Evaluation of the social cognitive abilities in adolescent heavy cannabis-users

Introduction: Cannabis is clearly the most popular illicit drug in North America, Europe and in other parts of the World. The specific behavioural effects of cannabis on emotion perception are at present unclear. Studies investigating effects of cannabis state for involvement of the endocannbinoid system in emotion processing. Cognitive impairments appear to increase with duration and frequency of cannabis use, suggesting persistent deficits as a result of long-term changes due to a neurotoxic effect of long-term cannabis exposure. Attention deficit/hyperactivity disorder (ADHD) in children and adolescents has been associated with attentional and executive problems, but also with socioemotional difficulties possibly associated with deficits in Theory of Mind (ToM). Socioemotional problems in ADHD are associated with more negative prognoses, notably interpersonal, educational problems, and an increased risk of developing other psychiatric disorders that emphasize the need to clarify the nature of their ToM deficits in connection with other comorbidities. Objectives: The aim of this study was to evaluate the social cognitive abilities and assess emotion-regulation skills of heavy cannabis-users diagnosed with CUD (cannabis use disorder) and CUD+ADHD and to compare the results to that of healthy non-using control cases. Method: Our study sample consisted of 30 cases diagnosed with CUD and 28 cases diagnosed with CUD+ADHD who were between the ages of 14-18 years and who applied to Ege University Faculty of Medicine Children and Adolescents Psychiatry Department Alcohol and Substance Use Disorder outpatient clinic, together with 30 healthy control cases who were matched with the patient groups for sociodemographic properties. First of all, K-SADS-PL was applied to all cases in order to determine comorbid diseases in accordance with DSM-5 criteria. Those who were determined to have accompanying psychiatric diseases such as psychotic disorders, mood disorders, anxiety disorders and specific learning disorder were not included in the study. Afterwards, sociodemographic data form was applied to all cases included in the study in order to query information related to age, sex, school and family. Cannabis and other substance use variables were assessed by using a standardized questionnaire. The severity of cannabis craving was measured with a visual analog scale. ADHD scale was used to assess ADHD and disruptive behavior disorders. In all cases, level of difficulty at emotion regulation was assessed with DERS. To evaluate social cognitive properties, Faces Test, Reading the Mind in the Eyes Test, The Unexpected Outcomes Test, Faux Pas, Hinting Test and Comprehension Test are applied to all cases. Results: All tests assessing social cognitive skills showed significant disturbance in cannabis-user groups compared to non-users. Total scores from DERS were significantly lower in non-users compared to cannabis-user groups. CUD+ADHD group compared to CUD group was not statistically significantly lower in the means of social cognition properties. Conclusion: In many researches it has been shown that heavy cannabis-use and ADHD may be associated with deficits in social cognition. Findings suggest that cannabis users may experience generalized problems in decoding basic emotions during social interactions. Our study demonstrates that cannabis dependence in adolescents is related with social cognition deficits and puts emphasis on the importance of substance use prevention as early as middle school.