Beyond the Diagnostic Binary: A Translational Use of the Research Domain Criteria to Improve the Measurement of Anxiety in the Context of Cannabis Use

Introduction: Epidemiological data indicate that over half of people who consume cannabis report anxiety reduction as a reason for use. Anxiety is frequently cited as a primary motivation for cannabis use among both medical and recreational consumers. The lifetime prevalence of anxiety disorders in the United States is approximately 34% with more recent data suggesting that the figure may be as high as 43%. Methods: Using a mixed methods design, we collected quantitative data through psychosocial assessment tools and demographic questionnaires from a sample of adult cannabis consumers (n = 30). These data were integrated with qualitative findings from semi structured interviews to contextualize consumers’ experiences and perceptions related to anxiety and cannabis use. Results: Medical cannabis consumers (n = 19) reported significantly more frequent consumption, averaging 28.95 days per month, as compared to recreational consumers (n = 11), averaging 23.55 days per month. Scores on the State-Trait Anxiety Inventory indicated clinically significant anxiety symptoms in both groups (39.95 for medical; 38.55 for recreational), with medical consumers more likely to endorse elevated anxiety. Qualitative analyses revealed nuanced and individualized interpretations of anxiety that extended beyond traditional binary diagnostic criteria revealing the Research Domain Criteria (RDoC) as a framework to better understand the relationship between anxiety and cannabis use. Discussion: The value of this work is its use of the RDoC framework to provide a new way to examine the relationship between anxiety and cannabis consumption. Currently the diagnosis of anxiety is binary based on DSM-5-TR criteria. This limitation makes it challenging to study the complex range of outcomes that occur when examining anxiety and cannabis use. Therefore, the opportunity to understand anxiety from a transdiagnostic framework such as RDoC enables researchers to study for whom and under what circumstances cannabis induces and/or reduces anxiety.