The relationship between cannabis use disorder in adolescents and metacognitions, cognitive flexibility, emotional dysregulation, and depressive–anxiety symptoms

Introduction and Aim: Cannabis is among the most commonly used substances by adolescents and is the most frequently associated illicit drug with misuse and dependence among young individuals. The development and maintenance of Cannabis Use Disorder (CUD) involve various individual, environmental, psychological, and genetic factors. One potential factor is metacognitive beliefs, which have been found to be associated with various addictive behaviors. However, studies examining the relationship between CUD and metacognitive beliefs are limited in the literature. The present study aimed to compare levels of depression, anxiety, stress, metacognitive beliefs, cognitive flexibility, and emotional dysregulation between adolescents diagnosed with CUD and a control group. Another aim of this study was to investigate the relationship between the severity of cannabis dependence and these parameters in adolescents with CUD. Method: The study included 69 patients aged 12–18 years diagnosed with CUD and 83 age- and sex-matched healthy controls. Participants were assessed using the Sociodemographic Data Form, Addiction Profile Index (BAPI), Metacognitions Questionnaire–Child and Adolescent Form (MCQ-CA), Cognitive Flexibility Scale (CFS), Depression Anxiety Stress Scale–21 (DASS-21), and Difficulties in Emotion Regulation Scale–Short Form (DERS-16). Results: Adolescents with CUD had significantly higher total MCQ-CA scores (p = 0.033), as well as higher levels in the MCQ-CA subdimension of superstition, punishment, and responsibility beliefs (p = 0.001) and DASS-21 scores (p <0.001) compared to the control group. Cognitive flexibility levels were significantly higher in the control group than in the CUD group (p = 0.004). In the CUD group, higher levels of negative metacognitive beliefs (p = 0.014) and higher DASS-21 scores (p = 0.007) were positively correlated with the severity of cannabis use (p <0.001, F = 7.512, R² = 0.365). Conclusion: Our findings highlight the importance of metacognitive beliefs in adolescents with CUD. The higher total scores on the metacognition scale and the subdimension of superstition, punishment, and responsibility beliefs among adolescents with CUD compared to controls suggest that metacognition may be associated with cannabis use. Negative metacognitive beliefs and depression, anxiety, and stress factors were shown to predict the severity of cannabis use. These results emphasize the importance of addressing metacognitive beliefs and comorbid emotional symptoms during treatment for adolescents with CUD. Interventions should therefore focus not only on reducing substance use but also on these associated psychological factors.