The Relationship Between Dissociative Experiences and Cannabis Use: a Systematic Review
Purpose of Review
This systematic review aimed to investigate the relation between cannabis use and dissociation.
Four analytical and 14 descriptive cross-sectional studies were included. There is no variation in the rates of cannabis use among individuals with dissociative experiences compared with the general population. In addition, the prevalence of dissociative disorders in subjects using cannabis is not different from those not using cannabis. The majority of the studies employed inadequate sampling procedures and a concurrent or retrospective assessment of the two variables, which might have increased the risk of bias, and only a few of them controlled for potential confounders.
The limited number of eligible studies, combined with the heterogeneity of study design and methodological limitations, do not support the association between cannabis and dissociative experiences and prevent from any inference about the direction of causality.
KeywordsCannabis Marijuana Dissociation Depersonalization Out-of-body experiences Dissociative experience scale
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.United Nations Office on Drugs and Crime. World drug report 2016. United Nations publication, Sales No. E.16.XI.7, Vienna, 2016. https://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf. Accessed 15 Nov. 2018.
- 2.European Monitoring Centre for Drugs and Drug Addiction. European Drug Report: trends and developments, 2014. http://www.emcdda.europa.eu/system/files/publications/963/TDAT14001ENN.pdf. Accessed 15 Nov. 2018.
- 3.European Monitoring Centre for Drugs and Drug Addictions. Statistical Bullettin 2017, 2017. http://www.emcdda.europa.eu/data/stats2017_en. Accessed 20 Oct. 2017.
- 4.World Health Organization. The health and social effects of nonmedical cannabis use, 2016. http://who.int/substance_abuse/publications/msbcannabis.pdf. Accessed 15 Nov. 2018.
- 13.•• Marconi A, Di Forti M, Lewis CM, Murray RM, Vassos E. Meta-Analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull. 2016;42:1262–9 Important review analysing the effect of cannabis use on psychosis and the dose-response relationship. CrossRefGoogle Scholar
- 17.• Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and mood disorders: a longitudinal study. J Affect Disord. 2015;172:211–8 Relevant study using a massive sample representative of adult population of US and a longitudinal design to investigate causal association between cannabis use and mood disorders. CrossRefGoogle Scholar
- 21.• Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and anxiety disorders: Results from a population-based representative sample. Eur Neuropsychopharmacol. 2016;26:493–505 Relevant study using a massive sample representative of adult population of US and a longitudinal design to investigate causal association between cannabis use and anxiety disorders. CrossRefGoogle Scholar
- 22.Notzon DP, PavlicovaM,Glass A,Mariani JJ, MahonyAL, Brooks DJ, Levin FR (2016) ADHD is highly prevalent in patients seeking treatment for cannabis use disorders. J Atten Disord. 1087054716640109.Google Scholar
- 27.•• Kevorkian S, Bonn-Miller MO, Belendiuk K, Carney DM, Roberson-Nay R, Berenz EC. Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample. Psychol Addict Behav. 2015;29:633–8 Large epidemiological survey investigating the relationship between trauma, PTSD and cannabis use disorders. CrossRefGoogle Scholar
- 39.Bulai I, Enea V. Dissociation and alexithymia in a Romanian sample of substance abuse patients. J Subst Abus. 2016;21:646–51.Google Scholar
- 42.Ahmed N, Ansari MA, Rehman RU. Psychiatric morbidity in psychoactive substance users—a multicentre study in Hyderabad. J Liaquat Univ Med Heal Sci. 2011;10:15–8.Google Scholar
- 48.Halikas JA, Goodwin DW, Guze SB. Marihuana use a survey of regular users. JAMA. 1971;217:692–4.Google Scholar
- 49.Luke DP, Kittenis M. A preliminary survey of paranormal experiences with psychoactive drugs. J Parapsychol. 2005;69:305–27.Google Scholar
- 51.Pekala RJ, Kumar VK, Marcano G. Hypnotic susceptibility, dissociation, and marijuana use: a relationship between high hypnotic susceptibility, marijuana use, and dissociative ability. Dissociation Prog Dissociative Disord. 1995;8:112–9.Google Scholar
- 54.Briere J. Trauma symptom checklist for children. Odessa: Psychological Assessment Resources; 1996.Google Scholar
- 55.Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation. 1993;6:16–27.Google Scholar
- 57.World Health Organization. The ICD-9 classification of mental and behavioural disorders. Geneva: World Health Organization; 1978.Google Scholar
- 58.APA. Diagnostic and statistical manual for mental disorders-III-R. Washington DC: American Psychiatric Association; 1987.Google Scholar
- 60.American Psychiatric Association. Diagnostic and statistical manual of mental disorders IV. Washington, DC: American Psychiatric Association; 1994.Google Scholar
- 61.Spitzer RL, Williams JBW, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID): I: history, rationale, and description. Arch Gen Psychiatry. 1992;49:624–9. https://doi.org/10.1001/archpsyc.1992.01820080032005.CrossRefGoogle Scholar
- 62.First MB, Gibbon M, Spitzer RL, Williams JBW. Structured clinical interview for DSM-IV-TR Axis I Disorders. New York: Biometrics Research, New York State Psychiatric Institute; 1997.Google Scholar
- 65.World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
- 70.• Abajobir AA, Najman JM, Williams G, Strathearn L, Clavarino A, Kisely S. Substantiated childhood maltreatment and young adulthood cannabis use disorders: a pre-birth cohort study. Psychiatry Res. 2017;256:21–31 Longitudinal study investigating the relationship between childhood adversities and cannabis use.CrossRefGoogle Scholar
- 83.Steiner J. Psychic retreats- patholocial organisations in psychotic, neurotic, and borderline patients. London: Routledge; 1993.Google Scholar
- 85.Michal M, Glaesmer H, Zwerenz R, Knebel A, Wiltink J, Brähler E, et al. Base rates for depersonalization according to the 2-item version of the Cambridge depersonalization scale (CDS-2) and its associations with depression/anxiety in the general population. J Affect Disord. 2011;128:106–11.CrossRefGoogle Scholar
- 86.Wing JK, Cooper JESN. Present State Examination (PSE). Measurement and classification of psychiatric symptoms; an instruction manual for the PSE and Catego Program. London: Cambridge University Press; 1974.Google Scholar
- 87.Steinberg M. Interviewer’s guide to the structured clinical interview for DSM-IV dissociative disorders (SCID-D). Arlington: American Psychiatric Pub; 1994.Google Scholar