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Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment. [ABSTRACT FROM AUTHOR]

Background: Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence.Design: Outpatients completed a comprehensive assessment when commencing cannabis treatment and predictors of treatment outcome were tested.Setting: A university hospital alcohol and drug outpatient clinic.Participants: 221 cannabis-dependent patients participated in a 6-week CBT program where the goal was abstinence.Measurements: Cannabis Expectancy Questionnaire and Cannabis Refusal Self-Efficacy Questionnaire, cannabis dependence severity [Severity of Dependence Scale], psychological distress [General Health Questionnaire] at baseline; the timeline follow-back procedure at baseline and each session.Findings: Patients reporting lower confidence in their ability to resist cannabis during high negative affect (emotional relief refusal self-efficacy) had a lower likelihood of abstinence (p=0.004), more days of use (p<0.001), and larger amount used (p<0.001). Negative cannabis expectancies predicted greater likelihood of abstinence (p=0.024). Higher positive expectancies were associated with lower emotional relief self-efficacy, mediating its association with outcome (p<0.001).Conclusions: Emotional relief refusal self-efficacy and negative expectancies are predictive of better treatment outcomes for cannabis dependence. Positive expectancies may indirectly predict poorer outcome because of a negative association with self-efficacy, but this conclusion remains tentative as directionality could not be established. [ABSTRACT FROM AUTHOR]

Background and aims Self-efficacy beliefs and outcome expectancies are central to Social Cognitive Theory ( SCT). Alcohol studies demonstrate the theoretical and clinical utility of applying both SCT constructs. This study examined the relationship between refusal self-efficacy and outcome expectancies in a sample of cannabis users, and tested formal mediational models. Design Patients referred for cannabis treatment completed a comprehensive clinical assessment, including recently validated cannabis expectancy and refusal self-efficacy scales. Setting A hospital alcohol and drug out-patient clinic. Participants Patients referred for a cannabis treatment [ n = 1115, mean age 26.29, standard deviation ( SD) 9.39]. Measurements The Cannabis Expectancy Questionnaire ( CEQ) and Cannabis Refusal Self- Efficacy Questionnaire ( CRSEQ) were completed, along with measures of cannabis severity [ Severity of Dependence Scale ( SDS)] and cannabis consumption. Findings Positive (β = −0.29, P < 0.001) and negative (β = −0.19, P < 0.001) cannabis outcome expectancies were associated significantly with refusal self-efficacy. Refusal self-efficacy, in turn, fully mediated the association between negative expectancy and weekly consumption [95% confidence interval (CI) = 0.03, 0.17] and partially mediated the effect of positive expectancy on weekly consumption (95% CI = 0.06, 0.17). Conclusions Consistent with Social Cognitive Theory, refusal self-efficacy (a person's belief that he or she can abstain from cannabis use) mediates part of the association between cannabis outcome expectancies (perceived consequences of cannabis use) and cannabis use. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are few valid clinical assessment instruments for cannabis. Self-efficacy, or the ability of users to resist temptation, is a central feature of social cognitive theory. This study outlines the development and validation of the Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), which measures the situational confidence to refuse cannabis. Method: One thousand two hundred and forty-six patients referred for cannabis assessment completed the CRSEQ including measures of cannabis consumption and dependence severity (Severity of Dependence Scale-Cannabis, SDS-C). The CRSEQ was subject to independent exploratory (n =621, mean age 26.88, 78.6% male) and confirmatory (n =625, mean age 27.51, 76.8% male) factor analysis. Results: Three factors: Emotional Relief, Opportunistic and Social Facilitation were identified. They provided a good statistical and conceptual fit for the data. Emotional Relief cannabis refusal self-efficacy was identified as most predictive of cannabis dependence, after controlling for cannabis consumption. Conclusions: The CRSEQ is recommended as a psychometrically sound and clinically useful measure for cannabis misuse treatment planning and assessment. [Copyright &y& Elsevier]

Background: Recent work suggests that 2 biologically based traits convey risk for alcohol misuse: reward sensitivity/drive and (rash) impulsiveness. However, the cognitive mechanisms through which these traits convey risk are unclear. This study tested a model predicting that the risk conveyed by reward sensitivity is mediated by a learning bias for the reinforcing outcomes of alcohol consumption (i.e., positive alcohol expectancy). The model also proposed that the risk conveyed by rash impulsiveness (RI) is mediated by drinkers’ perceived ability to resist alcohol (i.e., drinking refusal self-efficacy). Methods: Study 1 tested the model in a sample of young adults ( n = 342). Study 2 tested the model in a sample of treatment-seeking substance abusers ( n = 121). All participants completed a battery of personality, cognitive, and alcohol use questionnaires and models were tested using structural equation modeling. Results: In both studies, the hypothesized model was found to provide a good fit to the data, and a better fit than alternative models. In both young adults and treatment-seeking individuals, positive alcohol expectancy fully mediated the association between reward sensitivity and hazardous alcohol use. For treatment seekers, drinking refusal self-efficacy fully mediated the association between RI and hazardous drinking. However, there was partial mediation in the young adult sample. Furthermore, neither trait was directly associated with the other cognitive mediator. Conclusions: The hypothesized model was confirmed on a large sample of young adults and replicated on a sample of treatment-seeking substance abusers. Taken together, these findings shed further light on the mechanisms through which an impulsive temperament may convey risk for alcohol misuse. [ABSTRACT FROM AUTHOR]

High impulsivity predisposes young adults to engage in hazardous alcohol use. Experimental research has shown that reward-related impulsivity is causally-related to heavier drinking. Correlational studies suggest that positive alcohol outcome expectancies mediate this effect, but causation has yet to be established. This study sought to clarify this relationship by: 1) developing a new, individualized procedure for inducing reward-related impulsivity with high generalizability; 2) experimentally manipulating positive alcohol expectancies to determine its mechanistic role in reward-related impulsivity risk for drinking. Eighty-seven young adults (67% female; Mage = 19.19, SD = 2.01) received either a covert manipulation to reduce positive alcohol expectancies (n = 43) or control (n = 44) after being administered the Individualized Reward-Seeking Induction Schedule (IRIS). The primary outcome was self-reported confidence in the ability to refuse alcohol in cued situations (drinking refusal self-efficacy). Results showed that IRIS increased reward-related impulsivity (p < .001, drm = 0.48) and reduced drinking refusal self-efficacy (p = .029, η2P = .055, ωp2 = .043). Experimentally diminishing positive alcohol expectancies had a marginal effect on the reward-seeking induction when controlling for covariates (p = .057, η2P = .044). Findings provide preliminary validation of IRIS as a new methodology for investigating the causal role of reward-related impulsivity in alcohol-related cognition and youth drinking. [ABSTRACT FROM AUTHOR]

Abstract: Personality and cognitive processes are both related to alcohol use and misuse. A recent model of hazardous drinking referred, the 2-CARS model, postulates two major pathways to hazardous drinking. One pathway primarily involves the association between Reward Drive and Positive Outcome Expectancies, the second involves the association between Rash Impulsiveness and Drinking Refusal Self-Efficacy. In previous tests of the model, Drinking Refusal Self-Efficacy was found to have the most proximal impact on drinking, being directly influenced by Rash Impulsiveness, and indirectly influenced by Reward Drive through Positive Outcome Expectancies. The aim of the current study was to test the 2-CARS model in a larger independent sample. Results found that individuals with a strong Reward Drive showed higher Positive Outcome Expectancies, while individuals high in Rash Impulsiveness were more likely to report reduced Drinking Refusal Self-Efficacy. The present results also showed a theoretically unexpected pathway with a direct association between Rash Impulsiveness and Positive Outcome Expectancies. However, overall the results support the view that a greater understanding of hazardous drinking can be achieved by investigating the relationship between these personality and cognitive variables. [Copyright &y& Elsevier]

Background: The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence.Design: 273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest.Setting: A public hospital alcohol and drug clinic.Measurements: The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale-Cannabis were completed, along with measures of cannabis consumption.Findings: The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy.Conclusions: Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop and validate a shortened version of the Drinking Refusal Self-Efficacy Questionnaire-Revised Adolescent version (DRSEQ-RA) using a large sample of adolescents.Methods: Secondary school students (N = 2609, M = 14.52 years, SD = 0.94) completed the DRSEQ-RA (consisting of subscales: Social Pressure; Opportunistic; Emotional Relief) and the Alcohol Use Disorders Identification Test (AUDIT). These data were analysed using non-parametric item response theory (NIRT) including Mokken scalability coefficients, and confirmatory factor analysis.Results: Social Pressure subscale items were better able to distinguish between adolescents with lower or higher levels of drinking refusal self-efficacy, while the Opportunistic and Emotional Relief subscale items were able to distinguish adolescents with low drinking-refusal self-efficacy. The DRSEQ-RA was reduced from 19-items to a 9-item scale and retained the original three-factor structure. The reduced scale was named the Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent version (DRSEQ-SRA). The DRSEQ-RA and the DRSEQ-SRA have almost identical psychometric properties. They both demonstrated good fit to the data, each explained 18% of the variance in alcohol consumption, Adj. R2 = 0.18, p < .001 respectively. The DRSEQ-RA and the DRSEQ-SRA also have excellent scale and subscale internal reliability (αs = 0.92-0.99).Conclusions: The DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to test a new theoretical model of cannabis use incorporating biologically-based personality traits and social cognition. This biosocial cognitive theory (bSCT) has robust support in alcohol studies, but has not been applied to cannabis. The model proposes two pathways linking dimensions of impulsivity to cannabis use. The first predicts that the association between Reward Sensitivity (SR) and cannabis use is mediated by positive outcome expectancies. The second predicts that the relationship between Rash Impulsiveness (RI) and cannabis use is mediated by cannabis refusal self-efficacy. An extended version of this model was also tested and included a third pathway linking Punishment Sensitivity (SP) to cannabis use via higher negative outcome expectancies.Method: Participants were 252 18-to-21-year-olds who completed questionnaires assessing cannabis use, personality and social cognition. Theoretical models were tested using structural equation modeling.Results: The bSCT model provided a good fit to the data (CFI=0.95; RMSEA=0.07; SRMR=0.06). Positive cannabis expectancies and refusal self-efficacy partially mediated the association between SR and cannabis use (p<0.05). Cannabis refusal self-efficacy fully mediated the relationship between RI and cannabis use (p<0.05). The addition of a third SP pathway did not improve model fit.Conclusions: Consistent with alcohol studies, the association between impulsivity and cannabis use is largely mediated by social cognition. The bSCT may provide novel insights to inform prevention and treatment of problematic cannabis use. [ABSTRACT FROM AUTHOR]

Background and Aims: Relatively few cannabis dependent individuals seek treatment and little is known about the determinants of treatment seeking. Social Cognitive Theory (SCT) provides a useful framework for examining human behaviour and motivation which may be helpful in explaining treatment seeking. This study examined the differences in cannabis outcome expectancies and cannabis refusal self-efficacy between treatment seekers and non-treatment seekers with cannabis dependence.Design: Non-treatment seekers were referred to an illicit drug diversion program. Treatment seekers commenced an outpatient cannabis treatment program and completed a comprehensive assessment that included measures of cannabis outcome expectancies and refusal self-efficacy.Setting: A public hospital alcohol and drug outpatient clinic.Participants: 269 non-treatment seekers and 195 individuals commencing cannabis dependence treatment.Measurements: The Cannabis Expectancy Questionnaire (CEQ), Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), Severity of Dependence Scale - Cannabis (SDS-C), General Health Questionnaire (GHQ-28) and Readiness to Change Questionnaire (RTC) were completed.Findings: Treatment seekers had significantly higher levels of negative cannabis outcome expectancies and significantly lower levels of emotional relief refusal self-efficacy (belief in ability to resist using cannabis when experiencing negative affect) (ps<0.001). Treatment seekers had significantly higher levels of psychological distress and self-perceived cannabis dependence compared to non-treatment seekers (ps<0.001).Conclusions: High negative cannabis outcome expectancies and low emotional relief refusal self-efficacy may play a key role in motivation to seek treatment. [ABSTRACT FROM AUTHOR]

Objective This study seeks to establish whether meaningful subgroups exist within a 14–16 year old adolescent population and if these segments respond differently to the Game On: Know Alcohol (GOKA) intervention, a school-based alcohol social marketing program. Methodology This study is part of a larger cluster randomized controlled evaluation of the GOKA program implemented in 14 schools in 2013/2014. TwoStep cluster analysis was conducted to segment 2,114 high school adolescents (14–16 years old) on the basis of 22 demographic, behavioral, and psychographic variables. Program effects on knowledge, attitudes, behavioral intentions, social norms, alcohol expectancies, and drinking refusal self-efficacy of identified segments were subsequently examined. Results Three segments were identified: (1) Abstainers , (2) Bingers , and (3) Moderate Drinkers . Program effects varied significantly across segments. The strongest positive change effects post-participation were observed for Bingers , while mixed effects were evident for Moderate Drinkers and Abstainers . Conclusions These findings provide preliminary empirical evidence supporting the application of social marketing segmentation in alcohol education programs. Development of targeted programs that meet the unique needs of each of the three identified segments will extend the social marketing footprint in alcohol education. [ABSTRACT FROM AUTHOR]

Little is known about the subjective experience of alcohol desire and craving in young people. Descriptions of alcohol urges continue to be extensively used in the everyday lexicon of young, non-dependent drinkers. Elaborated Intrusion (EI) Theory contends that imagery is central to craving and desires, and predicts that alcohol-related imagery will be associated with greater frequency and amount of drinking. This study involved 1535 age stratified 18–25 year olds who completed an alcohol-related survey that included the Imagery scale of the Alcohol Craving Experience (ACE) questionnaire. Imagery items predicted 12–16% of the variance in concurrent alcohol consumption. Higher total Imagery subscale scores were linearly associated with greater drinking frequency and lower self-efficacy for moderate drinking. Interference with alcohol imagery may have promise as a preventive or early intervention target in young people. [Copyright &y& Elsevier]

Background: Self-efficacy is a core component of Social Cognitive Theory. Refusal self-efficacy is an individual's belief in their ability to refuse a substance in specific high-risk situations. Change in refusal self-efficacy is predictive of positive treatment outcomes. Measurement of refusal self-efficacy is critical as it directs coping skills development techniques though existing behavioural treatments. There is no validated measure of stimulant refusal self-efficacy. This study developed and validated the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) to measure confidence in the ability to refuse stimulants in specific high-risk situations.Method: Two hundred and seven stimulant-using patients referred for assessment completed the SRSEQ and measures including stimulant dependence severity (Severity of Dependence Scale-Stimulant, SDS-S). Confirmatory Factor Analysis (CFA) using structural equation modelling (SEM) was conducted to test the theoretically-driven three-factor structure of the SRSEQ. Criterion validity was tested with severity of stimulant dependence.Results: The CFA supported the three-factor structure. Emotional Relief (β = -0.27, p = .008), Opportunistic (β = -0.24, p = .013) and Social Facilitation (β = -0.32, p < .001) refusal self-efficacy were uniquely associated with stimulant dependence severity, explaining 55.1% variance.Conclusions: The SRSEQ is psychometrically sound and may be clinically useful to assist with assessment and treatment planning for stimulant use disorder. [ABSTRACT FROM AUTHOR]