The who and how of attentional bias in cannabis users: Associations with use severity, craving, and interference control

Emese Kroon, Lauren Kuhns, Annette Dunkerbeck, Janna Cousijn

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND AND AIM: Cognitive and motivational processes are thought to underlie cannabis use disorder (CUD), but research assessing how cognitive processes (e.g. interference control (IC)) interact with implicit (e.g. attentional bias (AB)) and explicit motivation (i.e. craving) is lacking. We assessed the presence of AB in cannabis users with varying use severity and tested models of moderation, mediation, and moderated mediation to assess how AB, craving, and IC interact in their association with measures of cannabis use.

DESIGN: Cross-sectional.

SETTING AND PARTICIPANTS: Eight studies performed by our lab in the Netherlands including never-sporadic, occasional (≤1/month), and regular cannabis users (≥2/week), and individuals in treatment for CUD were combined (N = 560; 71% male).

MEASUREMENTS: Studies included a Classic Stroop task (IC), a Cannabis Stroop task (AB), and measures of session induced and average session craving. Both heaviness of cannabis use (grams/week) and severity of use related problems were included.

FINDINGS: Only those in treatment for CUD showed an AB to cannabis (p =.019) and group differences were only observed when comparing CUD with never-sporadic users (p =.007). In occasional and regular users, IC was negatively associated with heaviness (β = .015, p <.001), but not severity of use. Average session craving (exploratory), but not session induced craving (confirmatory), mediated this association between AB and heaviness (β = .050, p =.011) as well as severity of use (β = .083, p =.009); higher AB was associated with heavier use and more severe problems through increased craving.

CONCLUSIONS: Attentional bias (AB) only appears to be present in cannabis users with the most severe problems and craving appears to mediate the association between AB and both heaviness and severity of use in occasional and regular users. The association of interference control (IC) with heaviness but not severity of use may point to sub-acute intoxication effects of cannabis use on IC.

Original languageEnglish
Pages (from-to)307-316
Number of pages10
Issue number2
Publication statusE-pub ahead of print - 3 Oct 2022

Bibliographical note

This article is protected by copyright. All rights reserved.


Dive into the research topics of 'The who and how of attentional bias in cannabis users: Associations with use severity, craving, and interference control'. Together they form a unique fingerprint.

Cite this