Reduced Anticipatory Pleasure in Early-Onset Severe Cannabis Use Disorder: A Retrospective, Cross-Sectional Study.

Pepe M.; Traccis F.; Mandracchia G.; Massetti M.; Platia M.; Panaccione I.; Franza R.; Sani G.; Di Nicola M. · European journal of investigation in health, psychology and education · 2026

**Background & Methods** This retrospective, cross-sectional study examined hedonic-motivational functioning in 121 outpatients with severe cannabis use disorder (CUD), stratified by age at onset (<18 vs. ≥18 years), compared against 112 healthy controls. Pleasure capacity was assessed using the Snaith-Hamilton Pleasure Scale (SHAPS) and Temporal Experience of Pleasure Scale (TEPS), with statistical adjustment for gender, education, and CUD duration. **Key Findings** • Early-onset CUD (before age 18) demonstrated significantly reduced anticipatory pleasure on TEPS-Anticipatory scores compared to late-onset CUD and healthy controls (p < 0.001), with this association persisting after adjustment for confounding variables. • Both CUD groups (regardless of onset age) showed elevated SHAPS scores indicating greater anhedonia compared to healthy controls (p < 0.001), though the anticipatory pleasure deficit was specifically prominent in the early-onset group. • CUD groups were comparable in overall clinical characteristics and cannabis use patterns, suggesting that age at onset—rather than current use severity—was the primary driver of reduced anticipatory pleasure capacity. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study has moderate limitations as a retrospective, cross-sectional design that cannot establish causality or temporal relationships. The relatively modest sample size (n = 121 CUD patients) may limit generalizability, and reliance on retrospective reporting of age at onset introduces potential recall bias. The study lacks objective measures of cannabis exposure (potency, frequency, duration) and does not control for potential confounders such as psychiatric comorbidities, other substance use, or neurobiological factors. However, the structured assessment scales (SHAPS, TEPS) are validated instruments for hedonic functioning. The findings represent Level 3 evidence (observational study) and provide preliminary evidence that early-onset CUD may confer specific motivational vulnerabilities. Results suggest clinical utility for identifying high-risk youth but require prospective, longitudinal validation to confirm developmental mechanisms and inform prevention strategies.

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