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Study breakdown

Nearly 80% of veterans with cannabis use disorder had a co-occurring mental health disorder

Retrospective CohortModerate evidence
The takeaway

Among veterans diagnosed with cannabis use disorder, 79% also had a mental health disorder and 77% had another substance use disorder, with comorbid veterans using significantly more mental health services.

VA clinicians, veterans, addiction treatment planners

79% had comorbid mental health; 77% had comorbid substance use disorders

What the researchers found

Of veterans with CUD (2010-2016), 79.1% had a comorbid mental health disorder and 76.8% had another substance use disorder. Veterans with CUD plus a mental health disorder used more individual psychotherapy than those with CUD alone. CUD was rarely an isolated diagnosis.

Why it matters

CUD among veterans is almost never a standalone condition. Effective treatment requires addressing co-occurring disorders, and integrated treatment models may be more appropriate than treating CUD in isolation.

The numbers in context

79.1% comorbid mental health disorder; 76.8% comorbid substance use disorder. Veterans with CUD + mental health disorder used more individual psychotherapy than CUD alone.

How the study worked

Retrospective analysis of national Veterans Health Administration administrative and clinical records from 2010-2016 examining comorbidity rates and mental health service utilization among veterans with CUD diagnoses.

What this study cannot tell us

Administrative data may have coding biases; CUD diagnoses in the VA may be underreported due to stigma and federal prohibition; cannot determine temporal ordering of diagnoses.

How to read the evidence

Large national VA dataset with complete administrative records, though subject to coding limitations.

When this study was published

Published in 2020.

The bigger picture

The VHA, as the largest US healthcare provider, is uniquely positioned to integrate CUD screening and treatment into existing mental health services rather than treating it separately.

Questions still open

  • Would integrated CUD + mental health treatment improve outcomes? Is CUD being adequately screened for in VA mental health settings?

Common questions

Why do so many veterans with CUD have other disorders?
Cannabis use disorder in veterans rarely occurs in isolation. Mental health conditions like PTSD, depression, and anxiety are common in veteran populations, and these conditions often co-occur with and may drive substance use as a coping mechanism.
What does this mean for treatment?
It means treating CUD in isolation would miss the point for most veterans. Integrated treatment addressing both substance use and mental health disorders simultaneously is likely to be more effective than addressing them separately.

Read the original research

Cannabis use disorder among veterans: Comorbidity and mental health treatment utilization.

Journal of substance abuse treatment, 109, 46-49

Citation

Ecker, Anthony H; Lang, Brent; Hogan, Julianna; Cucciare, Michael A; Lindsay, Jan. (2020). Cannabis use disorder among veterans: Comorbidity and mental health treatment utilization.. Journal of substance abuse treatment, 109, 46-49. https://doi.org/10.1016/j.jsat.2019.11.003

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