The association between recreational cannabis use and posttraumatic stress disorder: A systematic review and methodological critique of the literature

Indirect Associations Between PTSD Symptoms and Cannabis Problems in Young Adults: The Unique Roles of Cannabis Coping Motives and Medicinal Use Orientation

Background: Cannabis use in young adulthood has been associated with exposure to traumatic events and posttraumatic stress disorder (PTSD). Coping motives for cannabis use represent one mechanism linking PTSD with cannabis problems, yet some individuals with PTSD consider their cannabis use to be medicinal in nature. While a medicinal orientation to cannabis overlaps conceptually with coping motives, it could be associated with unique cannabis outcomes. Objectives: This study examined trauma-related coping motives and medicinal cannabis orientation as mediators of the association between PTSD symptoms and cannabis outcomes in young adults. Method: Data came from an online survey of 212 university students (M age = 19.41; 70.3% Women; 43.4% White) who used cannabis in the past month and endorsed a traumatic life event. Path analyses examined associations of PTSD symptoms with past month cannabis frequency and problems through medicinal cannabis orientation (i.e., number of mental health symptoms that cannabis is used to manage) and trauma-related coping motives. Results: PTSD symptoms were associated with trauma-related coping motives but not with medicinal cannabis orientation. Both trauma-related coping motives and medicinal cannabis orientation were uniquely associated with greater cannabis use frequency, but only trauma-related coping motives were associated with greater cannabis problems. There were significant indirect relationships from PTSD symptoms to cannabis use frequency and problems through trauma-related coping motives but not through medicinal cannabis orientation. Conclusions: Results support unique contributions of trauma-related coping motives and medicinal cannabis orientation to cannabis outcomes and suggest that trauma-related coping motives are specifically implicated in the link between PTSD and cannabis problems.

Longitudinal associations between insomnia, cannabis use and stress among US veterans

Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Directional associations between posttraumatic stress disorder symptoms and cannabis use in young adults: Uncovering variation by sex, race, and ethnicity

OBJECTIVE

Prevalence rates of cannabis use and PTSD vary, with men reporting greater cannabis use than females, females reporting higher rates of PTSD than males, and race and ethnic minority persons reporting higher rates of both cannabis and PTSD compared to non-Hispanic White individuals. This study extends our understanding of directional associations between cannabis use and PTSD from early to late young adulthood (18-26 years old) using two theoretical models: symptom-driven pathway and substance-induced pathway.

METHOD

Participants provided yearly data for 14 years, and the present study utilized data from Waves 9 through 14. Those endorsing Criterion A in at least one wave of data collection (n = 1,454) were included in the analytic sample. We used autoregressive latent trajectory with structured residuals to understand reciprocal associations for the full sample, as well as by sex and race or ethnicity.

RESULTS

For the full sample, we noted support for both symptom-driven and substance-induced pathways during early young adulthood (18-20) but only support for a symptom-driven pathway during late young adulthood (21-26). Males showed the same pattern as the full sample; however, for females, only a symptom-driven pathway during late young adulthood was found. For race and ethnic minority participants, we showed full cross-lagged effects during both early and late young adulthood and no associations for non-Hispanic White individuals.

CONCLUSIONS

Results indicate that both men and individuals from minoritized racial and ethnic groups are more likely to report heightened PTSD symptomology, maladaptive coping, and worsening symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).