Distress Intolerance and Cannabis Use: An Initial Empirical Investigation

Within the United States (U.S.), one-third of those who use cannabis (the most commonly used illicit drug in the U.S.), exhibit cannabis use problems significant enough to warrant a diagnosis of cannabis use disorder (CUD; Compton, Grant, Colliver, Glantz, & Stinson, 2004). Data suggests that quitting cannabis is highly difficult (Copersino et al., 2006), yet, there is little empirical knowledge about the nature of factors that relate to quit processes (e.g., self-efficacy). One potentially promising variable of relevance to CUD is distress intolerance (Leyro, Zvolensky, & Bernstein, 2010). Distress intolerance is referred to as (a) the perceived capacity to withstand negative emotional and/or aversive states, and (b) the behavioral act of withstanding distressing internal states elicited by some type of stressor. Although theoretically nested within a broader network of risk and protective processes, distress intolerance is posited to be related to, though conceptually distinct from, other variables (e.g., anxiety sensitivity; emotion regulation; Leyro et al., 2010). Individuals with higher levels of distress intolerance may be prone to maladaptively respond to distress (e.g., life stressors), and attempt to avoid negative emotions and/or aversive states (e.g., use cannabis to alter the perception or impact of negative mood, or to enhance positive mood). In contrast, persons with lower levels of distress intolerance may be more able to adaptively respond to distress (e.g., seek out alternative, more adaptive coping strategies instead of using cannabis). There is limited knowledge of the explanatory role of the inability to tolerate negative affect and other aversive internal sensations (e.g., withdrawal) in terms of CUD and the nature of the quit experience (e.g., beliefs about barriers to quitting). The aim of the present study was to examine the main and interactive effects of perceived and behavioral indices of distress intolerance in terms of cannabis quitrelated variables, including (a) failed quit attempts, and duration of average time to relapse for past quit attempts; (b) greater severity of withdrawal symptoms experienced while quitting in the past, lower selfefficacy for abstaining, and greater perceived barriers for quitting cannabis; and (c) greater CUD problems. The sample recruited was characterized by racially and ethnically diverse (65.2% minority) adult cannabis users, many of whom had not completed college (46.5%). The sample had high rates of co-occuring psychiatric and medical illness (e.g., 36.1% had a current anxiety disorder, 26.4% had a current mood disorder, and half endorsed a medical condition), and over 25% fell below the 2013 Federal Poverty Level. There was no empirical support for an interactive or main effect of perceived or behavioral distress intolerance for any of the dependent variables. Although previous studies did not employ most of the cannabis dependent measures utilized in the current report, the lack of significant effects in the regression models was surprising given previous work on the topic (focused largely on coping motives for cannabis use). At the bi-variate level, there was some modest evidence of a 'signal' for perceived distress intolerance for certain cannabis dependent variables; these effects ranged from small to moderate. These data suggest, at least among the present largely minority sample, neither perceived or behavioral distress intolerance are robustly related to the cannabis dependent measures. One conservative interpretation of these findings is that distress intolerance may not perform the same across all CUD samples. Post hoc analyses focused on perceived distress intolerance subfactors relations to the dependent variables; indirect explanatory role of negative affect in perceived distress intolerance-cannabis relations; and bi-variate relations between perceived and behavioral distress intolerance with other transdiagnostic distress processes. Results suggested (a) no incremental explanatory effect for specific perceived distress intolerance subfactors; (b) a significant indirect effect of negative affect in the relation between perceived distress intolerance and certain cannabis dependent variables; and (c) consistent evidence of convergent validity for perceived distress intolerance with other transdiagnostic affective vulnerability factors. I contextualize the findings in relation to past work, and the methodology employed in the current study. I discuss how future theory-driven work that seeks to uncover the time course and patterning between distress intolerance, negative mood, and cannabis use behavior are needed. I also suggest that this work will likely have the greatest impact when the social contexts of CUD populations (e.g., social determinants of health) are more directly integrated into the theoretical models.