How to Screen Veterans for Cannabis Use and Probable CUD
How should clinicians screen veterans for cannabis use and probable cannabis use disorder in routine care?
Veterans may use cannabis for chronic pain, PTSD, anxiety, and insomnia, but cannabis use disorder is associated with substantial psychiatric and health burden. In this national veteran sample, cannabis use and probable CUD varied meaningfully by geography, with the highest burden in the Pacific region, supporting systematic screening in routine veteran care rather than relying on spontaneous disclosure.
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Ask about any cannabis use in the past 6 months
Begin with the article's cannabis use screen: ask whether the veteran has used any cannabis over the past 6 months. The study defined cannabis broadly as marijuana, hashish, THC, pot, grass, weed, or reefer, so the question should capture any of these forms. Veterans who answer no are classified as nonusers for this workflow.
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Administer the 3-item CUDIT-SF to veterans who report use
If the veteran reports cannabis use, assess probable CUD with the 3-item Cannabis Use Disorders Identification Test-Short Form. Ask how often during the past 6 months the veteran was not able to stop using cannabis once started, how often a great deal of time was devoted to getting, using, or recovering from cannabis, and how often memory or concentration problems occurred after use. Each item is rated from 0 to 4, ranging from never to daily or almost daily.
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Score the screen and classify probable CUD
Sum the 3 CUDIT-SF items to obtain the total score. A score of 2 or higher is indicative of probable CUD according to the validated DSM-5-aligned screening approach used in the study. Veterans who report cannabis use but do not screen positive can be classified as cannabis users without probable CUD.
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Prioritize routine screening where prevalence is highest
Use geographic context to increase vigilance, especially in veteran populations from higher-prevalence regions. In this study, the Pacific region had the highest prevalence of cannabis use at 18.6% and probable CUD at 8.8%, and the authors concluded that routine screening may be particularly important in high-prevalence regions. High rates were not limited to states with legalized recreational cannabis, so do not restrict screening based on legalization status alone.
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Embed screening in VA primary care and mental health settings
Incorporate this brief screening process into VHA primary care and mental health services when caring for veterans. The study found that veterans with probable CUD were more likely to report the VA as their primary source of health care, and the authors specifically noted that systematic CUD screening within VHA settings may be particularly important. Positive screens identify veterans who may need referral to evidence-based treatment for CUD.
Clinical Considerations
- This study was cross-sectional, so its geographic patterns cannot establish that regional factors or cannabis legalization caused higher cannabis use or probable CUD.
- Probable CUD was identified by self-report with a screening tool rather than diagnostic interview, so underreporting or overreporting is possible.
- The weighted sample was nationally representative of US veterans but not necessarily representative at the state level.
- Smaller sample sizes in some regions and states may have reduced the precision of prevalence estimates.
Bottom Line
In veteran care, systematically ask about past-6-month cannabis use and use the 3-item CUDIT-SF, with especially routine implementation in VA settings and higher-prevalence regions such as the Pacific.
