Date of Award

4-1-2023

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Rob Lyerla, Ph.D., MGIS.

Second Advisor

Kieran J. Fogarty, Ph.D.

Third Advisor

Margaret E. Mattson, Ph.D.

Keywords

DSM-5, marijuana use disorders, marijuana/cannabis, national survey on drug use and health, prevalence

Abstract

Despite that marijuana (cannabis) is still considered, under federal law, an illegal Schedule I drug, marijuana is the most commonly used illicit substance in the United States. National trend data has shown that the prevalence of marijuana use has increased over time, particularly among those aged 18 years and older. Some individuals can use marijuana without harm; however, long-term and heavy marijuana users may experience health consequences, including marijuana use disorders (addiction). For the last 20 years, existing national and statelevel epidemiological, surveillance, and research data have analyzed marijuana use disorders (MUD) using previous diagnostic criteria (DSM-IV). There is limited published data analyzing recently incorporated DSM-5 diagnostic criteria into the National Survey on Drug Use and Health, a nationally representative cross-sectional annual survey that samples the civilian U.S. noninstitutionalized population. The following dissertation assesses and characterizes MUD estimates and correlates across different behavioral health domains using publicly available 2020 data from the National Survey on Drug Use and Health.

The first study examines basic sociodemographic and selected behavioral indicators associated with MUD. The results found that the 2020 MUD prevalence estimate (DSM-5) is almost three times higher than the 2019 estimate (DSM-IV). The results also found differences in the percentage of MUD by age, race/ethnicity, household income, employment status, education level, and selected behavioral health indicators. More than seventy percent of the respondents classified with MUD self-reported having marijuana cravings, and withdrawal symptoms, and that using marijuana in the past year has caused problems with family/friends and the law. In addition, seventy percent of the respondents classified with MUD self-reported that they may have obtained their marijuana via an unlawful market (outside of a marijuana store or dispensary).

The second study assesses the prevalence and correlation of having MUD among selected variables related to substance use and mental health conditions. Results found that MUD (DSM- 5) is prevalent and associated with comorbidities related to behavioral health (substance use and mental health). Findings show that early initiation (prior to 18 years of age), and current use of marijuana (past 30-days) is highly correlated with having MUD. Regression analyses also indicated that current use of substances (tobacco/nicotine and illicit drugs other than marijuana), substance use disorders, and having a diagnosis of a mental health condition are likely associated with having MUD. The study confirms that the co-occurrence of substance use, including substance use disorders, and selected mental health conditions are common, prevalent, and correlated among individuals with MUD.

The third study examines the prevalence and correlation among individuals who met the DSM-5 diagnostic criteria for MUD seeking substance use treatment. Results found that more than half of respondents with MUD self-reported receiving marijuana-specific treatment. Nevertheless, more than one-third of respondents with MUD felt the need for treatment, but they did not receive treatment (treatment gap) in the past year. A multiple logistic regression analysis found differences in correlates by the different types of treatment-related questions.

Characterizing and understanding, comorbidities, and utilization treatment patterns among individuals with MUD may shed a light on better and targeted public health interventions, especially in an ongoing and evolving marijuana policy landscape. This three-paper dissertation study establishes a national baseline for MUD and other behavioral health characteristics. Characterizing MUD by using the DSM-5 diagnostic criteria could help other national studies understand future marijuana use disorder patterns and also aid federal or local public health officials propose or modify existing marijuana-related legislation or public health policy.

Access Setting

Dissertation-Open Access

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