Not How Often but When: Self-Efficacy to Control Cannabis Use and PTSS

Clinical Impact Statement The present study has potential implications for better understanding the relationship between cannabis use and posttraumatic stress symptoms (PTSS) and clinical intervention for trauma survivors who use cannabis. Greater self-efficacy to control cannabis use during moments of emotional distress may be associated with lower PTSS. As such, dissemination of this information could inform survivors on best practices of cannabis use. Clinicians may also incorporate emotional awareness, self-efficacy to control use in response to distress, and adaptive coping strategies to replace use into interventions for trauma survivors who use cannabis. Objective: Cannabis use is prevalent with trauma survivors. Yet, the effects of cannabis use on posttraumatic stress symptoms (PTSS) have been equivocal with some studies showing a positive association and some showing a negative association. Integrating the self-medication hypothesis and social cognitive theory (SCT), the present study aimed to elucidate differential outcomes by considering frequency of cannabis use and self-efficacy to control cannabis use in different contexts (i.e., social facilitation, opportunistic, and emotional relief) in relation to PTSS. Method: Undergraduate students (N = 314) who endorsed lifetime trauma exposure and past-month cannabis use completed self-report measures assessing cannabis use behaviors, self-efficacy to control use, and PTSS. Results: Parallel mediation revealed that initially, greater frequency of cannabis use was associated with PTSS severity (beta = .16, SE = .09, p = .004). With the inclusion of emotional relief self-efficacy, opportunistic self-efficacy, and social facilitation self-efficacy to control cannabis use as parallel mediators, frequency of cannabis use no longer predicted PTSS severity. There was also a significant indirect effect of emotional relief self-efficacy to control cannabis use on frequency of use and PTSS (95% CI [.14, .31]). Conclusions: Self-efficacy to control cannabis use during moments of emotional distress could serve a critical role in the relationship between cannabis use and PTSS. These results may inform clinical intervention and provide survivors with a better understanding of how use impacts recovery.