One of the concerns about the growing legalization of marijuana is that people will abuse it rather than using it responsibly. Many people believe that marijuana is both safer and less addictive than other drugs, but there is such a thing as cannabis use disorder. Currently, much attention is placed on preventing adolescents from using marijuana, both because it’s illegal for people under 18 and because the drug can have particularly harmful effects on developing brains. However, researchers from the Duke University School of Medicine decided that we also need to address how to deal with marijuana abuse among older people.

A study published in the Journal of the American Academy of Child and Adolescent Psychiatry looked at the risk factors of problematic marijuana use in young adults. The researchers analyzed data available on 1,229 people who were taking part in the Great Smoky Mountains Study, which is a survey of children and adolescents in North Carolina originally designed to identify young people with emotional and behavioral disorders. The participants were followed between 1993 and 2015, and they were assessed every year between age 9 and 16, as well as at ages 19, 21, 26, and 30. Their mental health, education, work, and drug and alcohol use were all monitored.

The researchers used the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria for cannabis use disorder, which is defined as a pattern marked by at least two of the following occurring in a 12-month period:

  • Cannabis is often taken in larger amounts over a longer period than was intended.
  • A persistent desire or insignificant effort to cut down or control cannabis use.
  • A great deal of time is spent in activities necessary to obtain cannabis, use cannabis or recover from its effects.
  • Craving or a strong desire or urge to use cannabis.
  • Recurrent cannabis use resulting in failure to fulfill major role obligations at work, school or home.
  • Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.
  • Important social, occupational or recreational activities are given up or reduced because of cannabis use.
  • Recurrent cannabis use in situations which is physically hazardous.
  • Cannabis use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are unlikely to have been caused or exacerbated by cannabis.
  • Tolerance.
  • Withdrawal.


Despite prevailing concerns about young people using marijuana, the researchers found that 76.3 percent of the participants did not develop a cannabis use problem during their college years or in early adulthood. What they did find is that persistent users – people who used marijuana habitually into their late 20s and early 30s – tended to have a history of anxiety.  27 percent of the persistent user group reported anxiety disorders as children, and 23 percent as young adults. According to the study authors, this suggests that a focus on mental health and well-being in childhood could be a key to preventing cannabis use disorder as adults.

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