Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
College of Social Work, Florida State University, Tallahassee, FL, USA.
J Subst Use Addict Treat. 2024 Dec;167:209486. doi: 10.1016/j.josat.2024.209486. Epub 2024 Aug 14.
Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use.
We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment.
Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment.
This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
最近，多个州扩大了大麻合法化，这需要重新审视大麻使用、大麻使用障碍（CUD）的流行情况，以及 CUD 严重程度与物质使用治疗之间的关联。我们使用安德森的医疗保健使用行为模型作为检查治疗使用的概念/分析框架。
我们使用 2022 年全国毒品使用与健康调查（NSDUH；N=47100，年龄 18+）的数据，描述了过去一年大麻使用、CUD 和 CUD 严重程度、其他物质使用障碍以及物质使用治疗的流行情况。我们比较了 CUD 严重程度不同的社会人口统计学、心理健康、医疗保健使用以及大麻和其他物质使用特征。最后，我们使用逻辑回归模型来检验 CUD 严重程度与物质使用治疗之间的关联。
在美国成年人中，23.0%的人在过去一年中使用过大麻；7.0%的人患有 CUD（3.9%为轻度，1.9%为中度，1.2%为重度 CUD）；4.7%的人接受了物质使用治疗。在过去一年的大麻使用者中，30.3%的人患有 CUD（16.9%为轻度，8.4%为中度，5.0%为重度 CUD），9.6%的人接受了物质使用治疗。大麻使用者的其他物质使用障碍发生率是未使用者的 3-4 倍。在患有 CUD 的人中，38.4%的人患有中度/重度精神疾病，52.4%的人患有其他物质使用障碍，16.5%的人接受了物质使用治疗。在所有大麻使用者中，中度（调整后的比值比[aOR]=1.48，95%置信区间[CI]=1.03-2.13）和重度（aOR=2.57，95%CI=1.60-4.11）CUD 与物质使用治疗的可能性更大。在没有尼古丁依赖和酒精、阿片类药物、镇静剂/安定剂和兴奋剂使用障碍的大麻使用者中，只有重度 CUD（aOR=6.03，95%CI=3.37-10.78）与物质使用治疗的可能性更大。
这项研究表明，美国成年人中大麻使用和 CUD 的流行率有所增加，无论是否存在其他物质使用障碍，CUD 都与物质使用治疗的可能性更大有关。然而，患有 CUD 的人中治疗使用率总体较低令人担忧。医疗保健提供者需要为医疗和娱乐性大麻使用者提供有关耐受性和依赖性发展的教育。还需要采用减少伤害的策略，以最大限度地减少 CUD 的负面后果。
