Residential PTSD treatment outcomes during cognitive processing therapy for veterans with and without recent histories of cannabis use
Abstract
Prior evidence has suggested that cannabis use is associated with greater posttraumatic stress disorder (PTSD) symptom severity and worse outcomes following trauma-focused treatment. However, lack of high-quality randomized studies necessitates the use of clinical data to clarify the relationship between cannabis use and PTSD treatment to help inform clinical practice. A total of 114 veterans completed cognitive processing therapy in a residential PTSD treatment program. Differences in treatment response between cannabis users and nonusers were evaluated for measures of PTSD, depression, and posttraumatic growth using analysis of covariance to control for pretreatment scores and other drug use. At baseline, cannabis users reported higher levels of PTSD symptom severity relative to nonusers but reported similar levels of depression and posttraumatic growth. Significant differences between groups in the amount of change were not observed on any of the measures from before to after treatment; however, the total sample reported significant improvements in all measures of interest. These results suggest that PTSD treatment outcomes for cannabis users may be similar to nonusers when use is stopped during treatment. Additional data are needed regarding whether outcomes remain similar at follow-up, whether cannabis users maintain abstinence after treatment, and the impact of resumed cannabis use on PTSD symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Some studies have failed to find an association between cannabis use and PTSD treatment outcomes.
“However, other studies have failed to find an association between cannabis use and PTSD treatment outcomes (De Aquino et al., 2020; Hale et al., 2021; Petersen et al., 2021; Ruglass, Shevorykin et al., 2017).”
From Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data (2024) · cites this paper as Hale et al., 2021
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State of the Science of Cognitive Processing Therapy
Resick, P. A., LoSavio, S. T., Monson, C. M., Kaysen, D. L., Wachen, J. S., Galovski, T. E., Stirman, S. W., Nixon, R. D. V., & Chard, K. M. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.04.003 · Cited by 39 · see citing works
“…neither current nor past SUD, hazardous drinking, or cannabis use predict poorer PTSD outcomes or higher dropout from CPT among active-duty service members or veterans (Dondanville et al., 2019; Hale et al., 2021; Held et al., 2021; Kaysen et al., 2014; LoSavio et al., 2023 Straud et al., 2021).”
Effects of Cannabis on PTSD Recovery: Review of the Literature and Clinical Insights
Bedard‐Gilligan, M. A., Lehinger, E. A., Cornell-Maier, S., Holloway, A., & Zoellner, L. A. (2022) · Current Addiction Reports · doi:10.1007/s40429-022-00414-x · Cited by 16 · see citing works
“Notably, cannabis use does not appear to be associated with PTSD treatment response among individuals with either a primary PTSD diagnosis [83, 84] or co-occurring PTSD and substance use disorder diagnoses [85].”
BackgroundHill, M. L., Kline, A. C., Saraiya, T. C., Gette, J., Ruglass, L. M., Norman, S. B., Back, S. E., Saavedra, L. M., Hien, D. A., & Morgan-López, A. A. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102827 · Cited by 11 · see citing works
Understanding the Role of Endocannabinoids in Posttraumatic Stress Disorder
Ney, L. J. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26125527 · Cited by 6 · see citing works
“It is interesting to note that meta-analysis suggests that trauma-focused therapy works equally well regardless of cannabis use in patients with PTSD [363,364].”
Kimbrel, N. A., Dennis, P. A., Patel, T. A., Halverson, T. F., Dillon, K. H., Stephenson, M. E., Bourassa, K. J., Patel, P. R., Qin, X. J., Barr, P. B., et al. (2026) · Archives of Suicide Research · doi:10.1080/13811118.2026.2683477
- Authors
- Hale, A. C., Bremer-Landau, J., Wright, T. P., McDowell, J. E., & Rodriguez, J. L.
- Affiliations
- VA Ann Arbor Healthcare System (US)
- Battle Creek VA Medical Center (US)
- Venue
- Psychological Services
- Published
- 2021-11
- Volume
- 18
- Issue
- 4
- Pages
- 497-503
- ISSN
- 1541-1559 (ISSN-L)
- 1939-148X
- OpenAlex
- W3010068503
- Cited by
- 6
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 1
- FWCI
- 0.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, cannabis use, cognitive processing therapy, veterans, treatment response, depression, posttraumatic growth, cannabis abstinence, trauma-focused psychotherapy
- MeSH terms
- Cannabis, Humans, Stress Disorders, Post-Traumatic, Veterans, Cognitive Behavioral Therapy, Treatment Outcome
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