Comparison of Impulsivity, Sleep Disorder and Suicidal Thoughts In people with and without Marijuana Dependence

Document Type : Original Article


1 M.Sc. Mohaghegh Ardabili University

2 PhD in Family Counseling, Assistant Professor, University of Guilan

3 Master of Family Counseling, University of Guilan



This study aimed to compare impulsivity, sleep disorder, and suicidal thoughts in marijuana users and non-users. The present study was a comparative causal study. The statistical population of this study included students consuming marijuana as well as non-consuming students at the University of Gilan. Fifty male students consuming marijuana in the age group of 18 to 33 years were selected by purposive and snowballs sampling, and 50 non-consuming students were selected and placed in the other group. Participants completed the Bart (1995) Impulse Scale, the Pittsburgh Sleep Quality Index (1989), and the Beck Suicide Thought Scale (1961), respectively. Data were analyzed using multivariate analysis of variance, chi-square test, and independent t-test with SPSS-22 software. The results showed that marijuana users scored higher on all three subscales of impulsivity, i.e., cognitive, motor, and unplanned impulsivity, and showed a significant difference with the non-consumer group. In terms of sleep disorders, marijuana abusers in six subscales out of seven subscales, i.e., mental quality, sleep delay, sufficient sleep, sleep disorders, hypnotic drug, and daily sleep disorders, a significant difference with the non-consumer group. Moreover, in the suicidal ideation scale, people with marijuana abuse had a higher mean score on the Beck suicidal thoughts scale. Conclusion: The research findings can be used in designing therapeutic interventions for people addicted to marijuana.


  1. Anisi, Jafar; Fathi Ashtiani, Ali; Salimi, Seyed Hossein; Ahmadi, Khodabakhsh (2005). Assessing the validity of Beck Suicide Thought Scale in Soldiers, Institute of Martial Medicine, 7 (1), 37-33.

    Asadi Mujara, Samarra; Ilbigi, Rakhsareh; Akbari, Bahman; Hesari, Bahman (2017). Neuroticism, impulsivity and emotional dysregulation in patients with substance use disorders, Contemporary Psychology, No. 12, 147-143.

    Alessandra Costanza, Stéphane Rothen, Sophia Achab, Gabriel Thorens, Marc Baertschi, Kerstin Weber, Alessandra Canuto, Hélène Richard-Lepouriel,  Nader Perroud,  Daniele Zullino (2020). Impulsivity and Impulsivity-Related Endophenotypes in Suicidal Patients with Substance Use Disorders: an Exploratory Study. 19:1729–1744.

    Baldacchino A, Balfour D, Passetti F, Humphris G, Matthews K (2020). Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev.36(9):2056–68.

    Bari A, Robbins TW (2013). Inhibition and impulsivity: behavioral and neural basis of response control. Prog Neurobiol.108:44–79.

    Beck, TA. Steer, RA. (1991). Manual for the beck scale for suicide ideation. San Antonio, Tx: Psychologicasl Coporation. 1991.

    Beyrami, Mansour; Bakhshipour, Abbas; Fakhari, Ali; Khakpour, Zahra (2011). Comparison of impulsivity and its subscales in patients with eating disorder, obsession and normal group, Behavioral Sciences Research, 9 (5), 0-0.

    Blanc, M, L. Bonneau, S. B, Merrete, C., Savard, J., Ivers, H., Martin, C. M. (2007). Psychological and health related Quality of life factors associated with Insomnia in a population based sample. J Psychosom.

    Bridge ,JA., Goldstein ,TR., Brent ,DA (2006). Adolescent suicide and suicidal behavior. J Clin Psychol Psychiatry. 47(3-4), 372-94.

    Brook, J.S., Balka, E.B., Whiteman, M., 1999. The risks for late adolescence of early adolescent marijuana use. Am. J. Public Health. 89, 1549-1554. 

    Buysse, DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. (1998). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research. 28, 193-213.

    Castellanos-Ryan, N., Parent, S., Vitaro, F., Tremblay, R.E., Séguin, J.R., 2013. Pubertal development, personality, and substance use: a 10-year longitudinal study from childhood to adolescence. J. Abnorm. Psychol. 122, 782. 

    Castro JR, Gallo J, Loureiro H. (2004). Tiredness and sleepiness in bus drivers and road accidents in Peru: a quantitative study. SciELO Public Health. 11-8.

    Cernovsky Z, Sadek G, Chiu S (2014). Sleep of methadone patient and their urine screening tests. Canadian Journal of Addiction; 1 (5): 5-6.

    Chassin, L., Dmitrieva, J., Modecki, K., Steinberg, L (2010)., Cauffman, E., Piquero, A.R., ... Losoya, S. H. Does adolescent alcohol and marijuana use predict suppressed growth in psychosocial maturity among male juvenile offenders?. Psychol. Addict. Behav. 24, 48 60.

    Churchwell, J.C., Lopez-Larson, M., Yurgelun-Todd, D.A., (2010). Altered frontal cortical volume and decision making in adolescent cannabis users. Front. Psychol. 1, article 225.

    Clark L, Robbins TW, Ersche KD, Sahakian BJ (2016). Reflection Impulsivity in Current and Former Substance Users. Biol Psychiatry.60(5):515–22.

    Cobb-Clark, D.A., Kassenboehmer, S.C., Le, T., McVicar, D., Zhang, R., (2015). ‘High’-school: The relationship between early marijuana use and educational outcomes. Econ. Rec. 91, 247–266. 

    Cocaine, ecstasy and marijuana. Sleep Medicine Reviews 12, 381e389.

    Coryell W, Wilcox H, Evans SJ, Pandey GN, Jones-Brando L, Dickerson F, et al (2018). Aggression, impulsivity and inflammatory markers as risk factors for suicidal behavior. J Psychiatr Res.106:38–42.

    Crews FT, Boettiger CA. Impulsivity (2019). frontal lobes and risk for addiction. Pharmacol Biochem Behav.93(3):237–47.

    Crews, F., He, J., Hodge, C., (2007). Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol. Biochem. Behav. 86, 189-199. 

    Crumley, FE.(1990), Substance abuse and adolescent suicidal behavior. J Am Med Assoc. 263(22), 3051-6.

    Dan Luo, Lu Tan, Danlin Shen, Zhe Gao, LiangMing Yu, Mingfeng Lai, Jiajun Xu, and Jing L (2022). Characteristics of depression, anxiety, impulsivity, and aggression among various types of drug users and factors for developing severe depression: a cross-sectional study.22:274

    Fadai, Zahra; Ashuri, Ahmad; Hoshyari, Zahra; Izanloo, Bilal (2011). Analysis of the source path of control, depressive symptoms and academic achievement on suicidal thoughts: The role of gender moderation. Principles of Mental Health, 13 (2), 159-148.

    Faraone SV, Wilens TE (2007). Effect of stimulant medications for attention deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse, and diversion. J Clin Psychiatry.68(Suppl 11):15–22.

    Friends, Younes; Bahmani, Bahman; Azami, Yusuf; Godini, Ali Akbar (2013). Investigating the Relationship between Aggression and Impulsivity with Readiness for Addiction in Male Students: Journal of Rehabilitation, (14) 2, 156-142.

    Furihatta R, Uchiyama M, Takahhashi S, Suzuki M, Konno C, Osaki K, et al (2012). The association between sleep problems and perceived health status: a Japanese nationwide general population survey. Sleep Med Aug; 13 (7): 831-7. doi: 10.1016/j.sleep.2012.03.011.

    Gerra G, Zaimovic A, Raggi MA, Moi G, Branchi B, Moroni M, et al (2017). Experimentally induced aggressiveness in heroin-dependent patients treated with buprenorphine: comparison of patients receiving methadone and healthy subjects. Psychiatry Res.149(1–3):201–13.

    Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J, et al (2019). Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry.76(4):426–34.

    Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al (2014). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry.61(8):807–16.

    Grant BF, Stinson FS, Dawson DA, Chou SP, Kaplan K (2014). Prevalence and o-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders. Arch Gen Psychiatry.61(8):807–16.

    Gruber, S.A., Dahlgren, M.K., Sagar, K.A., Gonenc, A., Lukas, S.E., (2014). Worth the wait: effects of age of onset of marijuana use on white matter and impulsivity. Psychopharmacology (Berl). 231, 1455-1465. 

    Hall, W., (2009). The adverse health effects of cannabis use: What are they, and what are their .implications for policy? Int. J. Drug Policy. 20, 458-466.

    Hall, W., Degenhardt, L., 2009. Adverse health effects of non-medical cannabis use. Lancet374, 1383-1393.

    Hasler BP, Smith LJ, Cousins JC, Bootzin RR(2011). Circadian rhythms, sleep, and substance abuse. Sleep Med Rev 2012 Feb; 16 (1): 67-81. doi: 10.1016/j.smrv.2011.03.004.

    Hechtman L, Weiss G (1986). Controlled prospective fifteen year follow-up of hyperactives as adults: non-medical drug and alcohol use and anti-social behaviour. Can J Psychiatry.31(6):557–67.

    Henges, A. L., & Marczinski, C. A. (2012). Impulsivity and alcohol consumption in young social drinkers. Addictive behaviors, 37(2), 217-220.

    Hirschfield, RMA., Davidson, L(1998). Risk factors for suicide. Washington: American Psychiatric Press.

    Hoaken PNS, Stewart SH (2014). Drugs of abuse and the elicitation of human aggressive behavior. Addict Behav.28(9):1533–54.

    -Irwin, M. (2002). Effects of sleep and sleep loss on immunity and cytokines. Brain BehavImmun. 16(5): 503-512.

    1. Davis VanderVeen, Alexandra, R. Hershberger, Melissa A. Cyders. (2016).
    2. Davis, Vander, Veen, Alexandra, R. Hershberger, Melissa A. Cyders. (2016). UPPS-P Model Impulsivity and Marijuana Use Behaviors in Adolescents: A Meta-Analysis. UPPS-P model impulsivity and marijuana use behaviors in adolescents: A metaanalysis. Drug and alcohol dependence, 168, 181-190.

    Jabraili, Hashem; Moradi, Alireza and Mojtaba, Habibi (2020). The mediating role of substance use indices in the relationship between trait impulsivity and impaired emotional regulation with state impulsivity in chronic methamphetamine users: Armghan Danesh Journal, Yasouj School of Medical Sciences, Volume 25, Number 2, Pages 240-255.

    Jewett ME. (1997). Models of circadian and homeostatic regulation of human performance and alertness. Doctoral thesis. Cambridge, MA Harvard University.

    Johnston, L.D., O'Malley, P.M., Miech, R.A., Bachman, J.G., Schulenberg, J.E., 2014. Monitoring the Future National Results on Drug Use: 1975-2014: Overview, Key Findings on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, The University of Michigan.

    Karen Bolla, Charlene, E, Gamaldo, David, N, Neubaur, Jean Luad Cadet. (2008).  Sleep Disturbance in Heaby Marijuana User, SLEEP, Vol. 31, No. 6, 2008.

    Kaufman J, Charney D (2010). Comorbidity of mood and anxiety disorders. Depress Anxiety.12(S1):69–76.

    Kelly TM, Cornelius JR, Clark DB (2014). Psychiatric disorders and attempted suicide among adolescents with substance use disorders. Drug Alcohol Depend.73(1):87–97.

    Khojasteh Mehr, Reza; Rajabi, Gholamreza and Sotoudeh, Sidamid (2010). The effect of group cognitive-behavioral therapy on reducing depression and increasing marital satisfaction in women. Journal of Women Socio-Psychological Studies, 8 (24) 42-25.

    Kimberly, A, Babson, Matthew, Boden, Marcel, Bonn-Miller. (2013). Sleep Quality Moderates the Relation between Depression Symptoms and Problematic Cannabis Use among Medical Cannabis Users. The American Journal of Drug and Alcohol Abuse, 2013; 39(3): 211–216.

    Latif ZE, Šaltyte Benth J, Solli KK, Opheim A, Kunoe N, Krajci P, et al (2019). Anxiety, Depression, and Insomnia among Adults with Opioid Dependence Treated with Extended-Release Naltrexone vs. Buprenorphine-Naloxone: A Randomized Clinical Trial and Follow-up Study. JAMA Psychiatry.76(2):127-134.

    Lee B, London ED, Poldrack RA, Farahi J, Nacca A, Monterosso JR, et al (2019). Striatal dopamine d2/d3 receptor availability is reduced in methamphetamine dependence and is linked to impulsivity. J Neurosci.29(47):14734–40.

    Lee YS, Suchday S, Wylie-Rosett J. Perceived social support, coping styles, and Chinese immigrants’ cardiovascular responses to stress. Int J Behav Med 2012; 19: 174–185.

    Leger D, Poursain B. An international survey of insomnia: under recognition and under-treatment of a polysymptomatic condition. Curr Med Res Opin 2005 Nov; 21 (11): 1785-92.

    Li Q, Wang Y, Zhang Y, Li W, Yang W, Zhu J, et al (2021). Craving correlates with mesolimbic responses to heroin-related cues in short-term abstinence from heroin: an event-related fMRI study. Brain Res.2012(1469):63–72.

    Liddle, H. A., Rowe, C. L., Quille, T. J., Dakof, G. A., Mills, D. S., Sakran, E., & Biaggi, H. (2002). Transporting a research –based adolescent drug treatment into practice. Journal of substance abuse treatment, 22(4), 231-243.

    Macri, Azarakhsh; Ekhtiari, Hamed; Justice, Haniyeh; Ganjgahi, Habib and Naderi, Parisa (2008). The relationship between impulsivity indices and risky behaviors with craving intensity in different groups of opioid addicts, Iranian Journal of Psychiatry and Clinical Psychology, Fourteenth Year, No. 3. Autumn. 268-258.

    Meier, M.H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R.S., . . . Moffitt, T.E., 2012. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc. Natl. Acad. Sci. USA. 109, E2657-E2664. 

    Naqibi, Seyed Abolhassan; Azizpour, Mehdi; Ash'ari, server; Hosseini, Seyed Hamzeh; Alizadeh, Ahad (2014). Investigating the relationship between suicidal thoughts and religious beliefs in methadone maintenance patients in Sari in 2012: Journal of Religion and Health, (2) 1, 1-8.

    Peles E, Schreiber S, Adelson M. Variables associated with perceived sleep disorders in methadone maintenance treatment (MMT) Patients. Drug Alcohol Depend 2006 Apr 28; 82 (2): 103-10.

    Pettinati HM, O’Brien CP, Dundon WD (2013). Current status of co-occurring mood and substance use disorders: a new therapeutic target. Am J Psychiatry.170(1):23–30.

    Powell, J., Bradly, B. P., & Gray, J. A. (1992). Classical conditioning and cognitive determinants of subjective craving for opiates: An investigation of their relative contributions. British Journal of Addiction, 87, 1133-1144.

    Powell, J., Bradly, B. P., & Gray, J. A. (1992). Classical conditioning and cognitive determinants of subjective craving for opiates: An investigation of their relative contributions. British Journal of Addiction, 87, 1133-1144.

    -Powell, J., Gray, J. A., Bradly, B. P., Kasvikis, Y., Strang, J., Barrett, L., & Marks, I. (1990). The effects of exposure to drug-related cues in detoxified opiate addicts: A theoretical perspective and some data. Addictive Behaviors, 15, 339-354.

    Powell, J., Gray, J. A., Bradly, B. P., Kasvikis, Y., Strang, J., Barrett, L., & Marks, I. (1990). The effects of exposure to drug-related cues in detoxified opiate addicts: A theoretical perspective and some data. Addictive Behaviors, 15, 339-354.

    Prosecutor, Parikh. Developmental Psychology. Tehran: Samat Publications; 2010: 231

    Salehcheh, Maryam (2006) Negative Effects of Marijuana on Human Behaviors, Laboratory Physician Magazine: No. 22

    Schaub M, Boesch L, Stohler R (2016). Association between aggressiveness, schizotypal personality traits and cannabis use in Swiss psychology students. Psychiatry Res.143(2–3):299–301.

    Schierenbeck, E., Riemann, D., Berger, M., Hornyak, M.(2008). Effect of illicit recreational drugs upon sleep:

    Segl, B., Morral, A. R ., & Stevens, S. J. (2014). Adolscent substance abuse treatment in United States : Examplary models from a national evaluation study. Routledge. -----Nutt, D. (2012). Drugs without the hot air: Minimizing the harms of legal and illegal drugs. Tijdschrift voor Psychiatrie, 54(12), 1060-1061.

    Sekine Y, Ouchi Y, Takei N, Yoshikawa E, Nakamura K, Futatsubashi M, et al (2016). Brain serotonin transporter density and aggression in abstinent methamphetamine abusers. Arch Gen Psychiatry.63(1):90–100.

    Sohrabi, Mahboubeh and Nateghi, Mahboubeh (2017). the Effectiveness of Cognitive Behavioral Therapy on Suicidal Thoughts and Impulsivity in Adolescents with Drug Addiction, Quarterly Journal of Substance Abuse Research Addiction, Volume 11: Number 42

    Soltaninejad et al. (2012) Structural model of the relationship between borderline personality disorder, emotion-oriented coping style, impulsivity and suicidal thoughts in soldiers, Journal of Law Enforcement Medicine: No. 1; Pages182-176.

    Stanley, S. M., Markman, H. J., & Whitton, S. W. (2009). Communication, conflict, and Commitment: Insights on the foundations of relationship Success from a national survey. Family Process, 41(4), 659-675.

    UPPS-P model impulsivity and marijuana use behaviors in adolescents: A meta-analysis. Indiana University—Purdue University Indianapolis, Department of Psychology, 402 N Blackford St., Indianapolis, IN 46202, USA. Drug and Alcohol Dependence 168 (2016) 181–190.

    UPPS-P Model Impulsivity and Marijuana Use Behaviors in Adolescents:  A Meta-Analysis J. Davis VanderVeen† Alexandra R. Hershberger Melissa A. Cyders Indiana University – Purdue University Indianapolis, Department of Psychology.  402 N Blackford St. Indianapolis, IN, USA 46202 †

    Veldi, M., Aluoja, A., & Vesar, V. (2005). Sleep quality and more common sleep related problems. Sleep Med. 6(3), 269275.

    Whitters, A. C., Cadoret, R. J., & Widmer, R. B. (1985). Factors associated with suicide attempts in alcohol abusers. Jurnal of affective disorders, 9(1), 19-23.

    Winhusen T, Lewis D, Adinoff B, Brigham G, Kropp F, Donovan DM, et al (2018). Impulsivity is associated with treatment non-completion in cocaine and methamphetamine-dependent patients but differs in nature as a function of stimulant-dependence diagnosis. J Subst Abuse Treat.44(5):541–7.

    Winstanley CA, Olausson P, Taylor JR, Jentsch JD (2018). Insight into the relationship between impulsivity and substance abuse from studies using animal models. Alcohol Clin Exp Res.34(8):1306–18.

    Zilberman, M., Tavares, H., & el-Guebaly, N. (2003). Relationship between craving and personality in treatment seeking woman with substance-related disorders. BMC Psychiatry, 3, 1.

    Zilberman, M., Tavares, H., & el-Guebaly, N. (2003). Relationship between craving and personality in treatment seeking woman with substance-related disorders. BMC Psychiatry, 3, 1.

    Zorick T, Nestor L, Miotto K, Sugar C, Hellemann G, Scanlon G, et al (2018). Withdrawal symptoms in abstinent methamphetamine-dependent subjects. Addiction.105(10):1809-18.

    Zorick T, Nestor L, Miotto K, Sugar C, Hellemann G, Scanlon G, et al (2019). Withdrawal symptoms in abstinent methamphetamine-dependent subjects. Addiction.105(10):1809-18.