Recreational cannabis legalization broke the link between perceiving cannabis as low-risk and entering treatment: teens used more cannabis but sought less treatment, suggesting legalization changes social norms around treatment-seeking.
Adolescent health policymakers, substance use treatment providers, and cannabis legalization researchers.
What the researchers found
Before legalization, perceiving cannabis as low-risk predicted more use, which predicted more CUD treatment admissions. After legalization, the perception-to-use link strengthened but the use-to-treatment link was suppressed. The indirect effect of low-risk perception on treatment admissions via cannabis use existed before legalization but disappeared after.
Why it matters
Declining teen treatment admissions after legalization could be misread as declining need. This study suggests the decline reflects changing social norms and self-medication patterns, not less problematic use, meaning more teens with CUD may be going untreated.
The numbers in context
542 state-year observations from 2008-2019. Positive indirect effect of low-risk perception on CUD treatment via cannabis use before legalization, but not after. Legalization strengthened perception-to-use pathway and suppressed use-to-treatment pathway.
How the study worked
Two-way fixed effects (state and year) moderated mediation model using NSDUH and TEDS-A data from 2008-2019 (542 state-year observations) examining adolescents aged 12-17 across US states.
What this study cannot tell us
State-level prevalence data cannot capture individual-level pathways. Cannot distinguish between voluntary and mandated treatment admissions (legal referrals may decline with legalization). 2008-2019 data precedes the most recent legalization wave.
How to read the evidence
Large national dataset with sophisticated mediation model and state/year fixed effects. Ecological design (state-level data) limits individual-level inference.
When this study was published
2024 publication using 2008-2019 data.
The bigger picture
Legalization creates a paradox for adolescent health: it increases cannabis use while simultaneously making treatment feel less necessary. Without proactive outreach, a growing population of teens with problematic use may never connect with treatment services.
Questions still open
- Are teens with CUD in legalized states going untreated at higher rates?
- Would school-based screening programs counteract the decline in treatment-seeking after legalization?
Common questions
Why would treatment admissions drop if use is increasing?
Does this mean legalization is bad for teens?
Read the original research
Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization.
Substance use & misuse, 59(6), 962-970
Citation
Mennis, Jeremy; Stahler, Gerald J; Coffman, Donna L. (2024). Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization.. Substance use & misuse, 59(6), 962-970. https://doi.org/10.1080/10826084.2024.2310500
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide