Among 3,157 veterans, those with lifetime cannabis use disorder had 1.6 to 2.7 times higher odds of PTSD, mood disorders, anxiety, and suicidal ideation compared to cannabis users without CUD.
Veterans Affairs clinicians, military mental health researchers, and veterans navigating cannabis use decisions.
CUD veterans had 1.6-2.7x higher psychiatric burden than cannabis users without CUD
What the researchers found
Compared to veterans who never used cannabis, those with any lifetime use had elevated odds (ORs 1.5-8.3) of current and lifetime PTSD, mood disorders, anxiety disorders, substance use disorders, suicidal ideation, suicide attempts, and mental health treatment use. Veterans with CUD had even higher odds (ORs 1.6-2.7) of these conditions compared to cannabis users without CUD.
Why it matters
This study quantifies the psychiatric burden associated with cannabis use among veterans at a granular level, distinguishing between any use and disordered use. The graded relationship (more psychiatric burden with CUD than use alone) suggests dose-response dynamics.
The numbers in context
3,157 veterans. Cannabis users vs. never-users: ORs 1.5-8.3 for psychiatric conditions and suicidality. CUD vs. non-CUD cannabis users: ORs 1.6-2.7 for PTSD, mood disorders, anxiety, nicotine and alcohol dependence, and suicidal ideation.
How the study worked
Cross-sectional analysis of 3,157 veterans ages 21-96 from the National Health and Resilience in Veterans Study (NHRVS). Cannabis use and CUD assessed using the Mini International Neuropsychiatric Interview. Compared three groups: never-users, cannabis users without CUD, and those with lifetime CUD.
What this study cannot tell us
Cross-sectional design prevents causal inference. Self-reported cannabis use. Cannot determine temporal ordering of cannabis use and psychiatric conditions. Veteran population may not generalize to civilians.
How to read the evidence
Large nationally representative veteran sample with validated diagnostic interview. Limited by cross-sectional design.
When this study was published
2021 study from the National Health and Resilience in Veterans Study.
The bigger picture
The cross-sectional design leaves open whether cannabis use worsens psychiatric conditions, whether veterans with psychiatric conditions are more drawn to cannabis, or both. The high rates of treatment utilization among cannabis users suggest they are seeking help, which creates opportunities for screening and intervention.
Questions still open
- Does cannabis use precede or follow psychiatric conditions in veterans? Would targeted CUD treatment reduce psychiatric symptom burden? How does the psychiatric profile of veteran cannabis users differ from civilian users?
Common questions
Did cannabis use disorder carry more risk than casual cannabis use?
Were cannabis-using veterans getting treatment?
Read the original research
Burden of cannabis use and disorder in the U.S. veteran population: Psychiatric comorbidity, suicidality, and service utilization.
Journal of affective disorders, 278, 528-535
Citation
Hill, Melanie L; Nichter, Brandon M; Norman, Sonya B; Loflin, Mallory; Pietrzak, Robert H. (2021). Burden of cannabis use and disorder in the U.S. veteran population: Psychiatric comorbidity, suicidality, and service utilization.. Journal of affective disorders, 278, 528-535. https://doi.org/10.1016/j.jad.2020.09.099
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