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. Author manuscript; available in PMC: 2021 Mar 15.
Published in final edited form as: J Affect Disord. 2020 Jan 9;265:26–31. doi: 10.1016/j.jad.2020.01.029

Personality disorders and social support in cannabis dependence: A comparison with alcohol dependence

Jesse R Cougle a, Katherine A McDermott a, Jahn K Hakes b, Keanan J Joyner a
PMCID: PMC7065916  NIHMSID: NIHMS1549903  PMID: 31957689

Abstract

Background:

Cannabis use disorder (CUD) has been linked to personality disorders (PDs) and interpersonal problems, though these relationships have been understudied. We examined PDs and social support associated with cannabis dependence and how it may be distinguishable from alcohol dependence on these indices in a large representative sample.

Method:

Data on social support and Diagnostic and Statistical Manual of Mental Disorders-IV substance dependence and PDs were assessed in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N > 34,500).

Results:

Cannabis dependence was associated with higher rates of personality disorders and lower social support. Lifetime cannabis dependence without alcohol dependence was associated with higher rates of all PDs than alcohol dependence without cannabis dependence (with the exception of borderline PD). Cannabis dependence alone was also associated with lower social support than alcohol dependence alone.

Limitations:

The survey was conducted in 2004–2005 and relied on DSM-IV criteria.

Conclusions:

These findings highlight a broad range of PDs as well as deficits in social support in cannabis dependence. The potential interrelationships between interpersonal dysfunction and CUD as well as the relevance of PDs to treatment for CUD warrant further research.

Keywords: cannabis dependence, personality disorder, social support, alcohol dependence

1. Introduction

Cannabis use disorder (CUD) is a growing public health concern. In the US, the prevalence of CUDs has increased in recent years, likely due in part to loosening of state laws regarding its use as well as increases in cannabis potency (Hasin et al., 2017). Among regular users, cannabis has been linked to higher rates of dependence than alcohol (Cougle et al., 2016). Prospective research has found that persistent cannabis use and cannabis dependence were associated with financial difficulties, downward social mobility, and workplace problems (Cerda et al., 2016).

There is some evidence to suggest CUDs are associated with poor interpersonal functioning, as well. Research has linked cannabis use to poorer relationship quality in midlife (Cerda et al., 2016), and CUD has been associated with elevated rates of personality disorders (Cougle et al., 2016; Lopez-Quintero et al., 2011), which are characterized by severe interpersonal dysfunction. Further, multiple studies, including those using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Afifi, Henriksen, Asmundson, & Sareen, 2012; Smith, Homish, Leonard, & Cornelius, 2012), have found CUDs are associated with increased intimate partner aggression and victimization (Moore & Stuart, 2005; Testa & Brown, 2015).

Problematic cannabis use may have important direct effects on interpersonal dysfunction. The acute effects of cannabis on working memory, attention, and concentration (Crean, Crane, & Mason, 2011) may impair conversations and interactions individuals have while intoxicated and lead them to avoid certain social settings. Additionally, cannabis-induced alterations in mood and perception may make users less able to show empathy and provide support to their friends while intoxicated; this may also lead them to avoid relationship conflict, which could inhibit the high they experience. Cannabis may also induce an amotivational state (Volkow et al., 2016) that leads users to be anchored to their homes and less willing to take steps to develop relationships or meet up with friends; as such, severe loneliness may be a potential consequence. Cannabis use may contribute to aggression among some users (Moore & Stuart, 2005), perhaps by increasing arousal, paranoia, and disinhibition, or through its effects on attention and information processing (Testa & Brown, 2015). Cannabis withdrawal has also been linked to increased anger and aggression across multiple studies (Budney et al., 2001; Budney and Hughes, 2006; Kouri et al., 1999). Frequent coping-motivated cannabis use could also prevent individuals from developing more adaptive coping skills for handling uncomfortable social situations, relationship conflict, or emotional distress.

Interpersonal dysfunction could also contribute to problematic patterns of cannabis use. Individuals with CUDs commonly report using it to decrease aggression (Arendt et al., 2007), which suggests interpersonal conflict often precipitates cannabis use. Individuals with CUD also report using to cope with or avoid uncomfortable social situations (Buckner, Bonn-Miller, Zvolensky, & Schmidt, 2007); socially anxious individuals, in particular, are at elevated risk for CUD (Buckner et al., 2012). Being unmarried (Cougle et al., 2016) and living alone are risk factors for the progression from frequent use to CUD (Van der Pol et al., 2013).

Despite evidence to suggest an important bi-directional relationship between interpersonal dysfunction and CUD, several gaps in the literature exist. Some studies have relied on smaller, non-representative samples (Feingold et al., 2008). Additionally, research has compared cannabis users to non-users (DuRant et al., 2007; Temple & Freeman, 2011) or combined cannabis abuse and dependence in comparisons to the rest of a sample (Afifi et al., 2012; Smith et al., 2012). Multiple characteristics distinguish cannabis users from non-users (Cougle et al., 2016; Lopez-Quintero et al., 2011), and combining cannabis dependence with less severe (and more common) cannabis abuse likely dilutes associations that may be present between cannabis dependence or more severe CUD and interpersonal dysfunction. Indeed, one study of the NESARC found that the relationship between cannabis dependence with schizotypal personality disorder (OR = 7.32) was stronger than that found for cannabis abuse and this PD (OR = 2.83; Davis, Compton, Wang, Levin, & Blanco, 2013). Similarly, a more recent study relying on NESARC-III, which used DSM-5 criteria, found severe CUD showed stronger associations with presence of three PDs (OR = 8.0) than mild CUD (OR = 3.2; Hasin et al., 2016). Severe CUD was also associated with higher rates of outpatient treatment (8.7%) compared to mild CUD (1.1%).

Research is needed to examine whether interpersonal dysfunction is linked to severe patterns of cannabis use specifically rather than cannabis use more generally. Though personality disorders have been linked to cannabis use problems (Cougle et al., 2016; Lopez-Quintero et al., 2011), relations between specific PDs and such problems have been given little consideration. Lastly, while the consequences of cannabis dependence have been found to equal or exceed that for alcohol dependence (Cerda et al., 2016), differences between these disorders have been given little attention, especially with regard to interpersonal functioning. Alcohol dependence has also been linked to reduced social support (Dutton et al., 2014; Schuckit & Smith, 2001) and elevated rates of PDs (Cougle et al., 2016; Lopez-Quintero et al., 2011). Comparisons between cannabis and alcohol dependence could help distinguish interpersonal problems related to substance use disorders in general from those with specific relations to CUD. It could also potentially inform treatments for CUD populations, which may require strategies that are distinct from those used for other substance use disorders.

The goal of the present study was to examine personality disorders and social support in cannabis dependence using a large representative sample. We considered personality disorders, specifically, given the severity and range of interpersonal dysfunction they represent. We also focused on social support, given its strong connection to interpersonal functioning and its important role in many mental and physical health outcomes (Holt-Lunstad, Smith, Baker, Harris, & Stephenson, 2015). We hypothesized that cannabis dependence would be associated with lower social support and greater rates of all PDs. Given that interpersonal problems have also been linked to alcohol dependence (Afifi et al., 2012; Smith et al., 2012; Whisman, 2007), we considered our comparisons between cannabis and alcohol dependence exploratory and had no a priori hypotheses for these analyses, though we predicted having both diagnoses would be related to greater rates of PDs and lower social support than either diagnosis alone.

2. Methods

2.1. Sample and Procedures

The present sample was Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (Grant, Kamplan, Moore, & Kimball, 2007). The NESARC sample is reflective of the national non-institutionalized U.S. population, with young adults and under-represented minorities (e.g., African Americans) over-sampled to ensure adequate representation. Wave 2 data were collected in 2004–2005, with 34,653 total participants. Descriptive information for the sample used for the comparisons between alcohol and cannabis dependence is presented in Table 3.

2.2. Measures

2.2.1. Diagnostic assessment

Substance use disorders (SUDs) and personality disorders (PDs) were assessed using NIAAA’s Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV) (Grant et al., 2001). Cannabis dependence and alcohol dependence were outcomes of interest in the present analyses. All personality disorders were considered as predictor variables.

2.2.2. Perceived social support.

Perceived social support was assessed using the twelve item Interpersonal Support Evaluation List (ISEL) (Cohen & Hoberman, 1983). This is a widely used measure that has shown good reliability and validity (Merz et al., 2014; Ruan et al., 2008). Sample items include “There is someone I can turn to for advice about handling problems with my family.” Participants responded on a scale from 1 (definitely true) to 4 (definitely false). Items were averaged and coded such that higher scores indicated greater perceived social support.

2.3. Data Analytic Plan

All analyses were conducted with Statistical Analysis Software (SAS), version 9.4 PROC SURVEYLOGISTIC procedure. Multivariate logistic regression analyses were conducted controlling for age, gender, race, and ethnicity (Hispanic vs. non-Hispanic). Because income and marital status are likely to be a cause or consequence of substance use disorders (Cougle et al., 2016), we did not include these variables as covariates in analyses. Demographic variables were also compared between cannabis and alcohol dependent groups. For continuous outcomes, particularly the number of PDs endorsed and social support, least squares difference in means were calculated to provide the difference in means between those with cannabis dependence and those without.

Additional analyses examined ORs or least squares differences in means for those with lifetime cannabis dependence and those with co-occurring cannabis and alcohol dependence compared to an alcohol dependence reference group on PDs and social support, as well as the demographic variables. Thus, the reference group was again shared for both predictor variables, allowing for comparison of effect sizes. Past-year analyses were underpowered for these specific comparisons but are presented in Supplemental Table 1.

3. Results

3.1. Cannabis Dependence vs No Cannabis Dependence

Tables 1 and 2 show the associations between cannabis dependence and personality disorders and social support in the past year and lifetime, respectively. Both past-year and lifetime cannabis dependence diagnoses were associated with a significantly higher risk of all PDs. Past-year and lifetime cannabis dependence were also associated with lower social support.

Table 1.

Demographics, personality disorders and interpersonal functioning by past-year cannabis dependence diagnosis.

Descriptives, mean (s.e.) or N (wtd. %, [s.e.]) OR (95% CI) or least squares difference in means from “No Cannabis Dependence” baseline (SE)
No Cannabis Dependence Cannabis dependence
Personality disorder
     Antisocial 1100 (3.5 [0.07]) 30 (26.8 [1.7]) 5.45 (4.42–6.72)***
     Avoidant 800 (2.3 [0.05]) <15 [D]
     Dependent 150 (0.4 [0.02]) <15 [D]
     Obsessive-compulsive 2700 (8.0 [0.09]) 20 (17.4 [1.1]) 2.09 (1.80–2.44)***
     Paranoid 1700 (4.3 [0.07]) 20 (14.2 [1.1]) 2.54 (2.06–3.13)***
     Schizoid 1100 (3.0 [0.06]) <15 [D]
     Histrionic 650 (1.8 [0.04]) <15 [D]
     Borderline 2200 (5.8 [0.08]) 50 (40.8 [2.1]) 7.72 (6.45–9.24)***
     Schizotypal 1500 (3.9 [0.06]) 40 (25.8 [1.9]) 6.20 (5.02–7.65)***
     Narcissistic 2400 (6.1 [0.08]) 50 (39.0 [1.6]) 6.90 (5.95–8.00)***
     Any PD 7700 (21.2 [0.15]) 90 (72.4 [1.6]) 6.93 (5.89–8.14)***
     PD count (wtd. mean [s.e.]) 0.390 [0.003] 2.02 [0.06] 1.49 (0.06)***
Social support (wtd. mean [s.e.]) 3.54 [0.002] 3.41 [0.021] −0.18 (0.02)***
Nf 34,500 100 34,500
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Notes:

*

p<.05

**

p<.01

***

p<.001.

Cannabis dependence was compared to all other participants without cannabis dependence. All analyses controlled for age, gender, race, and ethnicity (Hispanic vs. non-hispanic). [D] Suppressed due to small cell count and low statistical power. Census Bureau authorization CBDRB-FY19–130.

Table 2.

Demographics, personality disorders and interpersonal functioning by lifetime cannabis dependence diagnosis.

Descriptives, mean (s.e.) or N (wtd. %, [s.e.]) OR (95% CI) or least squares difference in means from “No Cannabis Dependence” baseline (SE)
No Cannabis Dependence Cannabis dependence
Personality disorder
         Antisocial 950 (3.1 [0.07]) 200 (34.6 [1.4]) 11.0 (9.50–12.6)***
         Avoidant 750 (2.2 [0.05]) 70 (11.7 [1.0]) 4.94 (4.03–6.07)***
         Dependent 100 (0.3 [0.02]) 20 (4.9 [0.4]) 12.9 (10.1–16.4)***
         Obsessive-compulsive 2600 (7.7 [0.09]) 150 (26.3 [1.5]) 3.86 (3.28–4.54)***
         Paranoid 1600 (4.0 [0.07]) 150 (21.8 [1.5]) 5.54 (4.57–6.72)***
         Schizoid 1100 (2.9 [0.06]) 70 (11.7 [0.8]) 3.86 (3.24–4.59)***
         Histrionic 600 (1.6 [0.03]) 60 (11.3 [0.8]) 5.07 (4.25–6.05)***
         Borderline 2100 (5.5 [0.08]) 150 (28.4 [1.1]) 5.29 (4.70–5.95)***
         Schizotypal 1400 (3.7 [0.06]) 100 (19.2 [0.9]) 5.07 (4.46–5.75)***
         Narcissistic 2300 (5.8 [0.08]) 150 (25.0 [1.0]) 4.21 (3.74–4.73)***
         Any PD 7400 (20.6 [0.14]) 400 (69.7 [1.0]) 7.04 (6.38–7.76)***
         PD count (wtd. mean [s.e.]) 0.369 [0.003] 1.95 [0.04] 1.49 (0.04)***
Social support (wtd. mean [s.e.]) 3.54 [0.002] 3.46 [0.015] −0.127 (0.016)***
N 34,000 550 34,500
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Notes:

*

p<.05

**

p<.01

***

p<.001.

Cannabis dependence was compared to all other participants without cannabis dependence. All analyses controlled for age, gender, race, and ethnicity (Hispanic vs. non-hispanic). Census Bureau authorization CBDRB-FY19–130.

3.2. Cannabis Dependence versus Alcohol Dependence

Table 3 show the associations between interpersonal problems with lifetime diagnoses of cannabis dependence-only and comorbid cannabis and alcohol dependence, with alcohol dependence only as the reference group. Cannabis dependence only was associated with a significantly higher risk of all PDs, with the exception of borderline PD. Cannabis/alcohol dependence was associated with lower risk of dependent PD diagnosis and higher risk for all other PDs except avoidant PD. Compared to cannabis dependence-only, cannabis/alcohol dependence was associated with higher rates of antisocial, paranoid, and borderline PDs, and lower rates of avoidant and dependent PDs. Cannabis/alcohol dependence met for more PDs than either those with cannabis or alcohol dependence alone. Cannabis dependence with and without alcohol dependence was also associated with lower social support relative to alcohol dependence alone.

Table 3.

Demographics, personality disorders and interpersonal functioning by lifetime cannabis and alcohol dependence diagnosis.

Descriptives, mean (s.e.) or N (wtd. %, [s.e.]) OR (95% CI) or least squares difference in means from alcohol dependence alone (SE)
Cannabis dependence alone Alcohol dependence alone Both cannabis and alcohol dependence Cannabis dependence alone Both cannabis and alcohol dependence
Age 35.4 (0.4) 40.9 (0.2) 34.5 (0.3) 5.48 (0.43)*** 6.42 (0.28)***a
Female 70 1800 150 1.20 (1.01–1.41)* 0.76 (0.64–0.89)***b
38.2 [1.8] 34.1 [0.5] 31.9 [1.2]
Marital status
Married/cohabitating 70 2200 150 0.77 (0.67–0.88)*** 0.73 (0.63–0.84)***
50.1 [1.6] 56.6 [0.5] 42.1 [1.3]
Widowed/divorced/separated 40 1100 90 1.03 (0.89–1.19) 1.18 (0.99–1.39)
17.9 [1.0] 17.5 [0.4] 20.4 [0.4]
Never married 60 1200 150 1.35 (1.17–1.56)*** 1.28 (1.08–1.51)**
Race/Ethnicity 32.0 [1.5] 25.9 [0.4] 37.5 [1.5]
White 90 3000 250 0.56 (0.51–0.63)*** 1.47 (1.21–1.79)***c
65.9 [1.2] 75.2 [0.4] 72.0 [1.4]
Black <15 <15 <15 [D] [D]
Hispanic 30 700 60 0.80 (0.68–0.94)** 1.04 (0.83–1.29)
8.7 [0.7] 10.8 [0.2] 9.1 [0.2]
Other race/ethnicity <15 <15 <15 [D] [D]
Income 40,270 (982) 34,520 (248) 26,840 (657) 0.24 (0.02)*** 0.44 (0.16)**
[ln(income)]
Education
High school dropout 20 19.5 [1.5] 550 11.8 [0.3] 60 15.8 [1.1] 1.80 (1.49–2.18)*** 0.78 (0.58–1.04)c
Diploma/ 100 2800 300 0.91 (0.81–1.03) 1.74 (1.43–2.12)***c
Some college 60.5 [1.5] 62.7 [0.4] 72.7 [1.1]
College graduate 30 1100 25.5 50 0.73 (0.65–0.82)*** 0.52 (0.44–0.61)***b
20.0 [0.8] [0.4] 11.5 [0.6]
Personality disorder
Antisocial 30 450 150 1.91 (1.64–2.23*** 3.10 (2.50–3.84)***b
(18.0 [1.1]) (10.0 [0.3]) (41.0 [1.7])
Avoidant <15 200 (4.9 [0.2]) 60 (11.9 [1.2]) 2.38 (1.82–3.12)*** 1.12 (0.85–1.47)b
Dependent <15 40 (0.7 [0.09]) 20 (4.4 [0.6]) 8.57 (6.62–11.1)*** 0.65 (0.49–0.88)**c
Obsessive-compulsive 30 (18.8 [1.0]) 650 (13.4 [0.3]) 100 (29.1 [2.0]) 1.54 (1.34–1.77)*** 1.82 (1.48–2.23)***
Paranoid 30 (14.8 [0.6]) 450 (9.2 [0.3]) 100 (24.4 [2.0]) 1.46 (1.29–1.65)*** 2.06 (1.66–2.56)***b
Schizoid 20 (8.7 [0.3]) 300 (5.9 [0.2]) 60 (12.9 [1.2]) 1.47 (1.33–1.63)*** 1.60 (1.28–2.00)***
Histrionic <15 250 (5.0 [0.2]) 50 (12.4 [1.1]) 1.53 (1.37–1.71)*** 1.56 (1.26–1.93)***
Borderline 40 (16.5 [1.1]) 700 (14.5 [0.3]) 150 (32.9 [1.6]) 1.02 (0.87–1.21) 2.69 (2.16–3.35)***c
Schizotypal 30 (14.1 [1.1]) 400 (7.8 [0.3]) 90 (21.2 [1.3]) 1.77 (1.44–2.16)*** 1.76 (1.36–2.28)***
Narcissistic 40 (21.1 [1.1]) 550 (11.1 [0.3]) 100 (26.5 [1.4]) 1.97 (1.70–2.30)*** 1.44 (1.16–1.78)**
Any PD 100 (50.4 [1.7]) 1900 (40.0 [0.5]) 300 (77.1 [1.0]) 1.41 (1.23–1.61)*** 3.48 (2.92–4.15)***c
PD count (wtd. mean [s.e.]) 1.38 [0.04] 0.83 [0.012] 2.16 [0.05] 0.49 (0.04)*** 1.30 (0.05)***c
Social support (wtd. mean [s.e.]) 3.47 [0.012] 3.52 [0.004] 3.46 [0.020] −0.07 (0.02)*** −0.10 (0.02)***
Nf 150 4500 400
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Notes:

*

p<.05

**

p<.01

***

p<.001.

Difference between ORs or means for the cannabis dependence and combined cannabis/alcohol dependence group is significant at

a

p<.05

b

p<.01

c

p<.001.

Cannabis dependence and combined cannabis/alcohol dependence were compared to those with alcohol dependence alone. Demographic analyses did not control for covariates. All other analyses controlled for age, gender, race, and ethnicity (Hispanic vs. non-hispanic). [D] Suppressed due to small cell count and low statistical power. Census Bureau authorization CBDRB-FY19–130.

4. Discussion

The goal of the current study was to examine PDs and social support in those with cannabis dependence. Overall, we found PDs were very common in those with cannabis dependence, with this group endorsing two PDs on average and 72% having at least one PD. Unsurprisingly, cannabis dependence was also associated with reduced social support.

It was interesting to note higher rates of all PDs in cannabis dependence compared to those without the disorder. The relationship between antisocial PD and cannabis dependence makes sense, given that cannabis was illegal in most states at the time of the survey, and engaging in illegal behavior is one of the criteria for antisocial PD diagnosis (American Psychiatric Association, 2013). However, borderline and narcissistic PDs were more common in those with cannabis dependence and (along with schizotypal PD) were more strongly related to cannabis dependence than antisocial PD in past year analyses.

We had no a priori hypotheses for the comparisons between cannabis and alcohol dependence, though we found higher rates of every PD except borderline PD in cannabis dependence alone compared to alcohol dependence alone. Most individuals with lifetime history of cannabis dependence also had a lifetime history of alcohol dependence, and, unsurprisingly, those meeting for both diagnoses (and a more severe substance use disorder profile) had a significantly higher rate of PD and a greater number of PDs compared to either diagnosis alone. This study set out to examine whether differences in PDs exist between cannabis and alcohol dependence, not why they might exist. We did not control for co-occurring substance use or comorbidity in our analyses, as these variables could be a cause or consequence of these disorders. A range of characteristics may help explain the differences between these two diagnoses, and future research may wish to examine these differences more rigorously, using longitudinal designs, for example.

Surprisingly little research has examined social support in CUD, though strong correlates of low social support such as depression (Zimet, Dahlem, Zimet, & Farley, 1988) have been linked to cannabis dependence ( Cougle et al., 2016; Lopez-Quintero et al., 2011). The current study’s findings of a relationship between cannabis dependence with lower social support represents a novel contribution to this literature. Alcoholism is characterized by intense feelings of loneliness (Åkerlind & Hörnquist, 1992), so it was also interesting to note lower social support in cannabis dependence alone compared to alcohol dependence alone. The lower perceived social support in cannabis dependence may be a consequence of the social withdrawal effects of cannabis use (Volkow et al., 2016), though individuals who are anxious in social situations or avoid contact with others may also be prone to use as a means to cope with such feelings or escape such situations. The elevated rates of PDs in cannabis dependence may also contribute to reduced social support in this group.

The vast range of personality dysfunction linked to cannabis dependence in this study begs for an examination of potential mediating mechanisms in future research. Problems of impulsivity and emotion regulation are found in PDs (Linehan, 1987) as well as CUDs (Bujarski et al., 2012) and may represent factors accounting for their co-occurrence. Individuals with interpersonal problems may also be more likely to use cannabis to cope, and coping motives have been found to predict the progression to dependence (Van der Pol et al., 2013). Prolonged cannabis use may also contribute directly to greater isolation, distrust of others, and a general deterioration in social functioning. Experimental and longitudinal research is needed to examine these relationships.

The current study possesses a few limitations. First, the survey was conducted in 2004–2005, and multiple states have passed laws legalizing recreational cannabis use since then. Thus, the population of cannabis users has changed since the survey. Additional research is needed to examine these relationships in newer data and different populations, including samples from other countries. The current survey also relied on DSM-IV criteria for substance use disorders instead of more recent DSM-5 criteria. However, DSM-IV substance dependence has excellent concordance with DSM-5 moderate to severe substance use disorder (Goldstein et al., 2015). It is noteworthy that the newer NESARC-III survey did not assess most personality disorders and other aspects of interpersonal functioning (e.g., social support) (Grant et al., 2014); thus, the survey we chose seemed particularly well-suited for addressing our specific study aims. Interestingly, in the NESARC-III survey, which was collected in 2012, the rates of borderline PD among those with moderate to severe cannabis use disorder actually exceeded we found in the NESARC among those with cannabis dependence (Kerridge et al., 2018). Lastly, some of the past-year analyses may have been underpowered. The fact that past year findings were highly consistent with lifetime analyses, which had much greater power, give us more confidence in these effects.

The findings of the current study add uniquely to the literature on the potential causes and consequences of CUD. The high rates of PDs and low social support found in cannabis dependence may contribute to the high relapse and attrition rates associated with cannabis cessation interventions (Budney, Moore, Rocha, & Higgins, 2006). Treatments for CUDs may benefit from incorporating components that address interpersonal and emotion regulation problems found in personality disorders such as borderline personality disorder (e.g., Dialectical Behavior Therapy) (Linehan, 1987). Research is needed to understand the mechanisms underlying personality dysfunction in CUD.

Supplementary Material

1

Highlights.

  • Compared personality disorders (PD) and social support between cannabis and alcohol dependence

  • Cannabis dependence alone had higher rates of most PDs than alcohol dependence alone

  • Cannabis dependence alone was associated with lower social support than alcohol dependence alone

Acknowledgements

This manuscript used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which can be accessed at the website of the National Institute on Alcohol Abuse and Alcoholism at http://www.niaaa.nih.gov. This paper is released to inform interested parties of research and to encourage discussion. Any opinions and conclusions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Census Bureau. All results have been reviewed to ensure that no confidential information is disclosed. The statistical summaries reported in this document have been cleared by the Census Bureau’s Disclosure Review Board release authorization number CBDRB-FY19-130.

Role of Funding Source

Dr. Cougle is supported by grant R34DA035944 awarded from the National Institutes of Health, Bethesda, MD, USA.

Footnotes

Conflict of Interest

No conflict declared

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