Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 9, pp 1317–1326 | Cite as

Psychosocial sequelae of cannabis use and implications for policy: findings from the Christchurch Health and Development Study

  • David M. Fergusson
  • Joseph M. Boden
  • L. John Horwood
Invited Reviews



The Christchurch Health and Development Study is a longitudinal study of a birth cohort of 1265 children who were born in Christchurch, New Zealand, in 1977. This cohort has now been studied from birth to the age of 35.

Scope of this review

This article examines a series of findings from the CHDS that address a range of issues relating to the use of cannabis amongst the cohort. These issues include: (a) patterns of cannabis use and cannabis dependence; (b) linkages between cannabis use and adverse educational and economic outcomes; (c) cannabis and other illicit drug use; (d) cannabis and psychotic symptoms; (e) other CHDS findings related to cannabis; and (f) the consequences of cannabis use for adults using cannabis regularly.


In general, the findings of the CHDS suggest that individuals who use cannabis regularly, or who begin using cannabis at earlier ages, are at increased risk of a range of adverse outcomes, including: lower levels of educational attainment; welfare dependence and unemployment; using other, more dangerous illicit drugs; and psychotic symptomatology. It should also be noted, however, that there is a substantial proportion of regular adult users who do not experience harmful consequences as a result of cannabis use.


Collectively, these findings suggest that cannabis policy needs to be further developed and evaluated in order to find the best way to regulate a widely-used, and increasingly legal substance.


Cannabis Cannabis dependence Education Unemployment Welfare dependence Gateway theory Psychosis 



The Christchurch Health and Development Study has been funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation, the Canterbury Medical Research Foundation and the New Zealand Lottery Grants Board.

Conflict of interest

The authors declare no conflicts of interest.

Ethical standard

All data described herein were collected with the informed consent of participants. All aspects of study design and conduct have been approved by the Canterbury (New Zealand) Ethics Committee.


  1. 1.
    Hall W, Lynskey M (2009) The challenges in developing a rational cannabis policy. Curr Opin Psychiatry 22(3):258–262CrossRefPubMedGoogle Scholar
  2. 2.
    Macleod J, Oakes R, Copello A, Crome I, Egger M, Hickman M, Oppenkowski T, Stokes-Lampard H, Smith G (2004) Psychological and social sequelae of cannabis and other illicit drug use by young people: A systematic review of longitudinal, general population studies. Lancet 363:1579–1588CrossRefPubMedGoogle Scholar
  3. 3.
    Room R, Fischer B, Hall W, Lenton S, Reuter P (2008) Cannabis policy: Moving beyond stalemateGoogle Scholar
  4. 4.
    Hall W (2014) What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? AddictionGoogle Scholar
  5. 5.
    The National Organization for the Reform of Marijuana Laws (2004) NORML: Working to reform marijuana laws. The National Organization for the Reform of Marijuana Laws. Accessed 27 July 2005
  6. 6.
    Marijuana Policy Project (2014) Marijuana Policy Project. Marijuana Policy Project. Accessed 17 Feb 2015
  7. 7.
    Drug Policy Alliance (2015) Drug Policy Alliance. Drug Policy Alliance. Accessed 17 Feb 2015
  8. 8.
    Citizens Against Legalizing Marijuana (2015) Citizens Against Legalizing Marijuana. Citizens Against Legalizing Marijuana. Accessed 20 Feb 2015
  9. 9.
    Project SAM (2015) SAM: Smart Approaches to Marijuana. Project SAM. Accessed 20 Feb 2015
  10. 10.
    van Ours J, Williams J (2009) Why parents worry: initiation into cannabis use by youth and their educational attainment. J Health Econ 28(1):132–142CrossRefPubMedGoogle Scholar
  11. 11.
    Townsend L, Flisher AJ, King G (2007) A systematic review of the relationship between high school dropout and substance use. Clin Child Fam Psychol Rev 10(4):295–317CrossRefPubMedGoogle Scholar
  12. 12.
    Lynskey MT, Hall W (2000) The effects of adolescent cannabis use on educational attainment: a review. Addiction 95:1621–1630CrossRefPubMedGoogle Scholar
  13. 13.
    Ellickson P, Bui K, Bell RM, McGuigan KA (1998) Does early drug use increase the risk of dropping out of high school? J Drug Issues 28:357Google Scholar
  14. 14.
    Pedersen W (2011) Cannabis and social welfare assistance: a longitudinal study. Addiction 106(9):1636–1643. doi: 10.1111/j.1360-0443.2011.03436.x CrossRefPubMedGoogle Scholar
  15. 15.
    Schmidt L, Weisner C, Wiley J (1998) Substance abuse and the course of welfare dependency. Am J Public Health 88(11):1616–1622PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Degenhardt L, Chiu WT, Sampson N, Kessler RC, Anthony JC (2007) Epidemiological patterns of extra-medical drug use in the United States: Evidence from the National Comorbidity Survey Replication, 2001-2003. Drug Alcohol DependGoogle Scholar
  17. 17.
    Hammer T (1992) Unemployment and use of drug and alcohol among young people: a longitudinal study in the general population. Br J Addict 87(11):1571–1581CrossRefPubMedGoogle Scholar
  18. 18.
    Morrell SL, Taylor RJ, Kerr CB (1998) Jobless. Unemployment and young people’s health [published erratum appears in Med J Aust 1998 20;168(8):412]. Med J Aust 168(5):236–240PubMedGoogle Scholar
  19. 19.
    Peck DF, Plant MA (1986) Unemployment and illegal drug use: concordant evidence from a prospective study and national trends. Br Med J Clin Res Edn 293(6552):929–932CrossRefGoogle Scholar
  20. 20.
    Horwood LJ, Fergusson DM, Hayatbakhsh MR, Najman JM, Coffey C, Patton GC, Silins E, Hutchinson D (2010) Cannabis use and educational achievement: findings from three Australasian cohort studies. Drug Alcohol Depend 110:247–253CrossRefPubMedGoogle Scholar
  21. 21.
    Fergusson DM, Boden JM (2008) Cannabis use and later life outcomes. Addiction 103:969–976CrossRefPubMedGoogle Scholar
  22. 22.
    Solowij N, Stephens RS, Roffman RA, Babor T, Kadden R, Miller M, Christiansen K, McRee B, Vendetti J (2002) Cognitive functioning of long-term heavy cannabis users seeking treatment. J Am Med Assoc 287(9):1123–1131CrossRefGoogle Scholar
  23. 23.
    Solowij N, Battisti RA (2008) The chronic effects of cannabis on memory in humans: a review. Curr Drug Abuse Rev 1:81–98CrossRefPubMedGoogle Scholar
  24. 24.
    Eldreth DA, Matochik JA, Cadet JL, Bolla KI (2004) Abnormal brain activity in prefrontal brain regions in abstinent marijuana users. Neuroimage 23(3):914–920CrossRefPubMedGoogle Scholar
  25. 25.
    Matochik JA, Eldreth DA, Cadet JL, Bolla KI (2005) Altered brain tissue composition in heavy marijuana users. Drug Alcohol Depend 77(1):23–30CrossRefPubMedGoogle Scholar
  26. 26.
    Fergusson DM, Horwood LJ (1997) Early onset cannabis use and psychosocial adjustment in young adults. Addiction 92(3):279–296CrossRefPubMedGoogle Scholar
  27. 27.
    Kandel DB, Davies M, Karis D, Yamaguchi K (1986) The consequences in young adulthood of adolescent drug involvement: an overview. Arch Gen Psychiatry 43:746–754CrossRefPubMedGoogle Scholar
  28. 28.
    Krohn MD, Lizotte AJ, Perez CM (1997) The interrelationship between substance use and precocious transitions to adult statuses. J Health Soc Behav 38(1):87–103CrossRefPubMedGoogle Scholar
  29. 29.
    Degenhardt L, Chiu WT, Conway K, Dierker L, Glantz M, Kalaydjian A, Merikangas K, Sampson N, Swendsen J, Kessler RC (2009) Does the ‘gateway’ matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. Psychol Med 39(1):157–167PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Fergusson DM, Boden JM, Horwood LJ (2006) Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction 101:556–569CrossRefPubMedGoogle Scholar
  31. 31.
    Hall W, Lynskey M (2005) Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug Alcohol Rev 24(1):39–48. doi: 10.1080/09595230500126698 CrossRefPubMedGoogle Scholar
  32. 32.
    Mayet A, Legleye S, Falissard B, Chau N (2012) Cannabis use stages as predictors of subsequent initiation with other illicit drugs among French adolescents: use of a multi-state model. Addict Behav 37(2):160–166. doi: 10.1016/j.addbeh.2011.09.012 CrossRefPubMedGoogle Scholar
  33. 33.
    Kandel DB (2003) Does marijuana use cause the use of other drugs? J Am Med Assoc 289(4):482–483CrossRefGoogle Scholar
  34. 34.
    Kandel DB (2002) Stages and Pathways of Drug Involvement: Examining the Gate-way Hypothesis. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  35. 35.
    Kandel DB, Yamaguchi K (2002) Stages of drug involvement in the US population. In: Kandel DB (ed) Stages and pathways of drug involvement: examining the gateway hypothesis. Cambridge University Press, New York, pp 65–89CrossRefGoogle Scholar
  36. 36.
    Huba GJ, Wingard JA, Bentler P (1981) A comparison on two latent variable causal models of adolescent drug use. J Pers Soc Psychol 40:180–193CrossRefPubMedGoogle Scholar
  37. 37.
    Hays RD, Widaman KF, DiMatteo MR, Stacy AW (1987) Structural equation models of current drug use: are appropriate models so simple(x)? J Pers Soc Psychol 52:134–144CrossRefPubMedGoogle Scholar
  38. 38.
    Donovan JE, Jessor R (1985) Structure of problem behavior in adolescence and young adulthood. J Consult Clin Psychol 53:890–904CrossRefPubMedGoogle Scholar
  39. 39.
    O’Donnell JA, Clayton RR (1982) The stepping-stone hypothesis—marijuana, heroin, and causality. Chem Depend Behav Biomed Issues 4:229–241Google Scholar
  40. 40.
    Fergusson DM, Horwood LJ (2000) Does cannabis use encourage other forms of illicit drug use? Addiction 95(4):505–520CrossRefPubMedGoogle Scholar
  41. 41.
    Morral AR, McCaffrey DF, Paddock SM (2002) Reassessing the marijuana gateway effect. Addiction 97:1493–1504CrossRefPubMedGoogle Scholar
  42. 42.
    Allison PD (2009) Fixed effects regression models. Sage, Newbury ParkGoogle Scholar
  43. 43.
    Hamerle A, Ronning G (1995) Panel analysis for qualitative variables. In: Arminger G, Clogg CC, Sobel ME (eds) Handbook of statistical modeling for the social and behavioral sciences. Plenum Press, New York, pp 401–451CrossRefGoogle Scholar
  44. 44.
    Fergusson DM, Boden JM, Horwood LJ (2007) Unemployment and suicidal behaviour in a New Zealand birth cohort: a fixed effects regression analysis. Crisis 28(2):95–101CrossRefPubMedGoogle Scholar
  45. 45.
    Boden JM, Fergusson DM, Horwood LJ (2012) Alcohol misuse and violent behavior: findings from a 30-year longitudinal study. Drug Alcohol Depend 122(1–2):135–141. doi: 10.1016/j.drugalcdep.2011.09.023 CrossRefPubMedGoogle Scholar
  46. 46.
    Boden JM, Fergusson DM, Horwood LJ (2013) Alcohol misuse and criminal offending: findings from a 30-year longitudinal study. Drug Alcohol Depend 128(1–2):30–36CrossRefPubMedGoogle Scholar
  47. 47.
    Boden JM, Fergusson DM, Horwood LJ (2013) Alcohol misuse and relationship breakdown: findings from a longitudinal birth cohort. Drug Alcohol Depend 133(1):115–120. doi: 10.1016/j.drugalcdep.2013.05.023 CrossRefPubMedGoogle Scholar
  48. 48.
    Fergusson DM, Boden JM, Horwood LJ (2009) Tests of causal linkages between alcohol abuse or dependence and major depression. Arch Gen Psychiatry 66(3):260–266CrossRefPubMedGoogle Scholar
  49. 49.
    Fergusson DM, Boden JM, Horwood LJ (2013) Alcohol misuse and psychosocial outcomes in young adulthood: results from a longitudinal birth cohort studied to age 30. Drug Alcohol Depend 133(2):513–519CrossRefPubMedGoogle Scholar
  50. 50.
    Fergusson DM, Horwood LJ (2000) Alcohol abuse and crime: a fixed effects regression analysis. Addiction 95(10):1525–1536CrossRefPubMedGoogle Scholar
  51. 51.
    Fergusson DM, Horwood LJ, Ridder EM (2005) Tests of causal linkages between cannabis use and psychotic symptoms. Addiction 100:354–366CrossRefPubMedGoogle Scholar
  52. 52.
    Boden JM, Fergusson DM, Horwood LJ (2007) Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychol Med 37(3):431–440CrossRefPubMedGoogle Scholar
  53. 53.
    Pistis M, Perra S, Pillolla G, Melis M, Muntoni AL, Gessa GL (2004) Adolescent exposure to cannabinoids induces long-Lasting changes in the response to drugs of abuse of rat midbrain dopamine neurons. Biol Psychiatry 56(2):86–94. doi: 10.1016/j.biopsych.2004.05.006 CrossRefPubMedGoogle Scholar
  54. 54.
    Klugmann M, Klippenstein V, Leweke FM, Spanagel R, Schneider M (2011) Cannabinoid exposure in pubertal rats increases spontaneous ethanol consumption and NMDA receptor associated protein levels. Int J Neuropsychopharmacol 14(4):505–517. doi: 10.1017/s1461145710001562 CrossRefPubMedGoogle Scholar
  55. 55.
    Realini N, Rubino T, Parolaro D (2009) Neurobiological alterations at adult age triggered by adolescent exposure to cannabinoids. Pharmacol Res 60(2):132–138. doi: 10.1016/j.phrs.2009.03.006 CrossRefPubMedGoogle Scholar
  56. 56.
    Golub A, Johnson BD (2002) Substance use progression and hard drug use in inner-city New York. In: Kandel DB (ed) Stages and pathways of drug involvement: examining the gateway hypothesis. Cambridge University Press, New York, pp 90–112CrossRefGoogle Scholar
  57. 57.
    Hawkins JD, Hill KG, Guo J, Battin-Pearson SR (2002) Substance use norms and transition in substance use. In: Kandel DB (ed) Stages and pathways of drug involvement: examining the gateway hypothesis. Cambridge University Press, New York, pp 42–64CrossRefGoogle Scholar
  58. 58.
    Korhonen T, Huizink AC, Dick DM, Pulkkinen L, Rose RJ, Kaprio J (2008) Role of individual, peer and family factors in the use of cannabis and other illicit drugs: a longitudinal analysis among Finnish adolescent twins. Drug Alcohol Depend 97:33–43. doi: 10.1016/j.drugalcdep.2008.03.015 PubMedCentralCrossRefPubMedGoogle Scholar
  59. 59.
    Alfonso JP, Huedo-Medina TB, Espada JP (2009) Risk factors predictors of the pattern of substance use during the adolescence. Anales De Psicologia 25(2):330–338Google Scholar
  60. 60.
    Bahr SJ, Hoffmann JP, Yang X (2005) Parental and peer influences on the risk of adolescent drug use. J Prim Prev 26(6):529–551CrossRefPubMedGoogle Scholar
  61. 61.
    Pomerleau OF, Pomerleau CS (1987) A biobehavioral view of substance abuse and addiction. J Drug Issues 17(1–2):111–131Google Scholar
  62. 62.
    Neiss R (1993) The role of psychobiological states in chemical dependency: who becomes addicted? Addiction 88(6):745–756CrossRefPubMedGoogle Scholar
  63. 63.
    Andreasson S, Allebeck P, Engstrom A, Rydberg U (1987) Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet 2(8574):1483–1486CrossRefPubMedGoogle Scholar
  64. 64.
    Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE (2002) Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. Br Med J 325(7374):1212–1213CrossRefGoogle Scholar
  65. 65.
    Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J (2005) Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. Br Med J 330(7481):11CrossRefGoogle Scholar
  66. 66.
    van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H (2002) Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol 156(4):319–327CrossRefPubMedGoogle Scholar
  67. 67.
    Johns A (2001) Psychiatric effects of cannabis. Br J Psychiatry 178:116–122CrossRefPubMedGoogle Scholar
  68. 68.
    Arseneault L, Cannon M, Witton J, Murray RM (2004) Causal association between cannabis and psychosis: examination of the evidence. Br J Psychiatry 184. doi: 10.1192/bjp.184.2.110
  69. 69.
    Fergusson DM, Boden JM, Horwood LJ (2011) Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort. Soc Psychiatry Psychiatr Epidemiol 46(10):933–942CrossRefPubMedGoogle Scholar
  70. 70.
    Badiani A, Boden JM, De Pirro S, Fergusson DM, Horwood LJ, Harold GT (2015) Tobacco smoking and cannabis use in a longitudinal birth cohort: evidence of reciprocal causal relationships. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2015.02.015 PubMedGoogle Scholar
  71. 71.
    Fergusson DM, Poulton R, Smith PF, Boden JM (2006) Cannabis and psychosis: a summary and synthesis of the evidence. Br Med J 332:172–176CrossRefGoogle Scholar
  72. 72.
    Tamminga CA, Holcomb HH (2005) Phenotype of schizophrenia: a review and formulation. Mol Psychiatry 10:27–39CrossRefPubMedGoogle Scholar
  73. 73.
    Caspi A, Moffitt T, Cannon M, McClay J, Murray R, Harrington H, Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig I (2005) Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-o-methyltransferase gene: longitudinal evidence of a gene × environment interaction. Biol Psychiatry 57:1117–1127CrossRefPubMedGoogle Scholar
  74. 74.
    Fergusson DM, Horwood LJ, Swain-Campbell NR (2002) Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction 97:1123–1135CrossRefPubMedGoogle Scholar
  75. 75.
    Horwood LJ, Fergusson DM, Coffey C, Patton GC, Tait R, Smart D, Letcher P, Silins E, Hutchinson DM (2012) Cannabis and depression: an integrative data analysis of four Australasian cohorts. Drug Alcohol Depend 126:369–378. doi: 10.1016/j.drugalcdep.2012.06.002 CrossRefPubMedGoogle Scholar
  76. 76.
    van Ours JC, Williams J, Fergusson DM, Horwood LJ (2013) Cannabis use and suicidal ideation. J Health Econ 32(3):524–537CrossRefPubMedGoogle Scholar
  77. 77.
    Patton GC, Coffey C, Carlin JB, Sawyer SM, Lynskey M (2005) Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 100(10):1518–1525CrossRefPubMedGoogle Scholar
  78. 78.
    Fergusson DM, Horwood LJ, Boden JM (2008) Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a 25 year longitudinal study. Accid Anal Prev 40:1345–1350CrossRefPubMedGoogle Scholar
  79. 79.
    Gruber AJ, Pope HG, Hudson JI, Yurgelun-Todd D (2003) Attributes of long-term heavy cannabis users: a case–control study. Psychol Med 33(8):1415–1422CrossRefPubMedGoogle Scholar
  80. 80.
    Hall W, Solowij N (1997) Long-term cannabis use and mental health. Br J Psychiatry 171:107–108CrossRefPubMedGoogle Scholar
  81. 81.
    Harrison GP Jr, Gruber AJ, Hudson JI, Huestis MA, Yurgelun-Todd D (2002) Cognitive measures in long-term cannabis users. J Clin Pharmacol 42(11 Suppl):41S–47SGoogle Scholar
  82. 82.
    Messinis L, Kyprianidou A, Malefaki S, Papathanasopoulos P (2006) Neuropsychological deficits in long-term frequent cannabis users. Neurology 66(5):737–739CrossRefPubMedGoogle Scholar
  83. 83.
    Volkow ND, Baler RD, Compton WM, Weiss SRB (2014) Adverse health effects of marijuana use. N Engl J Med 370(23):2219–2227. doi: 10.1056/NEJMra1402309 CrossRefPubMedGoogle Scholar
  84. 84.
    Greenwald G (2009) Drug decriminalization in Portugal: Lessons for creating fair and successful drug policies. Cato Institute, Washington, DCGoogle Scholar
  85. 85.
    Hughes CE, Stevens A (2010) What can we learn from the portuguese decriminalization of illicit drugs? Br J Criminol 50(6):999–1022. doi: 10.1093/bjc/azq038 CrossRefGoogle Scholar
  86. 86.
    Hughes CE, Stevens A (2012) A resounding success or a disastrous failure: re-examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugs. Drug Alcohol Rev 31(1):101–113. doi: 10.1111/j.1465-3362.2011.00383.x CrossRefPubMedGoogle Scholar
  87. 87.
    Pope HG (2002) Cannabis, cognition and residual confounding. J Am Med Assoc 287(9):1172–1174CrossRefGoogle Scholar
  88. 88.
    Richter ED, Laster R (2004) The Precautionary Principle, epidemiology and the ethics of delay. Int J Occup Med Environ Health 17(1):9–16PubMedGoogle Scholar
  89. 89.
    Antó JM (2005) The precautionary approach: from Birth to childhood. Epidemiology for risk assessment: losing the beginner’s confidence. Eur J Public Health 15. doi: 10.1093/eurpub/cki172
  90. 90.
    Doll R (1998) Uncovering the effects of smoking: historical perspective. Stat Methods Med Res 7(2):87–117. doi: 10.1177/096228029800700202 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • David M. Fergusson
    • 1
  • Joseph M. Boden
    • 1
  • L. John Horwood
    • 1
  1. 1.Christchurch Health and Development Study, Department of Psychological MedicineUniversity of Otago, ChristchurchChristchurchNew Zealand

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