Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults

Abstract

Findings on neurocognitive effects of sustained cannabis use are heterogeneous. Previous work has rarely taken time of abstinence into account. In this review, we focus on understanding sustained effects of cannabis, which begin when clinical symptoms of the drug have worn off after at least 14 days. We conducted a search between 2004 and 2015 and found 38 studies with such a prolonged abstinence phase. Study-design quality in terms of evidence-based medicine is similar among studies. Studies found some attention or concentration deficits in cannabis users (CU). There is evidence that chronic CU might experience sustained deficits in memory function. Findings are mixed regarding impairments in inhibition, impulsivity and decision making for CU, but there is a trend towards worse performance. Three out of four studies found evidence that motor function remains impaired even after a time of abstinence, while no impairments in visual spatial functioning can be concluded. Functional imaging demonstrates clear differences in activation patterns between CU and controls especially in hippocampal, prefrontal and cerebellar areas. Structural differences are found in cortical areas, especially the orbitofrontal region and the hippocampus. Twenty studies (57 %) reported data on outcome effects, leading to an overall effect size of r mean = .378 (CI 95 % = [.342; .453]). Heavy use is found to be more consistently associated with effects in diverse domains than early age of onset. Questions of causality―in view of scarce longitudinal studies, especially those targeting co-occurring psychiatric disorders―are discussed.

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Fig. 1
Fig. 2

Notes

  1. 1.

    2++ = “high quality systematic reviews of case control or cohort studies, high quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal”

    2+ = “well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal” (Baker et al. 2010, p. 359)

  2. 2.

    By convention, effects of r = .10 to .29 count as small, effects of r = .30 to 0.49 as medium and effects of r = 0.50 or more as large (Cohen 1988).

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Acknowledgments

Authors thank Levente Kriston and Christiane Baldus for their critical comments on a former draft of this paper, Paula Schäffer for proof reading and Juliette Bernardini and Lilly von Osten for their committed help.

Authors’ contributions

FG, SK, SB planned the design, in-/excluded eligible literature and drafted the manuscript. PMS contributed methods, consulting and critical revision. PMS, SB, FG, SK analyzed and interpreted data. Under SB’s supervision, JB and LvO collected data, researched articles, and graded studies. FG, RT were involved in all parts of the review as general supervisors of the research group. All authors read and approved the final manuscript.

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There was no specific funding for this work. The German Center for Addiction Research in Childhood and Adolescence is a University-based non-government institute and partially funded by the City of Hamburg.

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This article was reviewed for publication under the editorship of Dr. Edith Sullivan.

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Ganzer, F., Bröning, S., Kraft, S. et al. Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults. Neuropsychol Rev 26, 186–222 (2016). https://doi.org/10.1007/s11065-016-9316-2

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Keywords

  • Cannabis
  • THC
  • Marijuana
  • Cognitive effects
  • Neuropsychology
  • Systematic review