Depression, not PTSD, was independently associated with cannabis dependence in combat veterans | Research

The takeaway

Among Israeli combat veterans using cannabis, those screening positive for dependence used more cannabis weekly and had higher moral injury scores, with depression (AOR 1.98) but not PTSD independently predicting dependence.

Military psychologists, addiction medicine specialists, and veteran affairs clinicians.

Depression doubled odds of cannabis dependence; PTSD was not significant

What the researchers found

Veterans with cannabis dependence used significantly more cannabis per week and scored higher on moral injury "other" and "betrayal" subscales. After controlling for confounders, depression was significantly associated with dependence (AOR 1.98, 95% CI 1.05-3.72), while PTSD was not (AOR 1.19, 95% CI 0.56-2.54).

Why it matters

The finding that depression, not PTSD, independently predicted cannabis dependence in veterans challenges the common assumption that veterans use cannabis primarily to self-medicate PTSD.

The numbers in context

Depression AOR: 1.98 (95% CI 1.05-3.72, p<0.05). PTSD AOR: 1.19 (95% CI 0.56-2.54, not significant). Dependent users consumed more grams per week and had higher moral injury scores.

How the study worked

Cross-sectional study of Israeli combat veterans discharged within the past 5 years. Compared those screening positive vs. negative for cannabis dependence on sociodemographic and clinical variables using SPSS.

What this study cannot tell us

Cross-sectional cannot determine causation. Screening tools rather than diagnostic interviews. Israeli military context may not generalize. Self-reported cannabis quantity.

How to read the evidence

Appropriate statistical controls, but cross-sectional and screening-based diagnosis.

When this study was published

Published in 2022.

The bigger picture

If depression is the key driver of cannabis dependence in veterans, treatment strategies should prioritize depression management alongside cannabis cessation support.

Questions still open

Would treating depression first improve cannabis dependence outcomes in veterans? Is the PTSD-CUD relationship truly non-significant, or underpowered in this sample?

Common questions

Do veterans use cannabis because of PTSD?

Surprisingly, PTSD was not independently associated with cannabis dependence in this study. Depression was the stronger predictor, nearly doubling the odds of dependence.

What else predicted cannabis dependence in veterans?

Higher weekly cannabis dosage and higher moral injury scores (particularly around betrayal) were associated with dependence, alongside depression.

Read the original research

Sociodemographic and clinical correlates of cannabis dependence among Israeli combat veterans.

Journal of substance abuse treatment, 139, 108786

View on PubMed ↗Publisher’s paper ↗

Citation

Asper, Ariel; Binenfeld, Elishav; Pshitizky, Harel; Feingold, Daniel. (2022). Sociodemographic and clinical correlates of cannabis dependence among Israeli combat veterans.. Journal of substance abuse treatment, 139, 108786. https://doi.org/10.1016/j.jsat.2022.108786