Objective: An increasing number of states have approved posttraumatic stress disorder (PTSD) as a qualifying condition for medical marijuana, though little evidence exists evaluating the effect of marijuana use in PTSD. We examined the association between marijuana use and PTSD symptom severity in a longitudinal, observational study. Methods: From 1992-2011, veterans with PTSD (N=2276) were admitted to specialized VA treatment programs with assessments conducted at intake and four months after discharge. Subjects were classified into four groups according to marijuana use: those with no use at admission or after discharge (“never used”); those who used at admission but not after discharge (“stoppers”); those who used at admission and after discharge (“continuing users”); and those using after discharge but not at admission (“starters”). Analyses of variance compared baseline characteristics and identified relevant covariates. Analyses of covariance then compared groups on follow-up measures of PTSD symptoms, drug and alcohol use, violent behavior, and employment. Results: After adjusting for relevant baseline covariates, marijuana use was significantly associated with worse outcomes in PTSD symptom severity, violent behavior, and measures of alcohol and drug use. At follow up, stoppers and never users had the lowest levels of PTSD symptoms (p<0.0001) and starters had the highest levels of violent behavior (p<0.0001). After adjusting for covariates and using never users as a reference, starting marijuana had an effect size on PTSD symptoms of +0.34 (Cohen’s d = change/SD) and stopping marijuana had an effect size of −0.18. Conclusions: In this observational study, initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.

Veterans with PSUD have more severe problems along several dimensions and use more numerous and varied services than those with 1 SUD. This distinctive clinical profile warrants research to develop and evaluate methods for treating patients with complex multimorbid disorders that involve interactions between medical morbidity and psychosocial dysfunction.

Brief educational interventions may alter some stigmatizing negative attitudes toward mental illness in healthcare trainees in low- and middle-income countries.

This study sought to determine the minimal clinically important difference (MCID) for two frequently used measures of symptom severity in Post-Traumatic Stress Disorder: the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL). Data from a randomized clinical trial of antipsychotic medication in military-related treatment-resistant PTSD (N= 267) included assessments 4 times over 26 weeks. Methods for estimating the MCID were based on both the anchor-based approach, using the Clinical Global Impressions (CGI) severity and improvement scales, rated by both clinicians and patients; and the distribution-based approach (based on standardized z-scores). Severity and change scores on the CAPS and PCL were converted to z-scores and compared across CGI levels using analysis of variance. The average difference in CAPS z-scores between each of three CGI levels between "moderate" to "severe" and from "no change" to "much improved" was 0.758 for clinician CGI ratings and 0.525 for patient CGI ratings and were similar for the PCL (0.483 and 0.471) with all differences significant at p<.0001). Clinically meaningful CAPS and PCL severity and change z-scores range between 0.5-0.8 standard deviations. The MCID estimates suggested here provide an empirical basis for determining whether statistically significant changes in CAPS and PCL scores are clinically meaningful.