A comparative cross-sectional analysis of reasons for cannabis use and cannabis use disorder severity in young and older adult cohorts

Abstract Background Cannabis use prevalence is highest among young adults (18–25), but recent epidemiological trends indicate rapid increases in cannabis use prevalence among older adults (50 +). Moreover, women progress to problematic use more quickly than men. These phenomena highlight the importance of better understanding why adults use cannabis, how their reasons relate to the severity of cannabis use disorder (CUD), and how age and sex may inform tailored harm prevention approaches across the lifespan. Methods This study combines baseline data from four studies on cannabis use and stress conducted in an academic medical setting in the southeastern U.S. Participants were young adults (age 18–25; N = 138; 44.9% female) and older adults (age 50–76; N = 111; 48.7% female) with CUD. Multivariable linear, cumulative logistic and Poisson regression models were developed to examine the relationships between age cohort, reasons for using cannabis, and CUD symptoms and severity. Interaction terms were created to evaluate the modifying effect of sex on these relationships. Results Older adults demonstrated less CUD severity relative to young adults. Although young adults endorsed 9 of the 11 CUD symptoms more frequently than older adults, older adults endorsed hazardous use more frequently relative to young adults. Older adults reported greater use for physical discomfort compared to young adults, and there was a sex × age interaction in social pressure to use, where young adult males reported more social pressure to use compared to older adult males and young adult females. Regardless of age cohort, greater use due to urges/temptations to use, conflict with others, and unpleasant emotions were associated with greater CUD severity. Neither sex nor age moderated associations between reasons for use and CUD symptoms. Conclusions Consistent with prior research, CUD symptom severity and reasons for use differed between young adults and older adults, and more severe CUD was associated with negatively reinforcing reasons for use, regardless of age or sex. The unique finding of greater endorsement of hazardous use among older adults could point to a potential target for education and harm prevention interventions tailored to this age group. Overall, different reasons for cannabis use and CUD symptom endorsement by age cohort emphasize the need for age-tailored interventions.