What Predicts Whether Problematic Cannabis Use Persists, Stops, or Starts Later in Life | Research

The takeaway

A 20-year study identified distinct risk profiles for persistent, limited, and delayed patterns of problematic cannabis use, with anxiety disorders predicting persistence and childhood trauma predicting late onset.

Read this if you want to understand what childhood and adolescent factors predict different patterns of problematic cannabis use in adulthood.

6.7% showed persistent problematic use; childhood trauma predicted delayed-onset problems in the late 20s

What the researchers found

Following 1,229 people from childhood through age 30, this study identified four distinct patterns of problematic cannabis use (cannabis use disorder or daily use) in early adulthood.

The persistent pattern (6.7% of the sample) characterized people with problematic use in both late adolescence (19-21) and early adulthood (26-30). These individuals had more anxiety disorders across their development and more severe cannabis use disorder symptoms during late adolescence compared to those whose problems were limited to adolescence.

The limited pattern (13.3%) described people with problematic use only in late adolescence who then stopped. They had more childhood family instability and dysfunction as distinguishing risk factors.

The delayed pattern (3.7%) captured those who developed problems only in early adulthood (26-30). These individuals had more externalizing disorders, maltreatment, and peer bullying during childhood, suggesting that early adversity can fuel problematic cannabis use years later.

No significant differences were found by sex or race/ethnicity.

Why it matters

This is one of the longest-running studies to track cannabis use patterns from childhood through age 30. Identifying distinct risk profiles for different trajectories means prevention and intervention efforts could be tailored to specific risk factors rather than using one-size-fits-all approaches.

The numbers in context

1,229 participants followed for 20 years. Persistent problematic use: 6.7%. Limited problematic use (adolescence only): 13.3%. Delayed problematic use (adulthood only): 3.7%. No sex or race/ethnicity differences.

How the study worked

Prospective 20-year cohort study (Great Smoky Mountains Study, 1993-2015) with 1,229 participants representative of western North Carolina. Yearly assessments from ages 9-16, with follow-ups at 19, 21, 26, and 30. Multinomial logistic regression examined pairwise associations between use patterns and childhood/adolescent risk factors.

What this study cannot tell us

Based on a single geographic region (western North Carolina), which may limit generalizability to urban or more diverse populations. Cannabis potency and availability changed significantly over the 20-year study period. Self-reported use may underestimate actual problematic patterns.

How to read the evidence

Strong evidence from a prospective 20-year cohort study with representative sampling and validated assessment instruments across multiple developmental stages.

When this study was published

Published in 2017, covering data from 1993 to 2015.

The bigger picture

This study challenges the assumption that problematic cannabis use follows a single trajectory. The delayed-onset pattern is particularly notable because it shows that childhood adversity can predict cannabis problems that don't emerge until the late 20s, well past the typical adolescent risk window.

Questions still open

Could early intervention for childhood trauma prevent delayed-onset problematic cannabis use decades later? Do persistent users have biological vulnerabilities beyond anxiety that maintain their use patterns? Would these trajectories look different in states with legal cannabis?

Common questions

Do most people grow out of problematic cannabis use?

In this study, 13.3% had problematic use only during late adolescence (ages 19-21) and then stopped, compared to 6.7% who persisted into their late 20s. However, 3.7% developed problematic use for the first time in adulthood, showing that problems can also emerge later.

What predicts lifelong problematic cannabis use?

Persistent problematic use (from adolescence through age 30) was associated with anxiety disorders across development and more severe cannabis use disorder symptoms during late adolescence. Childhood family instability alone was more associated with problems that resolved after adolescence.

Read the original research

Predicting Persistent, Limited, and Delayed Problematic Cannabis Use in Early Adulthood: Findings From a Longitudinal Study.

Journal of the American Academy of Child and Adolescent Psychiatry, 56(11), 966-974.e4

View on PubMed ↗Publisher’s paper ↗

Citation

Hill, Sherika; Shanahan, Lilly; Costello, E Jane; Copeland, William. (2017). Predicting Persistent, Limited, and Delayed Problematic Cannabis Use in Early Adulthood: Findings From a Longitudinal Study.. Journal of the American Academy of Child and Adolescent Psychiatry, 56(11), 966-974.e4. https://doi.org/10.1016/j.jaac.2017.08.012