Veterans who co-use tobacco and cannabis have worse mental health symptoms | Research

The takeaway

Among Iraq and Afghanistan war veterans, those who used both tobacco and cannabis in the past 30 days reported significantly higher levels of stress, PTSD, depression, and anxiety compared to those using only one substance.

Veterans, VA clinicians, and researchers studying substance use and military mental health.

Co-users had significantly higher PTSD and depression scores

What the researchers found

Past 30-day co-users of tobacco and cannabis endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Lifetime and past 30-day rates of both tobacco and cannabis use were high among OEF/OIF veterans.

Why it matters

Veterans have elevated rates of both tobacco and cannabis use. Understanding that co-use is associated with worse mental health symptoms could inform integrated treatment approaches.

The numbers in context

1,230 OEF/OIF veterans surveyed. Co-users had significantly higher stress, PTSD, depression, and anxiety scores than single-substance users.

How the study worked

Cross-sectional survey of 1,230 OEF/OIF veterans examining co-use patterns of tobacco products (cigarettes, vaping) and cannabis, with validated measures of mental health symptoms.

What this study cannot tell us

Cross-sectional design cannot determine causation. Self-reported substance use and mental health. Convenience sample of veterans may not represent all service members.

How to read the evidence

Moderate sample size with validated measures, but cross-sectional design and convenience sampling limit causal inference.

When this study was published

Published in 2022.

The bigger picture

Whether co-use worsens mental health or people with worse mental health are more likely to use both substances cannot be determined from this study, but the association suggests co-users may need more comprehensive care.

Questions still open

Does tobacco-cannabis co-use worsen mental health, or do veterans with worse symptoms seek both substances? Would addressing co-use in treatment improve mental health outcomes?

Common questions

Is using both tobacco and cannabis worse than using just one?

The study found co-users reported higher levels of stress, PTSD, depression, and anxiety, but cannot determine whether co-use causes worse mental health or vice versa.

How common was co-use among veterans?

Both lifetime and past 30-day rates of tobacco and cannabis use were high among the OEF/OIF veteran sample, with substantial overlap in co-use.

Read the original research

Co-use of Tobacco Products and Cannabis among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes.

Journal of psychoactive drugs, 54(3), 250-257

View on PubMed ↗Publisher’s paper ↗

Citation

Fitzke, Reagan E; Davis, Jordan P; Pedersen, Eric R. (2022). Co-use of Tobacco Products and Cannabis among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes.. Journal of psychoactive drugs, 54(3), 250-257. https://doi.org/10.1080/02791072.2021.1956026