Cannabis Use Disorder Prevalence and Risk Factors: A Population-Level Analysis
Abstract
Analysis of 42,000 participants found a 9.3% lifetime prevalence of cannabis use disorder, with early onset use and daily use patterns as the strongest predictors. Legalization status was associated with increased prevalence in adjusted models.
Study Summary
This population-level analysis used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative sample of 42,093 US adults. DSM-5 cannabis use disorder (CUD) was assessed via structured diagnostic interview. Lifetime CUD prevalence was 9.3% among ever-users, with 12-month prevalence of 2.9%. Early onset of use (before age 15) was the strongest predictor (OR 4.7). Daily use was associated with OR 6.2 for CUD. States with recreational cannabis legalization showed 23% higher CUD prevalence after adjusting for demographic confounders. High-potency product use was associated with OR 2.8 for CUD. The study found that CUD is substantially underdiagnosed and undertreated — only 7.4% of those meeting CUD criteria had received any treatment in the past year.
Key Findings
- 19.3% lifetime CUD prevalence among ever-users; 12-month prevalence 2.9%
- 2Early onset (before age 15) strongest predictor: OR 4.7 for CUD
- 3Daily use associated with OR 6.2 for CUD development
- 4Recreational legalization states showed 23% higher CUD prevalence
- 5Only 7.4% of those with CUD received treatment — massive treatment gap
Clinical Implications
- CUD screening should be routine in primary care, particularly for daily users and early-onset users
- The treatment gap for CUD is substantial — improved access to CBT and MET is needed
- Legalization policies should be accompanied by public health messaging on CUD risk
- High-potency product use is a modifiable risk factor that clinicians can address
Study Limitations
- Cross-sectional design — cannot establish causal relationships
- Self-reported cannabis use subject to underreporting, particularly in non-legal states
- DSM-5 CUD criteria may over-diagnose tolerance and withdrawal in heavy users
- Survey conducted 2012–2013; cannabis potency and legalization landscape have changed significantly