Older adults with cannabis use disorder endorsed fewer diagnostic symptoms, potentially masking problem severity | Research

The takeaway

Adults 65+ with cannabis use disorder were significantly less likely to endorse hazardous use and withdrawal criteria compared to younger adults, suggesting current diagnostic tools may underdetect CUD in older populations.

Geriatric psychiatrists, addiction medicine specialists, diagnostic tool developers

Older adults had 96% lower odds of endorsing hazardous cannabis use (OR 0.04)

What the researchers found

For CUD, adults 65+ had dramatically lower odds of endorsing hazardous use (OR 0.04) and withdrawal (OR 0.39 and 0.16); for AUD, 7 of 11 criteria were endorsed less often by older adults.

Why it matters

If older adults systematically underreport key CUD criteria, they may be underdiagnosed, undermining treatment access.

The numbers in context

CUD: hazardous use OR 0.04 (95% CI 0.01-0.17); withdrawal A OR 0.39 (0.20-0.73); withdrawal B OR 0.16 (0.05-0.48); AUD: 7 of 11 criteria endorsed less often by 65+.

How the study worked

Cross-sectional analysis of 2021-2023 NSDUH (N=12,264 for CUD, N=17,494 for AUD); multivariable logistic regression for each DSM-5 criterion with age group as independent variable.

What this study cannot tell us

Self-reported endorsement may reflect true differences or bias; NSDUH may underrepresent severe disorders in elderly; cross-sectional design.

How to read the evidence

Large nationally representative sample with criterion-by-criterion analysis, but cannot distinguish true symptom differences from reporting differences.

When this study was published

Published 2025, data 2021-2023

The bigger picture

As cannabis use grows among older adults, diagnostic tools developed on younger populations may need age-specific adaptations.

Questions still open

Are older adults truly experiencing fewer symptoms or interpreting them differently? Should age-adapted CUD criteria be developed? Does retirement mask occupational impairment?

Common questions

Do older adults show cannabis use disorder differently?

Yes. Adults 65+ were far less likely to report hazardous use and withdrawal symptoms, the two criteria with the largest age gaps.

Why might this matter?

If older adults experience or report fewer DSM-5 criteria, their CUD may be underdiagnosed or classified as less severe than it actually is.

Read the original research

DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?

International journal of environmental research and public health, 22(6)

View on PubMed ↗Publisher’s paper ↗

Citation

Choi, Namkee G; Morris, Jeffrey A; Marti, C Nathan. (2025). DSM-5 Criteria for Alcohol and Cannabis Use Disorders: Are Older Adults Less Likely to Endorse Certain Criteria?. International journal of environmental research and public health, 22(6). https://doi.org/10.3390/ijerph22060843