Adolescents who use cannabis even as little as once a month demonstrate significantly poorer academic performance and increased emotional distress when compared with those who have never used cannabis in their lifetime, according to a large national study published in the journal Pediatrics. Led by Ryan Sultán, M.D., principal investigator at the Mental Health Informatics Lab at Columbia, the findings also indicate a dose-response relationship between cannabis use frequency and the severity of emotional, social, and academic impairment.
The research team analyzed data from the 2018 to 2022 Monitoring the Future surveys, a cross-sectional and self-reported national survey of public and private high school students in the United States. They examined the responses of more than 160,000 eighth, 10th, and 12th graders and stratified cannabis use into five groups: noncurrent (zero occasions of use in a month), monthly (one or two), weekly (three to nine), and near-daily use (10 or more); nonusers were those who had never tried cannabis in their lifetime. Over a quarter of respondents reported any cannabis use, with 18% indicating noncurrent or monthly use, 3.6% using it weekly, and 4.6% reporting near-daily use.
It’s not uncommon for a young teen to smoke marijuana only a few times before showing signs of withdrawal and worsening mood.
— Dr. Ryan Sultán
“While previous studies have focused on the effects of frequent cannabis use among teens, our study found that any amount of cannabis use at all may put kids at risk of falling behind in school, and the kids using most often may have the greatest risk,” says Dr. Sultán, who specializes in adolescent substance use. “Teens using it regularly often struggle to focus, miss school, and may lose interest in their future plans.”
The Risks of Adolescent Cannabis Use on Psychosocial Outcomes
Although psychosocial outcomes, which include a range of indicators from academic functioning to self-regulation, were poorer with increased frequency, the difference between nonuse and any cannabis use was significant. Adolescents who used cannabis at least once or twice a month were about 1.5 to two times as likely to experience a poorer emotional state — including anxiety, low self-esteem, existential distress, and anhedonia — compared with nonusers. They were also two to three times more likely to exhibit high impulsivity and aggression. Near-daily users, meanwhile, were almost four times as likely to receive poor grades and miss school.
All these associations were even stronger among cannabis users under 16. “The real-world impact can be dramatic,” Dr. Sultán says. “It’s not uncommon for a young teen to smoke marijuana only a few times before showing signs of withdrawal and worsening mood.”
A teenager’s brain is still developing the circuits for learning, self-control, and emotional regulation. Using cannabis, even casually, during these critical growth periods can derail normal development.
— Dr. Tim Becker
Researchers are particularly concerned because today’s cannabis products contain two to three times more tetrahydrocannabinol (THC) than in the past, increasing their potency. Previous studies have indicated that using cannabis during adolescence, when the brain is still developing critical neural connections, may have lasting effects on cognitive functions essential for academic performance.
“A teenager’s brain is still developing the circuits for learning, self-control, and emotional regulation,” says Tim Becker, M.D., a coauthor of the study and a child and adolescent psychiatrist at NewYork-Presbyterian Westchester Behavioral Health and assistant professor of clinical psychiatry at Weill Cornell Medicine. “Using cannabis, even casually, during these critical growth periods interferes with those processes and can derail normal development.”
Implications for Clinicians
The findings underscore the importance of broadening clinical vigilance beyond high-frequency users, and cannabis use should be a consideration when evaluating new-onset behavioral or affective changes in adolescents. “Clinicians should maintain a low threshold for screening when adolescent patients present with declining academic performance, mood disturbance, anhedonia, or disengagement from previously valued activities — even in the absence of reported frequent use,” says Dr. Sultán. The authors advocate for prevention and early intervention strategies that reinforce prosocial engagement and nonsubstance-related coping, with particular attention to patients under 16.
A version of this article originally appeared on Columbia’s newsroom.
