PTSD contributes to teen and young adult cannabis use disorders
Open accessAbstract
Background Previous studies involving adults suggest that Post Traumatic Stress Disorder (PTSD) increases the prevalence of cannabis use disorders (CUD) (cannabis dependence and cannabis abuse). However, little work with PTSD and CUD has been conducted involving adolescents, despite the fact that CUD typically have their onset during adolescence. This study addresses the effect of PTSD on CUD among teenagers transitioning to young adulthood.Method The subjects in this ongoing study were the offspring of adult men with a lifetime history of a substance use disorder (SUD) (SUD+probands, N=343) vs those with no lifetime history of a SUD (SUD-probands, N=350). The participants were initially recruited when the index sons of these fathers were 10-12 years of age, and subsequent assessments were conducted at age 12-14, 16, 19, 22, and 25. Other variables examined were an index of behavioral undercontrol associated with future risk for developing SUD, known as the Transmissible Liability Index, or TLI, and affiliation with deviant peers. Multivariate logistic regression and path analyses were conducted.Results Of these 693 subjects, 31 subjects were diagnosed with PTSD, and 161 were diagnosed with a CUD. The CUD subjects included 136 male participants and 25 female participants, including 103 (64%) Caucasian participants and 58 (36%) participants of other races. Logistic regression demonstrated that the development of a CUD was associated with deviance of peers (Wald=63.4, p=0.000), the TLI (Wald=28.8, p=0.000), African American race (Wald=14.2, p=0.000), PTSD (Wald=12.7, p=0.000), male gender (Wald=12.0, p=0.001), household SES (Wald=9.2, p=0.002), and being an offspring of a SUD+proband (Wald=6.9, p=0.009). Path analyses demonstrated that PTSD is directly associated with the presence of a CUD and with peer deviance, that higher peer deviance is associated with the presence of a CUD, and that PTSD mediated the association between peer deviance and CUD.Conclusions These findings suggest that PTSD contributes to the etiology of CUD among teenagers making the transition to young adulthood beyond the effects of deviant peers, the TLI (Transmissible Liability Index, a measure of risk for SUD), and demographic factors.
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Individuals with PTSD have elevated rates of cannabis abuse/dependence.
“Notably, elevated rates of cannabis abuse/dependence among individuals with PTSD have been reported48, 49.”
From Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: A positron emission tomography study (2013) · cites this paper as [49]
Patients with PTSD exhibit high rates of cannabis abuse, which may represent a form of self-medication.
“This line of reasoning is corroborated by the observation that patients with PTSD exhibit high rates of cannabis abuse which may represent a form of self-medication [16]”
From Plasma concentrations of endocannabinoids and related primary fatty acid amides in patients with post-traumatic stress disorder (2013) · cites this paper as [16]
Patients with PTSD often abuse cannabinoids.
“Interestingly, patients with PTSD often abuse cannabinoids [16]”
From Plasma concentrations of endocannabinoids and related primary fatty acid amides in patients with post-traumatic stress disorder (2013) · cites this paper as [16]
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BackgroundSelf-citationRacial effects on the clinical presentation of alcoholics at a psychiatric hospital
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MethodSelf-citationPsychiatric classification and publication
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Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090 · see citing works
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“Considering the augmented Cannabis use by post-traumatic stress disorder (PTSD) patients (Kessler et al., 1995; Cornelius et al., 2010), which may present changes in endocannabinoid system functioning (Hauer et al., 2013; Neumeister et al., 2013), this conduct could represent an empirical…”
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“It also appears that social anxiety disorder and post-traumatic stress disorder are risk factors for developing problematic patterns of cannabis use (48,49).”
BackgroundEndocannabinoids and Mental Disorders
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“Posttraumatic stress disorder (PTSD) has also been associated with substance use (Cornelius et al., 2010; Jacobsen et al., 2001), including the self-medication of PTSD symptoms with CNS depressants (such as alcohol, marijuana and opioids) (Jacobsen et al.”
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Advancing the science on cannabis concentrates and behavioural health
Bidwell, L. C., Martin‐Willett, R., & Karoly, H. C. (2021) · Drug and Alcohol Review · doi:10.1111/dar.13281 · Cited by 60 · see citing works
“Further, cannabis use patterns may generally disturb affect with greater levels of use associated with long-term effects on psychiatric conditions [94–96].”
Metrik, J., Stevens, A. K., Gunn, R. L., Borsari, B., & Jackson, K. M. (2020) · Psychological Medicine · doi:10.1017/s003329172000197x · Cited by 55 · see citing works
“, 2018), to our knowledge, only one other longitudinal study has specifically examined the reverse association from PTSD to cannabis-related outcomes finding support for the putative role of PTSD diagnosis in the etiology of CUD (Cornelius et al., 2010).”
Boyes, M. E., Cluver, L. D., & Gardner, F. E. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0046905 · Cited by 52 · see citing works
“PTSD symptoms are often co-morbid with anxiety, depression, and the experiencing of somatic symptoms [16,17,18,19].”
BackgroundInterrelationships among depression, anxiety, flourishing, and cannabis use in youth
Butler, A. E., Patte, K. A., Ferro, M. A., & Leatherdale, S. T. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.10.007 · Cited by 50 · see citing works
“D Available literature has highlighted a presumable association where cannabis users have been found to experience poorer mental health (16,20–23), however, there is limited knowledge related to the patterns and frequency of youth cannabis use and possible factors associated with initial uptake.”
BackgroundNeumeister, A. (2013) · Depression and Anxiety · doi:10.1002/da.22031 · Cited by 47 · see citing works
“These results explain testimonies of PTSD patients who claim that plant-derived cannabinoids provide relief for the haunting nightmares and other symptoms of PTSD and are consistent with the high rates of cannabis abuse among PTSD patients.[9, 10] This attempt at selfmedication with cannabis with its primary psychoact…”
ResultPatterns of Multiple Victimization Among Maltreated Children in Navy Families
Grasso, D. J., Saunders, B. E., Williams, L. M., Hanson, R. F., Smith, D. W., & Fitzgerald, M. M. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21853 · Cited by 45 · see citing works
“This is in accord with studies showing more problems with drug and alcohol use (Cornelius et al., 2010; Danielson et al., 2009), juvenile delinquency (Ford, Hartman, Hawke, & Chapman, 2008), high utilization of intensive mental health services (Koltek, Wilkes, & Atkinson, 1998), and adult conduct…”
ResultSheerin, C. M., Lind, M. J., Bountress, K. E., Marraccini, M. E., Amstadter, A. B., Bacanu, S., & Nugent, N. R. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22484 · Cited by 40 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript conflicting results (Cornelius et al., 2010) and likely high rates of false-positive findings (Koenen, 2007).”
InfluentialFord, J. D., Charak, R., Modrowski, C. A., & Kerig, P. K. (2018) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2018.1441354 · Cited by 37 · see citing works
“This is consistent with reports of a relationship between PV and substance use problems (Chan, 2015; Cornelius et al., 2010; Danielson et al., 2010; Fite et al., 2016; Ford et al., 2010, 2008; Lucenko, Sharkova, Huber, Jemelka, & Mancuso, 2015; Wade et al., 2016).”
ResultDaily-level associations between PTSD and cannabis use among young sexual minority women
Dworkin, E. R., Kaysen, D. L., Bedard‐Gilligan, M. A., Rhew, I. C., & Lee, C. M. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.06.007 · Cited by 36 · see citing works
“…concerning given evidence that PTSD is associated with increased risk for substance use, including cannabis, in the general population (Cougle, Bonn-Miller, Vujanovic, Kvolensky, & Hawkins, 2011; Kevorkian et al., 2015) and in the transition from adolescence to adulthood (Cornelius et al., 2010).”
Backgroundal'Absi, M., & Allen, A. M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.687106 · Cited by 34 · see citing works
“This side of the discussion is based on findings suggesting that cannabis or THC is associated with reduced responses to affective and threatening stimuli (Phan et al., 2008; Gruber et al., 2009; Cornelius et al., 2010; Gorka et al., 2014; Conrad et al., 2015; Childs et al., 2017; Crane and Phan, 2021).”
BackgroundThe Use of Medicinal Marijuana for Posttraumatic Stress Disorder
Yarnell, S. C. (2015) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.15r01786 · Cited by 30 · see citing works
Arranz, S., Monferrer, N., Algora, M. J., Cabezas, Á., Solé, M., Vilella, E., Labad, J., & Sánchez‐Gistau, V. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.04.040 · Cited by 30 · see citing works
Bilevicius, E., Sommer, J. L., Asmundson, G. J. G., & El-Gabalawy, R. M. (2019) · Depression and Anxiety · doi:10.1002/da.22947 · Cited by 27 · see citing works
Neighborhood disorder, peer network health, and substance use among young urban adolescents
Mason, M. J., Light, J. M., Mennis, J. L., Rusby, J. C., Westling, E. H., Crewe, S., Zaharakis, N. M., Way, T., & Flay, B. R. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.05.005 · Cited by 26 · see citing works
“For example, African American adolescents with elevated levels of stress experience greater peer deviance and thus greater likelihood of having a cannabis use disorder diagnosis, highlighting the interactive role of peers and stress on marijuana use (Cornelius et al., 2010).”
Determining Risks for Cannabis Use Disorder in the Face of Changing Legal Policies
Taylor, M. B., Cousijn, J., & Filbey, F. M. (2019) · Current Addiction Reports · doi:10.1007/s40429-019-00288-6 · Cited by 25 · see citing works
Hicks, T. A., Zaur, A. J., Keeley, J. W., & Amstadter, A. B. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109623 · Cited by 23 · see citing works
Lee, J. Y., Brook, J. S., Finch, S. J., & Brook, D. W. (2017) · Substance Abuse · doi:10.1080/08897077.2017.1363121 · Cited by 22 · see citing works
Cole, J., Sprang, G., & Silman, M. (2018) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-018-0239-3 · Cited by 20 · see citing works
Rossi, R., Reda, F., Federico, I., Jannini, T. B., Socci, V., D’Aurizio, G., Pettorruso, M., Pacitti, F., Rossi, A., Martinotti, G., et al. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.10.023 · Cited by 18 · see citing works
Kondev, V., Winters, N. D., & Patel, S. (2021) · International review of neurobiology · doi:10.1016/bs.irn.2020.09.007 · Cited by 17 · see citing works
Murkar, A., Kendzerska, T., Shlik, J., Quilty, L. C., Saad, M., & Robillard, R. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04185-7 · Cited by 17 · see citing works
“Cannabinoids in particular have relevancy to PTSD both as therapeutic products [10–13] as well as drugs of abuse [7, 9].”
BackgroundGilhooly, T., Bergman, A. J., Stieber, J., & Brown, E. J. (2018) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2018.1446861 · Cited by 15 · see citing works
“The majority of the existing evidence suggests that the self-medication hypothesis (Khantzian, 1985) is the most likely, with PTSD preceding SUD (Brady et al., 2000; Cornelius et al., 2010; McFarlane, 1998; Ortiz, 2013; Read et al., 2012; Stewart et al., 1998).”
BackgroundZaharakis, N. M., Mason, M. J., Mennis, J. L., Light, J. M., Rusby, J. C., Westling, E. H., Crewe, S., Flay, B. R., & Way, T. (2017) · Prevention Science · doi:10.1007/s11121-017-0816-y · Cited by 13 · see citing works
Cornelius, J. R., Kirisci, L., Reynolds, M., & Tarter, R. E. (2014) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2014.895833 · Cited by 13 · see citing works
“The current longitudinal study assessed whether life stress mediates the relationship between TLI as assessed at age 10–12 and subsequent development of SUD, after controlling for other relevant factors (7,8,10,11).”
BackgroundSelf-citationKatzman, M. A., Bleau, P., Blier, P., Chokka, P. R., Kjernisted, K. D., & Ameringen, M. V. (2021) · doi:10.32920/14638581 · Cited by 13 · see citing works
Li, Y., Zhi, W.-J., Qi, B., Wang, L.-F., & Hu, X. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2023.1216524 · Cited by 10 · see citing works
“Surveys have shown that an increasing number of patients in the PTSD population are relieving their adverse symptoms by smoking cannabis (Kessler et al., 1995; Cornelius et al., 2010).”
BackgroundPost-traumatic stress disorder symptom clusters predicting substance abuse in adolescents
Donbæk, D. F., Elklit, A., & Pedersen, M. U. (2014) · Mental Health and Substance Use · doi:10.1080/17523281.2013.873071 · Cited by 12 · see citing works
Mauries, S., Dufayet, G., Lengereau, A., Lejoyeux, M., Geoffroy, P. A., & Dupong, I. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.111321 · Cited by 10 · see citing works
Adams, Z. W., Hahn, A. M., McCart, M. R., Chapman, J. E., Sheidow, A. J., Walker, J. H., de Arellano, M. A., & Danielson, C. K. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106742 · Cited by 9 · see citing works
“…PTSD was identified as a significant predictor of drug and alcohol problems above and beyond other risk factors including demographic characteristics, transmissible SUD risk, family factors, trauma exposure, and affiliation with deviant peers (Cornelius et al., 2010; Haller & Chassin, 2014).”
BackgroundKearns, N. T., Powers, M. B., Jackson, W. T., Elliott, T. R., & Ryan, T. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1485180 · Cited by 7 · see citing works
“Previous research has found strong associations between PTSD and several illicit substances, including cannabis [42,43], cocaine [44,45], and heroin [45].”
BackgroundCornelius, J. R., Salloum, I. M., Ferrell, R. E., Douaihy, A. B., Hayes, J., Kirisci, L., Horner, M. S., & Daley, D. C. (2012) · PubMed · Cited by 7 · see citing works
Self-citationDe Aquino, J. P., Sofuoglu, M., Stefanovics, E. A., & Rosenheck, R. A. (2020) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2020.1818248 · Cited by 6 · see citing works
Goodman, G., Blum, B., Rentrop, C. B., Malberg, N. T., & Agrawal, P. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20105789 · Cited by 8 · see citing works
“Furthermore, PTSD is linked with adolescent cannabis use disorder [15] and high rates of concurrent substance misuse [16].”
BackgroundDonbæk, D. F., & Elklit, A. (2015) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-015-0040-5 · Cited by 5 · see citing works
Levelt, W. J. M. (2008) · Cited by 5 · see citing works
Wheeler, P., Stevens-Watkins, D., Dogan, J., & McCarthy, D. (2020) · Journal of Ethnicity in Substance Abuse · doi:10.1080/15332640.2020.1793861 · Cited by 5 · see citing works
“, 2017), higher tendency to use marijuana to cope with racism and psychological distress compared to women (Assari et al., 2019; Brook et al., 2011; Buckner et al., 2016; Cornelius et al., 2010), and greater socioeconomic disadvantage compared to other African American men (Kogan et al.”
BackgroundLe cannabis et les enfants et adolescents canadiens
Grant, C. N., & Bélanger, R. E. (2017) · Paediatrics & Child Health · doi:10.1093/pch/pxx018 · Cited by 4 · see citing works
“Il semble également que le trouble d’anxiété sociale et le syndrome de stress post-traumatique sont des facteurs de risque de profils problématiques de consommation de cannabis (48,49).”
BackgroundGhelani, A. (2020) · The Journal of Sociology & Social Welfare · doi:10.15453/0191-5096.4367 · Cited by 4 · see citing works
“Trauma and post-traumatic stress disorder (PTSD) have additionally been implicated in the emergence of CUD’s among young people (Cornelius et al., 2010; Kevorkian et al., 2015).”
BackgroundCannabis and Psychosis: A Review of the Risk Factors Involved
Amar, M. B. (2020) · American Journal of Plant Sciences · doi:10.4236/ajps.2020.1112139 · Cited by 3 · see citing works
“Moreover, it has been demonstrated that childhood trauma increases the risk of substance abuse, including cannabis consumption, in adolescence and adulthood [142] [143] [144] [145].”
BackgroundSomé, N. H., Wells, S. L., Felsky, D., Hamilton, H. A., Ali, S., Elton‐Marshall, T., & Rehm, J. T. (2021) · Research Square · doi:10.21203/rs.3.rs-828073/v1 · Cited by 3 · see citing works
Cohen-Filipic, K. (2013) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/mtx8-5d83 · Cited by 2 · see citing works
Cornelius, J. R., Kirisci, L., Reynolds, M., Vanyukov, M. M., & Tarter, R. E. (2015) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2015.1011744 · Cited by 2 · see citing works
“The development of the TLI has allowed a quantitative assessment of risk for SUD, utilizing an instrument with proven predictive validity and reliability (7,23).”
Self-citationButler, A. E. (2018) · UWSpace (University of Waterloo) · Cited by 2 · see citing works
Pütz, A., Hapfelmeier, G., Martin, A., Bender, S., & Walg, M. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15090177 · Cited by 1 · see citing works
“There is evidence that PTSD is often overlooked in clinical evaluations of adolescents with substance use disorders (Cornelius et al., 2010).”
Cornelius, J. R., & Kirisci, L. (2013) · PubMed · Cited by 1 · see citing works
Self-citationBlum, B., Goodman, G., Rentrop, C. B., Malberg, N. T., & Agrawal, P. (2022) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2022.2127625 · Cited by 1 · see citing works
“Research also indicates that PTSD contributes to adolescent cannabis use disorder (Cornelius et al., 2010) and has a high comorbidity with adolescent substance misuse in general (Zeitlin, 1999).”
BackgroundKatzman, M. A., Bleau, P., Blier, P., Chokka, P. R., Kjernisted, K. D., & Ameringen, M. V. (2021) · doi:10.32920/14638581.v1 · Cited by 1 · see citing works
Webster, V. (2013) · University of the Witwatersrand, Johannesburg Institutional Repository on DSpace (University of the Witwatersrand, Johannesburg) · Cited by 1 · see citing works
Trauma and Adolescent Addiction
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Posttraumatic Stress Disorder: Neurological, Genetic, and Epigenetic Bases
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PTSD and Substance Abuse Treatment
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“National epidemiological data suggest that lifetime CUD prevalence is around 6.3% [68], with a PTSD diagnosis increasing the prevalence of CUD [69].”
InfluentialAlejo, E. G., & Arias, J. M. C. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108214
- Authors
- Cornelius, J. R., Kirisci, L., Reynolds, M., Clark, D. B., Hayes, J., & Tarter, R.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Cornelius, Jack R.
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2010-02
- Volume
- 35
- Issue
- 2
- Pages
- 91-94
- ISSN
- 0306-4603 (ISSN-L)
- PMC
- PMC2784238
- OpenAlex
- W1988593105
- Cited by
- 80
- References
- 40
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 9 · 2019: 2 · 2018: 7 · 2017: 7 · 2016: 3 · 2015: 7 · 2014: 7 · 2013: 10 · 2012: 4
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (K24AA015320, R01AA013370, K24 AA15320, R01AA015173, R01 AA14357, K02AA000291, R01AA014357, R01AA013397, R01AA 13397)
- National Institute on Drug Abuse (R01 DA 14635, P50-DA 05605, K02DA017822, R01DA014635, P50DA005605, R01DA019142)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- post-traumatic stress disorder, cannabis use disorder, adolescents, young adults, peer deviance, substance use disorder risk, mediation, African American youth, household socioeconomic status, gender differences, transition to young adulthood, addiction treatment, substance use disorder recovery
- MeSH terms
- Adolescent, Adult, Marijuana Abuse, Child, Female, Humans, Longitudinal Studies, Male, Pennsylvania, Risk Factors, Stress Disorders, Post-Traumatic, Young Adult
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