Cannabis use disorder was more strongly linked to veteran suicide risk than alcohol use disorder alone
Among 4,069 veterans, those with cannabis use disorder had higher odds of suicidal ideation and planning than those with alcohol use disorder alone, even after controlling for psychiatric and trauma factors.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- CUD-only veterans had 6x higher odds of lifetime suicide planning vs. AUD-only
- Evidence Grade:
- Large nationally representative veteran sample with comprehensive covariate adjustment. Cross-sectional design limits causal inference but associations are robust.
- Study Age:
- 2021 study from the National Health and Resilience in Veterans Study.
- Original Title:
- Comparative associations of problematic alcohol and cannabis use with suicidal behavior in U.S. military veterans: A population-based study.
- Published In:
- Journal of psychiatric research, 135, 135-142 (2021)
- Authors:
- Hill, Melanie L(7), Nichter, Brandon(3), Loflin, Mallory(6), Norman, Sonya B, Pietrzak, Robert H
- Database ID:
- RTHC-03200
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Is cannabis more dangerous than alcohol for veteran suicide risk?
This study found CUD was more strongly associated with suicidal ideation and planning than AUD among veterans, but cross-sectional data cannot prove causation. CUD may be a marker for other risk factors rather than a direct cause.
How common is comorbid alcohol and cannabis use disorder in veterans?
Among veterans who screened positive for CUD, one-third (33.3%) also screened positive for AUD. Among those with AUD, 8.7% also had CUD. The comorbid group had the highest suicide risk indicators.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-03200APA
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
MLA
Hill, Melanie L, et al. "Comparative associations of problematic alcohol and cannabis use with suicidal behavior in U.S. military veterans: A population-based study.." Journal of psychiatric research, 2021. https://doi.org/10.1016/j.jpsychires.2021.01.004
RethinkTHC
RethinkTHC Research Database. "Comparative associations of problematic alcohol and cannabis..." RTHC-03200. Retrieved from https://rethinkthc.com/research/hill-2021-comparative-associations-of-problematic
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.