Cannabis use disorders and PTSD were significantly underdiagnosed in military veterans
Structured clinical interviews found cannabis use disorders and PTSD were significantly underdiagnosed in VA medical records, while mood disorders and other substance disorders were overdiagnosed.
Quick Facts
What This Study Found
Researchers compared structured clinical interview diagnoses with VA electronic medical record diagnoses for 84 military veterans with confirmed cannabis use disorders. The structured interviews, considered the gold standard, found significant underdiagnosis of cannabis use disorders and PTSD in the VA system.
Other anxiety disorders were also underdiagnosed. In contrast, mood disorders and other substance use disorders were overdiagnosed compared to structured interview results. This pattern suggested clinicians were recognizing some conditions (depression, other substance problems) more readily than others (cannabis dependence, PTSD).
The findings indicated that routine clinical assessment was missing cannabis use disorders and trauma-related diagnoses at concerning rates.
Key Numbers
84 military veterans with confirmed cannabis use disorders. Cannabis use disorders: significantly underdiagnosed. PTSD and other anxiety disorders: significantly underdiagnosed. Mood disorders and other substance use disorders: overdiagnosed.
How They Did This
Cross-sectional study comparing structured clinical interviews (gold standard) with retrospective electronic medical record review for 84 military veterans with cannabis use disorders. Diagnosis rates were compared between the two methods.
Why This Research Matters
Underdiagnosis means undertreated conditions. If clinicians are not identifying cannabis use disorders and PTSD in veterans, these conditions go unaddressed, potentially worsening outcomes and complicating treatment for the conditions that are identified.
The Bigger Picture
The co-occurrence of cannabis use disorders and PTSD in veterans has become an increasingly important clinical issue. This study showed the VA system was better at recognizing some problems (depression, alcohol) than others (cannabis dependence, PTSD), creating treatment gaps.
What This Study Doesn't Tell Us
Small sample size (84 veterans). All participants had cannabis use disorders, so the findings may not generalize to all veterans. Single VA site. The direction of the diagnostic bias may reflect clinical priorities rather than inability to diagnose.
Questions This Raises
- ?Would routine structured screening improve diagnosis rates?
- ?Are clinicians less likely to diagnose cannabis use disorder because they view cannabis as less harmful?
- ?Does PTSD underdiagnosis reflect stigma or screening gaps?
Trust & Context
- Key Stat:
- Cannabis use disorders and PTSD both significantly underdiagnosed
- Evidence Grade:
- Cross-sectional comparison study with structured interviews as gold standard. Small sample from a single VA site limits generalizability.
- Study Age:
- Published in 2012. VA screening and assessment practices have evolved since, with increasing attention to cannabis use and PTSD co-occurrence.
- Original Title:
- The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA.
- Published In:
- Military medicine, 177(7), 786-8 (2012)
- Authors:
- Bonn-Miller, Marcel O(23), Bucossi, Meggan M, Trafton, Jodie A(2)
- Database ID:
- RTHC-00544
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why are cannabis use disorders underdiagnosed in veterans?
Clinicians may be more focused on other substances (alcohol, opioids) and mental health conditions (depression). Cannabis dependence can be subtler than other substance disorders, and routine clinical encounters may not probe for it as thoroughly as structured interviews do.
Why does underdiagnosis matter?
If cannabis use disorders and PTSD are not identified, they go untreated. This can worsen outcomes for the conditions that are identified and treated, since unaddressed substance use and trauma can undermine treatment for depression and other recognized diagnoses.
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Cite This Study
https://rethinkthc.com/research/RTHC-00544APA
Bonn-Miller, Marcel O; Bucossi, Meggan M; Trafton, Jodie A. (2012). The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA.. Military medicine, 177(7), 786-8.
MLA
Bonn-Miller, Marcel O, et al. "The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA.." Military medicine, 2012.
RethinkTHC
RethinkTHC Research Database. "The underdiagnosis of cannabis use disorders and other Axis-..." RTHC-00544. Retrieved from https://rethinkthc.com/research/bonn-miller-2012-the-underdiagnosis-of-cannabis
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.