Significant Association Between Cannabis Use and Psychotic Disorders

Researchers find that nonmedical use of cannabis was significantly associated with a diagnosis of psychotic disorder.


A recent article published in The American Journal of Psychiatry analyzed the relationship between cannabis use and the likelihood of individuals being diagnosed with “psychotic disorders” such as schizophrenia.

Utilizing self-report questionnaire data from 2001-2002 and 2012-2013, the authors found that self-reported nonmedical use of cannabis—particularly use meeting criteria for Cannabis Use Disorder as defined in the DSM-IV—was significantly associated with a self-reported diagnosis of a psychotic disorder among adults in the United States.

“Although the nature of the relationship of cannabis to psychosis has been debated—that is, whether the relationship is causal or due to shared genetic risk factors—a prudent conclusion appears to be that some part of the relationship is causal, and therefore that further study of the relationship is warranted,” the authors explain.

The relationship between cannabis (or marijuana) and psychosis has seen quite a bit of research, but direct causation is difficult to establish. However, some research does show a correlation between psychosis and cannabis use, although others have criticized this research for using causal language and being politically motivated.

Of course, the scientific difficulty here is the difference between correlation and causation. Defenders of cannabis often suggest that perhaps people predisposed to psychosis are drawn to cannabis use but that cannabis use itself does not cause psychosis. Some research could support this line of reasoning, such as a study that found no relationship between teenage cannabis use and adult mental health issues.

Other research does suggest the possibility of a causal relationship, however tentative, and with the cautionary note that more studies are needed. Either way, the correlational research is compelling.

The current study adds to existing research analyzing the correlation between “psychotic disorders” and cannabis use, focusing on U.S. adults, which the authors state is an under-examined population. Relying on self-report questionnaires from 2001-2002 and 2012-2013 associated with the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the authors asked the following three questions:

  • “Did the prevalence of current self-reported psychosis (a self-reported psychotic episode in the past year) change over time?”
  • “Were cannabis use indicators (any nonmedical use, frequent nonmedical use, daily/near-daily nonmedical use, or cannabis use disorder) associated with current self-reported psychosis in either survey?”
  • “Did the relationships of cannabis indicators and current self-reported psychosis change between 2001–2002 and 2012–2013?”

A total of 79,402 people responded to the two surveys. The first survey was approved by the U.S. Bureau of the Census and the Office of Management and Budget, while the second was reviewed and approved by the institutional review boards at the National Institutes of Health and the private data collection agency Westat.

Both surveys utilized the computer-assisted Alcohol Use Disorder and Associated Disabilities Interview Schedule program. Self-reporting of “psychotic disorders” was assessed using “nearly identical” sets of questions between the two surveys, asking whether a health professional had diagnosed the person with “schizophrenia or psychotic illness or episode.”

As mentioned, cannabis use indicators included four categories: any nonmedical use, frequent nonmedical use, daily/near-daily nonmedical use, and cannabis use disorder from the DSM-IV. In addition, the DSM-5’s “cannabis withdrawal” criterion was also included.

Variables controlled for included gender, age, race/ethnicity, education, and urbanicity. Past-year use of other drugs such as alcohol, tobacco, and stimulants was also controlled for because these substances could confound the study results.

Past-year self-reporting of a “psychotic disorder” diagnosis among U.S. adults was 0.33% in 2001-2002 and 0.80% in 2012-2013. After controlling for alcohol, tobacco, and stimulants, these results remained consistent, suggesting that none of these substances were responsible for the change in frequency between the two surveys.

This “provides evidence that psychotic disorders have been on the rise in the United States in recent decades.”

According to the authors, all indicators of nonmedical cannabis use were significantly associated with higher self-reported rates of “psychotic disorders” in the 2012-2013 survey, which the authors state is consistent with previous studies.

This association was true for only two cannabis use categories in the 2001-2002 survey: “any nonmedical cannabis use” and “cannabis use disorder.”

More intensive use of cannabis also seemed to have an impact:

“In addition, self-reported psychosis was significantly associated with frequent and daily/near-daily cannabis use in the more recent survey, supporting previous findings on a dose-response relationship between cannabis use and psychotic disorders.”

The authors state that this dose-response relationship should be studied in more depth in future research.

Participants who reported being diagnosed with the DSM-IV’s cannabis use disorder, along with cannabis withdrawal which was added into the DSM-5, held the highest significant association with “psychotic disorders” at 3.38%, compared to 0.68% for nonusers in the 2012-2013 survey.

This higher association with “psychotic disorders” was found in both surveys, with the 2001-2002 survey showing a 2.55% association for those diagnosed with cannabis use disorder, compared to 0.27% for nonusers.

The authors reflect that the comparatively higher association in the 2012-2013 survey may be due to the availability of higher potency cannabis products, which they state “have been associated with higher prevalence of psychosis.”

The authors noted several limitations to the study, such as the reliance on self-report questionnaires for both cannabis use and the diagnosis of “psychotic disorders.”

Additionally, they state that “directionality of the relationship cannot be determined in cross-sectional data,” again running into the problem of correlation (or “association”) versus causation.

They conclude:

“Nonmedical cannabis use and cannabis use disorder were consistently associated with self-reported psychotic disorders over time, while frequent and daily/near-daily use was also associated with self-reported psychotic disorders in the more recent survey. The increasing perception of cannabis as a harmless substance may deter the general public as well as health care providers from recognizing that nonmedical cannabis use may play a role in exacerbating the risk for psychotic disorders.
Therefore, improving public knowledge and educating providers about this risk may serve a useful function. In particular, identifying cannabis use disorder may help indicate individuals at increased risk of psychotic disorders. This information can inform addiction specialists and other clinicians about the need for evaluation and appropriate interventions and therapeutic modalities for individuals at risk.”



Livne, O., Shmulewitz, D., Sarvet, A. L., Wall, M. M., & Hasin, D. S. (2022). Association of cannabis use-related predictor variables and self-reported psychotic disorders: U.S. adults, 2001-2002 and 2012-2013. The American Journal of Psychiatry, 179(1), 36-45. (Link)

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Micah Ingle, PhD
Micah is part-time faculty in psychology at Point Park University. He holds a Ph.D. in Psychology: Consciousness and Society from the University of West Georgia. His interests include humanistic, critical, and liberation psychologies. He has published work on empathy, individualism, group therapy, and critical masculinities. Micah has served on the executive boards of Division 32 of the American Psychological Association (Society for Humanistic Psychology) as well as Division 24 (Society for Theoretical and Philosophical Psychology). His current research focuses on critiques of the western individualizing medical model, as well as cultivating alternatives via humanities-oriented group and community work.


  1. This higher association with “psychotic disorders” was found in both surveys, with the 2001-2002 survey showing a 2.55% association for those diagnosed with cannabis use disorder, compared to 0.27% for nonusers.

    The authors reflect that the comparatively higher association in the 2012-2013 survey may be due to the availability of higher potency cannabis products, which they state “have been associated with higher prevalence of psychosis.”

    The authors noted several limitations to the study, such as the reliance on self-report questionnaires for both cannabis use and the diagnosis of “psychotic disorders.”

    “Significant”? Way too wishy washy and biased. All sources are biased, even our host.

    H.R.2588 – Veterans Medical Marijuana Safe Harbor Act

    Opinions of U.S. Iraq and Afghanistan veterans regarding medical marijuana in 2020

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    • Certainly a major emphasis here in MIA is to expose the dangers of popular drugs. THC is a drug, so it is only fitting to examine possible harmful side effects from the use of marijuana.
      Based on personal observations and discussions with professionals who treat the suffering, it is my opinion that among other potential negative consequences for introducing THC into one’s system, lethargy must be examined. Millions of users who may become significantly lethargic, pose a threat to our society.

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  2. They must be joking!? “A survey based on Self-reported psychotic disorders?!” “Hey you, before you pull on that Joint, be careful you might suffer “psychotic disorder.” Which means you got a potent top-shelf strain!! Please pass that Doobie!! Great marketing Article!! Thank You!! Could they list the strains used in survey!? Peace out folks!!!

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  3. Thank You Micah,

    I think it depends on how Psychotic Disorder is interpreted.

    Cannabis can definitely cause “funny thinking”. But if a person stops smoking Cannabis the thinking is likely to return to normal.

    The “Long term Psychotic Disorders” are as a result of the treatments. This is the main reason that young Caribeann heritage people are 10 times more likely to get diagnosed with “Schizophrenia” than young indigenous UK People.

    Myself, I almost ended up permanently “Schizophrenic”, as a result of co operating with Psychiatric Treatment (following a poisoning in Amsterdam in 1980).

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    • Direct causation, yes!!! My son was diagnosed as having “Drug induced psychosis”.He was in the military hospital and sent back to the states for another milttary hospital for treatment and evaluation.
      I wanted to visit him at the hospital,but my son’s counselor said it was better if no family contact.
      He got a medical discharge,was deeply paranoid,disappeared ,2weeks later found he committed suicide.He was 29 yrs old.
      Research and family input needed.
      Just leave it to experts has still left me puzzled as to what happened.1989.

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  4. No doubt this post will generate the obligatory smirking remarks about “Reefer Madness.” But there’s nothing funny about any of this.

    I have read Alex Berenson’s “Tell Your Children” and Ross Grainger’s “Attacker Smoked Cannabis” and I have to say these cases of cannabis-associated violence sound eerily like the cases of antidepressant-associated violence I have been collating.

    Cannabis no longer belongs to the counterculture. Big Dope has gone mainstream. Their shares are bought and sold on the New York Stock Exchange by sedate potbellied bald white men.

    And now Big Dope is joining forces with Big Tobacco and Big Pharma — corporations which have decades of experience in hiding the truth and profiting from human misery.

    This will not end well.

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    • Oh Yes! Definitely elicited a “smirk.” I mean come on: “Big Dope has Gone Mainstream.” Nice rhetorical gimmick conflating with “Big Tobacco, et al. Well worn “Dope Fiend” Trope! What about the overwhelming alleviation of human misery provided by cannabis? What’s the stats on that? Assuming Cannabis may induce “psychosis” in a small cohort, that does not make cannabis a demon substance—it is real simple: If someone is a jerk by nature, and then they have a couple of alcoholic drinks, then more often than not, the effect of the alcohol is to make the jerk more of a jerk. Also, what if this purported “Cannabis tinged psychosis”for some experience it is a positive experience!?–I acknowledge Berneson’s journalistic muscle, especially his work on Covid, but on the pot issue, all i can say is, wholly unpersuasive, so chill out, and please pass that Doobie!!

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      • I didn’t sat anything about outlawing pot or any other drug. Nor did I give an estimate of what percentage of users experience psychosis and hallucinations.

        I do believe that people ought to know the harms of the drugs they are taking — whether we’re talking about Prozac or Paxil or pot. And now that Big Dope and Big Tobacco and Big Pharma are merging into one, look for the media to give the same sycophantic coverage to “medical marijuana” that they have been giving to so-called ‘antidepressants.”

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        • Hi Patrick, you write;

          “I have to say these cases of cannabis-associated violence sound eerily like the cases of antidepressant-associated violence I have been collating.”

          Is there something specific about these cases which you associate with one another that stands out? That is over and above the cases of alcohol related violence, or perhaps some of the racially motivated violence by the likes of Police etc?

          I’ve heard a little about ‘spellbinding’ and what a psychiatrist I spoke to calls ‘disinhibition’ as a result of drug consumption but….. I remain a skeptic on the causal type relationship between drug consumption and violence.

          I’d also like further information about the marriage between Bog Dope, Big Pharma and Tobacco. And where does Bog Booze fit into all of that? I just can’t see Ricky from Trailer Park Boys in an Armani suit buying and selling shares on the NY Stock Exchange lol

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          • I’m talking about sudden and senseless acts of horrifying violence with no apparent motive. I don’t know how much more specific you want me to get.

            For information on the marriage between Big Dope, Big Tobacco, Big Pharma, and Big Sugar, see Ross Grainger’s Attacker Smoked Cannabis.

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          • “I’m talking about sudden and senseless acts of horrifying violence with no apparent motive.”

            Oh, like Afghanistan lol. Seriously though, the way these narratives are “edited” by the State where I live, one would have zero possibility of understanding the ‘motives’. For example, there was a man who set fire to his children who claimed he had been ‘spiked’ with benzos (possibly by his wife) who was sent to prison for his offenses. The claim that he had been ‘spiked’ lacking any proof. And lawyers in Australia can be paid informants of Police (see Nicola Gobbo Lawyer X), or may simply ‘find out what ya got’ and then throw you under the bus once police have retrieved the ‘problematic’ evidence/documents. Sounds insane until one slips the net and they have to cover up their really bad cover up.

            Point being I KNOW from personal experience that such ‘spikings’ are concealed by the State via the “editing” of documents (and threatening of witnesses) before the lawyers have the opportunity to examine the facts which means that his defense is removed for the sake of ensuring he goes to prison.

            So this violence engaged in by this particular individual which may have been the result of the drugs, is actually attributed to his biology (untampered with via ‘spiking’).
            I note a similar story published just recently on MiA where the author claimed to know that their psychotic episode was NOT the result of a ‘spiking’ How could one be so certain without having had tests done post the ‘experience’? I think here of the situation with Prof. John Kearsley whose ‘victim’ was allowed to have a blood test done after the event, something the people who ‘cared’ for me denied me the right to, instead making the drugs I had been ‘spiked’ with my ‘regular medications’ after I had been subjected to interrogations by mental health and Police. Conceal the truth regarding the ‘spiking’ and then slander the victim for complaining about the covert drugging, making a victim of public officer misconduct and human rights abuses a paranoid delusional who needs ‘treatment’. Works a treat.

            Torture in Australia is a little more culturally accepted due to our history with our native population, police use of electricity still occurring to this day. I note the method of making ‘referrals’ to mental health services by police when their corruption and human rights abuses for ‘snowing’ seems a little more common than I at first thought. See above for the method of ‘police referral’ and use of mental health services to ‘snow’ Spratt, while the corruption watchdog conceals the evidence from the public.

            In fact Police put forward an “edited” version of events to the media in the case of Spratt, which was later identified as being false/fraudulent. Releasing his records to the media unlawfully (not unlike my medical records being released to slander when they ‘fuking destroyed’ me and my family for complaining about torture)

            I wonder how many of the officers who assaulted Spratt are taking ‘medications’ as a result of the trauma of their work, thus increasing the violence they are dishing out to the people they have a duty of care towards? (see Fanons European Policeman who tortured his wife and children in Wretched of the Earth)



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        • Why do you use term “Big Dope?” How is “Big Dope” distinguished from “Big Pharma?” What is difference between “Big Dope” and “Medical Marijuana?” Why the language games? What is “sycophantic coverage?” What would be counter-example of “non-sycophantic coverage.” Just trying to get to the core issue.

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        • The problem to the question you’re asking, is that the answer is, “it depends.” It depends on user perceptual status, the kind of substances most commonly used as well as or in addition to cannabis, the presence and kind of users’ physical and social peculiarities, and so on.

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      • There are still many states and jurisdictions where having marijuana is illegal; so, in those places it is basically outlawed. Although alcohol is legal (we tried outlawing it with prohibition in the 1920s which was a failure) there are very strict laws against driving while under the influence. Outlawing religion is a communist marxist idea. We have way too many legal mind-altering dangerous drugs, think of psychiatric drugs. Why legalize another dangerous drug such as marijuana? The only reason would be as they say “to make the rich richer and the poor poorer.” Why take the chance? And as long as we have the evil, dangerous psych drugs available, who needs marijuana? Thank you.

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  5. Correlation is not synonymous with causation!

    It makes no more sense to say that cannabis causes psychosis than to say that psychosis causes cannabis use. The common denominator is likely to be health-damaging social conditions.

    People in distressing conditions are more prone to “psychosis” and may also self-medicate with cannabis. It should be stressed that cannabis is much less harmful than any psychiatric drug. According to the DEA website, not a single death has ever been recorded from cannabis overdose.

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  6. Something does not directly have to cause death to be dangerous. I do not know the potency of cannibis versus psychiatric drugs. I know one thing that the amount of prescriptions written for any specific drug or a class of drugs does not ever prove its efficacy. As far as cannibis causing psychosis, I think I may have had a “psychotic episode” while smoking marijuana with friends way back in my college days. After that experience or rather experiences because I was dumb enough to try this twice; I said no to marijuana. Why I did not have enough sense to realize that similar things could happen while under the influence of prescribed psychiatic drugs escapes me except that I was brainwashed by their alleged but highly fale authority and expertise. I can not, in good conscience, condone the legalization of marijuana especially for recreational uses and I question its use for medical reasons. I am afraid that the desire to legalize marijuana is just another way to use mind altering drugs to dumb and numb us down so they can get their way with us, just like that seedy rich old geezer and the barfly stories. Thank you.

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  7. Mr. George Gurdjieff was fond of saying “Anything can be a drug.” He should know.

    Studies on the use of caffeine, nicotine, alcohol, diets, music, games, societal “norms”, almost anything people get “hooked” on or are pressured to consume or participate in could be shown in legitimate studies to alter consciousness. Mental illness is a profitable myth that must be maintained by the rich, but the changes in attitude they object to are alterations of consciousness, not a disease, or demonic possession.

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