., Allebeck, P., & Rydberg, U. (1987). Cannabis and schizophrenia: A longitudinal study of

Swedish conscripts. The Lancet, 330(8574), 1483–1486.

47 Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R., Wittchen, H.U., & Van Os, J. (2005). Prospective cohort

study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ, 330(7481), 11.
48 Large, M., Sharma, S., Compton, M.T., Slade, T., & Nielssen, O. (2011). Cannabis use and earlier onset of psychosis: A

systematic meta-analysis. Archives of General Psychiatry, 68, 555–561.

49 Semple, D.M., McIntosh, A.M., & Lawrie, S.M. (2005). Cannabis as a risk factor for psychosis: Systematic review. Journal

of Psychopharmacology, 19(2), 187–194.

50 Zammit, S., Allebeck, P., Andréasson, S., Lundberg, I., & Lewis, G. (2002). Self reported cannabis use as a risk factor for

schizophrenia in Swedish conscripts of 1969: Historical cohort study. BMJ, 325, 1199–1201.
51 Brook, D. W., Brook, J.S., Zhang, C., Cohen, P., & Whiteman, M. (2002). Drug use and the risk of major depressive

disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry, 59(11), 1039–1044.
52 Fergusson, D.M., Horwood, L.J., & Swain‐Campbell, N. (2002). Cannabis use and psychosocial adjustment in

adolescence and young adulthood. Addiction,97(9), 1123–1135.

53 Degenhardt, L., Hall, W., & Lynskey, M. (2003). Exploring the association between cannabis use and depression.

Addiction, 98(11), 1493–1504.

54 Agrawal, A., Nurnberger Jr, J.I., & Lynskey, M.T. (2011). Cannabis involvement in individuals with bipolar disorder.

Psychiatry Research, 185(3), 459–461.

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 7
 The Effects of Cannabis Use during Adolescence

55 Baethge, C., Baldessarini, R.J., Khalsa, H.M., Hennen, J., Salvatore, P., & Tohen, M. (2005). Substance abuse in first-
episode bipolar I disorder: Indications for early intervention. American Journal of Psychiatry, 162(5), 1008–1010.
56 Lev-Ran, S., Le Foll, B., McKenzie, K., George, T.P., & Rehm, J. (2013). Bipolar disorder and co-occurring cannabis use

disorders: Characteristics, co-morbidities and clinical correlates. Psychiatry Research, 209(3), 459–465.
57 Strakowski, S.M., DelBello, M.P., Fleck, D.E., Adler, C.M., Anthenelli, R.M., Keck, P.E., ... & Amicone, J. (2007). Effects of

co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Archives of
General Psychiatry, 64(1), 57–64.
58 Pedersen, W. (2008). Does cannabis use lead to depression and suicidal behaviours? A population‐based longitudinal

study. Acta Psychiatrica Scandinavica, 118(5), 395–403.

59 Ross, H.E., & Ivis, F. (1999). Binge eating and substance use among male and female adolescents. International Journal

of Eating Disorders, 26(3), 245–260.

60 Fergusson, D. M., & Boden, J. M. (2008). Cannabis use and adult ADHD symptoms. Drug and alcohol dependence, 95(1), 90–96.
61 Musty, R.E., & Kaback, L. (1995). Relationships between motivation and depression in chronic marijuana users. Life

Sciences, 56(23), 2151–2158.

62 Wittchen, H.U., Fröhlich, C., Behrendt, S., Günther, A., Rehm, J., Zimmermann, P., ... & Perkonigg, A. (2007). Cannabis

use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community
study in adolescents. Drug and Alcohol Dependence,88, S60–S70.
63 Strakowski, S.M., McElroy, S.L., Keck Jr, P.E., & West, S.A. (1996). The effects of antecedent substance abuse on the

development of first-episode psychotic mania. Journal of psychiatric research, 30(1), 59–68.

64 Buckner, J.D., Schmidt, N.B., Lang, A.R., Small, J.W., Schlauch, R.C., & Lewinsohn, P.M. (2008). Specificity of social

anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42(3), 230–239.
65 Cornelius, J.R., Kirisci, L., Reynolds, M., Clark, D.B., Hayes, J., & Tarter, R. (2010). PTSD contributes to teen and young

adult cannabis use disorders. Addictive Behaviors, 35(2), 91–94.

66 Greer, G.R., Grob, C.S., & Halberstadt, A.L. (2014). PTSD symptom reports of patients evaluated for the New Mexico

Medical Cannabis Program. Journal of Psychoactive Drugs, 46(1), 73–77.

67 Bergamaschi, M.M., Queiroz, R.H.C., Chagas, M.H.N., de Oliveira, D.C.G., De Martinis, B.S., Kapczinski, F., ... & Crippa,

J.A.S. (2011). Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia
patients. Neuropsychopharmacology, 36(6), 1219–1226.
68 Grant, J.E., Odlaug, B.L., Chamberlain, S.R., & Kim, S.W. (2011). Dronabinol, a cannabinoid agonist, reduces hair pulling

in trichotillomania: A pilot study. Psychopharmacology, 218(3), 493–502.

69 Kohn, Y., & Lerer, B. (2005). Excitement and confusion on chromosome 6q: The challenges of neuropsychiatric genetics

in microcosm. Molecular Psychiatry,10(12), 1062–1073.

70 Zhang, P.W., Ishiguro, H., Ohtsuki, T., Hess, J., Carillo, F., Walther, D., ... & Uhl, G.R. (2004). Human cannabinoid receptor

1: 5′ exons, candidate regulatory regions, polymorphisms, haplotypes and association with polysubstance abuse. Molecular
Psychiatry, 9(10), 916–931.
71 Caspi, A., Moffitt, T. E., Cannon, M., McClay, J., Murray, R., Harrington, H., ... & Craig, I. W. (2005). Moderation of the effect of

adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene:
Longitudinal evidence of a gene X environment interaction. Biological Psychiatry, 57(10), 1117–1127.
72 Henquet, C., Rosa, A., Krabbendam, L., Papiol, S., Faňanás, L., Drukker, M., ... & van Os, J. (2006). An experimental study

of catechol-O-methyltransferase Val158Met moderation of Δ-9-tetrahydrocannabinol-induced effects on psychosis and

cognition. Neuropsychopharmacology, 31(12), 2748–2757.
73 Steiner, M.A., & Wotjak, C.T. (2008). Role of the endocannabinoid system in regulation of the hypothalamic-pituitary-

adrenocortical axis. Progress in Brain Research, 170, 397–432.

74 Warner, V., Mufson, L., & Weissman, M.M. (1995). Offspring at high and low risk for depression and anxiety: Mechanisms

of psychiatric disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 34(6), 786-797.
75 Anthony, J.C. (2006). The epidemiology of cannabis dependence. In R.A. Roffman & R.S. Stephens (Eds.) Cannabis

dependence: Its nature, consequences and treatment (pp. 58-105). Cambridge, UK: Cambridge University Press.
76 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington,

DC: Author.
77 Ridenour, T.A., Lanza, S.T., Donny, E.C., & Clark, D.B. (2006). Different lengths of times for progressions in adolescent

substance involvement. Addictive Behavior, 31, 962–983.

78 Pearson, C., Janz, T., & Ali, J. (2013). Health at a glance: Mental and substance use disorders in Canada. (Statistics

Canada Catalogue no. 82-624-X).

79 Budney, A.J., & Hughes, J.R. (2006). The cannabis withdrawal syndrome. Current Opinion in Psychiatry, 19, 233–238.
80 Verweij, K.J., Zietsch, B.P., Lynskey, M.T., Medland, S.E., Neale, M.C., Martin, N.G., … Vink, J.M. (2010). Genetic and

environmental influences on cannabis use initiation and problematic use: A meta-analysis of twin studies. Addiction,
105(3), 417–430.
81 Chen, C.Y., O’Brien, M.S., & Anthony, J.C. (2005). Who becomes cannabis dependent soon after onset of use?

Epidemiological evidence from the United States: 2000–2001. Drug and Alcohol Dependence, 79(1), 11–22.

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 8
 The Effects of Cannabis Use during Adolescence

82 Coffey, C., Carlin, J.B., Lynskey, M., Li, N., & Patton, G.C. (2003). Adolescent precursors of cannabis dependence:

Findings from the Victorian Adolescent Health Cohort Study. British Journal of Psychiatry, 182, 330–336.
83 Lev-Ran, S., Le Strat, Y., Imtiaz, S., Rehm, J., & Le Foll, B. (2013). Gender differences in prevalence of substance use

disorders among individuals with lifetime exposure to substances: Results from a large representative sample. American
Journal on Addictions, 22(1), 7–13.
84 van der Pol, P., Liebregts, N., de Graaf, R., Korf, D.J., van den Brink, W., & van Laar, M. (2013). Predicting the transition

from frequent cannabis use to cannabis dependence: A three-year prospective study. Drug and Alcohol Dependence,
133(2), 352–359.
85 Fergusson, D.M., J.M. Boden, and L.J. Horwood. (2006). Cannabis use and other illicit drug use: testing the cannabis

gateway hypothesis. Addiction, 101(4), 556–569.

86 Secades-Villa, R., Garcia-Rodriguez, O., Jin, C.J., Wang, S., & Blanco, C. (2015). Probability and predictors of the cannabis

gateway effect: A national study. International Journal of Drug Policy, 26(2), 135–142.
87 Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.
88 D’Amico, E.J., Miles, J.N., Stern, S.A., & Meredith, L.S. (2008). Brief motivational interviewing for teens at risk of substance use

consequences: A randomized pilot study in a primary care clinic. Journal of Substance Abuse Treatment, 35, 53–61.
89 de Gee, E.A., Verdurmen, J.E., Bransen, E., de Jonge, J.M., & Schippers, G. M. (2014). A randomized controlled trial of a

brief motivational enhancement for non-treatment-seeking adolescent cannabis users. Journal of Substance Abuse
Treatment, 47, 181–188.
90 Martin, G., & Copeland, J. (2008). The adolescent cannabis check-up: Randomized trial of a brief intervention for young

cannabis users. Journal of Substance Abuse Treatment, 34, 407–414.

91 Dennis, M., Godley, S.H., Diamond, G., Tims, F.M., Babor, T., Donaldson, J., … Funk, R. (2004). The Cannabis Youth

Treatment (CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197–213.
92 Hendriks, V., van der Schee, E., & Blanken, P. (2011). Treatment of adolescents with a cannabis use disorder: Main

findings of a randomized controlled trial comparing multidimensional family therapy and cognitive behavioral therapy in the
Netherlands. Drug and Alcohol Dependence, 119, 64–71.
93 Liddle, H.A., Dakof, G.A., Turner, R.M., Henderson, C.E., & Greenbaum, P.E. (2008). Treating adolescent drug abuse: A

randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103, 1660–1670.
94 Walker, D.D., Stephens, R., Roffman, R., Demarce, J., Lozano, B., Towe, S., & Berg, B. (2011). Randomized controlled trial

of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the Teen
Marijuana Check-Up. Psychology of Addictive Behaviors, 25, 474–484.
95 Higgins, S.T., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F., & Fenwick, J.W. (1991). A behavioral

approach to achieving initial cocaine abstinence. American Journal of Psychiatry, 148, 1218–1224.
96 Carroll, K.M., Easton, C.J., Nich, C., Hunkele, K.A., Neavins, T.M., Sinha, R., … Rounsaville, B.J. (2006). The use of

contingency management and motivational/skills-building to treat young adults with marijuana dependence. Journal of
Consulting and Clinical Psychology, 74, 955–966
97 Stanger, C., Budney, A.J., Kamon, J.L., & Thostensen, J. (2009). A randomized trial of contingency management for

adolescent marijuana abuse and dependence. Drug and Alcohol Dependence, 105, 240–247.
98 Budney, A.J., Vandrey, R.G., Hughes, J R., Moore, B.A., & Bahrenburg, B. (2007). Oral delta-9-tetrahydrocannabinol

suppresses cannabis withdrawal symptoms. Drug and Alcohol Dependence, 86, 22–29.
99 Haney, M., Hart, C.L., Vosburg, S.K., Comer, S.D., Reed, S.C., & Foltin, R.W. (2008). Effects of THC and lofexidine in a

human laboratory model of marijuana withdrawal and relapse. Psychopharmacology, 197, 157–168.
100 Haney, M., Hart, C.L., Vosburg, S.K., Nasser, J., Bennett, A., Zubaran, C., & Foltin, R.W. (2004). Marijuana withdrawal in

humans: Effects of oral THC or divalproex. Neuropsychopharmacology, 29, 158–170.

101 Vandrey, R., & Haney, M. (2009). Pharmacotherapy for cannabis dependence: How close are we? CNS Drugs, 23, 543–553.
102 Gray, K.M., Watson, N.L., Carpenter, M.J., & Larowe, S.D. (2010). N-acetylcysteine (NAC) in young marijuana users: An

open-label pilot study. American Journal of Addiction, 19, 187–189.

103 Gray, K.M., Carpenter, M.J., Baker, N.L., DeSantis, S.M., Kryway, E., Hartwell, K.J., … Brady, K.T. (2012). A double-blind

randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. American Journal of Psychiatry, 169,
805–812.
104 Shrier, L.A., Rhoads, A.M., Fredette, M.E., & Burke, P.J. (2013). “Counselor in your pocket”: Youth and provider

perspectives on a mobile motivational intervention for marijuana use. Substance Use & Misuse. [Epub ahead of print].
105 Tait, R.J., Spijkerman, R., & Riper, H. (2013). Internet and computer based interventions for cannabis use: A meta-

analysis. Drug and Alcohol Dependence, 133, 295–304.

Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 9