Daily Cannabis Use Doubled While Cannabis Use Disorder Rates Dropped Nearly 50% From 2002-2019

Daily cannabis use prevalence increased 94% (AARC 11.68%). CUD among daily users decreased 47.9% (AARC -10.30%). Individual CUD criteria prevalence decreased 13.4-59.6% among daily users. In contrast, daily alcohol use decreased 10.86% while AUD among daily drinkers decreased only 3.9%. Treatment engagement and perceived need both decreased for cannabis.

Analysis of National Survey on Drug Use and Health data from 2002 to 2019. Computed temporal trends and average annual rates of change for CUD and AUD symptoms, treatment engagement, and perceived treatment need. Compared divergent trajectories of cannabis and alcohol use disorders.

The paradox of more daily use but less diagnosed disorder suggests that how people define "problematic" cannabis use is shifting with cultural acceptance. This has profound implications for diagnostic frameworks: if the same behavior is disorder in one cultural context but not another, the diagnostic criteria themselves may need examination.

This study raises fundamental questions about how substance use disorders are diagnosed. Many CUD criteria reference "harm" (e.g., continued use despite problems, failure to fulfill obligations). If legalization and normalization reduce the social and legal harms of use, fewer people meet these criteria even while using more cannabis.

NSDUH data are cross-sectional and self-reported, with possible changes in reporting honesty over time as cannabis became more accepted. Diagnostic criteria did not change between 2002 and 2019 (transition from DSM-IV to DSM-5 in 2013 may have affected comparability). The study ends in 2019 before the pandemic.