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. Author manuscript; available in PMC: 2025 Feb 25.
Published in final edited form as: Subst Use Misuse. 2024 Feb 25;59(7):1133–1140. doi: 10.1080/10826084.2024.2320400

Social Anxiety and Cannabis-Related Problems: The Serial Roles of Distress Tolerance and Cannabis Use Motives

Paige E Morris a, Luke A Vargo a, Julia D Buckner a,*
PMCID: PMC11025634  NIHMSID: NIHMS1978172  PMID: 38403969

Abstract

Individuals with elevated social anxiety are vulnerable to experiencing negative consequences related to cannabis use. One transdiagnostic vulnerability factor that has received little attention in the social anxiety-cannabis problem relation is distress tolerance, which is associated with more cannabis use to manage negative affect broadly (i.e., coping motives) and cannabis-related problems. However, it is unknown whether distress tolerance is related to greater cannabis use to manage social anxiety specifically (i.e., social anxiety motives). This study tested whether the relation between social anxiety and cannabis problems occurred via perceived distress tolerance among 309 (77.3% female) undergraduates who endorsed current (past three-month) cannabis use. Social anxiety was negatively associated with distress tolerance and positively associated with cannabis problems, coping, and social anxiety motives. Social anxiety was indirectly (via distress tolerance) related to more cannabis problems and motives to cope with negative affect generally and to cope with social anxiety specifically. Social anxiety was indirectly related to more cannabis problems via the serial effects of distress tolerance and coping and social anxiety motives. Findings suggest that individuals with elevated social anxiety may be vulnerable to using cannabis to manage negative affect (generally and social anxiety specifically) due to low perceived ability to tolerate psychological distress, which may lead to more cannabis problems.

Keywords: cannabis, marijuana, distress tolerance, social anxiety, motives, coping motives

Introduction

Cannabis is the most commonly used illicit substance among college students in the U.S., with 44% of full-time college students (ages 19-22) endorsing past-year use in 2020 (Schulenberg et al., 2021), 23.1 to 27.4% endorsing past three-month use (Buckner, Ecker, et al., 2016; Wang et al., 2019), and 26.2 to 29.4% endorsing past 30-day cannabis use (Patrick et al., 2022). Further, cannabis use among undergraduates is associated with a variety of negative consequences, including those that can impact their ability to succeed in college such as more absences from classes, lower grade point average (GPA), and delayed graduation (e.g., Arria et al., 2015; Suerken et al., 2016), as well as elevated anxiety and depression (e.g., Buckner et al., 2010). Social anxiety is a dimensional construct (Crome et al., 2010) that is positively related to cannabis problems such that individuals with greater social anxiety tend to experience more cannabis-related problems (Buckner et al., 2021; Ecker & Buckner, 2014; Foster et al., 2016; Villarosa-Hurlocker et al., 2019), even after accounting for variance attributable to other types of negative affect, including depression and other types of anxiety (Buckner, Heimberg, et al., 2012). Interesting, social anxiety tends to be unrelated to cannabis use frequency (for review see Single et al., 2022), suggesting that there is something about the way in which cannabis is used rather than the frequency it is used that plays a role in cannabis problem risk for this vulnerable group. Thus, identifying factors that play a role in the social anxiety-cannabis relation is important for improving cannabis-related outcomes among this group.

One understudied factor among individuals with elevated social anxiety that may play a role in these relations is distress tolerance. Perceived distress tolerance, defined as one’s perceived ability to endure experiential or subjective negative psychological and/or physical states (Simons & Gaher, 2005; Zvolensky et al., 2011), is related to greater social anxiety in both clinical (e.g., Laposa et al., 2015; Michel et al., 2016) and nonclinical (e.g., Keough et al., 2010) samples. Given that individuals with low levels of distress tolerance experience difficulty enduring negative affective states (e.g., Simons & Arens, 2007; Zvolensky et al., 2010), they may use cannabis in an attempt to manage their distress. This is concerning because using cannabis to cope may increase reliance on cannabis during periods of heightened distress, resulting in continued use despite cannabis-related problems (e.g., Simons & Arens, 2007). Indeed, the relationship between distress tolerance and cannabis outcomes has been well-documented (e.g., Buckner, Jeffries, et al., 2016; Bujarski et al., 2012; Farris et al., 2016; Hartmann & McLeish, 2022; Peraza et al., 2019). Specifically, lower levels of distress tolerance are significantly associated with greater cannabis use and use-related problems (e.g., Buckner, Jeffries, et al., 2016; Bujarski et al., 2012), cannabis dependence symptoms (e.g., Farris et al., 2016), and cannabis craving during heightened negative affective states (Buckner, Walukevich Dienst, et al., 2019). Thus, accumulating evidence indicates that distress tolerance is associated with greater negative affect, cannabis use, and use-related problems.

One relevant explanatory factor for understanding how low perceived ability to tolerate distress is associated with negative cannabis outcomes is reasons for cannabis use (i.e., motives). To illustrate, using cannabis to cope with negative affect (i.e., coping motives) mediates the relation between low distress tolerance and negative cannabis outcomes, such as cannabis craving, withdrawal, and perceived barriers to cannabis cessation (Peraza et al., 2019). Although the relation between distress tolerance and coping motives has been well-established, little empirical attention has been paid to the impact of distress tolerance on cannabis outcomes among individuals with elevated social anxiety specifically. Moreover, no known studies have tested whether lower levels of distress tolerance and using cannabis to cope with elevated social anxiety specifically (i.e., social anxiety motives) is associated with greater negative cannabis-related consequences.

The aim of the present study was to elucidate the roles of distress tolerance and cannabis use motives in the relation between social anxiety and cannabis problems in several ways. First, we sought to replicate prior work that social anxiety is associated with lower distress tolerance (e.g., Keough et al., 2010), greater cannabis use to cope with negative affect broadly (i.e., coping motives; e.g., Buckner, Bonn-Miller, et al., 2007; Buckner, Zvolensky, et al., 2012), and greater cannabis use to cope with social anxiety (i.e., social anxiety motives; e.g., Morris & Buckner, 2022). Second, in line with prior work indicating that distress tolerance is negatively associated with cannabis problems (Buckner, Jeffries, et al., 2016; Buckner, Keough, et al., 2007; Buckner, Zvolensky, et al., 2012) and coping motives (e.g., Peraza et al., 2019; Zvolensky et al., 2009), we tested whether social anxiety was related to cannabis outcomes via the indirect effects of distress tolerance (see Figure 1 for conceptual path). We hypothesized that social anxiety would be related to greater cannabis problems, coping motives, and social anxiety motives via the indirect effect of lower distress tolerance. Third, consistent with accumulating evidence that lower distress tolerance is associated with more negative cannabis outcomes (e.g., Buckner, Walukevich Dienst, et al., 2019; Bujarski et al., 2012; Peraza et al., 2019) and that the association between social anxiety and cannabis problems occurred via the indirect effects of coping motives and social anxiety motives (Morris & Buckner, 2022), we hypothesized that social anxiety would be significantly positively related to cannabis problems via the serial effects of lower distress tolerance and more coping motives and social anxiety motives (see Figure 2 for conceptual path).

Figure 1.

Figure 1

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Hypothesized Model of the Indirect Effect of Social Anxiety on Cannabis Outcomes (Use-Related Problems, Coping and Social Anxiety Motives) via Distress Tolerance

Figure 2.

Figure 2

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Hypothesized Serial Mediation Model of the Indirect Effect of Social Anxiety on Cannabis Problems via the Serial Effects of Distress Tolerance and Cannabis Use Motives (Coping and Social Anxiety Motives)

Method

Participants and Procedures

Participants were recruited through the psychology participant pool as part of a larger study of predictors of substance use among undergraduate students (Buckner, Lewis, et al., 2020; Buckner, Lewis, et al., 2019; Buckner, Zvolensky, et al., 2020; Mathews et al., 2019; Oakey-Frost et al., 2021). The university's Institutional Review Board approved the study and participants provided informed consent prior to data collection. Participants completed a series of self-report measures online using a secure data collection website (surveymonkey.com). Upon completion of the study, participants received research credits credit for their psychology course for compensation. Additionally, all participants received referrals to university-affiliated psychological outpatient clinics and contact information for the local crisis intervention hotline. Participants were eligible for the original study if they were at least 18 years of age and were eligible for the current study if they endorsed current (past three-month) cannabis use on a screening question, “Have you used cannabis in the past three months?”.

Of the 1148 that completed the survey, 317 endorsed current cannabis use; however, eight participants were excluded due to questionable validity of responses (described below). The final sample consisted of 309 participants (77.3% female) aged 18-33 (M = 19.96, SD = 1.83). The racial/ethnic composition was as follows: 72.8% Non-Hispanic/Latin White, 11.7% Non-Hispanic/Latin African American/Black, 4.9% Hispanic/Latin White, 3.6% Non-Hispanic/Latin Asian, 2.3% Non-Hispanic/Latin Multiracial, 1.6% Hispanic/Latin Multiracial, 1.0% Non-Hispanic/Latin American Indian, 1.0% Non-Hispanic/Latin ‘Other’, 1.0% Hispanic/Latin ‘Other’, and 0.3% Hispanic/Latin American Indian. Most of the sample was employed part-time (59.2%) or full-time (3.9%) and the class standing of the sample was: first-year (27.8%), sophomore (19.7%), junior (26.5%), senior (24.6%), and “other” or “N/A” (1.2%).

Regarding social anxiety, 22.3% of the sample scored above the clinical cutoff for social anxiety disorder (SAD; per Rodebaugh et al., 2011). Regarding cannabis use, most of the sample (67.3%) used cannabis at least two or three times per month and over half reported using cannabis for coping motives (51.8%) and social anxiety motives (58.6%).

Measures

The Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998) is a 20-item self-report measure of trait social anxiety (e.g., “When mixing socially, I am uncomfortable”). Participants were asked to indicate the degree to which they feel each statement is characteristic or true of them from 0 (not at all characteristic or true of me) to 4 (extremely characteristic or true of me) and items were summed to create a total score. As recommended by Rodebaugh et al. (2007), only the 17 straight forwardly-worded items were used, which has demonstrated good internal consistency in prior work (e.g., Buckner et al., 2021). The straightforward SIAS demonstrated excellent internal consistency in this sample (α = .95).

The Distress Tolerance Scale (DTS; Simons & Gaher, 2005) is a 15-item self-report measure of perceived distress tolerance (e.g., “I’ll do anything to stop feeling distressed or upset”). The DTS asks participants to “Think of times you feel distressed or upset” and rate their beliefs about their ability to tolerate distressing emotional states from 1 (strongly agree) to 5 (strongly disagree) and items are summed; thus, lower scores indicate less perceived ability to tolerate distress. The DTS has demonstrated good psychometric properties in prior work (e.g., Simons & Gaher, 2005; Zvolensky et al., 2009) and demonstrated excellent internal consistency in the present sample (α = .95).

The 19-item Marijuana Problems Scale (MPS; Stephens et al., 2000) assessed past 90-day cannabis-related problems (e.g., memory loss, lower productivity). Response options range from 0 (no problem) to 2 (serious problem) and items scored greater than 0 were counted to create a total number of cannabis-related problems. The MPS has demonstrated good internal consistency in prior work (e.g., Ecker & Buckner, 2014; Lozano et al., 2006). In the present sample, the MPS demonstrated acceptable internal consistency (α = .84).

The Marijuana Use Form (MUF; Buckner, Bonn-Miller, et al., 2007) assessed past three-month cannabis use frequency on a scale ranging from 0 (Less than once a month [including never]) to 10 (21 or more times per week). The MUF has demonstrated convergent validity with ecological momentary assessments of cannabis use (Buckner, Crosby, et al., 2012).

The Comprehensive Marijuana Motives Questionnaire (CMMQ; Lee et al., 2009) is a 36-item self-report measure of cannabis use motives. The three-item coping (e.g., “To forget your problems”) and social anxiety (e.g., “Because it relaxes you when you are in an insecure situation”) subscales were used in the present study. Participants were asked to think “of all the times you have used marijuana” and rate how often they used cannabis for each reason from 1 (almost never/never) to 5 (almost always/always). Subscale items were summed to calculate a total score for the coping and social anxiety motives subscales. The reliability and validity of the CMMQ subscales has been well-documented in prior work (e.g., Blevins et al., 2016; Bonn-Miller et al., 2014) and internal consistency was good for the coping (α = .85) and social anxiety (α = .82) subscales in the present sample.

To identify random responders and/or participants that did not pay attention to the survey content, four questions from the Infrequency Scale (Chapman & Chapman, 1983) were used. Consistent with other online studies (e.g., Cohen et al., 2009), participants that incorrectly answered three or more questions were excluded from analyses (n = 8).

Data Analytic Strategy

We conducted analyses using SPSS 28. First, we conducted bivariate correlations among study variables to test whether social anxiety was related to distress tolerance and cannabis variables. To test what types of problems were related to social anxiety, we also conducted exploratory bivariate correlations. Next, we conducted a series of mediation models using PROCESS, a conditional process modeling program that utilizes an ordinary least squares-based path analytical framework to test for both direct and indirect effects (Hayes, 2018). All specific and conditional indirect effects were subjected to follow-up bootstrap analyses with 10,000 resamples from which a 95% confidence interval was estimated (Hayes, 2009; Preacher & Hayes, 2004, 2008). First, we used mediation models (PROCESS model 4) to test whether the relationship between social anxiety and cannabis-related problems and coping and social anxiety motives occurred indirectly via distress tolerance, with separate models for each motive (see Figure 1). Second, we conducted a serial mediation model (PROCESS model 6) to test whether the relationship between social anxiety and cannabis-related problems occurred indirectly via the serial effects of distress tolerance and these cannabis use motives, with separate models for each motive (see Figure 2). With this type of serial multiple mediator model, the independent variable can affect the dependent variable through four pathways: directly and/or indirectly via distress tolerance only, via cannabis use motives only, and/or via both sequentially, with distress tolerance affecting cannabis use motives (Hayes, 2013). Cross-sectional tests of putative indirect effects can serve as an important initial step in testing mediation (Hayes, 2018). Given the limitations of testing mediational effects using cross-sectional data, we conducted additional analyses, reversing the outcome and proposed mediator variables to increase confidence in the observed effects (Kenny, 2021). Specifically, we tested whether social anxiety was related to greater distress tolerance via the serial effects of cannabis problems then cannabis use motives, with separate models for each motive. Examining both the hypothesized and alternative models, where the proposed mediator and outcome variable are interchanged, bolsters confidence in the effects specified in the hypothesized model, given that the direction of causation cannot be determined by statistical analyses alone and that it cannot be theoretically ruled out that the outcome caused the putative mediator (Kenny, 2021; Lemmer & Gollwitzer, 2017). Relevant demographic and baseline variables (sex, age, past three-month cannabis use frequency) were included as covariates in all models.

Results

Results from the bivariate correlation analyses and descriptive statistics are presented in Table 1. Social anxiety was statistically significantly correlated with lower distress tolerance and greater cannabis problems, coping motives, and social anxiety motives (but was not statistically significantly related to cannabis use frequency). Distress tolerance was statistically significantly negatively correlated with cannabis problems, coping motives, and social anxiety motives (but was unrelated to cannabis use frequency). Social anxiety was statistically significantly positively correlated with the following specific cannabis related problems: withdrawal symptoms (r = .15, p = .009), memory loss (r = .13, p = .025), legal problems (r = .16, p = .004), feeling bad about use (r = .22, p < .001), lowered self-esteem (r = .18, p = .001), and lack of self-confidence (r = .18, p = .001).

Table 1.

Bivariate Correlations among Study Variables and Descriptive Statistics

1 2 3 4 5 6
1. Social anxiety - −.35** .16** .06 .27** .24**
2. Distress tolerance - - −.24** −.07 −.28** −.23**
3. Cannabis-related problems - - - .45** .48** .39**
4. Cannabis use frequency - - - - .38** .45**
5. Coping motives - - - - - .55**
6. Social anxiety motives - - - - - -
M 17.26 47.85 2.24 3.18 1.63 1.70
SD 13.51 12.84 2.91 2.70 0.86 0.89
Range 0-59 15-75 0-19 0-10 1-5 1-5
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Note. *p <.05. **p < .01.

Mediation Models

First, we tested whether the relation between social anxiety and cannabis problems occurred via the indirect effects of distress tolerance (Table 2). The full model statistically significantly predicted cannabis problems, R2 = .263, F(5, 303) = 21.67, p < .001. After controlling for shared variance, distress tolerance (but not social anxiety) remained statistically significantly related to cannabis problems. Social anxiety was indirectly related to cannabis problems via distress tolerance.

Table 2.

Distress Tolerance Mediational Models for Social Anxiety and Cannabis Outcomes

Paths b SE p 95% CI
LL UL
DV: Cannabis problems
Social anxiety → Distress tolerance (a) −0.320 0.051 <.001 −0.420 −0.219
Distress tolerance → Cannabis problems (b) −0.042 0.012 .001 −0.065 −0.018
Social anxiety → Cannabis problems (c) 0.031 0.011 .005 0.009 0.052
Social anxiety → Cannabis problems (c’) 0.017 0.011 .126 −0.005 0.040
Social anxiety → Distress tolerance → Cannabis problems (ab) 0.013 0.005 0.006 0.023
DV: Coping motives
Distress tolerance → Coping motives (b) −0.012 0.004 .001 −0.019 −0.005
Social anxiety → Coping motives (c) 0.015 0.003 <.001 0.009 0.022
Social anxiety → Coping motives (c’) 0.011 0.003 .001 0.005 0.018
Social anxiety → Distress tolerance → Coping motives (ab) 0.004 0.001 0.002 0.007
DV: Social anxiety motives
Distress tolerance → Social anxiety motives (b) −0.010 0.004 .007 −0.017 −0.003
Social anxiety → Social anxiety motives (c) 0.014 0.003 <.001 0.008 0.021
Social anxiety → Social anxiety motives (c’) 0.011 0.003 .001 0.004 0.018
Social anxiety → Distress tolerance → Social anxiety motives (ab) 0.003 0.001 0.001 0.006
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Note. DV = dependent variable. Path c = total effect of social anxiety on the dependent variable. Path c’ = direct effect of social anxiety on the dependent variable controlling for distress tolerance. Statistically significant effects are presented in bold. Sex, age, and past three-month cannabis use frequency were included as covariates in all models.

Next, we tested whether the relation between social anxiety and coping and social anxiety motives occurred via the indirect effects of distress tolerance, with separate models for each motive (Table 2). The full models statistically significantly predicted coping, R2 = .242, F(5, 303) = 19.34, p < .001, and social anxiety, R2 = .266, F(5, 303) = 22.00, p < .001, motives. After controlling for shared variance, both social anxiety and distress tolerance remained statistically significantly related to both coping motives and social anxiety motives. Social anxiety was indirectly related to both coping motives and social anxiety motives via distress tolerance.

Serial Mediation Models

Next, we tested whether the relation between social anxiety and cannabis-related problems occurred via the serial indirect effects of distress tolerance and cannabis use motives. To examine both coping motives and social anxiety motives as possible mediators, we conducted separate models for each motive 1 (Table 3). Regarding the model with coping motives, the full model with predictor and putative serial mediators (distress tolerance, coping motives) predicted statistically significant variance in cannabis-related problems, R2 = .343, F(6, 302) = 26.31, p < .001, and there was no longer a statistically significant direct effect of social anxiety on cannabis-related problems after controlling for distress tolerance and coping motives (Table 3). Social anxiety was indirectly related to more cannabis problems via the serial effect of distress tolerance and coping motives, and via distress tolerance and coping motives alone.

Table 3.

Serial Mediation Model of Social Anxiety Predicting Cannabis-Related Problems via Distress

Paths b SE p 95% CI
LL UL
Model 1: Coping motives
Distress tolerance (b1) −0.028 0.012 .016 −0.051 −0.005
Coping motives (b2) 1.095 0.181 <.001 0.740 1.451
Social anxiety (c’) 0.005 0.011 .648 −0.017 0.027
Indirect effects
 Social anxiety → Distress tolerance 0.009 0.004 0.002 0.018
 Social anxiety → Coping motives 0.012 0.005 0.003 0.023
 Social anxiety → Distress tolerance → Coping motives 0.004 0.002 0.001 0.008
Model 2: Social anxiety motives
Distress tolerance (b1) −0.035 0.012 .003 −0.059 −0.012
Social anxiety motives (b2) 0.649 0.185 .001 0.284 1.014
Social anxiety (c’) 0.010 0.011 .372 −0.012 0.033
Indirect effects
 Social anxiety → Distress tolerance 0.011 0.004 0.004 0.021
 Social anxiety → Social anxiety motives 0.007 0.004 0.001 0.016
 Social anxiety → Distress tolerance → Social anxiety motives 0.002 0.001 0.000 0.005
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Tolerance and Cannabis Motives

Note. Statistically significant effects are presented in bold. Sex, age, and past three-month cannabis use frequency were included as covariates in all models.

Regarding the model with social anxiety motives, the full model with predictor and putative serial mediators (distress tolerance, social anxiety motives) predicted statistically significant variance in cannabis-related problems, R2 = .292, F(6, 302) = 20.77, p < .001, and there was no longer a statistically significant direct effect of social anxiety on cannabis-related problems after controlling for distress tolerance and social anxiety motives (Table 3). The indirect effects were estimated and revealed that social anxiety was indirectly related to more cannabis problems via the serial effect of distress tolerance and social anxiety motives, and via distress tolerance and social anxiety motives alone.

Alternative Models

Regarding the alternative models, social anxiety was not indirectly related to distress tolerance via the serial effects of cannabis problems then coping motives, b = −0.007, SE = .005, 95% CI [−0.018, 0.000], or social anxiety motives, b = −0.004, SE = .003, 95% CI [−0.011, 0.000].

Discussion

This is the first known study to examine the role of distress tolerance in the association between social anxiety and cannabis outcomes. These hypotheses align with theoretical models of SAD (Clark & Wells, 1995; Rodebaugh et al., 2004), which conceptualize social anxiety as a perceived inability to tolerate distress related to fears of negative evaluations and motivational models of substance use (e.g., Baker et al., 2004), which posit that cannabis is used to avoid or escape negative affective states. Consistent with these conceptualizations, we found that social anxiety and distress tolerance were associated with using cannabis to cope with negative affect broadly per prior work (e.g., Buckner, Bonn-Miller, et al., 2007; Peraza et al., 2019), and we extended this work by finding it also related to using cannabis to cope with social anxiety specifically.

Findings indicated that social anxiety was indirectly related to cannabis problems via the serial effects of distress tolerance and coping motives and social anxiety motives, suggesting that individuals with elevated social anxiety with low perceived ability to tolerate distress are motivated to use cannabis to manage such distress, both generally and specifically related to social concerns, which may lead to greater use-related problems, potentially due to using cannabis to cope at the exclusion of more adaptive coping strategies. In support of this conceptualization, during a laboratory-induction of negative affect, individuals with low (but not high) distress tolerance endorsed more cannabis cravings when negative affect was at its greatest, as well as greater coping motives (Buckner, Walukevich Dienst, et al., 2019).

These findings may help inform clinical interventions in several ways. First, the finding that social anxiety is related to lower perceived distress tolerance adds to the growing body of literature on the importance of this construct in the assessment and treatment of anxiety disorders broadly. To illustrate, among individuals receiving cognitive-behavioral therapy (CBT) for SAD, those with lower distress tolerance at baseline had greater SAD symptom severity throughout the 12-week treatment period and post-treatment (Katz et al., 2017), suggesting that those with lower distress tolerance may be less likely to fully engage in treatment-related tasks that involve confronting distress related to social fears (e.g., exposures) and thus may not experience treatment gains to the same degree as those who have higher perceived ability to tolerate distress. However, no known studies have tested whether perceived ability to tolerate distress increases throughout the course of CBT treatment for SAD. Second, adapting empirically-supported SAD treatment protocols (e.g., Hope et al., 2019) to include skills that target distress tolerance skills directly may be beneficial for individuals who use cannabis to cope with negative affect broadly and/or social anxiety specifically. Third, researchers are encouraged to test whether treatment modalities designed specifically to improve distress tolerance, such as dialectical behavioral therapy (Zeifman et al., 2020), are useful in helping individuals with elevated social anxiety manage their cannabis-related problems. Fourth, targeting individual difference factors in cannabis use disorder treatment, such as social anxiety cannabis use motives, may be particularly useful as cannabis use is increasing in the U.S. (O’Grady et al., 2022). Also, given the high prevalence of cannabis use among college students (Patrick et al., 2022; Schulenberg et al., 2021), universities may benefit from employing targeted intervention and prevention strategies to reduce cannabis coping motives and social anxiety motives and improve distress tolerance. Doing so may reduce cannabis-related problems which may in turn improve outcomes (e.g., educational outcomes) among college students.

The current study had several limitations that may help inform future work in this area. First, our sample was non-treatment seeking and consisted primarily of non-Hispanic/Latin White female undergraduate students, and replication among more diverse samples and/or those seeking treatment is warranted. Second, given that cannabis use prevalence among young adults not enrolled in college is comparable to their college-attending peers (Patrick et al., 2022), additional research is necessary to examine if the presented results generalize to young adults that do not attend college. Third, although we conducted alternative models to improve confidence in these observed effects, these data were cross-sectional and future work examining temporal relations is warranted. Similarly, data were self-report, and biological verification of cannabis use could be an important next step. Fourth, data were collected in a state in which cannabis is legal for medicinal but not recreational purposes. Given that legalization status can influence patterns of cannabis use and associated outcomes (Budney et al., 2019), future work is necessary to test whether results generalize to states with different laws regarding cannabis use.

Despite these limitations, the current study highlights the role of distress tolerance in the social anxiety and cannabis problem association and suggests that distress tolerance may be a useful target in clinical interventions.

Funding:

Dr. Buckner receives funding from the U.S. Department of Health & Human Services' Graduate Psychology Education (GPE) Program (Grant D40HP33350) and the National Institute on Alcohol Abuse and Alcoholism (R21AA030071). The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.

Footnotes

Declarations of Interest: None

1

To assess whether controlling for the effects of each respective motive resulted in a differential pattern of findings, we entered coping and social anxiety motives into each respective model as a covariate. After controlling for age, sex, past three-month cannabis use frequency, and each respective motive, social anxiety was indirectly related to more cannabis problems via the serial effect of distress tolerance and coping motives, b = 0.002, SE = 0.001, 95% CI [0.000, 0.006], and via the serial effects of distress tolerance and social anxiety motives, b = 0.0003, SE = 0.001, 95% CI [0.000, 0.002].

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