The co-occurring use and misuse of cannabis and tobacco: a review.
paper
Cited
Public
- Authors
- Agrawal, Arpana; Budney, Alan J; Lynskey, Michael T
- Year
- 2012
- Journal
- Addiction (Abingdon, England)
- PMID
- 22300456
- DOI
- 10.1111/j.1360-0443.2012.03837.x
- PMCID
- PMC3397803
AIMS: Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use. METHODS: Selective review of published studies. RESULTS: Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking. CONCLUSIONS: There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge.
Overview of mechanisms contributing to the lifetime co-occurrence of cannabis and tobacco use.
Prevalence of cannabis use, cigarette smoking, cannabis use disorders (past 12 months) and nicotine dependence (based on the Fagerstrom Test of Nicotine Dependence (130)) in those aged 12 and older from the 2009 National Household Survey of Drug Use and Health (NSDUH)(5). For instance, 57.9% of cigarette smokers (including former smokers) report ever using cannabis compared with 11.9% of those who have never smoked cigarettes. Nicotine dependence based on Fagerstrom Test for Nicotine Dependence. Both cannabis use disorder (abuse/dependence) and nicotine dependence are recent.
Stages of progression from drug use to drug use disorders, followed by cessation or persistence and the influential role of withdrawal and treatment on these latter stages.
| Name | Type |
|---|---|
| 16-24 year olds local | cohort |
| absence of aversion from smoked substances local | phenotype |
| adolescents | cohort |
| adults | cohort |
| age at first opportunity to use cannabis local | phenotype |
| aggression | phenotype |
| airflow obstruction | phenotype |
| alcohol | phenotype |
| alcohol dependence | phenotype |
| Alcohol Dependence Symptoms | phenotype |
| Alcohol Use | phenotype |
| anger | phenotype |
| anxiety | phenotype |
| Australia | cohort |
| Australian study (Cameron and Williams) local | cohort |
| Blunt local | drug |
| Blunt smokers local | cohort |
| Breath holding local | phenotype |
| bupropion | drug |
| caffeine | drug |
| Caffeine abuse/dependence local | phenotype |
| cannabinoids | drug |
| Cannabis abstinence outcomes local | phenotype |
| cannabis dependence | phenotype |
| Cannabis dependent patients local | cohort |
| cannabis initiation | phenotype |
| cannabis progression local | phenotype |
| Cannabis smokers local | cohort |
| cannabisβtobacco coβuse local | phenotype |
| cannabis use | phenotype |
| cannabis use disorder | phenotype |
| cannabis withdrawal | phenotype |
| carbon monoxide | drug |
| chest sounds local | phenotype |
| Chrna3 | gene |
| CHRNA5 | gene |
| Chrnb4 | gene |
| chronic bronchitis | phenotype |
| cigarettes | phenotype |
| Cigar use local | phenotype |
| Cnr1 | gene |
| cocaine | phenotype |
| Cocaine abuse/dependence local | phenotype |
| cognitive processes | phenotype |
| conduct disorder | phenotype |
| co-occurring cannabis and tobacco involvement local | phenotype |
| co-occurring cannabis and tobacco use local | phenotype |
| Co-occurring cannabis-tobacco use local | phenotype |
| cotinine | drug |
| coughing local | phenotype |
| Coughing local | phenotype |
| craving | phenotype |
| cross-drug adaptation local | phenotype |
| cross-drug reinforcement local | phenotype |
| CYP2A6 | gene |
| Daily cannabis use local | phenotype |
| daily smoking | phenotype |
| decreased appetite | phenotype |
| depression | phenotype |
| deviant peers | phenotype |
| Dip use local | phenotype |
| disinhibition | phenotype |
| dizziness | phenotype |
| drug dependence | phenotype |
| drug expectancies local | phenotype |
| Drug expectancies local | phenotype |
| DSM-IV | phenotype |
| dual abstinence local | phenotype |
| Dutch adolescent cohort local | cohort |
| early cannabis use | phenotype |
| early onset of drug use local | phenotype |
| employment | phenotype |
| endocannabinoids | drug |
| ever smoking | phenotype |
| exercise-related shortness of breath local | phenotype |
| externalizing disorders | phenotype |
| FAAH | gene |
| general externalizing psychopathology local | phenotype |
| General problem behavior local | phenotype |
| genetic factors | cohort |
| genetic vulnerability | phenotype |
| Giggling local | phenotype |
| health-care utilization local | phenotype |
| Health-care utilization local | phenotype |
| Hemodynamic consequences local | phenotype |
| HIV infection | phenotype |
| impulsivity | phenotype |
| increased appetite | phenotype |
| individuals who use both cannabis and tobacco local | cohort |
| Inhalation patterns local | phenotype |
| irritability | phenotype |
| Joint local | drug |
| Joint smokers local | cohort |
| Kendler et al. study | cohort |
| Lifetime co-occurring use of cannabis and tobacco local | phenotype |
| lipids | drug |
| Lower probability of making a tobacco quit attempt local | phenotype |
| lung cancer | phenotype |
| Lung capacity local | phenotype |
| malaria | phenotype |
| marijuana | phenotype |
| methamphetamine | drug |
| mood disorders | phenotype |
| morning sputum local | phenotype |
| National Household Survey on Drug Use and Health 2009 local | cohort |
| nausea | phenotype |
| nervousness | phenotype |
| nicotine | drug |
| nicotine dependence | phenotype |
| Nicotine replacement medications local | drug |
| nicotine replacement therapy | drug |
| nicotine use | phenotype |
| nicotine withdrawal | phenotype |
| nocturnal wakening with chest tightness local | phenotype |
| non-smoked forms of tobacco local | drug |
| Non-tobacco smokers local | phenotype |
| novelty seeking | phenotype |
| NSDUH | cohort |
| onset of cannabis use | phenotype |
| opioid dependence | phenotype |
| other drug use | phenotype |
| Past month cannabis use local | phenotype |
| peer affiliations local | phenotype |
| Persistent smokers local | phenotype |
| Persistent tobacco use local | phenotype |
| phlegm production local | phenotype |
| Pipe use local | phenotype |
| Pleasurable rush local | phenotype |
| polycyclic aromatic hydrocarbons local | drug |
| Poorer tobacco cessation outcomes local | phenotype |
| positive reinforcement | phenotype |
| preference for smoked substances local | phenotype |
| psychoactive substances | drug |
| psychomotor agitation | phenotype |
| psychosocial problems | phenotype |
| Puff volume local | phenotype |
| Quit tobacco use local | phenotype |
| reduced lung functioning local | phenotype |
| regular tobacco smoking local | phenotype |
| relapse | phenotype |
| Relapse to cannabis local | phenotype |
| relationships | phenotype |
| respiratory complications local | phenotype |
| respiratory distress local | phenotype |
| respiratory function impairment local | phenotype |
| respiratory health local | phenotype |
| Respiratory health local | phenotype |
| respiratory symptoms local | phenotype |
| restlessness | phenotype |
| rs16969968 | variant |
| Salicylates local | drug |
| school | phenotype |
| school performance | phenotype |
| self-reported availability local | phenotype |
| Shakes/tremors local | phenotype |
| Sleep difficulties local | phenotype |
| smoked forms of tobacco local | drug |
| smoking | phenotype |
| smoking behavior | phenotype |
| smoking cessation | phenotype |
| smoking (inhalation) local | drug |
| smoking initiation | phenotype |
| Smoking topography local | phenotype |
| Stomach pain local | phenotype |
| Subjective liking local | phenotype |
| Subjective reactions local | phenotype |
| subjective reactions to cannabis local | phenotype |
| subjective reactions to tobacco local | phenotype |
| substance use | phenotype |
| sustained cannabis use local | phenotype |
| sustained drug involvement local | phenotype |
| Sustained tobacco abstinence local | phenotype |
| tar local | drug |
| teens | cohort |
| Tetrahydrocannabinol | drug |
| Tobacco dependence symptoms local | phenotype |
| tobacco initiation | phenotype |
| tobacco involvement local | phenotype |
| tobacco misuse local | phenotype |
| tobacco progression local | phenotype |
| tobacco smokers local | cohort |
| Tobacco smokers local | cohort |
| tobacco smokers smoking 1-10 cigarettes/day local | cohort |
| tobacco use | phenotype |
| Tobacco withdrawal local | phenotype |
| Treatment-seeking alcohol-dependent patients local | cohort |
| Treatment-seeking opioid-dependent patients local | cohort |
| tuberculosis | phenotype |
| Twin cohort | cohort |
| United States | cohort |
| U.S. National Longitudinal Survey of Youth local | cohort |
| U.S. population aged 12 and older local | cohort |
| U.S. representative sample local | cohort |
| U.S. twins local | cohort |
| varenicline | drug |
| weight loss | phenotype |
| wheezing local | phenotype |
| withdrawal | phenotype |
| withdrawal features local | phenotype |
| withdrawal severity | phenotype |
| women | cohort |
| young adult cannabis dependent subjects local | cohort |
| Young et al. study local | cohort |
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