Using Cannabis To Help You Sleep: Heightened Frequency of Medical Cannabis Use among Those with PTSD
Marcel O. Bonn-Miller, Kimberly A. Babson, and Ryan Vandrey
Drug and Alcohol Dependence, 2014, 136, 162–165.
Background : The use of cannabis for medical purposes is proliferating in the U.S., and PTSD is an explicitly approved condition for accessing medical cannabis in 5 states. Prior research suggests that people with PTSD often use cannabis to help cope with their condition, and that doing so results in more frequent and problematic cannabis use patterns. Specific coping motivations, such as sleep improvement, among medical cannabis users, have not been examined.
Methods : The present study evaluated specific coping use motivations, frequency of cannabis and alcohol use, and mental health among a convenience sample of patients (N=170) at a medical cannabis dispensary in California.
Results : Those with high PTSD scores were more likely to use cannabis to improve sleep, and for coping reasons more generally, compared with those with low PTSD scores. Cannabis use frequency was greater among those with high PTSD scores who used for sleep promoting purposes compared with those with low PTSD scores or those who did not use for sleep promoting purposes.
Conclusions : Consistent with prior research, this study found increased rates of coping oriented use of cannabis and greater frequency of cannabis use among medical users with high PTSD scores compared with low PTSD scores. In addition, sleep improvement appears to be a primary motivator for coping-oriented use. Additional research is needed to examine the health consequences of this pattern of cannabis use and whether alternative sleep promoting interventions (e.g. CBT-I) could reduce the reliance on cannabis for adequate sleep among those with PTSD.
Cannabis is the most widely used illicit substance in the United States (SAMHSA, 2012) and the legalization of cannabis for medicinal purposes has become a growing trend. The approved conditions for which cannabis may be doctor-recommended varies at the state level, but most states allow medical use of cannabis for certain medical disorders/problems (e.g., cancer, severe and chronic pain, HIV/AIDS). The use of medical cannabis for psychological disorders, however, is not as common. Currently, only 5 of 20 states with medical cannabis laws explicitly allow the medical use of cannabis as a treatment for those with posttraumatic stress disorder (PTSD).
Though there has been a general dearth of empirical research speaking to the use and effects of cannabis among those with PTSD, existing evidence suggests that individuals with PTSD, particularly those with heightened hyperarousal symptoms, use cannabis primarily for coping reasons (e.g., Boden et al., 2013; Bonn-Miller et al., 2007a; Passie et al., 2012), and that such coping-oriented use may be associated with heavier and more problematic cannabis use patterns (e.g., dependence), as documented in the general population (Bonn-Miller and Zvolensky, 2009). Following, there has been increasing interest in understanding, among those with PTSD, the specific motives for which cannabis is used. In a study among 20 adult females with PTSD, Bonn-Miller and colleagues (2010) found poor sleep quality to interact with PTSD symptom severity in the prediction of coping-oriented cannabis use. Here, individuals with elevated PTSD symptoms and sleep problems were particularly likely to use cannabis to cope.
Though Bonn-Miller and colleagues (2010) documented the importance of sleep problems in terms of understanding the association between PTSD and coping-oriented cannabis use, little research has been conducted to examine whether specific symptoms of PTSD are being “treated” with cannabis use, and, in particular, whether individuals with PTSD use cannabis specifically to improve sleep, or instead to cope with negative affect more broadly. Here, recent work has demonstrated that specific psychoactive components of cannabis may initially facilitate sleep onset (Russo et al., 2007; Schierenbeck et al., 2008), though long-term and problematic use has been associated with sleep disturbances, including altered sleep architecture (Bolla et al., 2008; Vandrey et al., 2011). Additionally, there has yet to be an investigation of how specific coping motivations are associated with use frequency within this context.
The present study sought to examine (1) the specific cannabis motives that distinguish a medicinal cannabis-using individual with PTSD from an individual without PTSD, and (2) whether the interaction of PTSD and PTSD-specific use motives are associated with more severe use frequency. We hypothesized that medical cannabis users with PTSD would be more likely to report cannabis use specifically to improve sleep, compared to those without PTSD. Further, due to the development of tolerance to the sleep-inducing effects of cannabis (Schierenbeck et al., 2008), as well as prior documented associations between coping-oriented use and heavy cannabis use patterns (Bonn-Miller and Zvolensky, 2009), we hypothesized that those with PTSD who also used for sleep motives would evidence greater cannabis use frequency. As research has demonstrated that depression and alcohol use are both associated with PTSD (McFarlane, 1998; Shalev et al., 1998) and cannabis use (Bovasso, 2001; Griffin et al., 2002), depressive symptoms and alcohol use were included as covariates.