Why People Use Cannabis Predicts Whether Use Becomes Harmful, Review Finds

Coping motives are consistently linked to greater cannabis-related problems, while medical and coping reasons for use increasingly overlap in ways that complicate both clinical assessment and policy, according to a 2024 narrative review synthesizing recent literature on the motivational drivers of cannabis use across diverse populations.

Why This Matters

Cannabis is now the most commonly used federally illicit substance in the United States, and daily or near-daily use rates have risen sharply in recent years. As legalization expands and medical cannabis programs proliferate, clinicians face growing pressure to distinguish between use that is therapeutic, recreational, and clinically concerning. Understanding why a person uses cannabis, rather than simply how much or how often, is increasingly recognized as central to identifying who is at risk for cannabis use disorder. This review arrives at a moment when the motivational architecture of cannabis use has direct implications for screening, prevention, and regulatory design.

Clinical Summary

Cannabis use motives have been studied extensively through the lens of motivational models of substance use, most notably the framework developed by Cooper and colleagues that categorizes reasons for use into coping, enhancement, social, conformity, and expansion motives. A 2024 narrative review by Hawn and colleagues, published in Current Addiction Reports, synthesizes literature from 2017 through 2023 identified through searches of PsycINFO, PubMed/Medline, and CINAHL. The review is organized around these motive categories and examines their associations with cannabis use frequency, cannabis-related problems, and cannabis use disorder across populations including adolescents, young adults, older adults, veterans, and racial, ethnic, sexual, and gender minority groups. The mechanistic rationale is straightforward: individuals who use cannabis primarily to regulate negative emotional states are engaging in negative reinforcement cycles that maintain and escalate use, creating a pathway from distress to disorder.

The review’s central finding is that coping motives, defined as using cannabis to escape or manage negative emotions such as anxiety, depression, or stress, are the most consistently replicated predictors of problematic cannabis use and cannabis use disorder across virtually all populations examined. Coping motives mediate the relationships between depression, anxiety, emotion dysregulation, childhood trauma, and downstream cannabis problems. A particularly notable finding is that medical and health-related cannabis use motives overlap substantially with coping motives, raising the possibility that a “medical” framing may obscure what is functionally coping-driven use. The authors also highlight that minority stress, experienced disproportionately by racial, ethnic, sexual, and gender minority individuals, elevates coping-motivated use. Key limitations include the narrative rather than systematic design, the absence of risk-of-bias assessment for included studies, and the reliance on cross-sectional data for many of the cited associations. The authors call for prospective longitudinal studies and validated instruments that can clearly differentiate medical from coping motives before these findings can inform clinical guidelines or policy.

Dr. Caplan’s Take

This review articulates something many of us see daily in clinical practice: the reason someone reaches for cannabis tells you more about their risk trajectory than the cannabis itself. The coping-motive finding is robust and clinically intuitive. What is harder to navigate is the medical-coping overlap. I regularly encounter patients who frame their cannabis use as treatment for anxiety, insomnia, or chronic pain, and in many cases, it functions exactly as a coping mechanism for undertreated conditions. This is not a criticism of those patients. It is an observation that “medical use” as a category is doing a great deal of work that it may not be equipped to do, and clinicians who accept the framing uncritically may miss opportunities for more effective intervention.

In practice, I assess motives directly. When a patient describes using cannabis primarily to manage distress, mood, or anxiety, I treat that as a signal to evaluate the underlying condition more thoroughly and to discuss whether cannabis is addressing or perpetuating the problem. I do not reflexively discourage cannabis use, but I do insist on specificity: what symptom, what dose, what outcome, and what alternatives have been tried. Motive assessment should be a standard part of any cannabis-related clinical conversation, and this review supports that approach even though it cannot prescribe it.

Clinical Perspective

This review sits at an interesting point in the research arc. The association between coping motives and cannabis-related harm is among the most replicated findings in the cannabis use literature, and the review faithfully represents that evidence base. What it adds, and what is less settled, is the argument that medical cannabis motives and coping motives are empirically entangled. This claim is grounded in observed correlations and conceptual analysis rather than in studies specifically designed to disentangle the two constructs. For clinicians, the implication is not that medical cannabis use is inherently problematic but that current assessment tools and regulatory categories may be insufficient to distinguish adaptive medical use from maladaptive coping use. The evidence supports asking patients directly about the emotional function of their cannabis use, but it does not yet support specific screening thresholds or diagnostic algorithms for this distinction.

There are no pharmacological safety signals unique to this review, as it does not evaluate specific cannabis products, dosing, or drug interactions. However, clinicians should note that patients using cannabis to cope with anxiety or mood disorders may experience rebound symptom worsening with cessation, and that concurrent use of cannabis with benzodiazepines, sedating antidepressants, or opioids introduces additive central nervous system depression risks that are especially relevant in the veteran and chronic pain populations discussed in the review. The single most actionable recommendation from this evidence is to incorporate a brief motive assessment, even a few directed questions about why a patient uses cannabis, into routine intake and follow-up for any patient reporting regular use.

Study at a Glance

Study Type

Narrative review

Population

Adolescents, young adults, older adults, veterans, racial/ethnic minority individuals, sexual and gender minority individuals

Intervention

Not applicable (review of motivational correlates of cannabis use)

Comparator

Not applicable

Primary Outcomes

Cannabis use frequency, cannabis-related problems, cannabis use disorder symptoms

Sample Size

Not applicable (narrative synthesis of multiple studies, 2017 to 2023)

Journal

Current Addiction Reports, 2024, 11:1045-1054

Year

2024

DOI

10.1007/s40429-024-00599-3

Funding Source

Not reported in available text

What Kind of Evidence Is This

This is a narrative review, not a systematic review or meta-analysis. It occupies a lower tier in the evidence hierarchy than systematic reviews because it does not employ a registered protocol, formal inclusion and exclusion criteria, or risk-of-bias assessment for included studies. The single most important inference constraint this imposes is that the completeness and representativeness of the cited literature cannot be independently verified, meaning the synthesis reflects the authors’ expert judgment and thematic priorities rather than a reproducible, exhaustive evidence map.

How This Fits With the Broader Literature

The coping-motive finding is strongly consistent with decades of motivational-model research across multiple substances, and it aligns with meta-analytic evidence, including a recent meta-analysis cited in the review confirming that all five standard motives are associated with cannabis-related problems but that coping motives show the most consistent and clinically significant associations. The medical-coping overlap argument extends prior work by Bujarski and colleagues and others who have noted the conceptual blurriness of medical cannabis use categories, but it remains an area where empirical resolution lags behind clinical and policy urgency.

The minority stress component of the review builds on established frameworks from Meyer and others, applying them specifically to cannabis use motives in ways that are relatively novel. Ecological momentary assessment studies cited in the review represent a methodological advance over retrospective self-report, but the body of real-time data remains small. Overall, this review consolidates rather than challenges existing findings, while raising the medical-coping overlap as a frontier question that demands targeted research.

Common Misreadings

The most likely overinterpretation is reading this review as evidence that medical cannabis use is inherently harmful or that it inevitably masks coping-driven use. The review does not establish that conclusion. It identifies a conceptual and empirical overlap between medical and coping motives and flags this as a concern worthy of further investigation, but the cross-sectional and correlational nature of most cited studies means that the direction and clinical significance of this overlap remain unresolved. Equating “medical motive” with “coping motive” in clinical or policy settings would exceed what the current evidence supports.

Bottom Line

This narrative review consolidates strong evidence that coping motives are the most reliable motivational predictor of cannabis-related harm and raises an important but empirically unsettled concern about the overlap between medical and coping use. It does not establish causal pathways or provide clinical decision rules. For practice now, its contribution is to reinforce that assessing why a patient uses cannabis, not just how much, should be a routine part of clinical evaluation.

References

1. Hawn SE, et al. Cannabis use motives: a narrative review of the recent literature (2017-2023). Current Addiction Reports. 2024;11:1045-1054. DOI: 10.1007/s40429-024-00599-3
2. Cooper ML, Kuntsche E, Levitt A, Barber LL, Wolf S. Motivational models of substance use: a review of theory and research on motives for using alcohol, marijuana, and tobacco. In: Sher KJ, ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Oxford University Press; 2016.
3. Bujarski SJ, Norberg MM, Copeland J. The association between distress tolerance and cannabis use-related problems: the mediating and moderating roles of coping motives and gender. Addictive Behaviors. 2012;37(10):1181-1184.
4. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin. 2003;129(5):674-697.