Chauchard E, Septfons A, Chabrol H
Laboratoire Octogone-CERPP, pavillon de la recherche, université Toulouse II Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France.
Encephale. 2013 Dec;39(6):385-92. doi: 10.1016/j.encep.2013.03.008. Epub 2013 Aug 5.
While cannabis has been recognized as the most illicit drug use in the world, few studies focusing on cannabis self-change and cannabis relapse or abstinence in adult non-treatment samples have been conducted. The first aim of this study was to understand cannabis self-change motives, coping and adaptation strategies and evaluating perceived benefits from cannabis cessation. The second aim was to compare, in a convenience sample of non-treatment-seeking adult cannabis smokers, motivations to quit smoking cannabis, coping and adaptive strategies, as well as perceived benefit from cessation between cannabis abstinent and participants who relapse.
Sixty-three participants (31 men and 32 women) who attempted to quit cannabis in a non-controlled environment without medical help and were enrolled. They completed the Marijuana Quit Questionnaire (MJQQ), a self-report questionnaire collecting information in three areas: sociodemographic characteristics, cannabis use history (including any associated problems), and participants' characteristics regarding their "most difficult" (self-defined) attempt to quit in a non-controlled environment. For this study the index quit attempt was characterized in two areas: reasons for quitting marijuana, coping strategies used while quitting. Two additional questionnaires were added to the MJQQ; the Brief Cope, and a questionnaire assessing perceived benefit of the cannabis quit attempt. The participants were on average 28.5 years old (±5.1), and started using cannabis on average at 15.8 years (±2.8). Seventy-four percent (n=45) of the participants met the DSM-IV criteria for cannabis dependence before cannabis cessation. T-tests were used to compare abstainers and participants who relapsed after the quit attempt.
Realizing that cannabis induces disabling cognitive disorders such as affection of memory, concentration and attention were reported by 71% of the participant as a motivation for quitting cannabis use. Then, being more energetic (reported by 68%) and more active during the day (62%), being able to control their life (67%), proving themselves they could quit (60%), saving money (60%), as well being less worried about their health (57%) were also reported as motivations to quit cannabis use. Different coping and adaptation strategies were also reported. First, environmental strategies such as disposing of both cannabis (71%) and equipment to smoke (71%), no longer going to places where cannabis is smoked (33%) or lifestyle changes (68%) were used to cope with cannabis cessation. Then cognitive strategies such as motivation, willingness (71%), self-control and having a positive perception of the situation (68%) were also reported. Regarding coping strategies, participants accepted and learned how to live with the new situation (68%), and social support from family (32%) and friends (30%) were reported. Perceived benefits were linked with motivations for cannabis cessation. Thus, participants reported having more energy (75%), being more active (73%), less tired (70%) and recovering memory (57%) after cannabis cessation. Fifty-two percent of participants relapsed after the quit attempt. Abstainers had significantly higher scores on two subscales: the "negative impact of cannabis use on one's health and on self and social image" (t(61)=-3.84; P<0.001; d=-0.76) and "negative reinforcement (e.g. seeking relief for specific physical symptoms or social problems caused by cannabis)" (t(61)=3.56; P=0.01; d=-0.51) than non-anstainers. Non-abstainers reported significantly less social support from family (t(61)=-3.85; P<0.001, d=-0.76) and friends (t(61)=-2.22; P=00.03, d=-0.51) than abstainers.
This study underlines different aspects of cannabis cessation, self-change, relapse, and abstinence. Social and family support, as well as social network appears to be of prime importance in relapses and prevention programs for cannabis use. New perspectives for research on cannabis cessation self-change and relapses are thus highlighted, notably regarding factors that could predict relapse or success in cessation of smoking cannabis. Research on cannabis self-change and relapse are warranted for both prevention and therapeutic programs.
虽然大麻已被公认为全球最常见的非法药物，但针对成年非治疗样本中自我改变、复吸或戒断大麻的研究却很少。本研究的首要目的是了解大麻自我改变的动机、应对和适应策略，并评估大麻戒断的感知益处。第二个目的是在一个寻求非治疗的成年大麻吸烟者的便利样本中，比较戒烟动机、应对和适应策略，以及大麻戒断者和复吸者之间戒断的感知益处。
招募了63名参与者（31名男性和32名女性），他们在无医疗帮助的非受控环境中尝试戒断大麻。他们完成了大麻戒烟问卷（MJQQ），这是一份自我报告问卷，收集三个方面的信息：社会人口学特征、大麻使用史（包括任何相关问题），以及参与者在非受控环境中“最困难”（自行定义）的戒烟尝试的特征。对于本研究，索引戒烟尝试在两个方面进行了特征描述：戒烟原因、戒烟时使用的应对策略。在MJQQ基础上增加了另外两份问卷；简易应对量表，以及一份评估大麻戒烟尝试感知益处的问卷。参与者平均年龄为28.5岁（±5.1），平均15.8岁（±2.8）开始使用大麻。74%（n = 45）的参与者在大麻戒断前符合DSM-IV大麻依赖标准。采用t检验比较戒断者和戒烟尝试后复吸的参与者。
71%的参与者报告称，意识到大麻会引发诸如记忆、注意力和专注力等认知障碍，是促使他们戒烟的动机。此外，68%的人表示精力更充沛，62%的人表示白天更活跃，67%的人表示能够掌控自己的生活，60%的人表示想证明自己能戒掉，60%的人表示能省钱，57%的人表示对健康的担忧减少，这些也都被报告为戒烟的动机。还报告了不同的应对和适应策略。首先，采用了环境策略，如处理大麻（71%）和吸烟器具（71%）、不再前往吸食大麻的场所（33%）或改变生活方式（68%）来应对大麻戒断。然后，也报告了认知策略，如动机、意愿（71%）、自我控制和对情况的积极认知（68%）。关于应对策略，参与者接受并学会了如何适应新情况（68%），还报告了来自家人（32%）和朋友（30%）的社会支持。感知益处与大麻戒断动机相关。因此，参与者报告称，戒断大麻后精力更充沛（75%）、更活跃（73%）、更不累（70%）且记忆力恢复（57%）。52%的参与者在戒烟尝试后复吸。在两个子量表上，戒断者的得分显著更高：“大麻使用对个人健康、自我和社会形象的负面影响”（t(61)= -3.84；P < 0.001；d = -0.76）和“负强化（例如，为大麻引起的特定身体症状或社会问题寻求缓解）”（t(61)= 3.56；P = 0.01；d = -0.51）。非戒断者报告称，来自家人（t(61)= -3.85；P < 0.001，d = -0.76）和朋友（t(61)= -2.22；P = 0.03，d = -0.51）的社会支持显著少于戒断者。
本研究强调了大麻戒断、自我改变、复吸和戒断的不同方面。社会和家庭支持以及社会网络在大麻使用的预防和复吸项目中似乎至关重要。因此，突出了大麻戒断自我改变和复吸研究的新视角，特别是关于可预测大麻戒断复吸或成功的因素。大麻自我改变和复吸的研究对于预防和治疗项目都很有必要。
