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Amotivational syndrome is a psychological condition characterized by a loss of motivation commonly attributed to a minority of long term chronic users of Cannabis. The existence of the condition is contended amongst the scientific community and there is no set criterion used to define and determine Amotivational syndrome. Evidence of the existence of the syndrome is primarily supported by case studies whilst laboratory findings are comparatively limited in evidence supporting Amotivational syndrome (Hall, 1994), with many of these studies critiqued for their lack of control groups in their methodologies and data on the representativeness of samples. Studies vary in their support for Amotivational syndrome due to measuring the condition against varying constructs of motivation, however most studies overlap within measurements of westernized ideals of productivity. Due to the similarity between commonly cited symptoms of Amotivational syndrome to that of depressive disorders, the causal relationship between the two is uncertain. More recently studies have found heavy marijuana consumption to be limited to individuals initially inclined to low motivation and depression, and that cannabis serves as a facilitator to a developing psychopathology of depression as opposed to cannabis use being the causal agent to the onset of depression. There has been evidence that the use of SSRI’s can lead to symptoms similar to that of Amotivational syndrome but the condition has been found to be reversible.

Definition and characteristics
Definitions of Amotivational Syndrome differ due to vagueness of established characteristics and the use of varied measurements, resulting in a lack of a systematic diagnostic criterion. This has resulted in subjective observation without dependent objective measure being used to determine behavioral data in relation to Amotivational syndrome. (Mendelson, 1976). The expression ‘Amotivational Syndrome’ was first conceived in 1968 as a diminished desire to work found amongst frequent marijuana users within a younger demographic (Smith, 1968). More recent studies have reconceptualised Amotivational syndrome as a rarity amongst chronic long term cannabis users. (Halikas, 1982). The World health organization defines Amotivational syndrome as ''“A constellation of features said to be associated with substance use, including apathy, loss of effectiveness, diminished capacity to carryout complex or long-term plans, low tolerance for frustration, impaired concentration. and difficulty in following routines.”''.

Measuring Amotivational syndrome
Amotivational syndrome is primarily defined by a deprivation in motivation over an extended period of time, and most studies measuring motivation have been based on Westernized values of productivity such as employment history and educational achievement or on performance on laboratory tasks. Researchers who utilise Westernized values of motivation in their studies assume participants share these values whilst participants may value different pursuits and objectives. A large quantity of studies was conducted in the 1960’s and 1970s in order to validate Amotivational syndrome’s existence, yet most of these studies were methodologically flawed as few used control groups as well as deriving behavioral data from subjective accounts. Later research arguing against the existence of Amotivational syndrome identifies major methodological flaws in the study designs in controlled laboratory settings. Studies conducted at these times did not have means to control the marijuana potency given to participants which restricted researchers from examining does effect relationships. Controlled laboratory studies with humans have attempted to amend methodologic faults in earlier marijuana research.

Whilst several studies report on academic achievement as a westernized measurement construct for motivation, multiple factors are not considered or controlled in these experiments. High school students have been reported in prior studies to do worse in school, although a review found that these students also performed poorly before they used cannabis. One study of college students established that casual and infrequent users had higher grade point averages than non-users but heavy users had slightly worse result as compared to abstainers, suggesting greater evidence for Amotivation experienced amongst heavy users than any other group. In a college-age population, Amotivational Syndrome appears synonymous with previous clinical depression within subjects and according to employment data there is no evidence for a correlation of lower wages, poor work performance or job turnover to level of cannabis use. A report which reviewed all major studies of the effects of cannabis use submitted as part of a Commission of inquiry by the Canadian government noted that the previous studies lacked comparable control groups in their methodologies and data on the representativeness of samples, with most studies having multiple-drug users tested. The report also cited two issues with these studies in making cross cultural comparisons as well as most studies having tested participants who were multiple drug users, making it difficult to isolate the effects of marijuana.

Many studies testing Amotivational syndrome lack in properly isolating marijuana’s impact from competing external factors affecting motivation. It has been noted that marijuana’s properties have contributed to difficulty in studies completing objective non biased measurement. It’s long half-life and high intoxicant activity of its THC component has resulted in many previous behavioral and psychological tests examining individuals who are still relatively intoxicated. Most studies fail to identify previous mental illnesses from any effect directly caused by cannabis and have used subjects with preexisting psychiatric problems. As well as this, a large quantity of the studies was completed without the social circumstances of the studied subjects having been properly contextualized. Due to this many of these studies have been reviewed to lack basic empirical consistency for appropriate scientific conceptualization in determining this condition. Out of the studies conducted in this field there are no long-term longitudinal studies which attempt to identify personality traits associated with chronic cannabis usage. Motivation cannot be directly observed and can only be defined operationally from some other behavior, making it difficult to measure due to its inherent ambiguity. Several different constructs or means have been applied in the attempt to define motivation. To compare the effects of marijuana in casual and heavy smokers on an objective measure of motivation which is unrestricted operant work. Data indicated that heavy users were able to maintain motivation to work. More recent clinical trials have attempted to test Amotivation under the concept of general self-efficacy, which attempts distinguishes between efficacy and outcome expectation. Findings are mixed in testing under this framework it was determined that marijuana users did not differ in their level of motivation compared to abstainers of marijuana use. It has been observed that during intervals of withdrawal from cannabis for long periods of time there is a loss of ambition and goal orientation but these conditions revert after several months of abstinence. (Cohen, 1986).

Perceptions of Amotivational Syndrome
Perceptions differ to the nature of Amotivational syndrome due to different opinions of the value of clinical observations and controlled studies in which there is confusion as to whether the syndrome is only observed during usage or is a more permanent consequence that follows a long period of usage. A selection of case studies primarily contributes to evidence fitting the description of the condition whereas field and laboratory studies contain more mixed results and are highlighted. For daily cannabis users in Egypt and the Caribbean have been reported to impair motivation and social performance over months and years. In societies where heavy cannabis use is widespread the existence of Amotivational syndrome has not been supported in the conducted field studies in Jamaica and Costa Rica. In Jamaica marijuana was culturally perceived as an energizer in which workers would take breaks to smoke marijuana to increase motivation and productivity. whilst some parents would encourage their children to use cannabis to improve performance at school.

Evidence for the existence of Amotivational syndrome mainly consists of results from case histories and observational reports, which report that chronic heavy marijuana users experience a narrowing of interests, increased apathy and inability to concentrate for extended periods of time. Laboratory studies provide little support for the condition however findings suggest that long term marijuana users experience a loss of ambition along with impaired school and work performance. Heavy usage of these individuals is linked to linked to poorer educational outcomes and higher school drop-out rates and poorer educational outcomes. Chronic use of marijuana does not result in major cognitive changes in memory, intelligence or learning capabilities, although there is inconsistent laboratory evidence that suggests that sustained use can lead to subtle problems in performing complex tasks. A Canadian report found no conclusive evidence that cannabis produced personality change but that in certain circumstances it could reduce motivation for performing certain manually conducted tasks, but this was not conclusive of Amotivational syndrome. Whilst empirically validated research has been insignificant in validating the existence of the syndrome on humans, memory and attention have been found to be affected from marijuana usage which have been theorized to potentially impact levels of motivation.

Relationship between depression and cannabis use
Due to the similarities between Amotivational syndrome’s list of characteristics and those of Depressive disorders, the relationship between the two is unclear. Clinical depression often includes apathy, poor concentration and fatigue which are common elements of Amotivational syndrome’s definition. Due to this conflicting research determining whether cannabis use serves as a facilitator to a developing psychopathology of depression as opposed to cannabis use being the causal agent to the onset of depression and lack of motivation has clouded the true relationship between cannabis use and depression. Studies report no significant association with depression in adults and that measures of motivation correlated more with depression than with marijuana consumption, even among heavy users. It has been determined that marijuana consumption exists across a large range of youth groups but heavy marijuana consumption is found to be limited to those already inclined to low motivation and depression. The populations used in clinical studies are often psychiatric referrals studied in this type of research and that perceived sufferers Amotivational syndrome caused by cannabis often had signs of clinical depression prior to their use of cannabis. The symptoms of "Amotivational syndrome" could be comprehended by some researchers as an assisted endogenous depressive disorder that arises within a small group of chronic cannabis users. For cannabis users who complained of apathy and loss of motivation, these individuals saw improvement in their condition when treated with antidepressant medication. Evidence based on a selection of case studies reports that the use of SSRI’s can lead to symptoms similar to that of Amotivational syndrome occurring weeks or months after treatment. Characterized by a lack of apathy, motivation, lack of appropriate concern, and in some cases disinhibition, onset was observed in patients being treated for panic disorder, depression and Obsessive Compulsive Disorder when treated with Fluoxetine of Fluvoxamine. The condition Is reversible by dose reduction of SSRIS or a change in medication class.