Cannabis use disorder was more strongly linked to veteran suicide risk than alcohol use disorder alone

What the researchers found

Among veterans with AUD, 8.7% also had CUD, while 33.3% of those with CUD also had AUD. CUD alone carried higher odds of suicidal ideation and planning than AUD alone. Compared to AUD-only veterans, those with CUD-only had 6.1 times higher odds of lifetime suicide planning and 2.6 times higher odds of lifetime suicidal ideation. Comorbid AUD/CUD carried 3.3 times higher odds of past-year suicidal ideation vs. AUD alone.

Why it matters

Veterans have elevated suicide risk, and substance use disorders are known contributors. This study reveals that CUD may be a stronger indicator of suicide risk than AUD in veterans, challenging the typical clinical focus on alcohol as the primary substance concern.

The numbers in context

4,069 veterans. CUD-only vs. AUD-only: OR 6.1 for lifetime suicide plans, OR 2.6 for lifetime ideation, OR 2.4 for past-year ideation. AUD/CUD comorbid vs. AUD-only: OR 3.3 for past-year ideation, OR 1.9 for lifetime ideation, OR 1.7 for lifetime plans. All ORs adjusted for psychiatric covariates.

How the study worked

Cross-sectional analysis of 4,069 veterans from the 2019-2020 NHRVS. Compared past-year and lifetime suicidal ideation, plans, and attempts across groups: AUD only, CUD only, comorbid AUD/CUD, and neither. Odds ratios adjusted for sociodemographic, military, trauma, and psychiatric factors.

What this study cannot tell us

Cross-sectional design cannot establish causation. CUD and suicidality may share underlying risk factors (trauma, depression). Screening-based CUD identification, not clinical diagnosis. Cannot determine temporal ordering of CUD and suicidality.

How to read the evidence

Large nationally representative veteran sample with comprehensive covariate adjustment. Cross-sectional design limits causal inference but associations are robust.

When this study was published

2021 study from the National Health and Resilience in Veterans Study.

The bigger picture

As cannabis becomes more available through state legalization, routine screening for CUD in veterans could be as important as alcohol screening for suicide prevention. The finding that CUD alone outpaces AUD alone in suicide risk indicators suggests cannabis-specific clinical attention is warranted.

Questions still open

• Why is CUD more strongly associated with suicidality than AUD in veterans? Is cannabis use a marker for undertreated psychiatric conditions? Would CUD treatment reduce suicide risk in veterans?

Common questions

Read the original research

Comparative associations of problematic alcohol and cannabis use with suicidal behavior in U.S. military veterans: A population-based study.

Journal of psychiatric research, 135, 135-142

Citation

Hill, Melanie L; Nichter, Brandon; Loflin, Mallory; Norman, Sonya B; Pietrzak, Robert H. (2021). Comparative associations of problematic alcohol and cannabis use with suicidal behavior in U.S. military veterans: A population-based study.. Journal of psychiatric research, 135, 135-142. https://doi.org/10.1016/j.jpsychires.2021.01.004

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