Cannabis use disorders among adults in the United States during a time of increasing use of cannabis

Background: Using U.S. National Surveys on Drug Use and Health (NSDUH) data, researchers found that prevalence of cannabis use among adults increased in recent years, but prevalence of DSM-IV cannabis use disorder (CUD) was stable. Examining trends of all individual CUD criteria and of CUD severity may elucidate reasons for the lack of increases in CUD. Methods: Data were from 749,500 persons aged 18 or older who participated in the 2002-2017 NSDUH. Descriptive analyses and logistic regressions were applied. Results: Among adults during 2002-2017, past-year prevalence of DSM-IV CUD remained stable at 1.5% to 1.4%, but cannabis use increased from 10.4% to 15.3%, daily/near daily use increased from 1.9% to 4.2%, and mild DSM-5 CUD increased from 1.4% to 1.9%. Among adult cannabis users, past-year prevalence of DSM-IV CUD decreased from 14.8% to 9.3%, daily/near daily use increased from 18.0% to 27.2%, and DSM-5 moderate (4-5 criteria) and severe (6+ criteria) CUD decreased from 4.3% to 3.1% and from 2.4% to 1.3%, respectively. Examining trends in individual CUD criteria during 2002-2017 among adults overall revealed increases in two criteria (tolerance; spending a lot of time getting/using cannabis or getting over cannabis effects) and decreases/no changes in other criteria; among adult cannabis users, there was no change in one criterion (tolerance) and decreases in other criteria. Conclusions: DSM-5's single dimension CUD measure may be more sensitive to diagnosis prevalence changes than the separate DSM-IV cannabis dependence and abuse categories. Future diagnostic approaches to assessing CUD may benefit from quantitatively oriented criteria.