October 22, 2018

GREO BRIEF CANNABIS USE AND GAMBLING

BACKGROUND

On October 17, 2018, Canada legalized the consumption of cannabis, directing the provinces to establish their own regulatory frameworks for how cannabis is distributed and sold within their jurisdictions. This is similar to how legalized gambling is regulated in Canada, with the provinces determining how, and to what extent, gambling is offered. Now that both gambling and cannabis are regulated at the provincial level, it is important to take a look at how cannabis use might affect gambling behaviour, or vice versa. Clarifying the relationship between the two will help inform any regulations surrounding their co-occurrence (e.g., cannabis in casinos). We conducted a brief review of the literature on cannabis use and gambling.

CURRENT REGULATORY PRACTICES

 In US states with legalized cannabis (e.g., Massachusetts and Nevada), cannabis consumption is not allowed in casinos

Casino gambling and cannabis smoking are legal in Massachusetts, but it will not be legal to combine the two. A newly passed ballot initiative legalizing cannabis bans the use in public places -- which include casinos. Similarly, Nevada prohibits cannabis smoking on casino premises.

CANNABIS USE AND GAMBLING

 Studies show that increased gambling and increased cannabis use often co-occur although the underlying mechanisms and causes of this relationship are poorly understood

Cannabis use, similar to other substances, tends to correlate with gambling and often co- occur (Bonnaire, Kovess-Masfety, Guignard, Richard, du Roscoät & Beck, 2017; Leppink, Derbyshire, Chamberlain & Grant, 2014; Momper, Delva, Grogan-Kaylor, Sanchez & Volberg, 2010), although the underlying mechanisms and causes of this relationship are poorly understood. A study showed that among respondents who had current cannabis dependence, one third also had gambling problems (Barnes, Welte, Tidwell & Hoffman, 2015). Treatment- seeking problem gamblers with a history of drug abuse also report high lifetime rates of cannabis use (72.7%; Kausch, 2003). In addition, there may be a relationship between alcohol, gambling, and marijuana. Specifically, a study of those in treatment found that high

1 October 22, 2018 frequency alcohol drinkers both gambled and used cannabis more frequently than low frequency alcohol users (Stinchfield, Kushner & Winters, 2005).

There is some evidence from twin studies that the relationship between problem gambling and cannabis dependence may be more influenced by environmental factors than genetic factors (Xian, Giddens, Scherrer, Eisen & Potenza, 2014). Therefore, early environmental experiences may play an important role and research suggests that early cannabis use may predict future problem gambling (Dowling, Merkouris, Greenwood, Oldenhof, Toumbourou & Youssef, 2017). For this reason we examine what we know about cannabis and gambling in youth and young adults.

YOUTH AND YOUNG ADULTS

 Current research suggests that increased cannabis use is related to increased gambling problems in youth

 Problem gambling in youth may exist within a larger ‘problem behavior syndrome’, the co- occurrence of substance use (such as cannabis) and delinquent behaviours (such as conduct disorder)

 Young adults who report using cannabis before/while gambling endorse greater gambling quantity, frequency, negative consequences, and problem severity than those who deny using before/while gambling

Previously, research found that cannabis use among youth was associated with a lower likelihood of gambling (Kaminer, Burleson & Jadamec, 2002; Proimos, DuRant, Pierce & Goodman, 1998). However, more current research suggests that increased cannabis use relates to increased gambling problems (Lee, Martins, Pas & Bradshaw, 2014; Stuhldreher, Stuhldreher & Forrest, 2007). For example, a study of problem gambling among students in Ontario, Canada found that problem gamblers were 11 times more likely to report cannabis dependence than students without gambling problems (Cook et al, 2015). Notably, cannabis use is associated with problem gambling on a newer development – internet gambling (McBride, & Derevensky, 2009; Potenza, Wareham, Steinberg, Rugle, Cavallo, Krishnan-Sarin & Desai, 2011).

Problem gambling may exist within a larger ‘problem behavior syndrome’ (Barnes, Welte, Hoffman & Tidwell, 2011). Problem behaviour syndrome refers to the co-occurrence of substance use (such as cannabis) and delinquent behaviours (such as conduct disorder) among youth. As one adolescent problem behavior increases, the likelihood of other problem behaviors also increases. Cannabis use among youth problem-gambling may be (at least partially) responsible for low-average grades, cigarette smoking, current alcohol use, and gambling with friends (Hammond et al, 2014). This finding may add credence to the problem behavioural syndrome hypothesis.

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Among youth being treated for cannabis dependence, 22% had experienced gambling problems (Petry & Tawfik, 2001). Compared to those who only experienced cannabis abuse, those with both cannabis dependence and gambling problems reported:

 A greater frequency of overall drug and alcohol use

 Greater intensity of marijuana use

 More illegal activity

 Greater somatization and anxiety symptoms

 Higher levels of victimization

 More sexual partners in the previous 90 days

Shifting the view from youth to young adults (e.g., age 18-25), a relationship was seen between previous-year cannabis use and gambling behaviour (LaBrie, Shaffer, LaPlante & Wechsler, 2003). Young adults with gambling problems were more likely to have smoked cannabis within the last month (Engwall, Hunter & Steinberg, 2004). Young adults who report using cannabis before/while gambling report greater gambling quantity, frequency, negative consequences, and problem severity than those who deny using before/while gambling (Cronce, Bittinger, Di Lodovico & Liu, 2017).

CANNABIS USE, DECISION MAKING, & RISK TAKING

 While we found no research that specifically looks at the effects of cannabis use on gambling behaviour, there is some evidence that cannabis use can affect decision making and risk taking

 Cannabis users may be more reactive to wins and losses, which may make gambling more attractive

 The mixed findings with respect to cannabis and decision making are similar to those found with alcohol: some research suggests that gamblers may be willing to take more risks when gambling in venues that serve alcohol, other research suggests that alcohol consumption has little impact

Gamblers who use cannabis may have greater impulsivity (Leppink, Derbyshire, Chamberlain & Grant, 2014) and cannabis users may be more reactive to wins and losses, which may make gambling more attractive (Acheson et al., 2015). While we found no research that specifically looks at the effects of cannabis use on gambling behaviour, there is some evidence that cannabis use can affect decision making and risk taking.

Long-term (chronic) cannabis use is related to impaired learning, memory and other cognitive functioning (Fletcher et al., 1996; Heishman et al., 1997; Pope and Yurgelun-Todd, 1996; Solowij, 1998; Solowij et al., 2002). Long-term cannabis users also have poorer decision

3 October 22, 2018 making on the Iowa Gambling Task (IGT) (Whitlow et al, 2004). This cognitive task simulates real-life decision making involving uncertainty, rewards, and punishments – similar to that of gambling. It is used as a model of real-world risk-taking and decision making. Impaired decision making on the IGT has been found for other drugs such as cocaine (Bartzokis et al., 2000; Grant et al., 2000; Monterosso et al., 2001), opiates (Petry et al., 1998), and alcohol (Mazas et al., 2000) abusers. However, there is some evidence that impairments in decision making may be worse for cannabis users compared to other substance users (Verdejo-Garcia, Benbrook, Funderburk, David, Cadet & Bolla, 2007).

Research on the effects of long-term cannabis use suggests that it can lead to impaired decision making. However, the (acute) effects of smoking cannabis have demonstrated mixed results. Among recreational cannabis users, the effects of low-potency vs. high-potency cannabis was examined. High-potency cannabis (13% THC) showed greater impairment of motor control and executive function compared to low-potency cannabis (4% THC), but neither potency affected decision making (Ramaekers, Kauert, van Ruitenbeek, Theunissen, Schneider & Moeller, 2006). They found little evidence that smoking cannabis impaired decision making among recreational users. Similar findings have been found with experienced cannabis users. Among experienced cannabis users, having smoked cannabis affected speed on the IGT but not performance (Vadhan, Hart, van Gorp, Gunderson, Haney & Foltin, 2007) – this suggests that among experienced cannabis users, acute cannabis use may not further affect decision making in-the-moment.

CO-OCCURANCE OF GAMBLING AND SUBSTANCE USE

The mixed findings with respect to cannabis and decision making are similar to those found with other substances. Specifically, alcohol and nicotine use co-occur with gambling (see Lorains, Cowlishaw & Thomas, 2011), yet the research on the acute effects of drinking or smoking are mixed. In terms of alcohol, gamblers may be more willing to take risks when gambling in venues that serve alcohol (Leino et al., 2017). However, other research suggests that alcohol consumption has little impact on problem gambling behaviour (Markham et al., 2012; Sagoe et al., 2017). It’s similarly mixed with nicotine, were long-term smokers may spend more on gambling (Petry and Onken, 2002), yet nicotine consumption has little impact on gambling behavior (McGrath, Barrett, Stewart & Schmid, 2011). Thus, while gambling may correlate with alcohol, nicotine and cannabis use, there is a lack of evidence to suggest a causal relationship. That is to say, one cannot determine if substance use causes gambling or vice versa.

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