What are the effects of cannabis on stress response?

Cannabis Effects on Stress Response

Cannabis use is associated with blunted affective stress responses and is commonly used as a maladaptive stress-coping strategy, but this pattern increases risk for cannabis use disorder and does not provide therapeutic benefit—instead, it creates a cycle of emotional dysregulation and compulsive use that worsens long-term stress management capacity. 1, 2

Acute Effects on Stress Response

Blunted Emotional Reactivity

• Regular cannabis users demonstrate significantly blunted positive affect, state stress, and state anxiety responses when exposed to acute stress challenges (public speaking, mental arithmetic, cold-pressor tests), indicating emotional dysregulation rather than therapeutic stress relief 2
• This blunted response represents impaired emotional processing, not improved stress management 2
• Cardiovascular stress responses (blood pressure, heart rate, mean arterial pressure) remain unchanged in cannabis users, suggesting the blunting effect is purely affective rather than physiological 2

Paradoxical Stress-Coping Motivation

• Cannabis is commonly used as a stress-coping strategy, particularly among individuals experiencing greater life stress, negative life events, and trauma 1
• Anxiety sensitivity—especially cognitive concerns about mental dyscontrol and social concerns about negative evaluation—drives coping-motivated cannabis use among trauma-exposed individuals 3
• Despite widespread use for stress relief, anxiety reactions and panic attacks are actually the most frequent acute symptoms associated with cannabis use 4

Chronic Effects and Neurobiological Consequences

Brain Stress Pathway Alterations

• Chronic cannabis use causes alterations in brain-stress pathways that exacerbate compulsive drug seeking and sensitize individuals to stress-related drug use 1
• Cannabis inhibits GABAergic inhibitory action on glutaminergic neurons, increasing susceptibility to excitotoxicity and disrupting normal stress response mechanisms 5, 6
• Changes in glutamate and dopamine signaling contribute to psychiatric complications including increased risk for psychotic disorders 5, 6

Decision-Making Deficits

• Chronic use is associated with decision-making deficits that perpetuate maladaptive coping patterns 1
• Structural changes in the orbitofrontal cortex—essential for decision-making—occur with adolescent cannabis use and develop more rapidly in adolescents than adults 5, 6
• Disrupted prefrontal cortex connectivity affects impulse control and stress management capacity 6

Psychiatric Stress-Related Complications

Anxiety and Mood Disorders

• Cannabis use may be associated with increased risk for developing depressive disorders and may exacerbate existing psychiatric disorders in vulnerable individuals 6
• Older adults who use cannabis are at higher risk for behavioral health issues including anxiety and depression 5, 6
• High doses of THC may trigger psychotic symptoms in vulnerable individuals, with increasing cannabis potency (average THC concentration nearly doubled from 9% in 2008 to 17% in 2017, with concentrates reaching 70%) elevating this risk 5, 6

Insufficient Evidence for Therapeutic Use

• Medical cannabis should not be recommended for treating affective disorders, anxiety disorders, or PTSD due to insufficient evidence from controlled trials 7
• Small trials of THC for depression found no improvement; instead, anxiety and psychotic symptoms emerged in over 50% of hospitalized patients 7
• While some single-dose CBD studies showed reduced anxiety in laboratory settings for social anxiety disorder, evidence remains insufficient for clinical recommendation 7

Risk Stratification for Cannabis Use Disorder

High-Risk Populations

• Individuals using cannabis for stress-coping purposes are at greatest risk for addiction, particularly those experiencing chronic stress versus experimental users 1
• Early onset of cannabis use, especially weekly or daily use, strongly predicts future dependence 6
• Approximately 10% of adults with chronic cannabis use develop cannabis use disorder, characterized by clinically significant impairment or distress 6
• One randomized trial found participants receiving a medical cannabis card had almost twice the incidence of developing cannabis use disorder within 12 weeks compared to controls 6

Withdrawal and Perpetuation of Stress

• Long-term daily cannabis users experience withdrawal symptoms after cessation including sleep disturbances, appetite changes, and abdominal pain, typically occurring within 3 days and lasting up to 14 days 6
• Chronic use potentiates stress-related motivation to use/abuse cannabis, creating a self-perpetuating cycle 1
• Contrary to expectations, cannabis craving actually decreases in response to acute stress challenges, suggesting the stress-relief narrative does not align with physiological craving patterns 2

Clinical Implications

Prevention and Intervention Approach

• Stress-coping interventions targeting the underlying anxiety sensitivity and maladaptive coping patterns are essential for prevention and recovery 1, 3
• Harm reduction focused on reducing the amount ingested may facilitate recovery efforts, though complete cessation remains the goal 1
• Screen specifically for stress-coping motivations, trauma history, and anxiety sensitivity (particularly cognitive and social concerns) to identify high-risk individuals 3

Common Pitfalls to Avoid

• Do not accept patient reports of cannabis as "therapeutic" for stress without recognizing this represents maladaptive coping that worsens long-term outcomes 1, 2
• Recognize that blunted stress responses indicate emotional dysregulation, not improved stress management 2
• Be aware that the relationship between cannabis and anxiety remains unclear regarding causality, but frequent cannabis users consistently have high prevalence of anxiety disorders 4