Cannabis Use Disorder Is Strongly Linked to Generalized Anxiety Under DSM-5 Criteria
Using DSM-5 criteria in a nationally representative sample, generalized anxiety disorder was significantly associated with cannabis use disorder, with lifetime GAD linked to lifetime CUD and past-year GAD linked to past-year CUD.
Quick Facts
What This Study Found
Lifetime GAD was associated with lifetime alcohol and cannabis use disorders but not tobacco. Past-year GAD was associated with past-year cannabis and tobacco use disorders but not alcohol. Alcohol use disorder (but not CUD or TUD) was associated with higher GAD treatment-seeking.
Key Numbers
NESARC-III nationally representative sample. Lifetime GAD positively associated with lifetime alcohol and cannabis use disorder. Past-year GAD associated with past-year cannabis and tobacco use disorder. Controlled for demographics and comorbidities.
How They Did This
Cross-sectional analysis of the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), examining associations between DSM-5 GAD and alcohol, cannabis, and tobacco use disorders with demographic covariates.
Why This Research Matters
The relationship between anxiety and cannabis use is often debated — do anxious people self-medicate with cannabis, or does cannabis cause anxiety? This large national study using updated DSM-5 criteria helps clarify these comorbidity patterns.
The Bigger Picture
Many cannabis users report using it for anxiety, yet this study shows GAD and CUD frequently co-occur. The finding that people with CUD+GAD don't seek treatment more than GAD alone suggests cannabis may serve as self-medication that delays formal care.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine direction of causation. Self-reported substance use and mental health diagnoses. NESARC-III data collected before recent waves of cannabis legalization.
Questions This Raises
- ?Does treating GAD reduce cannabis use disorder, or vice versa?
- ?Should anxiety screening be standard in cannabis use disorder treatment programs?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large nationally representative sample with comprehensive diagnostic assessment — strong evidence for the comorbidity pattern, though causation cannot be established.
- Study Age:
- Recent analysis using DSM-5 criteria to update understanding of the GAD-substance use disorder relationship.
- Original Title:
- Prevalence and correlates of alcohol, cannabis, and tobacco use disorder in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.
- Published In:
- Journal of anxiety disorders, 115, 103060 (2025)
- Authors:
- Zech, James M(3), Patel, Tapan A(2), Cougle, Jesse R(3)
- Database ID:
- RTHC-08025
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Are people with anxiety more likely to develop cannabis use disorder?
This study found a significant association — people with generalized anxiety disorder were more likely to have cannabis use disorder. However, the cross-sectional design can't tell us which came first.
Does cannabis help or worsen anxiety?
The co-occurrence of GAD and CUD suggests a complex relationship. While many people use cannabis for anxiety relief, the association with disordered use raises concerns about self-medication that may maintain or worsen the underlying condition.
Read More on RethinkTHC
- anxiety-leaving-house-weed-withdrawal-agoraphobia
- anxiety-response-technique-weed-withdrawal
- anxiety-toolkit-weed-withdrawal
- anxiety-worse-after-quitting-weed
- breathing-exercises-weed-withdrawal-anxiety
- cannabis-induced-anxiety
- does-weed-help-anxiety
- grounding-techniques-weed-withdrawal
- health-anxiety-weed-withdrawal
- manage-anxiety-without-weed
- quitting-weed-anxiety-disorder
- quitting-weed-anxiety-medication-ssri
- self-medicating-anxiety-with-weed
- therapy-quitting-weed-anxiety
- weed-and-anxiety
- weed-biphasic-effect-anxiety
- weed-generalized-anxiety-disorder
- weed-panic-attacks
- weed-paranoia
- weed-social-anxiety
- weed-tolerance-anxiety-stopped-working
- weed-withdrawal-anxiety
- weed-withdrawal-panic-attacks-night
- weed-withdrawal-work-anxiety
- withdrawal-anxiety-vs-real-anxiety
Cite This Study
https://rethinkthc.com/research/RTHC-08025APA
Zech, James M; Patel, Tapan A; Cougle, Jesse R. (2025). Prevalence and correlates of alcohol, cannabis, and tobacco use disorder in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.. Journal of anxiety disorders, 115, 103060. https://doi.org/10.1016/j.janxdis.2025.103060
MLA
Zech, James M, et al. "Prevalence and correlates of alcohol, cannabis, and tobacco use disorder in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.." Journal of anxiety disorders, 2025. https://doi.org/10.1016/j.janxdis.2025.103060
RethinkTHC
RethinkTHC Research Database. "Prevalence and correlates of alcohol, cannabis, and tobacco ..." RTHC-08025. Retrieved from https://rethinkthc.com/research/zech-2025-prevalence-and-correlates-of
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.