The mental health-cannabis nexus: Patterns of use among U.S. adults with depression, anxiety, and ADHD.

BACKGROUND: An increasing number of U.S. adults report using cannabis to help manage depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). Associations of mental health (MH) diagnoses and ADHD with the trajectory of drug use disorder (DUD) diagnosis, cannabis use (CU) frequency, and reasons for use are understudied. OBJECTIVE: To assess associations between depression, anxiety, and self-rated MH with DUD past-12-month CU frequency, and six reasons for use, and examine whether associations differed by ADHD status. METHODS: We used cross-sectional, nationally-representative, web-based panel data of 2400 U.S. adults (ages 18-64 from the 2023 National Wellbeing Survey), we estimated weighted logistic regression models for binary outcome variables and a weighted ordinary least squares regression model for CU frequency, adjusting for sociodemographic covariates. We applied post-stratification weights to adjust estimates to align with U.S. Census benchmarks by age, sex, race/ethnicity, and region. We also included interaction terms to assess whether the association between MH-cannabis differed by ADHD diagnosis. RESULTS: Lower MH was associated with greater odds of reporting using cannabis to escape problems (aOR: 0.67, 95% CI: 0.60-0.76), manage daily stressors (aOR: 0.79, 95% CI: 0.70-0.89), and help falling asleep (aOR: 0.90, 95% CI: 0.81-0.99). These coping- and symptom-management reasons for CU, rather than using for recreational purposes, defined the self-medication pattern. Many of these associations differed by ADHD status. Reporting a diagnosis of depression was associated with greater odds of DUD (aOR: 1.84, 95% CI: 1.25-2.69). Therapeutic motives and sleep-related motives were more commonly endorsed by women and racial and ethnic minority adults. CONCLUSIONS: These cross-sectional results identify co-occurring patterns of MH and CU among adults and support trauma-informed, integrated behavioral health approaches rather than CU alone to manage symptoms.