(PS1-B32) Cross-country Variation in Pathways from Distress Tolerance to Cannabis Abuse in Young Adults

Substance use disorders (SUDs) are associated with tremendous morbidity and mortality worldwide. Distress tolerance, the capacity to withstand uncomfortable emotional and physical experiences, appears to reduce risk for SUDs, particularly among people who rely on drugs to cope with strong negative emotions. However, studies of this effect are restricted almost entirely to US samples. It is not yet known whether distress tolerance can avert problematic drug use in other cultures and countries, creating a barrier to developing generalizable SUD interventions.

The present study tested a model of negative consequences of cannabis use (e.g., risky behavior, poor academic and job performance) in a sample of university students from 7 countries across North and South America, Africa, and Europe (total N = 1,500). We examined distress tolerance in relation to various motives for using cannabis (i.e., coping, conformity, social, enhancement, expansion) and whether any of these motivational dimensions statistically mediated distress tolerance’s association with cannabis use problems (i.e., adverse consequences of cannabis use, such as being unhappy, done something impulsive that they regretted, poor academic or occupational performance). We used multiple-group structural equation modeling (SEM) to examine the consistency of these pathways across all 7 countries. We predicted that distress tolerance would be linked to lower cannabis use problems, and that much of this association would be accounted for by distress tolerance’s inverse relationship with using cannabis to cope with negative emotion. (See https://osf.io/thzsc/?view_only=6c0e7ec5589840b6931fb0aebf0046f6 for full preregistration.)

Distress tolerance had a statistically significant effect (b = -0.129, p < 0.001) on cannabis use consequences in our total sample (N = 1,565), but this effect varied substantially across countries. Specifically, the median effect size was 0.022 (SD = 0.167) with the largest effects in Uruguay (b = 0.254) and Argentina (b = -0.236) and the smallest effects in South Africa (b = 0.022) and Spain (b = 0.030). When the 5 cannabis use motives were included in the SEM, the association between DT and cannabis consequences was partially mediated (total standardized indirect effect = -0.063, p < 0.001) in the full sample with the pathway from distress tolerance to coping to cannabis consequences having the only significant indirect effect (b = -0.055, p < 0.001). Similar to the direct effect between distress tolerance and cannabis use consequences, the partial mediation effects of coping motives varied significantly across countries (Mdn = -0.064, SD = 0.054) with strongest indirect effects found in Canada (b = -0.077) and South Africa (b = -0.071) and the smallest effects in Spain (b = -0.064) and UK (b = 0.009).

In sum, we tested a model in which distress tolerance predicted risk for negative cannabis use consequences both directly and indirectly (via cannabis-use motives). We believe our findings across these diverse samples provides evidence for distress tolerance’s potential as a prevention and intervention target for cannabis use disorder, and perhaps and other SUDs (e.g., tobacco, opioids), around the world.