Resting state functional connectivity in dependent cannabis users: The moderating role of cannabis attitudes.

Background: The global increase in lenient cannabis policy has been paralleled by reduced harm perception, which has been associated with cannabis use initiation and persistent use. However, it is unclear how cannabis attitudes might affect the brain processes underlying cannabis use.

Methods: Resting state functional connectivity (RSFC) within and between the executive control network (ECN), salience network (SN), and default mode network (DMN) was assessed in 110 near-daily cannabis users with cannabis use disorder (CUD) and 79 controls from The Netherlands and Texas, USA. Participants completed a questionnaire assessing the perceived benefits and harms of cannabis use from their personal, friends-family's, and country-state's perspectives and reported on their cannabis use (gram/week), CUD severity, and cannabis-related problems.

Results: RSFC within the dorsal SN was lower in cannabis users than controls, while no group differences in between-network RSFC were observed. Furthermore, heavier cannabis use was associated with lower dorsal SN RSFC in the cannabis group. Perceived benefits and harms of cannabis - from personal, friends-family's, and country-state's perspectives - moderated associations of cannabis use, CUD severity, and cannabis use-related problems with within-network RSFC of the SN, ECN, and DMN. Personal perceived benefits and country-state perceived harms moderated the association between CUD severity and RSFC between the ventral and dorsal DMN.

Conclusions: This study highlights the importance of considering individual differences in the perceived harms and benefits of cannabis use as a factor in the associations between brain functioning and cannabis use, CUD severity, and cannabis use-related problems.