How to Screen Veterans for Probable Cannabis Use Disorder
How should clinicians screen US veterans for cannabis use and probable cannabis use disorder in routine care?
Veterans may use cannabis to manage chronic pain, PTSD, anxiety, or insomnia, but cannabis use and probable cannabis use disorder are linked to important psychiatric and health risks. This guide applies to clinicians in primary care, general mental health, and specialty veteran-serving settings who need a brief, structured way to identify veterans who may need further assessment or treatment.
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Ask about any cannabis use in the past 6 months
Begin screening with the article's cannabis use question: whether the veteran has used any cannabis, including marijuana, hashish, THC, pot, grass, weed, or reefer, over the past 6 months. Classify a no response as no cannabis use for this screen and a yes response as requiring symptom-based follow-up rather than assuming use alone indicates disorder.
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Administer the 3-item CUDIT-SF to veterans who report use
For veterans who endorse past-6-month cannabis use, administer the 3-item Cannabis Use Disorders Identification Test-Short Form. Ask how often during the past 6 months the veteran was not able to stop using cannabis once started, how often a great deal of time was devoted to getting, using, or recovering from cannabis, and how often memory or concentration problems occurred after using cannabis.
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Score the CUDIT-SF and identify probable CUD
Rate each CUDIT-SF item on the 0 to 4 scale from Never to Daily or almost daily and sum the 3 items. A total score of 2 or higher indicates probable cannabis use disorder according to the validated screening threshold used in the article. Veterans who report cannabis use but score below 2 should be classified as cannabis users without a positive probable CUD screen.
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Interpret use and disorder risk separately
Do not treat cannabis use prevalence as interchangeable with probable CUD burden. The article found that New England had relatively high cannabis use at 13.4% but lower probable CUD at 3.5%, while the Pacific region had the highest prevalence of both cannabis use at 18.6% and probable CUD at 8.8%.
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Prioritize routine screening in higher-risk clinical settings
Incorporate systematic screening into VHA primary care and mental health services, especially in higher-prevalence regions. The article specifically highlights the Pacific region as having the highest burden and notes that veterans using the VA as their primary source of health care were more likely to report cannabis use and to screen positive for probable CUD.
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Use a positive screen to trigger further intervention planning
When a veteran screens positive for probable CUD, identify the need for referral to evidence-based treatment for CUD rather than ending the assessment at cannabis use disclosure alone. The article emphasizes targeted screening and intervention efforts and recommends preparing clinics to systematically assess cannabis use and deliver evidence-based treatments.
Clinical Considerations
- This study was cross-sectional, so the regional differences it identified should not be interpreted as proving that geography or cannabis policy caused cannabis use or probable CUD.
- Probable CUD was identified with a self-report screening tool rather than a diagnostic interview, so underreporting or overreporting is possible.
- Smaller sample sizes in some regions and states may have reduced the precision of prevalence estimates, particularly below the regional level.
- The sample was nationally representative of US veterans after weighting, but it was not necessarily representative at the state level.
Bottom Line
In veteran care, screen past-6-month cannabis use first and then use the 3-item CUDIT-SF, with a score of 2 or higher indicating probable CUD and warranting further clinical follow-up or treatment referral.
