Clinical correlates of homelessness and cannabis use among U.S. low-income veterans.

Stefanovics E.; Potenza M.; Tsai J. · Journal of psychiatric research · 2026

**Background & Methods** This review study examined a nationally representative sample of 1,031 low-income U.S. veterans, categorizing 235 participants into three groups: lifetime homelessness without cannabis use (HLS; n=27, 13.2%), cannabis use without homelessness (CU; n=174, 73.2%), and both homelessness and cannabis use (HLS+CU; n=34, 13.6%). Group-stratified bivariate and multivariate analyses were employed to investigate associations between homelessness, cannabis use, and clinically relevant variables. **Key Findings** • Cannabis use was significantly associated with residence in states with legalized cannabis. Veterans with both homelessness and cannabis use (HLS+CU) demonstrated substantially worse clinical profiles compared to either condition alone, including higher rates of arrests, poor subjective health status, and polydrug use with stimulants being particularly prevalent. • HLS+CU was more strongly associated with trauma-related and psychiatric comorbidities compared to cannabis use alone, including higher trauma burden, current posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), suicidal behavior, history of arrest, and eviction history. • Most veterans with HLS+CU reported receiving support from VA programs and services focused on homelessness, suggesting substantial healthcare engagement despite complex clinical presentations. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This review study has notable limitations. The cross-sectional design precludes causal inference regarding relationships between homelessness, cannabis use, and psychiatric outcomes. The sample size of 235 categorized participants is relatively modest, potentially limiting generalizability despite the nationally representative recruitment strategy. Specific measures for homelessness duration, cannabis frequency/quantity, and psychiatric assessment tools are not detailed in the abstract. The authors appropriately note that homelessness may be more strongly associated with trauma-related and psychiatric concerns, whereas cannabis use may be more strongly associated with substance use and addictive behaviors, suggesting distinct but potentially overlapping pathophysiological mechanisms. The findings support Level III evidence and highlight the need for integrated, trauma-informed interventions but should be interpreted cautiously pending full manuscript review of methodology and statistical approaches.

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