{"doi":"10.1111/add.12580","title":"Commentary on van der <scp>P</scp>ol <i>et al</i>. (2014): Reconsidering the association between cannabis exposure and dependence","abstract":null,"journal":"Addiction","year":2014,"id":619228,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1597927,"name":"Elizabeth C. Temple","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Commentary on van der <scp>P</scp>ol <i>et al</i>. (2014): Reconsidering the association between cannabis exposure and dependence","abstract":"The existence of a positive, and relatively strong, association between cannabis exposure/tetrahydrocannabinol (THC) dose and cannabis dependence is an assumption on which much cannabis-related research, public policy and health advice has been based. Van der Pol et al.'s 1 findings, however, throw this into some doubt. To understand why there is a discrepancy here, and its import, it is essential to consider how cannabis exposure/dose is typically measured and, thereby, how past studies may have clouded our understanding of the association between cannabis use and dependence. Cannabis exposure has been assessed in a variety of ways, tending to include measurement of some combination of age at first use, duration of use, quantity consumed and frequency of use, with the latter often employed in isolation as a proxy for THC dose 2. Although known to be only approximations of exposure, these variables are used by researchers for a number of reasons. Foremost among these are the efficiencies associated with the use of self-report questionnaires, which are often completed anonymously by participants and remotely from researchers. The classification of cannabis as an illicit substance within most jurisdictions globally, however, also acts to prevent the vast majority of cannabis researchers from undertaking as thorough an assessment of cannabis exposure/dose as has been demonstrated by van der Pol et al. 1. In the relatively small number of studies where THC dose has been confirmed, this has generally been via ‘cannabis cigarettes’ purchased from the US National Institute on Drug Abuse (NIDA). These studies, however, do not replicate normal usage of cannabis, such as that assessed in van der Pol et al.'s study. Specifically, NIDA joints range from 3 to 7% in THC content and are typically smoked in a prescribed manner (i.e. uniform puff size/duration and breath hold) (e.g. 3); in comparison, van der Pol et al.'s participants were using cannabis ranging from 3.6 to 15.7% THC and they smoked it as per usual, such that their smoking topographies varied. Taken together with the finding that total number of puffs and puff volume were significant predictors of dependence in van der Pol et al.'s study, these differences throw at least some doubt on the ‘real world’ validity of findings from previous studies (whether using real or proxy measures of exposure/dose) and illustrate how important naturalistic studies are to increasing our understanding of the acute and long-term effects of cannabis use, including dependence. Of particular interest here is the ‘typical’ smoking topography that van der Pol et al. 1 found was predictive of cannabis dependence. Taking more frequent puffs of greater volume when commencing a session is evocative of someone seeking a quick hit, such as to ‘take the edge off’, then smoking with less urgency as the desired effects kick in. As such, the ‘typical’ smoking topography may be indicative of using cannabis to cope with psychological distress/stress. Such an interpretation would be in line with findings from two other studies from the same research team, which also found that cannabis exposure/THC variables did not distinguish dependent from non-dependent users 4 nor predict future dependence in frequent users 5. Instead, these studies found that cannabis dependence was predicted by consuming cannabis alone, use for coping and expansion motives, use of other substances and comorbid mood and anxiety disorders 4, and living alone, coping motives for use and stress 5. These findings are supportive of the self-medication hypothesis 6, and consistent with both Van Dam, Bedi & Earleywine's 7 proposition that anxiety is causally related to the development of abuse/dependence in heavy users, and Buckner & Carroll's 8 finding that, within a cannabis-dependent sample, reducing anxiety led to reduced cannabis use yet reducing cannabis use did not lead to decreased anxiety. Evidently, research is needed to further this line of inquiry and, particularly, to test the posited link between ‘typical’ smoking topographies, psychosocial distress/stress and coping motives for use. While most cannabis researchers will not be able to complete as extensive an assessment of cannabis exposure/THC dose as van der Pol et al. 1, it should be possible to include additional items within self-report questionnaires or interview schedules; for example, to determine what proportion of a joint participants typically consume to achieve their desired state and whether their smoking topography is ‘typical’ or ‘atypical’ in nature. Furthermore, we need to question our assumptions about the association between cannabis exposure/THC dose and dependence, including being open to the possibility that our understanding of cannabis dependence may be more accurate if dependence is viewed as being indicative of a user who is experiencing comorbid psychosocial distress/stress. This is not to ignore the possibility that cannabis use by such individuals may also act to exacerbate their condition, but rather to recognize that cannabis exposure/THC dose itself may be less important to our understanding or prediction of cannabis dependence than concurrent or pre-existing psychosocial distress/stress. None.","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"24903289","pmcid":null,"openalex_id":"https://openalex.org/W2053822352","authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[{"year":2017,"count":1}],"oa_status":"closed","license":"http://onlinelibrary.wiley.com/termsAndConditions#vor","oa_locations":[{"url":"https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fadd.12580","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.12580","host_type":"publisher"},{"url":"https://doi.org/10.1111/add.12580","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/24903289","host_type":"repository"},{"url":"http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/43566","host_type":"repository"}],"fields_of_study":["Cannabis and Cannabinoid Research","Substance Abuse Treatment and Outcomes","Forensic Toxicology and Drug Analysis","Cannabis","Dronabinol","Female","Humans","Male","Marijuana Abuse","Marijuana Smoking"],"mesh_terms":["Cannabis","Marijuana Abuse","Female","Humans","Male","Marijuana Smoking","Dronabinol"],"keywords":["Cannabis","Cannabis Dependence","Effects of cannabis","Illicit drug","Psychology","Psychiatry","Proxy (statistics)","Medicine","Drug","Environmental health","Cannabidiol","Methodology","Dependence","Psychosocial Distress","Smoking Topography","Thc Dose","Cannabis Exposure"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-03T06:26:46.872393Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}