Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T11:47:47.836Z Has data issue: false hasContentIssue false
  • English
  • Français

Cannabis use and posttraumatic stress disorder: prospective evidence from a longitudinal study of veterans

Published online by Cambridge University Press:  17 June 2020

Jane Metrik Open the ORCID record for Jane Metrik [Opens in a new window] ,
Angela K. Stevens ,
Rachel L. Gunn ,
Brian Borsari  and
Kristina M. Jackson
Jane Metrik*
Affiliation:
Providence VA Medical Center, Providence, RI 02908, USA Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
Angela K. Stevens
Affiliation:
Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
Rachel L. Gunn
Affiliation:
Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
Brian Borsari
Affiliation:
San Francisco VA Health Care System, San Francisco, CA 94121, USA Department of Psychiatry, University of California – San Francisco, San Francisco, CA 94103, USA
Kristina M. Jackson
Affiliation:
Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
*
Author for correspondence: Jane Metrik, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis.

Methods

Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms.

Results

A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155–0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI −0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028–0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI −0.022 to 0.262).

Conclusions

Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.

Keywords

Cannabis use disordercannabisPTSDtraumaveterans
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 3 , February 2022 , pp. 446 - 456
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agrawal, A., & Lynskey, M. T. (2014). Cannabis controversies: How genetics can inform the study of comorbidity. Addiction, 109(3), 360–370. doi:10.1111/add.12436.CrossRefGoogle Scholar
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.Google Scholar
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33–51.CrossRefGoogle ScholarPubMed
Black, N., Stockings, E., Campbell, G., Tran, L. T., Zagic, D., Hall, W. D., … Degenhardt, L. (2019). Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic review and meta-analysis. The Lancet. Psychiatry, 6(12), 995–1010. doi:10.1016/S2215-0366(19)30401-8.CrossRefGoogle ScholarPubMed
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7712061.CrossRefGoogle ScholarPubMed
Boden, M. T., Babson, K. A., Vujanovic, A. A., Short, N. A., & Bonn-Miller, M. O. (2013). Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence. American Journal on Addictions, 22(3), 277–284. doi:10.1111/j.1521-0391.2012.12018.x.CrossRefGoogle ScholarPubMed
Bonn-Miller, M. O., Boden, M. T., Vujanovic, A. A., & Drescher, K. D. (2013). Prospective investigation of the impact of cannabis use disorders on posttraumatic stress disorder symptoms among veterans in residential treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 193–200. doi:10.1037/a0026621.CrossRefGoogle Scholar
Bonn-Miller, M. O., Harris, A. H., & Trafton, J. A. (2012). Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Psychological Services, 9(4), 404–416. doi:10.1037/a0027622.CrossRefGoogle ScholarPubMed
Bonn-Miller, M. O., Moos, R. H., Boden, M. T., Long, W. R., Kimerling, R., & Trafton, J. A. (2015). The impact of posttraumatic stress disorder on cannabis quit success. American Journal of Drug and Alcohol Abuse, 41(4), 339–344. doi:10.3109/00952990.2015.1043209.CrossRefGoogle ScholarPubMed
Bonn-Miller, M. O., Vujanovic, A. A., Boden, M. T., & Gross, J. J. (2011). Posttraumatic stress, difficulties in emotion regulation, and coping-oriented marijuana use. Cognitive Behaviour Therapy, 40(1), 34–44. doi:10.1080/16506073.2010.525253.CrossRefGoogle ScholarPubMed
Borodovsky, J. T., & Budney, A. J. (2018). Cannabis regulatory science: Risk-benefit considerations for mental disorders. International Review of Psychiatry, 30(3), 183–202. doi:10.1080/09540261.2018.1454406.CrossRefGoogle ScholarPubMed
Bryant, R. A., Creamer, M., O'Donnell, M., Forbes, D., McFarlane, A. C., Silove, D., & Hadzi-Pavlovic, D. (2017). Acute and chronic posttraumatic stress symptoms in the emergence of posttraumatic stress disorder: A network analysis. The Journal of the American Medical Association Psychiatry, 74(2), 135–142. doi:10.1001/jamapsychiatry.2016.3470.Google ScholarPubMed
Buckner, J. D., Jeffries, E. R., Crosby, R. D., Zvolensky, M. J., Cavanaugh, C. E., & Wonderlich, S. A. (2018). The impact of PTSD clusters on cannabis use in a racially diverse trauma-exposed sample: An analysis from ecological momentary assessment. The American Journal of Drug and Alcohol Abuse, 44(5), 532–542. doi:10.1080/00952990.2018.1430149.CrossRefGoogle Scholar
Carey, K. B. (1997). Reliability and validity of the time-line follow-back interview among psychiatric outpatients: A preliminary report. Psychology of Addictive Behaviors, 11(1), 26–33. doi:10.1037//0893-164x.11.1.26.CrossRefGoogle Scholar
Chandra, S., Radwan, M. M., Majumdar, C. G., Church, J. C., Freeman, T. P., & ElSohly, M. A. (2019). New trends in cannabis potency in USA and Europe during the last decade (2008-2017). European Archives of Psychiatry and Clinical Neuroscience, 269(1), 5–15. doi:10.1007/s00406-019-00983-5.CrossRefGoogle Scholar
Cohen, B. E., Gima, K., Bertenthal, D., Kim, S., Marmar, C. R., & Seal, K. H. (2010). Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. Journal of General Internal Medicine, 25(1), 18–24. doi:10.1007/s11606-009-1117-3.CrossRefGoogle ScholarPubMed
Cornelius, J. R., Kirisci, L., Reynolds, M., Clark, D. B., Hayes, J., & Tarter, R. (2010). PTSD Contributes to teen and young adult cannabis use disorders. Addictive Behaviors, 35(2), 91–94. doi:10.1016/j.addbeh.2009.09.007.CrossRefGoogle Scholar
Cougle, J. R., Bonn-Miller, M. O., Vujanovic, A. A., Zvolensky, M. J., & Hawkins, K. A. (2011). Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychology of Addictive Behaviors, 25(3), 554–558. doi:10.1037/a0023076.CrossRefGoogle Scholar
Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within-person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583–619. doi:10.1146/annurev.psych.093008.100356.CrossRefGoogle ScholarPubMed
Davis, A. K., Lin, L. A., Ilgen, M. A., & Bohnert, K. M. (2018). Recent cannabis use among Veterans in the United States: Results from a national sample. Addictive Behaviors, 76, 223–228. doi:10.1016/j.addbeh.2017.08.010.CrossRefGoogle ScholarPubMed
Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., … Collabora, G. A. D. U. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet. Psychiatry, 5(12), 987–1012. doi:10.1016/S2215-0366(18)30337-7.CrossRefGoogle Scholar
Earleywine, M., & Bolles, J. R. (2014). Marijuana, expectancies, and post-traumatic stress symptoms: A preliminary investigation. Journal of Psychoactive Drugs, 46(3), 171–177. doi:10.1080/02791072.2014.920118.CrossRefGoogle ScholarPubMed
ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995–2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613–619. doi:10.1016/j.biopsych.2016.01.004.CrossRefGoogle ScholarPubMed
Farris, S. G., & Metrik, J. (2016). Acute effects of cannabis on breath-holding duration. Experimental and Clinical Psychopharmacology, 24(4), 305–312. doi:10.1037/pha0000075.CrossRefGoogle ScholarPubMed
Farris, S. G., Metrik, J., Bonn-Miller, M. O., Kahler, C. W., & Zvolensky, M. J. (2016). Anxiety sensitivity and distress intolerance as predictors of Cannabis dependence symptoms, problems, and craving: The mediating role of coping motives. Journal of Studies on Alcohol and Drugs, 77(6), 889–897. doi:10.15288/jsad.2016.77.889.CrossRefGoogle ScholarPubMed
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured clinical interview for DSM-5 – research version (SCID-5 for DSM-5, research version; SCID-5–RV). Arlington, VA: American Psychiatric Association.Google Scholar
Freeman, T. P., & Winstock, A. R. (2015). Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychological Medicine, 45(15), 3181–3189. doi:10.1017/S0033291715001178.CrossRefGoogle ScholarPubMed
Fulton, J. J., Calhoun, P. S., Wagner, H. R., Schry, A. R., Hair, L. P., Feeling, N., … Beckham, J. C. (2015). The prevalence of posttraumatic stress disorder in operation enduring freedom/operation Iraqi freedom (OEF/OIF) veterans: A meta-analysis. Journal of Anxiety Disorders, 31, 98–107. doi:10.1016/j.janxdis.2015.02.003.CrossRefGoogle ScholarPubMed
Granger, C. W. J. (1969). Investigating causal relations by econometric models and cross-spectral methods. Econometrica, 37(3), 424–438. doi:10.2307/1912791.CrossRefGoogle Scholar
Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the life events checklist. Assessment, 11(4), 330–341. doi:10.1177/1073191104269954.CrossRefGoogle ScholarPubMed
Hamaker, E. L. (2018). How to run the RI-CLPM with Mplus. [Press release].Google Scholar
Hamaker, E. L., Kuiper, R.M., & Grasman, R.P. (2015). A critique of the cross-lagged panel model. Psychological Methods, 20(1), 102–116. doi:10.1037/a0038889.CrossRefGoogle ScholarPubMed
Haney, M., & Evins, A. E. (2016). Does cannabis cause, exacerbate or ameliorate psychiatric disorders? An oversimplified debate discussed. Neuropsychopharmacology, 41(2), 393–401. doi:10.1038/npp.2015.251.CrossRefGoogle ScholarPubMed
Hasin, D. S. (2018). US epidemiology of cannabis use and associated problems. Neuropsychopharmacology, 43(1), 195–212. doi:10.1038/npp.2017.198.CrossRefGoogle ScholarPubMed
Hill, M. N., Campolongo, P., Yehuda, R., & Patel, S. (2018). Integrating endocannabinoid signaling and cannabinoids into the biology and treatment of posttraumatic stress disorder. Neuropsychopharmacology, 43(1), 80–102. doi:10.1038/npp.2017.162.CrossRefGoogle ScholarPubMed
Hjorthoj, C. R., Fohlmann, A., Larsen, A. M., Arendt, M., & Nordentoft, M. (2012). Correlations and agreement between delta-9-tetrahydrocannabinol (THC) in blood plasma and timeline follow-back (TLFB)-assisted self-reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial. Addiction, 107(6), 1123–1131. doi:10.1111/j.1360-0443.2011.03757.x.CrossRefGoogle ScholarPubMed
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22. doi:10.1056/NEJMoa040603351/1/13 [pii].CrossRefGoogle ScholarPubMed
Hser, Y. I., Mooney, L. J., Huang, D., Zhu, Y., Tomko, R. L., McClure, E., … Gray, K. M. (2017). Reductions in cannabis use are associated with improvements in anxiety, depression, and sleep quality, but not quality of life. Journal of Substance Abuse Treatment, 81, 53–58. doi:10.1016/j.jsat.2017.07.012.CrossRefGoogle Scholar
Kevorkian, S., Bonn-Miller, M. O., Belendiuk, K., Carney, D. M., Roberson-Nay, R., & Berenz, E. C. (2015). Associations among trauma, posttraumatic stress disorder, cannabis use, and cannabis use disorder in a nationally representative epidemiologic sample. Psychology of Addictive Behaviors, 29(3), 633–638. doi:10.1037/adb0000110.CrossRefGoogle Scholar
Lawrence-Wood, E., Van Hooff, M., Baur, J., & McFarlane, A. C. (2016). Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety. Journal of Affective Disorders, 190, 278–281. doi:10.1016/j.jad.2015.10.029.CrossRefGoogle ScholarPubMed
Lee, J. Y., Brook, J. S., Finch, S. J., & Brook, D. W. (2018). Trajectories of cannabis use beginning in adolescence associated with symptoms of posttraumatic stress disorder in the mid-thirties. Substance Abuse, 39(1), 39–45. doi:10.1080/08897077.2017.1363121.CrossRefGoogle ScholarPubMed
Mammen, G., Rueda, S., Roerecke, M., Bonato, S., Lev-Ran, S., & Rehm, J. (2018). Association of cannabis with long-term clinical symptoms in anxiety and mood disorders: A systematic review of prospective studies. The Journal of Clinical Psychiatry, 79(4), 17r11839. doi: 10.4088/JCP.17r11839.CrossRefGoogle ScholarPubMed
Manhapra, A., Stefanovics, E., & Rosenheck, R. (2015). Treatment outcomes for veterans with PTSD and substance use: Impact of specific substances and achievement of abstinence. Drug and Alcohol Dependence, 156, 70–77. doi:10.1016/j.drugalcdep.2015.08.036.CrossRefGoogle ScholarPubMed
McFarlane, A. C. (1992). Avoidance and intrusion in posttraumatic stress disorder. The Journal of Nervous and Mental Disease, 180(7), 439–445. doi:10.1097/00005053-199207000-00006.CrossRefGoogle ScholarPubMed
Meier, M. H. (2017). Associations between butane hash oil use and cannabis-related problems. Drug and Alcohol Dependence, 179, 25–31. doi:10.1016/j.drugalcdep.2017.06.015.CrossRefGoogle ScholarPubMed
Metrik, J., Bassett, S. S., Aston, E., Jackson, K., & Borsari, B. (2018). Medicinal versus recreational cannabis use among returning veterans. Translational Issues in Psychological Science, 4(1), 6–20. doi:10.1037/tps0000133.CrossRefGoogle ScholarPubMed
Metrik, J., Jackson, K., Bassett, S. S., Zvolensky, M. J., Seal, K., & Borsari, B. (2016). The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. Psychology of Addictive Behaviors, 30(7), 743–754. doi:10.1037/adb0000210.CrossRefGoogle ScholarPubMed
Michael, T., Ehlers, A., Halligan, S. L., & Clark, D. M. (2005). Unwanted memories of assault: What intrusion characteristics are associated with PTSD? Behaviour Research and Therapy, 43(5), 613–628. doi:10.1016/j.brat.2004.04.006.CrossRefGoogle ScholarPubMed
Muthén, L. K., & Muthén, B. O. (1998–2012). Mplus user's guide (7th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.Google Scholar
Potter, C. M., Vujanovic, A. A., Marshall-Berenz, E. C., Bernstein, A., & Bonn-Miller, M. O. (2011). Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance. Journal of Anxiety Disorders, 25(3), 437–443. doi:10.1016/j.janxdis.2010.11.007.CrossRefGoogle ScholarPubMed
Ram, N., Conroy, D. E., Pincus, A. L., Lorek, A., Rebar, A., Roche, M. J., … Gerstorf, D. (2014). Examining the interplay of processes across multiple time-scales: Illustration with the intraindividual study of affect, health, and interpersonal behavior (iSAHIB). Research in Human Development, 11(2), 142–160. doi:10.1080/15427609.2014.906739.CrossRefGoogle Scholar
Ruglass, L. M., Shevorykin, A., Radoncic, V., Smith, K. M., Smith, P. H., Galatzer-Levy, I. R., … Hien, D. A. (2017). Impact of cannabis use on treatment outcomes among adults receiving cognitive-behavioral treatment for PTSD and substance use disorders. Journal of Clinical Medicine, 6(2), 14. doi: 10.3390/jcm6020014.CrossRefGoogle ScholarPubMed
Sayer, N. A., Orazem, R. J., Noorbaloochi, S., Gravely, A., Frazier, P., Carlson, K. F., … Oleson, H. (2015). Iraq and Afghanistan war veterans with reintegration problems: Differences by Veterans Affairs healthcare user status. Administration and Policy in Mental Health, 42(4), 493–503. doi:10.1007/s10488-014-0564-2.CrossRefGoogle ScholarPubMed
Schnyder, U. (2014). Treating intrusions, promoting resilience: An overview of therapies for trauma-related psychological disorders. The European Journal of Psychotraumatology, 5, 26520. doi:10.3402/ejpt.v5.26520.CrossRefGoogle ScholarPubMed
Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: Mental health disorders among 103788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167(5), 476–482. doi:167/5/476[pii]10.1001/archinte.167.5.476.CrossRefGoogle ScholarPubMed
Seal, K. H., Cohen, G., Waldrop, A., Cohen, B. E., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug and Alcohol Dependence, 116(1–3), 93–101. doi:10.1016/j.drugalcdep.2010.11.027.CrossRefGoogle Scholar
Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. American Journal of Public Health, 99(9), 1651–1658. doi:AJPH.2008.150284 [pii]10.2105/AJPH.2008.150284.CrossRefGoogle ScholarPubMed
Sliwinski, M. J. (2008). Measurement-burst designs for social health research. Social and Personality Psychology Compass, 2(1), 245–261. doi:10.1111/j.1751-9004.2007.00043.x.CrossRefGoogle Scholar
Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-reported alcohol consumption. In Litten, R. Z. & Allen, J. P. (Eds.), Measuring alcohol consumption: Psychosocial and biochemical methods (pp. 41–72). Totowa, NJ: Humana Press. https://doi.org/10.1007/978-1-4612-0357-5_3.CrossRefGoogle Scholar
Twomey, C. D. (2017). Association of cannabis use with the development of elevated anxiety symptoms in the general population: A meta-analysis. The Journal of Epidemiology and Community Health, 71(8), 811–816. doi:10.1136/jech-2016-208145.CrossRefGoogle ScholarPubMed
Villagonzalo, K. A., Dodd, S., Ng, F., Mihaly, S., Langbein, A., & Berk, M. (2011). The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program. Comprehensive Psychiatry, 52(5), 562–566. doi:10.1016/j.comppsych.2010.10.001.CrossRefGoogle Scholar
Walton, J. L., Cuccurullo, L. J., Raines, A. M., Vidaurri, D. N., Allan, N. P., Maieritsch, K. P., & Franklin, C. L. (2017). Sometimes less is more: Establishing the core symptoms of PTSD. The Journal of Traumatic Stress, 30(3), 254–258. doi:10.1002/jts.22185.CrossRefGoogle ScholarPubMed
Watson, D., O'Hara, M. W., Chmielewski, M., McDade-Montez, E. A., Koffel, E., Naragon, K., & Stuart, S. (2008). Further validation of the IDAS: Evidence of convergent, discriminant, criterion, and incremental validity. Psychological Assessment, 20, 248–259.CrossRefGoogle ScholarPubMed
Watson, D., O'Hara, M. W., Simms, L. J., Kotov, R., Chmielewski, M., McDade-Montez, E. A., …Stuart, S. (2007). Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS). Psychological Assessment, 19, 253–268.CrossRefGoogle Scholar
Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132–156.CrossRefGoogle ScholarPubMed
Wilkinson, S. T., Radhakrishnan, R., & D'Souza, D. C. (2016). A systematic review of the evidence for medical marijuana in psychiatric indications. Journal of Clinical Psychiatry, 77(8), 1050–1064. doi:10.4088/JCP.15r10036.CrossRefGoogle ScholarPubMed
Wilkinson, S. T., Stefanovics, E., & Rosenheck, R. A. (2015). Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. Journal of Clinical Psychiatry, 76(9), 1174–1180. doi:10.4088/JCP.14m09475.CrossRefGoogle ScholarPubMed
Wilkinson, S. T., van Schalkwyk, G. I., Davidson, L., & D'Souza, D. C. (2016). The formation of marijuana risk perception in a population of substance abusing patients. The Psychiatric Quarterly, 87(1), 177–187. doi:10.1007/s11126-015-9369-z.CrossRefGoogle Scholar