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. Author manuscript; available in PMC: 2016 Oct 1.
Published in final edited form as: Curr Opin Psychol. 2015 Oct 1;5:6–12. doi: 10.1016/j.copsyc.2015.03.002

Does Marijuana Use Contribute to Intimate Partner Aggression? A Brief Review and Directions for Future Research

Maria Testa 1, Whitney C Brown 1
PMCID: PMC4378538  NIHMSID: NIHMS672463  PMID: 25839050

Abstract

Marijuana users are more likely to perpetrate intimate partner aggression (IPA) than non-users, yet the mechanism responsible for this association is unknown. Recent studies considering the association between episodes of marijuana use and episodes of IPA have failed to find evidence consistent with an acute effect of marijuana. Research gaps are highlighted and a heuristic model of marijuana’s potential effects on IPA is presented. Research priorities include consideration of mediating mechanisms, moderating variables at the individual and couple level, and examination of acute effects of marijuana using daily report and EMA designs.

Marijuana is the most commonly used illegal substance in the US [1], widely used for its ability to induce relaxation and mild euphoria. The notion that marijuana use may contribute to intimate partner aggression (IPA) seems paradoxical. Yet marijuana has been positively associated with perpetration of IPA across a variety of samples [2], [3], [4], [5]. Understanding the association between marijuana and IPA takes on increasing urgency with the rapid growth in marijuana use and acceptance of legalization in recent years [6]. In 2013, 7.5% of Americans 12 and older used marijuana in the past month, an increase from 5.8% in 2007 [7]. As prevalence of marijuana use increases, any negative consequences associated with usage are expected to increase as well.

The literature on marijuana and IPA was reviewed in 2005 [8] and meta-analyzed in 2008 [9]. Based on 14 survey studies (32 effect sizes), there was a small but statistically significant effect of marijuana on physical IPA perpetration (d = .21) [9]. The current review focuses on approximately 30 studies published since 2008 that considered the effect of marijuana use on physical IPA perpetration. Studies that considered marijuana use as a consequence of IPA are not included. Studies were identified from the PsycInfo and Medline databases using the keywords CANNABIS or MARIJUANA with VIOLENCE. We included studies that assessed both perpetration and victimization, variables that are highly correlated [10] [11], but excluded studies that examined victimization only.

Following earlier convention [8,12], we distinguish between distal and proximal effects of marijuana. Distal effects refer to the relationship between marijuana use patterns and frequency of IPA, whereas proximal or acute effects refer to the occurrence of IPA while the user is under the influence of marijuana. It is a fallacy to conclude that distal effects reflect acute effects. Marijuana users may perpetrate IPA while under the influence of the drug, but an association at the distal level may also be spurious or reflect an indirect mechanism.

Cross-Sectional Studies

Because marijuana users differ from non-users on variables such as alcohol use, depression, and antisocial personality [13] [14]; [15], most survey studies control for potential confounding variables. Independent positive effects of marijuana on IPA have been found in adolescent and college samples [16]; [17]; [2]; [18] and in adult and adolescent emergency department patients [5]; [19]. In some studies the association was limited to certain groups, for example, college women but not men [20], or, college men but not women [3]. In the National Household Survey on Drug Abuse there was a relationship between marijuana and IPA among minorities but not Caucasians [21]. In one study marijuana was a significant predictor of IPA in bivariate but not in multivariate analyses [22]. In a small sample study of young adults, marijuana problems were associated with IPA for men [23] but not their female partners [24]

A few studies have considered the association between marijuana use and amount or severity of IPA perpetration within clinical samples in which rates of violence and substance use are elevated. Marijuana use was not associated with IPA among couples in which the man was entering substance abuse treatment [25], but it was in a sample of men and women in substance abuse treatment who had a history of violence [26]. In a sample arrested for partner violence, marijuana use predicted IPA for men but not for women [4].

Longitudinal Studies

Cross-sectional studies consider the relationship between retrospective reports of marijuana use and IPA assessed at a single point in time, using marijuana as the predictor and IPA as the outcome. Longitudinal studies consider the impact of marijuana use in an earlier time period on IPA in a later, non-overlapping time period, permitting proper temporal ordering. However, a longitudinal design is not necessarily superior to a cross-sectional design if acute drug effects are presumed, since marijuana use in Year 1 cannot directly influence IPA in Year 2.

In longitudinal studies of adolescents using short follow up intervals one study found a relationship between marijuana use and later dating aggression [27], whereas another did not [28]. Data from the National Longitudinal Study of Adolescent Health (AddHealth; N = 9,241) show that consistent marijuana use in adolescence is a strong predictor of IPA perpetration in early adulthood [29]. Similarly, marijuana use reported at age 22 predicted involvement in intimate relationships involving more conflict and less cohesion at age 27 [30]. Multilevel growth curve modeling was used to consider between- person effects of marijuana separate from within-person changes in use [31]. There were no within-wave associations between marijuana and IPA, meaning that increases (or decreases) in marijuana did not coincide with increases in IPA during that time period. However, there was a between-persons effect of marijuana among girls (not boys) suggesting that marijuana users differ from non-users on characteristics that predispose them toward later dating violence.

In contrast to the generally positive longitudinal effects among adolescents, a longitudinal study of young adult couples, beginning at the time of marriage and continuing for 9 years, suggests an inverse relationship between marijuana and IPA [32]. Couples in which both partners used marijuana frequently reported the fewest incidents of IPA over time. There was one exception to this pattern: among women with a history of IPA at the time of marriage, marijuana use was positively associated with later perpetration, suggesting the potential importance of individual moderators on marijuana’s effects.

Cannabis Use Disorder

Whereas the studies reviewed above considered use of marijuana as a predictor of IPA, others have considered cannabis use disorder (CUD) as a predictor. Because CUD criteria include withdrawal symptoms and substance use that interferes with daily functioning and social relationships [33], such individuals may be particularly likely to also report involvement in aggressive relationships. Roughly 1/3 of past year marijuana users meet criteria for CUD, or about 1.5% of the population based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) [34]. In analyses considering CUD rather than cannabis use, users who do not meet CUD criteria are classified with non-users.

Three separate papers have used data from Wave 2 of NESARC (N = 25,778) to consider the relationship between cannabis use disorder (CUD) and physical IPA over the past 12 months, after controlling for antisocial and other psychiatric symptoms [35]; [36]; [10]. CUD was positively associated with victimization and with mutual IPA; however, it was not associated with perpetration after controlling for victimization. This pattern suggests that CUD may be more strongly associated with relationship difficulties than with pure aggression perpetration.

Smith and colleagues [10] also considered the combination of alcohol use disorder (AUD) and CUD. Meeting criteria for both disorders reduced the odds of perpetration relative to meeting criteria for either AUD or CUD alone. However, having both AUD and CUD resulted in increased risk of victimization relative to either disorder alone. It is possible, as Smith suggests, that simultaneous use of cannabis lessens the aggressive effects of alcohol; however, since it is not known whether the substances are used together, this is speculative.

Two studies have considered the association of CUD on IPA within clinical samples. In a sample of court-referred offenders in which most had a substance use disorder (N = 1584, 81% male), AUD alone increased the odds of IPA perpetration whereas CUD alone did not [37]. However, the combination of AUD and CUD increased the odds of IPA relative to CUD alone but decreased it relative to AUD alone. Curiously, the opposite pattern of results was obtained in a Dutch sample (N = 1339) of men and women entering substance abuse treatment [38]. Having both AUD and CUD increased the odds of reporting severe physical IPA perpetration relative to having an AUD only; having a CUD only did not differ from AUD only. Because nearly all participants in these studies had some type of substance use disorder, effects of CUD are relative to effects of other types of disorders, whereas in NESARC, CUD effects are expressed relative to people generally without other SUDs.

Acute Effects of Marijuana

Examining the acute effects of marijuana on aggression that are believed to be responsible for the distal association requires experimental designs or event-level studies. To our knowledge, no experimental analog studies have considered the effects of administered marijuana on aggression toward an intimate partner; however, experimental studies suggest that marijuana may reduce aggression toward a stranger [39]; [40].

Another method of considering the acute effects of marijuana involves examining whether naturally occurring episodes of aggression tend to co-occur with episodes of marijuana use. TimeLine FollowBack (TLFB) methodology involves using a calendar as a guide to recall episodes of substance use and of IPA occurring over the previous time period. In a sample entering substance abuse treatment, TLFB data were collected regarding substance use and partner conflict episodes over 180 days [41]. Only daily cocaine predicted IPA; marijuana did not. In a sample of women arrested for domestic violence, also using 180 days of TLFB data, alcohol use predicted physical IPA but marijuana did not [42]. Using 30 days of TLFB data within a sample of 599 youth (ages 14–24) presenting to an urban emergency department, alcohol, marijuana, and cocaine use were all more likely to be reported on days of dating aggression [43]. However, in multilevel analyses, marijuana use failed to exert an independent effect on IPA, possibly because it was used in conjunction with other substances. Thus, none of the three TLFB studies provide evidence of a daily association between marijuana and IPA.

The dependence on retrospective data, up to 6 months, is a limitation of TLFB. Daily report and ecological momentary assessment (EMA) methodologies minimize recall bias through the use of time-stamped electronic reports to assess substance use and conflict episodes soon after occurrence. In a study of college students in dating relationships (N = 184), daily alcohol use was temporally associated with psychological and physical IPA perpetration over 60 days, but marijuana use was not [44]. In a small sample of college men in dating relationships (N = 67) there was no effect of marijuana on IPA over 90 days of reports [45]. In a similar but larger study of college women (N = 173), there was a positive effect of marijuana on psychological but not physical dating aggression [46]. In brief, none of the daily report studies support an event-level association of marijuana with physical IPA.

Marijuana Withdrawal

Marijuana withdrawal has been suggested as a mechanism explaining the association between marijuana and IPA [8,9,47]. Some dependent marijuana users who go without the drug for a few days experience unpleasant withdrawal effects including irritability, anxiety, and impaired functioning [48] [49], which may contribute to subsequent aggression. NESARC data were used to consider the role of marijuana withdrawal symptoms on aggression [50]. Smith and colleagues compared IPA perpetration among marijuana users reporting 2 or more withdrawal symptoms (9.8% of the 1,461 past-year marijuana users) to the remaining users, after controlling for relevant covariates. There was no main effect of withdrawal symptoms; however, withdrawal symptoms in combination with a history of prior aggression predicted concurrent IPA.

Conclusions and Directions for Future Research

Recent survey studies support the conclusion of prior reviews that there is a modest positive association, at the distal level, between marijuana use and perpetration of IPA [9]. In an earlier review, concern was expressed that marijuana’s effect might reflect the effects of other variables [8]. However, controlling for relevant covariates (e.g., antisocial behavior, other substance use, psychopathology) has become standard and typically results in attenuation but not elimination of the positive effect of marijuana. Confidence in the marijuana – IPA relationship is further strengthened by the fact that recent studies have used large and nationally representative samples [29,35]. However, TLFB and daily report studies have all failed to find evidence consistent with an acute effect of marijuana use on IPA, thus, the consistent distal effect of marijuana use in the absence of a proximal effect remains puzzling.

Understanding and ultimately preventing IPA among marijuana users requires identification of the mechanism responsible for the marijuana – IPA association. It is important for future research to move beyond simply documenting an association to testing possible mechanisms. Marijuana withdrawal effects have been suggested as one such mechanism [8,47] and a single study provides some evidence supporting the role of withdrawal symptoms in IPA among previously aggressive people [50]. However, withdrawal seems unlikely to explain the relationship fully, since withdrawal symptoms are experienced by only a minority of users and only after a few days of not using marijuana.

It is possible that the distal association between marijuana and IPA reflects indirect effects associated with drug use, for example, marijuana use may lead to involvement in more troubled relationships, with more aggressive partners [51]. Studies that consider moderators of the distal effect of marijuana on IPA can also help us to understand the relationship. A few recent studies suggest that marijuana may predict later aggression only among users with a history of partner aggression [32] [50]. It is also important to distinguish more clearly the effects of marijuana use from the effects of CUD or problematic use. To our knowledge, none have compared those with CUD to those who use marijuana but do not have CUD; however, such a comparison would help us to understand whether it is marijuana use, or problematic use, that increases risk of IPA.

It is particularly important to examine the acute effects of marijuana using prospective daily report or EMA designs. Very few studies have considered the event-level association and none have found evidence that marijuana use increases the likelihood of subsequent IPA after controlling for the effects of alcohol and other drugs. The failure to support an acute effect may indicate that the distal effect is spurious or at least does not reflect increased aggression while under the influence of marijuana. However, because previous samples were not recruited specifically because of their marijuana use, marijuana use was confounded with use of alcohol and other drugs, making it difficult to isolate its unique effects.

To address the limited research on marijuana’s acute effects, we are currently examining the temporal association between marijuana use and IPA using a sample of 200 community couples (ages 18–30) recruited because at least one partner uses marijuana multiple times per week. In addition to daily reports of couple functioning, ecological momentary assessment (EMA) allows recording of marijuana use and partner conflict episodes immediately after they occur. We also plan to follow couples at 3, 6, and 9 months following the reporting period, allowing us to observe the development of effects of marijuana use on couple outcomes over time. The study is unique in that it considers potential indirect and moderated effects of marijuana use, guided by a heuristic model, presented below.

Although marijuana increases positive affect [52], particularly among those who expect positive effects [53], it may also have negative acute consequences (path b), including elevated heart rate and increased arousal [53]; disinhibition [52], and impaired attention, cognition, memory, and information processing [54]; [55]; [53]; [56]. These negative effects may increase the likelihood of partner conflict as well as impair responses to conflict (path d), an indirect effect of acute marijuana use. For example, elevated heart rate and arousal, in the context of a modest criticism from or disagreement with one’s spouse, could be labeled as anger toward the partner [57], escalating conflict and potentially resulting in aggression. Inability to inhibit a response may also initiate or exacerbate partner conflict and cognitive impairment may inhibit conflict resolution.

Some individuals are more likely to experience negative acute effects of marijuana than others (path c, Individual Moderators). For example, marijuana users high in psychosis-proneness or schizotypy are more likely to report anxiety, paranoia, and cognitive disorganization after use [58]; [59]; [60]. Other moderators include marijuana expectancies [53] and depression [61]. Marijuana users who reported difficulty controlling aggression reported using marijuana for this purpose; however, these individuals were more likely than others to experience increased aggression while under its influence [61]. Assessment of several individual difference variables such as antisocial behavior, depression, and anxiety will allow us to consider whether the effects of acute marijuana on aggression are moderated.

Because IPA is a dyadic behavior, understanding marijuana’s potential effect on IPA requires consideration of moderators and context at the couple level as well as at the individual level (path e, Couple and Contextual Moderators). For example, acute negative marijuana effects – or withdrawal effects - experienced by one partner may result in IPA only if the couple has a history of aggression [50]. Couple usage patterns are also relevant to understanding marijuana’s effects on dyadic IPA. Concordant usage of a variety of substances is associated with more positive long-term couple consequences than discordant use (e.g., only one partner uses the drug) [62,63]. Shared marijuana use may encourage intimacy and reflect shared couple activities, whereas use by only one partner may foster conflict and resentment for the non-using partner. In our ongoing study, the presence of couples with both concordant and discordant marijuana use will allow us to test this hypothesis at the event-level.

Finally, although the relationship consequences of a single episode of marijuana use may be small, frequent negative couple interactions, occurring day after day, may have a cumulative negative impact on relationship functioning over time (path f) [64]. Such a model may account for the development of physical aggression from verbal aggression [65] and the declines in couple functioning over time that stem from discordant versus concordant substance use [32,63,66]. Couple functioning, including IPA, will be assessed at 3, 6, and 9 months following completion of the 30 day reporting period, allowing us to examine whether marijuana users who experience more negative short term consequences are subsequently more prone to development of IPA.

Conclusions

A few recent studies have begun to address the relationship between marijuana use and IPA with more sophistication, considering moderating variables [32] [50] and event-level associations [44,46]. We have highlighted what we believe are important research gaps and presented a heuristic framework that we hope will serve to guide future research efforts.

Figure 1.

Figure 1

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Heuristic Model of Marijuana’s Potential Effects on Intimate Partner Aggression

Highlights.

  • Marijuana use and IPA perpetration are positively associated in survey studies

  • Event-level studies fail to support a temporal effect of marijuana and IPA

  • Marijuana effects may be moderated by individual or couple differences

  • Additional studies of marijuana-using couples are needed to understand mechanisms

Acknowledgments

Research reported in this publication was supported in part by the National Institute on Drug Abuse of the National Institutes of Health under award number R01DA033994. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

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