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Nadia Solowij, PhD; Robert S. Stephens, PhD; Roger A. Roffman, DSW; Thomas Babor, PhD, MPH; Ronald Kadden, PhD; Michael Miller, PhD; Kenneth Christiansen, PsyD; Bonnie McRee, MPH; Janice Vendetti, MPH; for the Marijuana Treatment Project Research Group

JAMA. 2002;287:1123-1131.

Context  Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain.

Objective  To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence.

Design, Setting, and Participants  Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls.

Main Outcome Measures  Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence.

Results  Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P = .001) or controls (P = .005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P = .007), retention (P = .003), and retrieval (P = .002) compared with controls. Both user groups performed poorly on a time estimation task (P<.001 vs controls). Performance measures often correlated significantly with the duration of cannabis use, being worse with increasing years of use, but were unrelated to withdrawal symptoms and persisted after controlling for recent cannabis use and other drug use.

Conclusions  These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.

Author Affiliations: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, and Department of Psychology, University of Wollongong, Wollongong (Dr Solowij), New South Wales, Australia; Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Va (Dr Stephens); Innovative Programs Research Group, School of Social Work, University of Washington, Seattle (Dr Roffman); Department of Community Medicine (Dr Babor and Mss McRee and Vendetti) and Department of Psychiatry (Dr Kadden), University of Connecticut Health Center, Farmington; and The Village South Inc, Miami, Fla (Drs Miller and Christiansen).

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