Letters to the Editor
Bongs, a Method of Using Cannabis Linked to Dependence
Dear Editor:
Bongs are a type of water pipe popular among adolescents using cannabis because they allow for stronger effects than joints from the same amount of cannabis and because they are easy to buy or make. This study assessed the link between bong use and cannabis dependence in adolescents.
Participants were 390 students (221 boys, 169 girls; mean age 17.1 years, SD 1.1; range 15 to 20 years). They were drawn from a random sample of 14 classes from 3 secondary and grammar schools in the departments of Haute-Garonne and Pyrénées-Orientales, France. Participants completed a questionnaire assessing the frequency and preferred method of cannabis use. We assessed cannabis dependence according to DSM-IV criteria (1), using a self-report questionnaire derived from the Mini International Neuropsychiatric Interview (MINI) (2). This questionnaire comprised 7 items corresponding to DSM-IV criteria for substance dependence. Participants received a diagnosis of cannabis dependence if they met 3 or more of the 7 DSM-IV criteria. The questionnaire validity had been assessed in a preliminary study (n = 23 adolescents). In the preliminary study, the questionnaire was followed after 8 to 15 days by a clinical interview that employed the MINI module for assessing substance dependence. Agreement between the questionnaire and the interview for the diagnosis of cannabis dependence was evaluated with Cohen’s kappa coefficient, which was judged satisfactory at 0.79. Cronbach’s alpha coefficient of this questionnaire was 0.76.
Of the 390 participants, 55% were cannabis users (n = 214); of the girls, 43.8% were cannabis users; of the boys, 63% were cannabis users. Reported frequency of use was as follows: 41% used cannabis less than once monthly but at least once in the last 3 months, 17.9% used cannabis 2 to 3 times monthly, 26.8% used cannabis once or more than once weekly, and 14.3% used cannabis once or more than once daily. The preferred methods of use were joint (49.5%), bong (33.5%), ingestion (8.5%), and pipe (4.5%).
Of users, 43.7% met the criteria for cannabis dependence. There were no significant differences between boys and girls for the frequencies of cannabis use, for the preferred method of use, or for dependence. The rate of cannabis dependence among bong users was significantly higher than among joint users (54.4% vs 25%, P = 0.0002).
The link between bong use and cannabis dependence may reflect the fact that bong use contributes to dependence and (or) that dependence leads to using stronger methods, such as bongs.
References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994.
2. Lecrubier Y, Sheehan DV, Weiler E, Amorim P, Bonora I, Harnett Sheehan K, and others. The Mini Neuropsychiatric International Interview (MINI), a short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997;12:224–31.
Henri Chabrol, MD, PhD
Charlotte Roura, MA
Jennifer Armitage, MA
Toulouse, France
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