According to a study by researchers at National Development and Research Institutes, Inc. (NDRI) users of blunts (tobacco cigar shells filled with marijuana) do not understand or experience marijuana dependence in terms of conventional clinical criteria. Rather, they associate clinical symptoms with "harder" drugs such as heroin, crack, cocaine and nicotine. However, many suggested that blunts may have addictive potential because they contain tobacco (nicotine). This finding suggests that future studies on cannabis dependence should be designed to include blunts. The results of this study have been published in a recent issue of the International Journal of Drug Policy. (Eloise Dunlap, Ellen Benoit, Stephen J. Sifaneck and Bruce D. Johnson. Social constructions of dependency by blunts smokers: Qualitative reports. The International Journal of Drug Policy 17(3) 2006:171-182.) The NDRI study involved in-depth interviews with 92 users of blunts and cannabis in other forms (joints, pipes, bongs, etc.) in New York City. Respondents ranged in age from 14 to 62, and were racially diverse: 43% white, 40% Black and 15% Asian. Nineteen percent identified themselves as Latino/a, and 43% were female. When asked if they think blunts are addictive, respondents were evenly divided between affirmative and negative responses. In explaining their answers, many cited the role of tobacco, without prompting. Of those who said they think blunts are addictive, 17% said it is most likely because tobacco, which contains the physically addictive ingredient nicotine, is present in the blunts cigar shell. Among those who said they do not think blunts are addictive, 15% qualified their answers by saying that the tobacco in blunts is addictive, but the marijuana in them is not. For the most part, respondents did not assess the possibility of blunts dependence in terms that clearly correspond to official clinical criteria. Several users described smoking with increased frequency, but none of them reported developing tolerance, or smoking larger amounts to maintain desired effects. A growing number of articles in peer-reviewed journals report survey findings that support official definitions of cannabis dependence, yet clinically significant dependence symptoms are relatively rare among cannabis users. Official criteria (such as those in the Diagnostic and Statistical Manual of the American Psychiatric Association - DSM) have been revised in recent years to recognize the subjective nature of cannabis dependence. However, the NDRI researchers argue that the diagnostic criteria may not be relevant to the actual experiences of marijuana/blunts users and that survey methods may not be the best way to capture those experiences. In particular, surveys do not allow cannabis users to elaborate on the context of their use, particularly settings, which may influence the risk of dependence. The NDRI research team was able to gather such information through the in-depth interviews, but they also conducted field observations of more than 500 individuals during cannabis-smoking sessions in a number of settings. These observations, combined with the interview responses, revealed a system of etiquette based on sharing. The sharing etiquette observed is more complex and involved than sharing norms of previous marijuana using subcultures. Blunt-smoking etiquette includes norms respecting appropriate times and places for smoking, limiting the number of hits one takes before passing a blunt, and contributing to the cost and effort of a blunts-smoking event. The rules are enforced by peer pressure, including the implicit threat of ejection from the group and an argot of demeaning labels for those who violate the norms of sharing. "Smoking in groups seems to involve conduct norms that discourage compulsive or excessive consumption," said Eloise Dunlap, Ph.D., principal investigator in the study. "If people associate blunts with group settings, they may be less likely to see blunts as potentially addictive." The vast majority (86%) of blunts smokers interviewed said they prefer to smoke in groups. The few who reported occasionally smoking blunts alone said that when they did so they tended to replicate the group practice of taking a few puffs and then putting the blunt out. Although group conduct norms associated with blunts smoking can encourage more controlled use, the presence of tobacco in blunts may have a countervailing effect. The question of whether tobacco fosters dependence on blunts warrants further investigation and may yield data with significant implications for public-health and prevention messages. ### This study is part of a larger investigation of marijuana/blunts use, subcultures and markets in New York City, funded by the federal National Institute on Drug Abuse (R01 DA13690). Contact: Patrice Barron

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