Veterans With PTSD Used Cannabis to Cope and Experienced Worse Withdrawal and Cravings | Research

The takeaway

Cannabis-dependent veterans with PTSD reported greater use of cannabis to cope, more severe withdrawal, and stronger cravings, especially emotional and compulsive cravings, compared to veterans without PTSD.

Read this if you are a veteran using cannabis to cope with PTSD and considering quitting.

PTSD-cannabis links remained significant after controlling for other substances and diagnoses

What the researchers found

Among 94 cannabis-dependent military veterans preparing for a quit attempt, those with PTSD reported significantly more coping-motivated cannabis use, more severe withdrawal symptoms, and stronger cravings related to compulsivity, emotionality, and anticipation.

The links between PTSD and coping motives and between PTSD and craving remained significant even after controlling for concurrent cannabis, alcohol, and tobacco use, and co-occurring mood, anxiety, and substance use diagnoses. PTSD symptom severity was positively associated with all cannabis use characteristics measured.

Why it matters

PTSD and cannabis use disorder frequently co-occur in veterans. This study identifies a specific mechanism, coping-motivated use, that creates a feedback loop: PTSD symptoms drive cannabis use for emotional relief, which prevents natural PTSD processing, which maintains PTSD symptoms, which drives more cannabis use.

The numbers in context

94 cannabis-dependent veterans. PTSD associated with: increased coping motives, more severe withdrawal, stronger craving (compulsivity, emotionality, anticipation). Findings robust after controlling for alcohol, tobacco, mood, anxiety, and substance use diagnoses.

How the study worked

Cross-sectional study of 94 cannabis-dependent military veterans immediately prior to a cannabis quit attempt. Measures of PTSD diagnosis, symptom severity, coping motives, use problems, withdrawal, and craving were administered. Analyses conducted with and without adjusting for other substance use and co-occurring diagnoses.

What this study cannot tell us

Cross-sectional design cannot establish causal direction between PTSD and cannabis use characteristics. The veteran sample may not generalize to civilian populations. All measures were self-reported. The study captured a single timepoint immediately before a quit attempt, which may not represent typical use patterns.

How to read the evidence

Cross-sectional study with appropriate statistical controls; preliminary but robust within its design.

When this study was published

Published in 2013. Research on PTSD-cannabis interactions in veterans has expanded substantially.

The bigger picture

This study supports a "pernicious feedback loop" model between PTSD and cannabis use. Veterans use cannabis to manage PTSD symptoms, but this coping strategy may prevent recovery from both conditions. Treatment approaches that address both PTSD and cannabis use simultaneously are likely needed.

Questions still open

Would treating PTSD first reduce cannabis dependence? Would integrated PTSD-cannabis treatment be more effective than treating either alone? Do PTSD-related coping motives predict worse quit outcomes?

Common questions

Why do veterans with PTSD use cannabis?

This study found the primary motivation was coping with emotional distress. Veterans with PTSD reported using cannabis specifically to manage difficult emotions and PTSD symptoms. This coping motivation was significantly stronger in veterans with PTSD compared to those without, even after accounting for other substance use.

Does PTSD make it harder to quit cannabis?

The study suggests it does. Veterans with PTSD reported more severe withdrawal symptoms and stronger cravings, particularly emotion-related and compulsive cravings. If cannabis has been serving as an emotional coping tool for PTSD symptoms, removing it without addressing the underlying PTSD may leave veterans with unmanaged emotional distress, driving relapse.

Read the original research

Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence.

The American journal on addictions, 22(3), 277-84

View on PubMed ↗Publisher’s paper ↗

Citation

Boden, Matthew Tyler; Babson, Kimberly A; Vujanovic, Anka A; Short, Nicole A; Bonn-Miller, Marcel O. (2013). Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence.. The American journal on addictions, 22(3), 277-84. https://doi.org/10.1111/j.1521-0391.2012.12018.x