Marijuana Use, Abuse, And Dependence: Evaluation of Panic Responsivity to Biological Challenge (Report‪)‬

It has been suggested that panic attacks are linked to marijuana use and its disorders (Gale & Guenther 1971). This suggestion has been fueled by the clinical observation that marijuana use under certain contexts (e.g., unpredictable situations, negative affective states) may promote an acute fear response (panic attack) due, at least in part, to drug-induced cognitive-physiological changes associated with intoxication (Thomas 1996; Hollister 1986; Tunving 1985). Although this marijuana-panic work has been largely restricted to case examples and uncontrolled clinical observation, a growing, albeit currently highly limited, corpus of work has sought to empirically evaluate this putative linkage. Hathaway (2003) found that among weekly users of marijuana (n = 140), approximately 40% reported having had at least one panic attack related to such use. Zvolensky and colleagues (2006a) also found among a representative sample of adults (n = 4,745) that a lifetime history of marijuana dependence, but not use or abuse, was related to an increased risk of panic attacks. These effects were not attributable to polysubstance use, alcohol abuse, or demographic variables (Zvolensky et al. 2006a). More recently, marijuana use, abuse, and dependence were evaluated prospectively in relation to the development of panic attacks and panic disorder (Zvolensky et al. 2008). Participants at the start of the study were adolescents (n = 1,709) with a mean age of 16.6 years (SD = 1.2; time 1) and were re-assessed one year later (time 2), and then again as young adults (time 3; Mean age = 24.2 years, SD = 0.6). Results indicated that marijuana use and dependence were significantly prospectively associated with increased odds for the development of panic attacks and panic disorder. However, marijuana use and dependence were not incrementally associated with the development of panic attacks or panic disorder after controlling for daily cigarette smoking. This body of work is indirectly supported by other investigations showing that daily or weekly users of marijuana, especially when they are concurrent cigarette smokers, report greater levels of symptoms of somatic tension and arousal compared to nonusers (Buckner et al. In press; Bonn-Miller et al. 2005; Milich et al. 2000; Thomas 1996) and cognitive dyscontrol symptoms (e.g., depersonalization; Zvolensky et al. 2006b; Dannon et al 2004; Troisi et al. 1998; Mathew et al. 1993).