Cannabis cue-reactivity in cannabis use disorder: Diverging evidence in two distinct cannabis cultures

Abstract

Background: Cannabis policies and attitudes play a role in the development and presentation of cannabis use disorder (CUD), but it is unclear how these factors are related to biomarkers of addiction. The current study examined cross-cultural differences in cannabis attitudes, cannabis cue-reactivity in the brain and its associations with cannabis use measures and cannabis attitudes. Design: Cross-sectional fMRI study. Setting: The Netherlands (NL) and Texas (TX), USA. Participants: 104 cannabis users with CUD (44% female; NL-CUD = 54, TX-CUD = 50) and 83 non-using controls (52% female; NL-CON = 50, TX-CON = 33). Measurements: Self-reported positive (perceived benefits) and negative (perceived harms) cannabis attitudes and tactile cannabis cue-reactivity assessed using a 3T MRI scanner. Findings: While the CUD group overall was more positive and less negative about cannabis and reported higher craving, the TX-CUD group reported significantly more positive and less negative attitudes and less craving than the NL-CUD group. Cannabis cue-reactivity was observed in the CUD group in clusters including the precuneus, lateral occipital cortex, frontal medial cortex, nucleus accumbens, and thalamus. In the TX-CUD group, a positive association was observed between symptom severity and cue-induced craving and cannabis cue-reactivity in precuneus and occipital cortex clusters, while a negative association was observed in the NL-CUD group. In these clusters, individuals with more positive attitudes exhibited a positive association between craving and cue-reactivity and those with less positive attitudes exhibited a negative association. No associations with quantity of use were observed. Conclusions: Cue-induced craving might be deferentially associated with cannabis cue-reactivity across distinct cannabis use environments.