Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use
Background: The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high‐risk sample of military personnel not active in mental health treatment.
Conclusions: Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD.
(Source: Published Depression & Anxiety https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22954)
Marijuana Use is Associated with Worse Outcomes in Symptom Severity and Violent Behavior in Patients with PTSD
Conclusions: The above limitations notwithstanding, our study has suggestive implications for clinical practice and public policy. The results of our study provide no support for the hypothesis that marijuana is associated with general improvement in PTSD symptoms and the observed associations suggest that it may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Especially in light of the adverse health effects of marijuana use,1 these data indicate that providers should be cautious or even avoidant in using this agent to treat PTSD. Given that our study only shows associations and not causation, it remains possible that more severe PTSD symptoms drive people to seek marijuana to transiently self-medicate symptoms. Prospective randomized clinical trials would be needed to establish a more definitive understanding of the impact of marijuana use on individuals with PTSD
- Medical marijuana has been approved for treatment of post-traumatic stress disorder (PTSD) in several states, despite an absence of clinical trials evaluating efficacy and safety
- Psychiatrists are frequently asked whether they would recommend marijuana for PTSD
- This study shows that starting marijuana use may be associated with worse outcomes in PTSD
The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders
Abstract: The objective of the present study was to assess the association between cannabis use disorder (CUD) and self-injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and non-cannabis drug use disorder, CUD was significantly associated with both suicidal (OR=3.10, p=0.045) and nonsuicidal (OR=5.12, p=0.009) self-injury. CUD was the only variable significantly associated with self-injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans’ risk for self-injurious behavior. Keywords: Nonsuicidal self-injury, suicide, suicide attempts, posttraumatic stress disorder, depression, veterans
Despite the strong political push for legalization of cannabis, many questions and concerns have been raised regarding the safety of the drug, as heavy cannabis use has been associated with an array of physical and mental health problems, including pulmonary problems, cognitive impairment, lower levels of educational attainment, unemployment, and increased risk for mental health disorders, such as cannabis use disorder (CUD) and psychotic disorders (e.g., Borges et al., 2016; Curran et al., 2016; Gentes et al., 2016; Goldman et al., 2010; Hoch et al., 2015; Joshi et al., 2014; Sherman & McRae-Clark, 2016).
One area of research particularly important to the debate concerning cannabis legalization is the relationship between heavy cannabis use and self-injury. There has been only limited research on this association to date (e.g., Borges et al., 2016; Giletta et al., 2012; Moller et al., 2012), none of which has focused on veterans with mental health disorders—a population known to be at markedly increased risk for both suicidal and nonsuicidal self-injury (e.g., Bullman & Kang, 1994; Kimbrel et al., 2014a, 2014b, 2016a, 2016b). The present study aimed to address this gap in the literature by conducting the first comprehensive assessment of the association between CUD and self-injury among veterans with and without mental health disorders.
Cannabis Use and Self-injury in Veterans: Taken together, the findings from the literature reviewed above suggest that cannabis use is likely to be associated with increased risk for both suicidal and nonsuicidal self-injury in civilians. Unfortunately, the association between cannabis use and self-injury has been largely overlooked among veterans to date. The lack of research on this topic is surprising, given that a recent study found that rates of CUD had increased by over 50% among veterans who received their care from the Veterans Affairs (VA) Health Care System between 2002 and 2009 (Bonn-Miller et al., 2012). Other recent studies have shown that veterans with PTSD, depression, and other mental health disorders are at elevated risk for both suicidal (e.g., Kimbrel et al., 2014b e.g., Kimbrel et al., 2016b) and nonsuicidal self-injury (Kimbrel et al., 2014a, 2015a, 2016a). However, to our knowledge, no study has examined the relationship between CUD and self-injury in veterans to date, although one recent study did find that self-reported cannabis use was positively associated with self-reported suicidal ideation in a large sample of male veterans seeking treatment for PTSD (Gentes et al., 2016). This study did not, however, evaluate the relationship between cannabis use and actual self-injury (i.e., actual suicide attempts or nonsuicidal self-injury).