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Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users

Zaman, Tauheed MD; Malowney, Monica MPH; Knight, John MD; Boyd, J. Wesley MD, PhD

doi: 10.1097/ADM.0000000000000138
Original Research

Objective: Cannabis is the most commonly used illicit substance in the United States and is increasingly being legalized throughout the United States. Many believe that cannabis is relatively harmless, and some believe that cannabis is not addictive. We wondered what the rates of cannabis abuse and dependence might be among adolescents referred for substance use evaluations and also about the incidence of co-occurring psychiatric illnesses and substance use disorders among those individuals.

Methods: Herein, we analyze intake data from 483 adolescents referred for evaluation at an adolescent substance abuse clinic, with information gleaned from the adolescents and their parents or caregivers.

Results: Forty-seven percent of our sample met the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria for cannabis dependence and another 32% for cannabis abuse. Among adolescents with cannabis use disorders, the co-occurrence of alcohol and opioid abuse or dependence was high. These individuals also suffered from significant psychiatric comorbidities otherwise.

Conclusions: Our results show that cannabis use carries the risk of dependence and also carries with it significant risk of comorbidities, both with respect to other substance use disorders and other psychiatric illness. Given the growing body of research linking cannabis use with addiction and other psychiatric illness, public health efforts ought to center on the potential dangers of cannabis use.

From the Department of Addiction Psychiatry (TZ), San Francisco VA Hospital/University of California San Francisco, San Francisco, CA; Department of Population Health (MM), Maimonides Medical Center, Brooklyn, NY; Department of Medicine (JK), Boston Children's Hospital, Boston, MA; Department of Psychiatry (JWB), Cambridge Health Alliance, Cambridge, MA; and on Faculty (JK and JWB), Harvard Medical School, Boston, MA.

Send correspondence and reprint requests to J. Wesley Boyd, MD, PhD, Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge St, Cambridge, MA 02139. E-mail:

Each of the authors listed on the manuscript except one (TZ) participated in the original conceptualization of the project. All of the authors had full access to all of the data and participated in analyzing those results and in composing and editing drafts of the manuscript and approving the final draft. We had no outside funding for this project, and we have no conflicts of interest to declare.

Received October 19, 2014

Accepted April 15, 2015

© 2015 American Society of Addiction Medicine