Anxiety sensitivity and cannabis use: A systematic review and conceptualization of research findings

Anxiety sensitivity (AS), or fear of anxious arousal, is a transdiagnostic risk factor that may be associated with greater risk for problematic cannabis use. Individuals with high AS may use cannabis to cope with distressing physiological sensations. However, there is also conflicting research suggesting that individuals with high AS may avoid cannabis use because it is perceived to cause unpleasant physiological sensations. Rates of cannabis use disorder (CUD) are high and escalating in the US, so identification and understanding of risk factors such as AS is crucial for prevention and treatment of CUD. The purpose of the current review is to summarize and critically review the, at times, conflicting existing research on AS and CUD, present a unifying conceptualization of AS as a risk factor for CUD, and establish a future research agenda.

Empirical studies indexed in PubMed or PsycInfo as of Spring 2024 testing associations between AS and cannabis use were included. Fifty studies were reviewed and coded by two independent coders who evaluated study characteristics and risk of bias.

Results were qualitatively synthesized and suggested a direct association between elevated AS and greater levels of coping-oriented and possibly problematic cannabis use, but not lifetime cannabis use or cannabis use frequency.

A conceptual model is presented in which high AS may lead to greater coping-oriented cannabis use, and, in turn, problematic cannabis use in the presence of symptoms of psychopathology and positive cannabis expectancies. Future research should test this model utilizing prospective and/or experimental studies with valid assessments of AS and cannabis use among diverse cannabis using samples.