Weekly Cannabis Use Was Linked to Greater Social Anxiety Severity and Suicide Risk in a National Sample | Research

The takeaway

Among people with social anxiety disorder, at least weekly cannabis use was associated with greater symptom severity, treatment-seeking, and suicide attempt history, making frequency of use a more important marker than formal cannabis use disorder diagnosis.

Clinicians treating social anxiety, cannabis users with social anxiety, mental health researchers.

Weekly cannabis use linked to greater suicide risk in people with social anxiety disorder

What the researchers found

In both lifetime (N=1,255) and past-year (N=980) SAD samples, weekly+ cannabis use was significantly related to fear or avoidance of social situations interfering with relationships. Weekly+ use and CUD were associated with lifetime SAD severity, but only weekly+ use was associated with past-year severity. Weekly+ use but not CUD was related to greater odds of seeking SAD treatment and suicide attempt history.

Why it matters

Frequency of cannabis use may be a better clinical marker than a formal CUD diagnosis for identifying people with social anxiety who are at greater risk. The suicide risk finding is particularly important for clinicians assessing anxious patients who use cannabis.

The numbers in context

N=1,255 lifetime SAD, N=980 past-year SAD. Weekly+ use associated with greater SAD severity, treatment-seeking, and suicide attempt history. CUD associated with lifetime but not past-year severity. Weekly+ use was the stronger marker overall.

How the study worked

Cross-sectional analysis of a large nationally representative sample using DSM-5 criteria. Examined lifetime (N=1,255) and past-year (N=980) social anxiety disorder subsamples.

What this study cannot tell us

Cross-sectional design cannot determine causation. Self-reported cannabis use. People with worse anxiety may use more cannabis rather than cannabis worsening anxiety. DSM-5 criteria may classify differently than earlier versions.

How to read the evidence

Large nationally representative sample with DSM-5 criteria, limited by cross-sectional design.

When this study was published

Published 2023.

The bigger picture

Many people with social anxiety use cannabis to cope with social situations, but this study suggests that frequent use is associated with worse anxiety outcomes, not better. This challenges the self-medication narrative and suggests cannabis may perpetuate the avoidance cycle in SAD.

Questions still open

Does cannabis use worsen social anxiety or do more anxious people use more cannabis?
Would reducing cannabis use frequency improve social anxiety outcomes?

Common questions

Does cannabis help with social anxiety?

This study found the opposite pattern: weekly+ cannabis use was associated with worse social anxiety symptoms, more treatment-seeking, and higher suicide risk. Frequency of use was a better marker of severity than CUD diagnosis.

Is cannabis use linked to suicide risk in anxious people?

Yes. Weekly+ cannabis use was associated with greater odds of suicide attempt history in people with social anxiety disorder.

Read the original research

Prevalence and correlates of cannabis use among individuals with DSM-5 social anxiety disorder: Findings from a nationally representative sample.

Journal of psychiatric research, 163, 406-412

View on PubMed ↗Publisher’s paper ↗

Citation

Patel, Tapan A; Schubert, Frederick T; Zech, James M; Cougle, Jesse R. (2023). Prevalence and correlates of cannabis use among individuals with DSM-5 social anxiety disorder: Findings from a nationally representative sample.. Journal of psychiatric research, 163, 406-412. https://doi.org/10.1016/j.jpsychires.2023.05.079