Cannabis Use Disorder Is Strongly Linked to Generalized Anxiety Under DSM-5 Criteria | Research

The takeaway

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.

Mental health clinicians, addiction specialists, people with anxiety who use cannabis, and researchers studying substance use-mental health comorbidity.

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Large nationally representative sample with comprehensive diagnostic assessment — strong evidence for the comorbidity pattern, though causation cannot be established.

When this study was published

Recent analysis using DSM-5 criteria to update understanding of the GAD-substance use disorder relationship.

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.

Questions still open

Does treating GAD reduce cannabis use disorder, or vice versa? Should anxiety screening be standard in cannabis use disorder treatment programs?

Common 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 the original research

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

View on PubMed ↗Publisher’s paper ↗

Citation

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