Reflection impulsivity in adolescent cannabis users: a comparison with alcohol-using and non-substance-using adolescents

Rationale: Reflection impulsivity—a failure to gather and evaluate information before making a decision—is a critical component of risk-taking and substance use behaviours, which are highly prevalent during adolescence.

Objectives and methods: The Information Sampling Test was used to assess reflection impulsivity in 175 adolescents (mean age 18.3, range 16.5–20; 55% female)—48 cannabis users (2.3 years use, 10.8 days/month), 65 alcohol users, and 62 non-substance-using controls—recruited from a longitudinal cohort and from the general community and matched for education and IQ. Cannabis and alcohol users were matched on levels of alcohol consumption.

Results: Cannabis users sampled to the lowest degree of certainty before making a decision on the task. Group differences remained significant after controlling for relevant substance use and clinical confounds (e.g., anxiety, depressive symptoms, alcohol, and ecstasy use). Poor performance on multiple IST indices was associated with an earlier age of onset of regular cannabis use and greater duration of exposure to cannabis, after controlling for recent use. Alcohol users did not differ from controls on any IST measure.

Conclusions: Exposure to cannabis during adolescence is associated with increased risky and impulsive decision making, with users adopting strategies with higher levels of uncertainty and inefficient utilisation of information. The young cannabis users did show sensitivity to losses, suggesting that greater impulsivity early in their drug using career is more evident when there is a lack of negative consequences. This provides a window of opportunity for intervention before the onset of cannabis dependence.