Stigma toward individuals with cannabis use disorder across age groups: associations with familiarity and sociodemographic characteristics.
Table of Contents
Clinical Takeaway
People who personally know someone who uses cannabis tend to hold less stigmatizing attitudes toward those with cannabis use disorder, regardless of whether the person affected is an adolescent or an adult. Sociodemographic factors such as the age of the respondent also influence how much stigma is directed at individuals with CUD. Reducing stigma through public education and normalization of treatment-seeking may improve care engagement for people affected by CUD.
#39 Stigma toward individuals with cannabis use disorder across age groups: associations with familiarity and sociodemographic characteristics.
Citation: Basedow Lukas Andreas et al.. Stigma toward individuals with cannabis use disorder across age groups: associations with familiarity and sociodemographic characteristics.. Harm reduction journal. 2026. PMID: 42304466.
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Abstract: BACKGROUND: Stigma experienced by individuals with cannabis use disorder (CUD) has been identified as a significant impediment to their engagement with treatment programs. Therefore, this study aims to investigate the effect of sociodemographic factors and familiarity with cannabis on stigmatizing attributions towards adolescent and adult case vignettes of people affected by CUD. METHOD: A quota sampling web survey in Germany conducted by a professional survey institute including two case vignettes of people with a CUD, applying a 2 × 2 × 2 (age of vignette* age of participant*familiarity with cannabis/CUD) within-subject design. Sociodemographic information, questions about participants’ cannabis use experience, a measure of stigmatizing attitudes, and a short version of the attribution questionnaire. RESULTS: A total sample of n = 1603 (50.1% female) participants was recruited, with n = 501 being adolescent participants. Subjective social standing of the whole sample was slightly elevated (Mean social rank (SD) = 5.74 (1.8)). The adolescent case with a CUD was more stigmatized compared to an adult case (F(1, 3196) = 12.77; p < 0.001). Individuals who were more familiar with cannabis use (F(1,3196) = 19.65; p < 0.001) and/or CUD (F(1,3196) = 6.00; p =0 .014) reported fewer stigmatizing attributions. This effect of familiarity was more pronounced for adolescents compared to adults. CONCLUSIONS: Adults with CUD seem to receive less stigma compared to adolescents with CUD, while stigmatizing attributions are produced less often when people have more contact with cannabis use and CUD. Future studies should aim to systematically test the influence of different characteristics of stigmatizing persons on stigma production in order to offer tailored interventions.
What This Study Teaches Us
Adolescents with cannabis use disorder face significantly more stigma than adults with the same condition, but this stigma diminishes substantially when the person making the judgment has direct personal familiarity with cannabis use or CUD. The protective effect of familiarity is stronger when judging adolescents than adults.
Why This Matters Clinically
Stigma is a documented barrier to treatment engagement for people with CUD. If clinicians and the public understand that exposure and familiarity reduce stigmatizing attitudes, it supports arguments for public education and destigmatization campaigns, particularly around adolescent CUD where stigma runs highest. This has direct implications for how we frame CUD in our communities and practices.
Study Snapshot
| Study Design | Web-based quota sampling survey with factorial within-subject design using case vignettes (2x2x2 design: adolescent vs adult case, adolescent vs adult participant, high vs low familiarity with cannabis/CUD) |
| Population | N=1603 participants (50.1% female) recruited in Germany, including 501 adolescent participants. Mean subjective social rank 5.74 (SD 1.8) |
| Intervention | Participants read two case vignettes describing individuals with CUD (one adolescent, one adult). No intervention was administered; this was an observational measurement study |
| Primary Outcome | Stigmatizing attributions measured via stigmatizing attitudes scale and short version of attribution questionnaire |
| Key Result | Adolescent case received more stigma than adult case (F(1,3196)=12.77, p<0.001). Familiarity with cannabis use (F(1,3196)=19.65, p<0.001) and CUD (F(1,3196)=6.00, p=0.014) independently reduced stigmatizing attributions, with stronger protective effect for adolescent cases |
Where This Paper Deserves Skepticism
This is a vignette study, which means we’re measuring hypothetical stigmatizing attitudes rather than actual behavior toward real people with CUD, and stated attitudes often diverge from real-world actions. The abstract does not specify how ‘familiarity’ was operationalized or measured, making it unclear whether this means personal use, having a family member with CUD, professional exposure, or something else entirely. The study was conducted in Germany with a web-based sample, limiting generalizability to other healthcare systems and populations. The cross-sectional design establishes association only, not whether familiarity causes attitude change or whether people with less stigmatizing attitudes self-select into cannabis-familiar circles.
Dr. Caplan’s Take
I find the core observation clinically relevant: stigma toward adolescent CUD is real and measurable, and personal familiarity appears protective. But I’d want to understand the mechanism better before designing interventions. Is familiarity protective because it humanizes the condition, because stigmatizing people update their views with real experience, or because attitudes were never stigmatizing to begin with among the ‘familiar’ group? The stronger effect in adolescents is interesting and deserves follow-up, but vignette-based attitude measurement is a thin proxy for how we actually treat patients in the room. This paper is better at describing the problem than prescribing the solution.
Clinical Bottom Line
Stigma against adolescents with CUD is measurably higher than against adults with the same diagnosis, and personal exposure to cannabis use or CUD reduces stigmatizing attitudes. Clinicians should recognize both the pronounced stigma adolescents face and the potential value of destigmatization education grounded in real exposure and familiarity.
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