Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder
Open accessAbstract
OBJECTIVE: An increasing number of states have approved posttraumatic stress disorder (PTSD) as a qualifying condition for medical marijuana, although little evidence exists evaluating the effect of marijuana use in PTSD. We examined the association between marijuana use and PTSD symptom severity in a longitudinal, observational study. METHOD: From 1992 to 2011, veterans with DSM-III/-IV PTSD (N = 2,276) were admitted to specialized Veterans Affairs treatment programs, with assessments conducted at intake and 4 months after discharge. Subjects were classified into 4 groups according to marijuana use: those with no use at admission or after discharge ("never-users"), those who used at admission but not after discharge ("stoppers"), those who used at admission and after discharge ("continuing users"), and those using after discharge but not at admission ("starters"). Analyses of variance compared baseline characteristics and identified relevant covariates. Analyses of covariance then compared groups on follow-up measures of PTSD symptoms, drug and alcohol use, violent behavior, and employment. RESULTS: After we adjusted for relevant baseline covariates, marijuana use was significantly associated with worse outcomes in PTSD symptom severity (P < .01), violent behavior (P < .01), and measures of alcohol and drug use (P < .01) when compared with stoppers and never-users. At follow-up, stoppers and never-users had the lowest levels of PTSD symptoms (P < .0001), and starters had the highest levels of violent behavior (P < .0001). After adjusting for covariates and using never-users as a reference, starting marijuana use had an effect size on PTSD symptoms of +0.34 (Cohen d = change/SD), and stopping marijuana use had an effect size of -0.18. CONCLUSIONS: In this observational study, initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior, and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.
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Starting or continuing cannabis use during treatment is associated with PTSD symptom exacerbation.
“starting or continuing cannabis use during treatment has been associated with PTSD symptom exacerbation (Wilkinson et al., 2015)”
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 Wilkinson et al., 2015
The Results (Clinical and Community Adjustment Outcomes; page unavailable) report significantly higher PTSD symptom severity at follow-up among starters and continuing users than among never users and stoppers. However, the Methods define starters by use after discharge and continuing users by use at admission and after discharge; the study does not establish that they started or continued use during treatment. (LLM, conf=0.88)
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Self-citation
- Authors
- Wilkinson, S. T., Stefanovics, E., & Rosenheck, R. A.
- Affiliations
- Yale University (US)
- Corresponding author
- Wilkinson, Samuel T.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2015-09-23
- Volume
- 76
- Issue
- 09
- Pages
- 1174-1180
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC6258013
- OpenAlex
- W1772122366
- Cited by
- 145
- References
- 37
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 15 · 2023: 8 · 2022: 12 · 2021: 13 · 2020: 22 · 2019: 17 · 2018: 14 · 2017: 13 · 2016: 10 · 2015: 3
- FWCI
- 16.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R25MH071584)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- cannabis use, post-traumatic stress disorder, PTSD symptom severity, violent behavior, veterans, alcohol consumption, drug use, cannabis cessation, medical cannabis, treatment outcomes
- MeSH terms
- Alcohol Drinking, Employment, Female, Humans, Longitudinal Studies, Male, Marijuana Smoking, Middle Aged, Severity of Illness Index, Stress Disorders, Post-Traumatic, Time Factors, Veterans, Violence, Case-Control Studies, Drug Users
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