Understanding barriers to treatment for cannabis use disorder in the United States

As cannabis becomes more potent and widely used in the United States – especially among young adults – concerns about cannabis use disorder are growing. More than 16 million Americans meet the criteria, yet most never receive treatment.

Despite the scale of the issue, we know surprisingly little about who gets help and why so many don't. This treatment gap raises urgent questions about access, awareness and stigma. As laws and attitudes around cannabis shift, understanding the real-world barriers to care is more important than ever.

A new study from Florida Atlantic University and collaborators is among the few to track cannabis use treatment trends over time, drawing on national data from the 2003, 2011 and 2019 National Survey on Drug Use and Health. Researchers analyzed 16 years of patterns, examining how factors like gender, race and ethnicity, age, education, insurance coverage, and urban versus rural residence influence access to treatment.

Using robust statistical methods, the study identifies key predictors of who receives help – and reveals the most common reasons why many don't. The findings offer critical insights to guide more targeted, equitable approaches to addressing cannabis use disorder as legalization and usage rates continue to rise.

Results of the study, published in the journal Substance Use & Misuse, reveal a concerning trend: over the 16-year period, the number of individuals receiving treatment for cannabis use disorder declined, even as the need remained high – from 19% in 2003 to just 13% in 2019. Across all three time points – 2003, 2011 and 2019 – most people with cannabis use disorder did not receive any form of treatment.

When asked why they didn't seek help, participants cited a range of barriers. Increasingly, individuals reported not knowing where to find treatment or feeling unready to stop using cannabis. Other common reasons included the cost of treatment, concerns about stigma, and fears that seeking help could negatively impact their job or career.

The study also identified consistent predictors of who was more likely to receive treatment. People who had received mental health services in the past year or who were under community supervision (such as probation or parole) were significantly more likely to access treatment for cannabis use disorder.

Interestingly, Hispanic individuals had much lower odds of receiving treatment compared to non-Hispanic white individuals in 2003, but this difference was no longer significant in more recent years – suggesting some progress toward equal access. Additionally, a prior arrest, which was not linked to treatment in 2003, became a strong predictor in later years, associated with two to three times higher odds of receiving cannabis use disorder treatment.

Cannabis use disorder treatment is often overshadowed by treatments for other substance use disorders, despite its growing prevalence and impact. Barriers to treatment are not only widespread but also evolving over time. Understanding these shifting challenges – and the consistent predictors of who does and doesn't get help – can guide targeted efforts to expand access and improve outcomes for those struggling with this disorder."

Brian D. Graves, Ph.D., senior author and assistant professor in the Phyllis and Harvey Sandler School of Social Work within FAU's College of Social Work and Criminal Justice

Most individuals with cannabis use disorder were male, and those who received treatment were more likely to be older, non-Hispanic white, and have lower incomes. Over time, fewer people with private insurance sought treatment, while more used public insurance.

Mental health care and involvement with the justice system were strong predictors of receiving treatment. People who had been arrested or were on probation or parole were much more likely to access care. Self-help groups and outpatient rehab were the most common treatment settings.

Key barriers to treatment included not feeling ready to stop, not knowing where to go, cost, stigma and fear of job-related consequences – concerns that increased in recent years. For example, in 2019, 38% didn't know where to seek help, and 28% feared job impacts, up from single-digit percentages in earlier years.

"Our findings highlight an urgent and growing need for targeted outreach and improved education about available treatment options for cannabis use disorder," said Graves. "Beyond simply increasing awareness, we must address the practical obstacles – like affordability and access – as well as the perceptual barriers such as stigma and misinformation that prevent many individuals from seeking help. Achieving access to care requires coordinated, systemic efforts that prioritize the unique challenges faced by varied communities affected by cannabis use disorder. Only through comprehensive strategies can we hope to close the treatment gap and provide effective support to those who need it most."

Study co-authors are Orion Mowbray, Ph.D., University of Georgia; Lydia Aletraris, Ph.D., University of Georgia; and Jay O'Shields, Ph.D., University of Alabama at Birmingham.