Adolescent-Onset Cannabis Use Disorder Is Associated With Greater Self-Reported Apathy Among Adults Living with HIV in Florida
Authors: Britton Mark , Porges Eric , Cohen Ronald , Wang Yan , Ibanez Gladys , Somboonwit Charurut , Cook Robert 
Published: September 2022

INTRODUCTION Heavy cannabis use has been associated with increased self-reported apathy, or the reduction in motivation and goal-oriented behavior. Apathy is also prevalent in people living with HIV (PLWH). Cannabis use is prevalent among PLWH and has been associated with alterations in brain areas linked to motivation and reward. However, there is a paucity of studies directly examining heavy cannabis use as a predictor of apathy in this population. The current study focuses on age of initiating heavy use, as the neurobehavioral effects of chronic cannabis use may be intensified by early heavy use. We hypothesized that adolescent-onset heavy users would show greater apathy than adult-onset heavy users and that both groups would show greater apathy than never-heavy users and never-users. METHODS Baseline data were taken from a larger study of marijuana use, cognition, and health in adults living with HIV; included participants had complete marijuana use data (N = 236). The Marin Apathy Evaluation Scale – Self (AES-S) was used to measure self-reported apathy. The marijuana section of the Substance Abuse Module (SAM-5) was administered. Participants were divided, based on age of first meeting criteria for Cannabis Use Disorder, into early-onset (<18) CUD, late-onset CUD, never-CUD, and never-user groups. To account for variations in cell size and outliers, a robust one-way ANOVA was conducted using the WRS2 R package, with age of onset of CUD as a predictor and AES-S total score as dependent variable; results were submitted to Hochberg post-hoc tests. RESULTS The mean age of included participants was 49.81 years. 73% of participants identified as black/African American, and 54% were assigned male at birth. 8% of included participants had early-onset CUD; 29% had late-onset CUD; 43% never met criteria for CUD; and 20% never used marijuana. 71.6% of participants currently used marijuana at least once a week. The mean AES-S score was 29.81. Age of CUD onset predicted AES-S score, F(3,48.5)=5.84, p = 0.002. Post hoc tests revealed that the early-onset group (mean = 33.4) was significantly more apathetic than the never-user group (mean = 28.5) (Ψ = 5.95, CI=1.73-10.16, p = 0.002) and the never-CUD group (mean = 29.9) (Ψ = 4.02, CI = 0.60-7.43, p = 0.013). No difference was detected between late-onset (mean = 30.1), never-CUD, and never-user groups (p >.05). DISCUSSION We observed that age of Cannabis Use Disorder onset is associated with AES-S score among adults living with HIV, such that adolescent-onset Cannabis Use Disorder predicted higher levels of apathy relative to groups with no history of Cannabis Use Disorder or cannabis use. Two interpretations of this finding may be advanced: first, that individuals predisposed to apathy are more likely to engage in heavy substance use; second, that early-onset substance use alters behavior and perhaps underlying reward circuitry. Limitations of this study include the absence of a control group without HIV and the cross-sectional nature of our data. Future directions include assessing the roles of current age, depression, and HIV viral suppression as potential covariates.