Addictive Behaviors 93 (2019) 166–172
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Marijuana use motives mediate the association between experiences of childhood abuse and marijuana use outcomes among emerging adults
Lidia Z. Mesheshaa, , Ana M. Abrantesa,b, Bradley J. Andersonb, Claire E. Blevinsa,b, Celeste M. Cavinessa,b, Michael D. Steina,b,c a
Warren Alpert School of Medicine of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA Butler Hospital, General Medicine Research, 345 Blackstone Boulevard., Providence, RI 02906, USA c Boston University School of Public Health, Health, Law, Policy, & Management, Boston, MA, USA b
H I GH L IG H T S
abuse is a risk factor for problematic substance use in later years. • Childhood motives increase risk for use and problems for those with a history of abuse. • Coping • Motives may be an important intervention target for young adult marijuana users.
A B S T R A C T
Introduction: Experiences of childhood sexual abuse (CSA) and childhood physical abuse (CPA) are associated with poor mental health outcomes including substance use in subsequent years. Marijuana use motives (i.e., coping with negative aﬀect, enhancing positive aﬀect, or improving social interactions) may inﬂuence problematic substance use among young adults. Speciﬁcally, motives may be associated with severity of marijuana use outcomes among individuals who have experienced CSA or CPA. This study investigated the indirect eﬀect of marijuana use motives between experiences of CSA or CPA and marijuana use and problems among emerging adults. Method: Participants were 397 young adults (50.1% male, 66.2% White) between ages 18–25 years, who reported 15.85 (SD = 11.66) days of marijuana use in the past month. Participants reported on history of childhood abuse, marijuana use days, problems, and motives for use. Results: Findings suggest a signiﬁcant indirect eﬀect of coping motives in the association between CPA and marijuana use days and marijuana problems. Further, both coping motives and marijuana use days indicated a signiﬁcant indirect eﬀect between CPA and problems. Motives of socializing or enhancement did not have a signiﬁcant indirect eﬀect between CPA and marijuana use or problems. There were no signiﬁcant ﬁndings with CSA and marijuana use outcomes. Discussion: Coping motives might be an important potential target for future marijuana interventions in persons with childhood physical abuse.
1. Introduction Approximately 11% of the population reports having experienced childhood sexual abuse (CSA) and 16–22% endorse childhood physical abuse (CPA; Gilbert et al., 2010; Felitti, Anda, Nordenberg, et al., 1998). CSA and CPA impact mental health in subsequent years where these experiences can activate, maintain, and increase the recurrence of psychiatric disorders, including substance use disorders (Carr, Martins, Stingel, Lemgruber, & Juruena, 2013). CSA and CPA have consistently been associated with higher frequency of alcohol and drug use, related problems, and greater risk for developing a substance use disorder in later years (Aﬁﬁ, Henriksen, Asmundson, & Sareen, 2012; Khoury, Tang, Bradley, Cubells, & Ressler, 2010). Although both CSA and CPA are linked with increased risk for substance use, there are some mixed ⁎
results regarding marijuana use outcomes, where some studies found associations with CSA (Duncan et al., 2008) and others with CPA (Lo & Cheng, 2007). Experiences of CSA and CPA do not always result in the development of post-traumatic stress disorder, nevertheless, they are often associated with low mood, heightened anxiety, blunted aﬀect, poor social skills, and low satisfaction with interpersonal relationships (Fergusson, Boden, & Horwood, 2008; Valle & Silovsky, 2002). Researchers have proposed that childhood abuse may lead to increased substance use and related problems by way of using substances to cope with negative aﬀect related to the abuse (Delker & Freyd, 2014). Indeed, investigations suggest that poor emotion regulation mediate the association between childhood abuse and substance use outcomes (Barahmand, Khazaee, & Hashjin, 2016; Vilhena-Churchill & Goldstein, 2014).
Corresponding author. E-mail address: [email protected]
https://doi.org/10.1016/j.addbeh.2019.01.040 Received 23 August 2018; Received in revised form 21 December 2018; Accepted 27 January 2019 Available online 28 January 2019 0306-4603/ © 2019 Elsevier Ltd. All rights reserved.
Addictive Behaviors 93 (2019) 166–172
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Marijuana Use Days
Childhood Physical Abuse Marijuana Use Motives
Childhood Sexual Abuse
Fig. 1. Conceptual model of the eﬀects of childhood abuse on marijuana use motives, marijuana use days and marijuana problems.
with childhood abuse, and that coping motives mediated the path between childhood abuse and marijuana problems among a sample of young adult marijuana users. To date, only Vilhena-Churchill and Goldstein (2014) have investigated this association between childhood abuse, motives, and marijuana outcomes among young adults. The current study aimed to replicate and extend the ﬁndings of Vilhena-Churchill and Goldstein's (2014) ﬁndings in examining the role of marijuana motives in the relation between a history of CSA and CPA and marijuana problems among a heavy marijuana-using sample of young adults. Vilhena-Churchill & Goldstein's sample consisted of past year marijuana users, whereas our sample recruited based on current marijuana use status. We hypothesized that marijuana motives (using to cope with negative aﬀect, enhance positive emotions, and social facilitation) would mediate the association between childhood abuse (CSA and CPA) and marijuana use frequency and related problems. See Fig. 1 for a conceptual model.
Speciﬁcally, individuals with a history of abuse may be using substances to avoid or redirect attention away from overwhelming emotions (Briere, Hodges, & Godbout, 2010), reduce tension (Greeley & Oei, 1999), or self-medicate (Khantzian, 1997). Studies have found that using a substance to cope with negative aﬀect is associated with high rates of substance-related problems (Merrill, Wardell, & Read, 2014; Moitra, Christopher, Anderson, & Stein, 2015). One study found that coping motives were associated with marijuana-related problems, although they did not ﬁnd the same association for enhancement and social motives among young adults (Moitra et al., 2015). While others have noted that young adults reporting greater number of DSM-IV criteria for cannabis dependence were more likely to endorse coping, enhancement, and social motives compared to individuals with fewer DSM-IV items (Bonn-Miller & Zvolensky, 2009). Further, motives for use have been suggested as a potential mechanism for more problematic outcomes for those with a history of childhood abuse. For example, drinking to cope with negative emotions as well as drinking to enhance positive emotions mediated the relation between CSA and alcohol problems in adult women (Grayson & Nolen-Hoeksema, 2005). Similarly, among young adult drinkers, a study found that enhancement motive mediated the path between childhood abuse and alcohol-problems for men and coping motive for women (Goldstein, Flett, & Wekerle, 2010). Prior studies suggest that social motives for both alcohol and marijuana use are associated with greater frequency of use (Kuntsche, Knibbe, Gmel, & Engels, 2005). Rogosch, Oshri, and Cicchetti (2010), using a developmental cascade model, found that childhood maltreatment is related to poor social competence and increased cannabis use in adolescence. As such, there is a possibility that individuals with a history of childhood abuse and resultant under-developed social competence may be motivated to use cannabis for social facilitation. However, prior research has not fully investigated the role of social motives in the pathway between childhood abuse and cannabis use and problems. There is a need to investigate marijuana use outcomes particularly among young adults. Marijuana is the most commonly used psychoactive drug among young adults with 34% reporting past year and 20% reporting past month use, and marijuana's use peaks during young adulthood (Center for Behavioral Health Statistics and Quality, 2014; Johnston, O'Malley, Bachman, Schulenberg, & Miech, 2016). Marijuana is associated with a host of negative outcomes in young adults including poor mental health, lower life satisfaction, cognitive impairments, increased risk for motor vehicle accidents, and cannabis use disorder (Volkow, Baler, Compton, & Weiss, 2014). A recent study suggested that despite similar rates of marijuana use, young adults reported heterogeneous experiences of marijuana-related problems (Pearson et al., 2017). The authors noted that while 10% reported no marijuana problems, another 10% reported 19 or more problems related to their use. This wide range of marijuana problems suggests the need to better understand factors contributing to the discrepant experiences of marijuana-related problems. As noted above, motives for use may be indicative of problematic marijuana outcomes. Vilhena-Churchill and Goldstein (2014) found that coping and conformity motives correlate
2. Method Study participants were young adults recruited between January 2012 and March 2015 for a “health behaviors study.” Participants were recruited via Southern New England Craigslist and Facebook advertising, and through advertisements placed in local college newspapers, on public transportation, and on commercial radio. Interested individuals contacted the study by phone or email and were given a 10min anonymous phone screen. The screen included demographic, substance use, sexual activity, mental health, and general health questions. Eligible individuals were invited for an in-person interview at the research site and oﬀered compensation ($40) and free Sexually Transmitted Infection testing (Blevins et al., 2018; Tzilos, Reddy, Caviness, Anderson, & Stein, 2014). Eligibility criteria for the parent study included being 18–25 years old, current alcohol or marijuana use, being heterosexually active in the last six months, not having suicidal ideation in the past two weeks, and living within 30 min of the research site (see Stein et al., 2018 for details on larger trial). Of the 2645 individuals screened by phone, 1217 were ineligible. The most common reasons for ineligibility were not being heterosexually active (235), having suicidal ideation (234), outside the age range (148), and living at a distance (53). The remaining 1428 eligible persons were invited for an interview and 834 were either not interested (n = 130 actively refused; n = 202 passively refused, i.e. indicating initial interest with no follow through; or were already participating in a research study), or did not keep a scheduled appointment (n = 502). Five hundred ninety-four persons provided written informed consent (the study was approved by the Institutional Review Board of a research hospital in Southern New England) after which 23 persons were found to be ineligible and 13 withdrew their participation. The ﬁnal sample in the parent study was 558, and the current analysis included those 397 who had used marijuana in the past month.
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Table 1 Background characteristics by childhood sexual abuse and by childhood physical abuse. Sample
Age Sex Female Male Race Minority White Latino/a Not Latino/a Latino/a MJ use daysc Coping motive Enhancement motive Social motive MJ problem severity
Childhood sexual abuse
Childhood physical abuse a
(N = 397)
No (n = 345)
Yes (n = 52)
No (n = 305)
Yes (n = 91)
21.11 ( ± 2.09)
21.21 ( ± 2.07)
20.48 ( ± 2.08)
21.13 ( ± 2.07)
21.10 ( ± 2.14)
198 (49.9%) 199 (50.1%)
152 (76.7%)b 193 (97.0%)b
46 (23.2%)b 6 (3.0%)b
144 (72.7%)b 161 (81.3%)b
54 (21.3%)b 37 (18.7%)b
134 (33.8%) 263 (66.2%)
111 (82.8%)b 234 (89.0%)b
23 (17.2%)b 29 (11.0%)b
93 (69.4%)b 212 (80.9%)b
41 (30.6%)b 50 (19.1%)b
344 (86.6%) 53 (13.4%) 15.85 ( ± 11.66) 2.24 ( ± 0.75) 2.98 ( ± 0.73) 2.40 ( ± 0.72) 5.08 ( ± 4.70)
301 (87.5%)b 44 (83.0%)b 15.77 ( ± 11.73) 2.21 ( ± 0.75) 2.98 ( ± 0.73) 2.39 ( ± 0.72) 5.08 ( ± 4.73)
43 (12.5%)b 9 (17.0%)b 16.39 ( ± 11.25) 2.43 ( ± 0.78) 2.93 ( ± 0.71) 2.47 ( ± 0.74) 5.10 ( ± 4.57)
0.368 0.720 0.053 0.777 0.409 0.980
270 (78.7%)b 35 (66.0%)b 15.19 ( ± 11.69) 2.17 ( ± 0.75) 2.94 ( ± 0.72) 2.36 ( ± 0.70) 4.92 ( ± 4.73)
73 (21.3%)b 18 (34.0%)b 17.90 ( ± 11.34) 2.46 ( ± 0.73) 3.10 ( ± 0.75) 2.51 ( ± 0.77) 5.58 ( ± 4.62)
0.052 0.001 0.080 0.087 0.242
a P-values testing the signiﬁcance of between group diﬀerences were based on the Pearson χ2-test of independence for diﬀerences in counts and the t-test for diﬀerences in means. b Percentages were calculated based on the row marginal to facilitate comparisons by sex, race, and ethnicity. c Marijuana use days in the past 30-days.
enhancement motives were 0.832, 0.766, and 0.836, respectively.
2.1.1. Demographics Participants were asked to provide demographic information, including age, gender, and race/ethnicity. Race and ethnicity were assessed using two separate questions, the ﬁrst querying ethnicity (Latino/Hispanic yes/no), and the second racial background.
2.3. Analytical methods We present descriptive statistics to summarize the characteristics of the sample and use t-tests and Pearson χ2-tests to compare persons CPA and CSA on background characteristics, motives for marijuana use, marijuana use days, and marijuana problems. We used Mplus 7 (Muthén & Muthén, 1998–2015) to estimate a 5equation model and test the speciﬁc indirect eﬀects representing the mediation hypotheses. Age, sex, race, and ethnicity were included as exogenous control variables in the equations estimating the direct effects of CPA and CSA on coping, social, and enhancement motives; error terms for the 3 equations predicting marijuana use motives were allowed to freely co-vary. The equations for marijuana use days included CPA, CSA, coping motives, enhancement motives, social motives, and age, sex, race, and ethnicity as control variables. The equation for marijuana problems included the above variables plus marijuana use days. Following suggested guidelines (Fritz & MacKinnon, 2007; MacKinnon, Lockwood, & Williams, 2004; Williams & MacKinnon, 2008), we estimated 95% and 99% conﬁdence interval estimates by bias-corrected bootstrap with 10,000 replications to test the signiﬁcance of the indirect eﬀects. Coeﬃcients were considered statistically signiﬁcant at the 0.05 (0.01) levels if the 95% (99%) conﬁdence interval estimate excluded 0. Exact p-values are not available using this method. We present the structural (unstandardized) coeﬃcients, the 95% conﬁdence interval estimate, the fully standardized coeﬃcient for continuous covariates, and the y-standardized coeﬃcient for categorical covariates. We do not present 99% conﬁdence interval estimates herein, but do identify coeﬃcients signiﬁcant at the 0.01 level. In addition to the structural coeﬃcients for the 5-equation model, we present the total and speciﬁc indirect eﬀects of CSA and CPA on marijuana use days (mediators are marijuana motives) and marijuana problems (mediators are marijuana motives and marijuana use days).
2.1.2. Childhood abuse Experiences of CPA and CSA were assessed using three items from the Trauma History Questionnaire (Green, 1996). Participants were asked to respond (yes/no) to questions inquiring about experiences of sexual (e.g., has anyone ever made you have intercourse, oral or anal sex against your will?) or physical abuse (e.g., Has anyone in your family ever beaten, “spanked” or pushed you hard enough to cause physical injury?) prior to age 17. 2.2. Marijuana use frequency, problems, and motives 2.2.1. Frequency Participants were asked to recall the 90 days prior to the interview using the Timeline Follow-Back (TLFB) method (Sobell & Sobell, 1996) and report days during which they used marijuana. Analyses were based on the most recent 30-days of marijuana use days. 2.2.2. Problems The Marijuana Problems Scale (MPS; Stephens, Roﬀman, & Curtin, 2000) was used to assess negative consequences experienced as a result of marijuana use (in this sample, Cronbach's α = 0.837). Participants rated 19 marijuana-related problems over the past 90 days as either 0 (no problem), 1 (minor problem), or 2 (serious problem). 2.2.3. Motives Motives for marijuana use were assessed with the ThreeDimensional Measure of Drinking Motives (Cooper, Russell, Skinner, & Windle, 1992) adapted for marijuana use. Participants rated 15-items assessing reasons for marijuana use in the past 6 months on a 4-point Likert scale (1 = Never/Almost Never to 4 = Almost Always). The measure assessed 3 types of motives: Coping (e.g., “To forget your worries”), Social (e.g., “Because it's what most of your friends did when got together”), and Enhancement (e.g., “Because it's fun”). Internalconsistency reliabilities in this sample for coping, social, and
3. Results Participants averaged 21.11 ( ± 2.09) years of age and 49.9% were female, (see demographic characteristics in Table 1). The mean 30-day rate of marijuana use was 15.85 ( ± 11.66). The MPS has a possible range of 0–38. In this sample the observed range was 0–28 (Mean = 5.08, SD = 4.70, median = 4.00). 168
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There were gender diﬀerences in both CSA (χ2 = 35.64, p < .001) and CPA (χ2 = 4.12, p < .042), race diﬀerence in CPA (χ2 = 6.64, p < .010), and ethnicity diﬀerences in CPA (χ2 = 4.16, p < .041). Racial minorities reported higher rates of CPA compared to whites (36.6% vs 19.1%) and persons of Latino/a ethnicity reported higher CPA compared to non-Latino/a (34.0% vs 21.3%). Of the total sample, 279 (70.5%) did not experience any abuse, 26 (6.6%) reported CSA but not CPA, 65 (16.4%) reported CPA but not CSA, and 26 (6.6%) reported experiencing both CPA and CSA. Individuals with a history of CPA had signiﬁcantly higher (t = −3.26, p = .001) mean scores on coping motives compared to those without CPA. Marijuana use days, enhancement motives, social motives, and marijuana problems did not diﬀer signiﬁcantly by experiences of CPA or CSA. Marijuana Problems was positively and signiﬁcantly correlated with marijuana use days (r = 0.29, p < .01), coping motive (r = 0.47, p < .01), enhancement motive (r = 0.28, p < .01), and social motive (r = 0.34, p < .01). Males used marijuana signiﬁcantly more frequently than females (r = 0.25, p < .01). Marijuana use days was positively and signiﬁcantly correlated with coping motive (r = 0.46, p < .01), enhancement motive (0.28, p < .01), and social motive (r = 0.28, p < .01). Neither CSA nor CPA were correlated signiﬁcantly with days of use or problems. Persons reporting CPA were signiﬁcantly more likely to report coping motive (r = 0.16, p < .01). CPA was not associated signiﬁcantly with enhancement or social motives. CSA was not associated with any motive. Results for the 5-equation SEM are presented in Table 2. Adjusting for age, sex, race, and ethnicity, the direct eﬀect of CPA on coping motive was statistically signiﬁcant (b = 0.267, 95%CI 0.095; 0.439, p < .01) (Eq. 1). None of the exogenous variables were associated signiﬁcantly with enhancement motive (Eq. 2). Adjusting for demographic characteristics, neither CPA nor CSA were associated signiﬁcantly with social motive (Eq. 3). Males had signiﬁcantly higher adjusted mean scores on social motives compared to females (b = 0.200, 95%CI 0.054; 0.347, p < .01). White individuals had signiﬁcantly lower adjusted mean scores on social motives than persons identifying other racial origins (b = −0.241, 95%CI -0.417; −0.064, p < .01). Neither CPA nor CSA had signiﬁcant direct eﬀects on marijuana use days (Table 2, Eq. 4). Males had higher frequency of use than females (b = 5.486, 95%CI 3.392; 7.580, p < .01) and coping motive had a signiﬁcant direct eﬀect on marijuana days (b = 6.286, 95%CI 4.720; 7.852, p < .01); the standardized eﬀect of coping on marijuana use days was 0.408. Coping (b = 2.390, 95%CI 1.496; 3.284, p < .01) and social motives (b = 0.946, 95%CI 0.222; 1.670, p < .05) both had signiﬁcant direct eﬀects on marijuana problems (Eq. 5). Again, neither CPA nor CSA had signiﬁcant direct eﬀects on problems after adjusting for other variables in the model. These data do not indicate that marijuana motives mediate the effect of CSA on either marijuana use days or marijuana problems (Table 3). None of the speciﬁc indirect eﬀects of CSA was statistically signiﬁcant. The speciﬁc indirect eﬀect of CPA on marijuana use days, as mediated by coping, was signiﬁcant (b = 1.681, 95%CI 0.536; 2.827, p < .01). The speciﬁc indirect eﬀects of CPA on marijuana use days via enhancement or social motives, were not signiﬁcant. The speciﬁc indirect eﬀect of CPA on marijuana problems, as mediated by coping, was signiﬁcant (b = 0.639, 95%CI 0.147; 1.132, p < .05). Speciﬁc indirect eﬀects of CSA of marijuana problems via days of use, enhancement, or social motives, were not signiﬁcant statistically.
Table 2 Parameter estimates for a structural equation model estimating the direct and indirect eﬀects of childhood abuse on marijuana use days and marijuana problems (N = 397). Equation
95% CIa LCL
0.022 0.140 −0.059 0.059 0.201 0.267⁎⁎
−0.014 −0.014 −0.230 −0.184 −0.033 0.095
0.058 0.293 0.111 0.302 0.435 0.439
0.060 0.185 −0.079 0.078 0.267 0.354
2. Enhancement motive Age −0.004 Sex (male) 0.160 Race (White) −0.062 Latino/a (yes) −0.051 CSA (yes) −0.025 CPA (yes) 0.181
−0.043 −0.003 −0.236 −0.293 −0.263 −0.004
0.034 0.324 0.111 0.191 0.214 0.366
−0.012 0.220 −0.085 −0.070 −0.034 0.249
3. Social motive Age Sex (male) Race (White) Latino/a (yes) CSA (yes) CPA (yes)
−0.015 0.200⁎⁎ −0.241⁎⁎ −0.131 0.108 0.136
−0.052 0.054 −0.417 −0.377 −0.124 −0.041
0.022 0.347 −0.064 0.114 0.340 0.313
−0.043 0.278 −0.334 −0.183 0.150 0.189
4. MJ use days Age Sex (male) Race (White) Latino/a (yes) CSA (yes) CPA (yes) Coping Enhancement Social
−0.046 5.486⁎⁎ 0.696 −0.530 1.408 1.109 6.286⁎⁎ 0.580 0.749
−0.531 3.392 −1.717 −3.906 −1.764 −1.413 4.720 −0.979 −0.942
0.440 7.580 3.109 2.845 4.580 3.632 7.852 2.139 2.440
−0.008 0.472 0.060 −0.046 0.121 0.095 0.408 0.036 0.046
5. Marijuana problems Age −0.186 Sex (male) −0.152 Race (White) −0.258 Latino/a (yes) −0.380 CSA (yes) −0.776 CPA (yes) −0.156 Coping 2.390⁎⁎ Enhancement −0.101 Social 0.946⁎ MJ use days 0.030
−0.377 −1.054 −1.196 −1.585 −2.048 −1.189 1.496 −0.716 0.222 −0.019
0.004 0.750 0.679 0.826 0.495 0.877 3.284 0.514 1.670 0.078
−0.082 −0.032 −0.055 −0.081 −0.165 −0.033 0.384 −0.016 0.145 0.074
1. Coping motive Age Sex (male) Race (White) Latino/a (yes) CSA (yes) CPA (yes)
Note: CSA = Childhood Sexual Abuse; CPA = Childhood Physical Abuse. a Conﬁdence limits were estimated by bias-corrected bootstrap with 10,000 replications. Parameter estimates were considered signiﬁcant at the.05 level if the 95% conﬁdence interval excluded 0. Parameter estimates were considered signiﬁcant at the 0.01 level if the 99% conﬁdence interval (not presented) excluded 0. b Unstandardized coeﬃcients. c Coeﬃcients were fully standardized for continuous covariates and y-standardized for categorical covariates. ⁎ p < .05. ⁎⁎ p < .01.
These ﬁndings were largely consistent with the results of VilhenaChurchill and Goldstein (2014), who reported that coping motives, but not enhancement or social motives, mediate the relation between childhood abuse and marijuana problems. Further, our results did not suggest any signiﬁcant associations between CSA and marijuana use or problems. Our ﬁndings of a signiﬁcant indirect eﬀect between CPA and marijuana-related problems through coping motives are consistent with theoretical frameworks for the development of coping behaviors. For example, Leipold and Greve (2009) propose that the formation of
4. Discussion In a sample of young adult frequent marijuana users, coping motives mediated the association between CPA and both marijuana use days and problems. However, neither enhancement nor social motives mediated the association between CPA and marijuana use or problems. 169
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marijuana to cope with negative aﬀect. Future longitudinal models with multiple assessment periods are needed to test this hypothesized developmental path. Experiencing CSA was not associated with any marijuana use motives, use days, or problems. This ﬁnding was contrary to our hypothesis and inconsistent with previous studies that reported an association between CSA and avoidant coping (Gibson & Leitenberg, 2001), risk factor for the development of cannabis dependence (Duncan et al., 2008), and prevalence of mental health diﬃculties compared to CPA (Fergusson et al., 2008). However, our ﬁnding was consistent with Lo and Cheng (2007)’s ﬁnding that CPA was a stronger predictor of young adult substance abuse compared to CSA. Although the literature is mixed, there is more evidence in the extant literature suggesting a greater negative impact of CSA compared to CPA on substance use outcomes. The current study's CSA ﬁndings may be due to our measurement of childhood abuse, which was limited to three items, and did not assess frequency and severity of abuse, which can be indicative of greater risk of problematic substance use (Molnar, Buka, & Kessler, 2001). Further still, of our sample's 52 participants who endorsed CSA, 50% also experienced CPA, whereas of the 91 participants who endorsed CPA a smaller percentage, 28% also experienced CSA. This overlap may have attenuated the eﬀects of CSA as most of the participants were endorsing either CPA only or CPA plus CSA. Our overall pattern of results for marijuana use motives and problems are consistent with the literature suggesting that using marijuana to cope is associated with greater experiences of negative aﬀect and low conﬁdence in coping with these emotions (Cooper, Kuntsche, Levitt, Barber, & Wolf, 2016). In general, research suggests that prolonged maladaptive coping strategies such as substance use or avoidance in stressful situations can make individuals vulnerable to poor psychological outcomes (Skinner, Edge, Altman, & Sherwood, 2003). This could be due to a number of factors including a pattern of preference for immediate relief rather than making eﬀort to improve long term outcomes, or giving more focus and attention to avoiding negative experiences and less to seeking positive ones (Cooper et al., 2016). These factors may contribute to propagating negative consequences for individuals who use marijuana primarily to cope with negative aﬀect. We did not ﬁnd that enhancement motives had an indirect eﬀect between childhood abuse and marijuana use outcomes as hypothesized. Prior investigations provided mixed ﬁndings for enhancement motives. While some studies found enhancement motives were associated with problems (Labouvie & Bates, 2002), other studies did not (Moitra et al., 2015; Simons, Correia, & Carey, 2000). A review of young adult drinking suggests that coping motives and enhancement are diﬃcult to disentangle and often overlap, resulting in inconsistent ﬁnding across trials (Kuntsche et al., 2005). Future studies are needed to explicate the diﬀerences and overlaps in the motives measures and how they are related to childhood abuse and subsequent marijuana use outcomes. Our results did not indicate an indirect eﬀect of social motives, however, there was a signiﬁcant direct eﬀect on problem severity. This ﬁnding may be related to individuals experiencing distress or anxiety in social settings and using marijuana to mitigate that anxiety. Indeed, there is a high rate of co-occurring marijuana use and social anxiety (Buckner, Heimberg, Matthews, & Silgado, 2012). Further, a study reported that coping motives mediate the associate between social anxiety and marijuana problems (Buckner, Bonn-Miller, Zvolensky, & Schmidt, 2007). Collectively, these results may suggest a similar eﬀect to enhancement motives where social motives are overlapping with coping motives such that individuals who endorse social motives are primarily using to cope with distress related to socialization. Evaluating motives for using substances may have clinical utility. Speciﬁcally, interventions targeting coping motives for individuals who endorse them, compared to other motives, have demonstrated positive outcomes (Banes, Stephens, Blevins, Walker, & Roﬀman, 2014; LaBrie et al., 2008). An intervention that speciﬁcally targeted coping among young adults who drink to cope with depression found that change in
Table 3 Total eﬀects, direct eﬀects, speciﬁc indirect eﬀects, and total indirect eﬀects representing the mediation hypothesis. (N = 397). Equation
95% CIa LCL
CSA on MJ use days via Coping Enhancement Social Total indirect eﬀect Direct eﬀect Total eﬀect
1.166 −0.014 0.081 1.332 1.408 2.740
−0.264 −0.255 −0.244 −0.350 −1.764 −0.733
2.795 0.227 0.406 3.014 4.580 6.212
0.109 −0.001 0.007 0.114 0.121 0.236
CPA on MJ use days via Coping Enhancement Social Total indirect eﬀect Direct eﬀect Total eﬀect
1.681⁎⁎ 0.105 0.102 1.888⁎⁎ 1.109 2.998⁎
0.536 −0.231 −0.204 0.634 −1.413 0.368
2.827 0.441 0.408 3.142 3.632 5.367
0.145 0.009 0.009 0.162 0.095 0.258
CSA on MJ problems via MJ use days Coping Enhancement Social Coping → use days Enhancement → use days Social → use days Total indirect eﬀect Direct eﬀect Total eﬀect
0.042 0.481 0.003 0.102 0.038 0.000 0.002 0.667 −0.776 −0.109
−0.099 −0.118 −0.078 −0.148 −0.048 −0.010 −0.010 −0.076 −2.048 −1.483
0.183 1.080 0.083 0.352 0.123 0.009 0.015 1.411 0.495 1.264
0.009 0.102 0.001 0.022 0.008 0.000 0.001 0.142 −0.165 −0.023
CPA on MJ problems via MJ use days Coping Enhancement Social Coping → use days Enhancement → use days Social → use days Total indirect eﬀect Direct eﬀect Total eﬀect
0.033 0.639⁎ −0.018 0.129 0.050 0.003 0.003 0.839⁎⁎ −0.156 0.683
−0.082 0.147 −0.146 −0.079 −0.042 −0.010 −0.009 0.270 −1.189 −0.392
0.148 1.132 0.109 0.336 0.142 0.016 0.015 1.408 0.877 0.148
0.007 0.136 −0.004 0.027 0.011 0.001 0.001 0.178 −0.033 0.145
Conﬁdence limits were estimated by bias-corrected bootstrap with 10,000 replications. Parameter estimates were considered signiﬁcant at the.05 level if the 95% conﬁdence interval excluded 0. Parameter estimates were considered signiﬁcant at the 0.01 level if the 99% conﬁdence interval (not presented) excluded 0. b Unstandardized coeﬃcients. c Coeﬃcients were fully standardized for continuous covariates and y-standardized for categorical covariates. ⁎ p < .05. ⁎⁎ p < .01.
coping styles is inﬂuenced by social and environmental events throughout the developmental process and that these coping styles persist in later years. Adverse events in childhood have been linked with maladaptive coping strategies (Gibson & Leitenberg, 2001) and we hypothesized that marijuana users with a history of CPA would develop speciﬁc coping behaviors that would drive poor substance use outcomes. Although diﬃcult to certify with cross-sectional data, it is likely that participants with a history of CPA may have developed an avoidant style of coping to manage negative aﬀect related to their abuse (Street, Gibson, & Holohan, 2005). And, over time, this avoidant coping behavior may have generalized to manage other types of negative aﬀect. In turn, as the individual with CPA progresses into a developmental stage where marijuana use is normative, this use may evolve into an avoidant coping strategy when experiencing negative aﬀective states. It is also possible that the euphoric and tension reduction eﬀects of marijuana serve as a conduit to help individuals temporarily escape or avoid unpleasant emotions, consequently perpetuating the use of 170
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drinking to cope was a signiﬁcant mediator for reductions in drinking levels and alcohol-related consequences (Blevins, Banes, Stephens, Walker, & Roﬀman, 2016). Another study with marijuana dependent adults reported that after an intervention, change in coping motives was associated with reductions in marijuana use days, dependence symptoms, and problems (Banes et al., 2014). Several study limitations should be noted. This study's measure of childhood abuse was brief, limited to assessing physical and sexual abuse, and did not assess length and duration of abuse. Future studies might consider a more comprehensive and detailed measure of childhood abuse that include experiences of childhood neglect and verbal abuse. Our measure of marijuana use motives was somewhat limited and did not include assessment of conformity or expansion motives for marijuana use. Further investigation that include conformity and expansion are warranted as both motives are associated with childhood maltreatment (Barahmand et al., 2016; Vilhena-Churchill & Goldstein, 2014). We did not rule out other types of trauma experiences or assess post-traumatic stress symptoms. Re-traumatization is common among childhood abuse survivors and future studies would beneﬁt from evaluating the impact of multiple types of traumas and posttraumatic symptoms on marijuana motives and outcomes of marijuana use. The study did not consider the co-use of other substances, which may be used for coping, enhancement, or socialization. Further, the mediation results, due to the cross-sectional nature of the data, limits our understanding of the relation between childhood abuse, marijuana motives, and days of use, and consequences. Prospective studies with multiple assessments of use, problems, and considering changes in the relative activation of coping styles could be informative in assessing the association over time. Finally, past six-month heterosexual sexual activity was an inclusion criterion for the parent study. This might have potentially excluded some participants who otherwise would have been included in this study. However, we only assessed for sexual behavior, not orientation or identity (Lindley, Barnett, Brandt, Hardin, & Burcin, 2008) which increases generalizability. Despite these limitations, there are a number of strengths associated with this work such as use of a comprehensive statistical model to assess the associations between variables of interest and the recruitment of a large and diverse community sample of both college and non-college young adults who currently use marijuana. Assessment of young adults is important given the higher risk for marijuana use and related problems at this developmental period. Experience of childhood abuse is prevalent and a risk factor for problematic marijuana use outcomes in young adulthood and may lead to long-term patterns of substance use. Results from the current study suggest that marijuana motives may be a marker for increased risk and as well as an important potential intervention target.
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