Towards a New Dynamic Interaction Model of Adolescent CUD Manifestation, Prevention, and Treatment: A Narrative Review

Round 1

Reviewer 1 Report

 

1.     In both the abstract and the main text, abbreviations such as CUD and THC should be spelled out in full upon their first occurrence.

 

2.     On line 170, the reference to "Chapter 2" is unclear. Could you please elaborate on what this section entails?

 

3.     Regarding the proposed model illustrated in Figure 2, the current depiction lacks comprehensiveness. It merely places the relationships above the elements of "drug, set, and setting." I suggest the authors to think creatively about synthesizing these elements in a way that establishes a robust connection between "drug, set, setting" and "cannabis, executive functions (EFs), and school performance." Additionally, the figure should be designed to be understandable on its own, without requiring supplementary text (i.e., prior understanding on set and setting).

 

4.     As a follow-up, I would appreciate it if the authors could forge a compelling and comprehensive connection between the elements of "drug, set, setting" and "cannabis, executive functions, and school performance" in their illustration in main text.

Author Response

Dear reviewer 1,

We have done our utmost to revise our manuscript in line with your comments and have also corrected language errors:  

1. Abbreviations such as CUD and THC are now spelled out upon their first occurrence.
2. The chapter ‘number’ (2) was outdated from the last version of the manuscript. We now changed the sentence to: “In chapter 3.3.1, effects of cannabis will be further discussed” as chapter 3.3.1. entails more information about (positive, negative, and neuropsychological) effects of cannabis use.
3. The model is now changed so that it is more understandable on its own. The relationships between drug use during adolescence, executive functions, and school performance are now correlations instead of having both minuses and pluses. Also, drug, set, and setting are now placed above these relationships as to show that the drug, set, and setting contribute independently to these three factors.
4. We tried to explain the model more understandably, and thereby also explain the connection between "drug, set, setting" and "cannabis use, executive functions, and school performance" better.

with kind regards,

 

on behalf of all authors 

Reviewer 2 Report

1. Conclusions chapter is to large - need just 2-3 ideas

2. The work need a separate chapter about limitations

Minor editing of English language required

Author Response

Dear reviewer 2,

We have done our utmost to revise our manuscript in line with your comments and have also corrected language errors:  

1. Shortening the conclusion significantly would have reduced it to an abstract and that is not doing justice to our work.
2. This feedback point was combined with feedback point 4 of reviewer 3; we wrote a separate chapter on limitations and combined this with recommendations for future research on this subject.

with kind regards,

on behalf of all authors

Reviewer 3 Report

dear colleagues this is a very interesting manuscript to me. but I have four comments: 

1) the major problem is the method used. the authors used a narrative review process which is biased and skewed. the authors however tried to present this as a systematic review (which is not). the method described is too loose and does not make sense. "PubMed and Web of Science were searched" if so what were the terms, MESH, inclusion/exclusion and other PRISMA like presentation. authors need to simply methods. pls try to make it simpler. presenting narrative review in shape for systematic review is misleading. 

2) as clinician I always wondered why Cannabinoids affect young people but not older? try to focus on age, sex, and other covariates when presenting results. what role do individual and environmental factors play in the development of cud in adolescents? 

3)the literature mixes adult vs adols. which need seperation. 

• 4)recommendations made for preventive and therapeutic interventions for the treatment of adolescents with CUD based on the literature are very broad and generic. i think can be sumurized. instead focus on how future research and sys review and meta analyses answer questions you not answered. 

recent umbrella review is shown that up to 20%+ of medical students have substance use symptoms with cannibis used being most. their academic performance is not affected? maybe this need to be discussed? role of age? https://pubmed.ncbi.nlm.nih.gov/37651841/ this does need to be cited

very minor point. i really like figure 2 but lines need to thin or thick based on strenght and +/- does not make sense a line need to be + and  a line need to be - and all - lines to be thick 

several issues in english need to be checked and improved before moving forward. 

Author Response

Dear reviewer 3,

We have doen our utmost to revise our manuscript in line with your comments and we also have corrected the language errors with the help of a native speaker:

1. In the method-section, search-terms are stated more clearly. Also, inclusion criteria are edited to be more straightforward. We did not use any specific exclusion criteria; we added this in the method section for transparency.
2. We tried to take this comment into account by adding mean age or age ranges (e.g., 14 - 21) more clearly in the text. As for considering individual/environmental factors, we payed a lot of attention to this within the chapters about 'set' (individual) and 'setting' (environmental).
3. Only in the section of ‘adverse effects of cannabis’ and in the first part of the section ‘effects of cannabis’ we chose to include some literature on adults. We decided this was necessary as there is not much literature on the positive therapeutic effects of cannabis in adolescents and we deemed it necessary to point out that cannabis can have positive properties. We now highlighted the fact that we used literature on adults in this section by adding the sentence: “including literature on both adults and adolescents, after which a focus is placed on adolescents”. On line 326.
4. This feedback point was combined with feedback point 2 of reviewer 2; we wrote a separate chapter on limitations and combined this with recommendations for future research on this subject.

1. We changed the model, and try to simplify it by making the lines from ‘cannabis use during adolescence’, ‘executive functions’, and ‘school performance’ correlations, rather than having two lines representing positive and negative relationality.

 

with kind regards,

 

on behalf of all authors 

Round 2

Reviewer 1 Report

The authors addressed all my concerns. 

Reviewer 3 Report

thank you