Between 2001-2002 and 2012-2013, cannabis use disorder increased 1.4 percentage points more among adults with psychiatric disorders than those without, confirming VA findings in the general population.
Psychiatrists, addiction medicine specialists, public health researchers, policy makers
What the researchers found
Across two nationally representative surveys (2001-2002 and 2012-2013), cannabis use, frequent use, and CUD all increased more among adults with psychiatric disorders. The excess increase for CUD among those with psychiatric disorders was 1.40 percentage points (95% CI: 0.58-2.21). This pattern held for most specific disorders (mood, anxiety, antisocial personality) and replicated findings from VA patient samples.
Why it matters
This study validates VA patient findings in a nationally representative sample, establishing that the disproportionate increase in CUD among psychiatric patients is not an artifact of the VA healthcare system but a nationwide pattern.
The numbers in context
N=43,093 (2001-2002) and 36,309 (2012-2013); disproportionate increases: cannabis use +2.45%, frequent use +1.58%, CUD +1.40% (all with 95% CIs excluding zero); pattern consistent across mood, anxiety, and antisocial personality disorders
How the study worked
Comparison of two national epidemiological surveys: 2001-2002 (n=43,093) and 2012-2013 (n=36,309). Logistic regression generated predicted prevalences of cannabis use, frequent use, and DSM-IV CUD. Additive interactions tested whether prevalence changes differed between those with and without psychiatric disorders.
What this study cannot tell us
Two cross-sectional surveys cannot track individuals over time. DSM-IV CUD criteria used; DSM-5 criteria may yield different results. Self-report data may underestimate use and disorder. 2012-2013 data predates widespread recreational legalization.
How to read the evidence
Strong: two large nationally representative surveys with validated diagnostic assessments and appropriate statistical methods.
When this study was published
2025 publication analyzing 2001-2002 and 2012-2013 data
The bigger picture
The convergent evidence from VA and general population data makes a strong case that psychiatric populations are uniquely vulnerable to increasing cannabis use problems. This should inform clinical guidelines and resource allocation.
Questions still open
- Has this disproportionate increase continued or accelerated since 2013 with further legalization?
- Are cannabis products with higher potency driving the excess CUD risk in psychiatric populations?
Read the original research
Cannabis Use and Cannabis Use Disorder Among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013.
Substance use & misuse, 60(2), 285-292
Citation
Hasin, Deborah S; Mannes, Zachary L; Livne, Ofir; Fink, David S; Martins, Silvia S; Stohl, Malki; Olfson, Mark; Cerdá, Magdalena; Keyes, Katherine M; Keyhani, Salomeh; Wisell, Caroline G; Bujno, Julia M; Saxon, Andrew. (2025). Cannabis Use and Cannabis Use Disorder Among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013.. Substance use & misuse, 60(2), 285-292. https://doi.org/10.1080/10826084.2024.2423374
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