Among homeless individuals in British Columbia, cannabis users had higher rates of psychotic disorders (32%) and depression linked to childhood emotional neglect, while stimulant users were more likely female, poly-substance users, and engaged in survival sex.
Read this if you work with homeless populations or are interested in the connections between trauma, substance use, and mental illness.
32% of cannabis users in the homeless sample had psychotic disorders
What the researchers found
Researchers compared cannabis and stimulant use patterns among a homeless population in British Columbia, finding distinct profiles for each substance.
Cannabis users had notably higher rates of lifetime psychotic disorders (32%). Among incarcerated cannabis users, there was greater childhood emotional neglect, and one in two had lifetime depressive disorders. Stimulant users were more likely to be female (43%), use multiple substances (average 3.2), and engage in survival sex (14%).
Childhood physical abuse and Caucasian ethnicity were associated with greater crack cocaine use. The findings suggest a developmental cascade where childhood abuse leads to depression and psychopathology, increasing cannabis dependence risk and potentially contributing to psychosis development.
Why it matters
Understanding different trauma and mental health profiles associated with different substances can inform targeted interventions for homeless populations, rather than treating all substance use the same way.
The numbers in context
32% of cannabis users had lifetime psychotic disorders; stimulant users: 43% female, 3.2 average substances, 14% survival sex; 50% of incarcerated cannabis users had depressive disorders; childhood emotional neglect linked to cannabis use
How the study worked
Cross-sectional analysis from the BC Health of the Homeless Study, conducted in three British Columbia cities. Used the Maudsley Addiction Profile, Childhood Trauma Questionnaire, and MINI Plus psychiatric interview.
What this study cannot tell us
Cross-sectional design cannot determine causal directions. Homeless populations have unique characteristics limiting generalizability. Self-reported trauma and substance use. Cannot separate pre-existing psychiatric vulnerability from substance effects.
How to read the evidence
Cross-sectional study with validated instruments, but specific to a homeless population and unable to establish causal pathways.
When this study was published
Published in 2015. The intersection of homelessness, trauma, and substance use remains a critical public health issue.
The bigger picture
Homelessness, trauma, substance use, and mental illness are deeply intertwined. Effective interventions need to address all of these factors together, and the specific substance used may signal different underlying trauma histories and psychiatric needs.
Questions still open
- Does childhood emotional neglect specifically predispose to cannabis use and psychosis, or is this association mediated by depression? Would trauma-informed treatment reduce cannabis-related psychosis in homeless populations?
Common questions
Why is cannabis linked to psychosis in homeless populations?
Do different drugs attract different people?
Read the original research
Stimulants and Cannabis Use Among a Marginalized Population in British Columbia, Canada: Role of Trauma and Incarceration.
International journal of offender therapy and comparative criminology, 59(13), 1487-98
Citation
Saddichha, Sahoo; Werker, Gregory R; Schuetz, Christian; Krausz, Michael R. (2015). Stimulants and Cannabis Use Among a Marginalized Population in British Columbia, Canada: Role of Trauma and Incarceration.. International journal of offender therapy and comparative criminology, 59(13), 1487-98. https://doi.org/10.1177/0306624X14541661
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