Frequently Asked Questions

In this 2022 nationally representative sample of US veterans, 11.6% reported cannabis use in the past 6 months and 2.9% screened positive for probable cannabis use disorder (CUD). In raw counts, 284 veterans reported cannabis use, 70 had probable CUD, and 2,087 reported no cannabis use among the 2,441 veterans who completed the survey.

The Pacific region had the highest prevalence of both outcomes, with 18.6% of veterans reporting cannabis use and 8.8% screening positive for probable CUD. The authors found significant geographic variation across the 9 US Census Bureau–defined regions overall (χ2₁₆ = 73.33, P < .001).

Yes. The Pacific region's probable CUD rate of 8.8% was significantly higher than every other region, including New England, which had a probable CUD rate of 3.5% (all uncorrected Ps < .05).

No. New England had relatively high cannabis use at 13.4% but a lower probable CUD rate of 3.5%. The Pacific region's cannabis use prevalence was significantly higher than all other regions except New England (P = .24), and New England's cannabis use prevalence did not significantly differ from any other region (all Ps > .17), suggesting that higher use prevalence did not always translate into the same disorder burden.

Among states with at least 30 respondents, the highest cannabis use prevalence was reported in Oregon (26.7%), California (22.4%), Oklahoma (20.5%), Massachusetts (16.7%), New York (15.7%), Alabama (15.0%), Illinois (14.9%), Arizona (14.3%), Ohio (14.1%), and Virginia (13.7%).

Among states with at least 30 respondents, the highest probable CUD rates were seen in Oregon (13.3%), Washington (9.6%), North Carolina (9.0%), California (6.7%), Indiana (4.9%), New York (4.5%), Pennsylvania (3.7%), Texas (3.2%), Wisconsin (3.1%), and Kentucky (3.1%).

They were more common in younger veterans, although the affected groups were still older on average. Veterans with probable CUD were younger than veterans who used cannabis without screening positive for CUD, and those veterans were younger than nonusers; the authors noted mean ages of 53 years for probable CUD and 59 years for cannabis use.

Veterans with probable CUD were more likely to be younger, more likely to be other/multiracial, and more likely to use the VA as their primary source of health care. They were also less likely to be married or partnered, less likely to have completed college, less likely to have served 10 or more years in the military, and less likely than nonusers to have an ADL or IADL disability.

Probable CUD was measured with the 3-item Cannabis Use Disorders Identification Test–Short Form (CUDIT-SF), a validated DSM-5–aligned screening tool. It asked about inability to stop using cannabis once started, time devoted to getting or using cannabis or recovering from it, and memory or concentration problems after use during the past 6 months. Each item was scored from 0 to 4, and a total score of 2 or higher indicated probable CUD.

Veterans who relied on the VA as their primary source of health care were significantly more likely to report cannabis use and to screen positive for probable CUD. The authors suggest that systematic CUD screening within VHA primary care and mental health services may be particularly important in high-prevalence regions.

The main limitations were that the study was cross-sectional, so it cannot establish causation; some regions and states had smaller samples, which may have reduced the precision of prevalence estimates; and cannabis use and probable CUD were assessed by self-report screening measures, which may lead to underreporting or overreporting.