Characteristics of adolescent cannabis use and social context predicting problematic use: A decision tree analysis

Identifying characteristics of adolescent cannabis use and the surrounding social context that may predict problematic use is important for delivering harm-reduction approaches in both clinical and public health settings. We used a decision tree analysis to identify combinations of various use characteristics (e.g., frequency, mode, duration, initiation age, polysubstance use) and social context risk factors (e.g., peer and household use, solitary use, ease of access) characterizing the highest risk groups for three indicators of problematic use (unsuccessful quit attempt, excessive use, feeling addicted). We analyzed data from 8,915 cannabis ever-users from a large sample of secondary school students (mean age 15.5) in Québec, Canada, who completed the COMPASS survey. Using cannabis at least 2-4 times per month was the most important predictor of problematic use and independently characterized the highest risk groups. Initiating use before age 14 and engaging in solitary use also predicted increased problematic use risk among adolescents whose sustained past-year use did not meet the 2-4 times per month threshold. No sociodemographic differentiation emerged among high-risk groups. When screening for risky cannabis use or promoting safer cannabis behaviours among adolescents, health care providers and public health groups should consider factors with the greatest potential to influence detrimental trajectories among this age group.