Cannabis may disrupt impulse control and emotional acceptance in young users, review finds

Cannabis is already the most widely used illicit drug among young people, and its links to depression, anxiety, conduct problems and psychosis are well documented. What has remained far murkier is the cognitive machinery underneath that association. A new systematic review, published in Frontiers in Adolescent Medicine, has taken a careful look at one proposed mechanism: emotion regulation, the capacity to monitor, evaluate and modulate emotional responses in line with situational demands. The verdict is intriguing but sobering. After an exhaustive search of six databases, the researchers led by Ronan Fleury of RCSI University of Medicine and Health Sciences in Dublin found only four studies that met their strict criteria, covering a combined 3,801 participants aged roughly 18 to 29. Across those studies, cannabis involvement was consistently associated with greater emotion regulation difficulties, but the pattern was strikingly specific rather than global, concentrated in impulse control, goal-directed behaviour and non-acceptance of emotions.

The review, registered prospectively on PROSPERO and funded by the Health Research Board, followed PRISMA 2020 guidelines and searched PubMed, PsycINFO, Web of Science, CINAHL, Embase and Scopus from inception to June 2025. To be eligible, studies had to include participants aged 12 to 30, contain a comparison group of non-users or infrequent users, defined as use on no more than one to two of the past 30 days, and report at least one validated self-report measure of emotion regulation. The team prespecified three instruments: the Emotion Regulation Questionnaire, which captures cognitive reappraisal and expressive suppression; the Difficulties in Emotion Regulation Scale, known as DERS, which probes six domains including nonacceptance, goals, strategies, clarity, impulsivity and awareness; and the Cognitive Emotion Regulation Questionnaire, which covers nine adaptive and maladaptive strategies from acceptance to catastrophizing. Risk of bias was assessed with the ROBINS-E tool, and findings were synthesised narratively.

The scarcity of qualifying evidence is itself a headline. Despite cannabis being used by an estimated 23 million Europeans aged 16 to 64 in the past year, and despite around one in five users developing cannabis use disorder, only four cross-sectional studies worldwide had examined the relationship with validated emotion regulation questionnaires in this age range. Three samples were drawn from university settings and one from an online survey. Cannabis exposure was defined in several distinct ways, including the SCID-5 structured clinical interview for DSM-5, the Marijuana Problem Scale, the Cannabis Use Disorders Identification Test, and simple frequency of use. Three of the four studies were rated at high or very high risk of bias, mainly because they relied on self-reported cannabis exposure and adjusted only limitedly for confounding variables such as psychiatric comorbidity and polysubstance use.

The most statistically powerful of the included studies came from Spain. Sara Weidberg and colleagues at the University of Oviedo examined 2,762 undergraduates with a mean age of 19.5 years, comparing 318 past-month cannabis users against 2,444 infrequent users or abstainers. Users showed higher global dysregulation scores on the DERS, but the significant associations were confined entirely to women. Within the female group, differences clustered in non-acceptance of emotional responses, impulse control difficulties, reduced goal-directed behaviour and lower emotional clarity. Mediation analyses indicated that DERS scores statistically mediated the association between past-month cannabis use and emotional distress in women, with no comparable effects appearing in men. Given the enormous sample, the absence of associations in men is unlikely to reflect low statistical power and instead suggests that cannabis use and reported regulation difficulties align more strongly among women in this cohort, though the cross-sectional design prevents any conclusion about temporal direction.

The remaining studies added texture to that pattern. Mohsen Akbari and colleagues in Iran studied 144 university students divided into cannabis use disorder, problematic internet use and non-affected comparison groups, using the SCID-5 to diagnose cannabis use disorder. Cannabis users reported significantly lower cognitive reappraisal scores on the ERQ than both comparison groups, and while expressive suppression also differed across groups, the reappraisal differences appeared larger and more decisive. This emphasis on reappraisal matters theoretically, because reappraisal is widely regarded as a protective strategy associated with resilience and better mental health outcomes, whereas habitual suppression and rumination are linked to greater symptom severity in depression and anxiety. In the United States, Julia Cavalli and Adriana Cservenka assessed 852 adults with a mean age of 26.9 years and found that higher DERS scores moderated the association between recent stress and cannabis-related problems, with emotion regulation difficulties amplifying the consequences of cannabis use most strongly at higher levels of stress.

The fourth study, by Benjamin Stone in the United States, illustrates how fragile the evidence base remains. Stone examined 198 undergraduates with a mean age of 19.2 years, but only 43 participants had available cannabis-use data for the review’s analyses. Descriptive patterns suggested that students with stronger positive substance-use expectancies and heavier cannabis involvement tended to show higher DERS scores, but none of these trends reached statistical significance, and neither total DERS scores nor any of the six subscales differed significantly between users and controls. The review team re-analysed Stone’s openly available data from the Open Science Framework to obtain comparable summary statistics, a methodological nicety that shows the lengths to which the synthesis went to align reporting across studies with heterogeneous aims and definitions.

What emerges from the cross-study synthesis is a pattern of specific regulatory deficits rather than a generalised inability to manage emotions. The domains most consistently implicated were impulse control, non-acceptance of emotions, goal-directed behaviour and emotional clarity, with reduced cognitive reappraisal also reported on the ERQ. The magnitude of associations appears modest throughout, suggesting small-to-moderate relationships. This specificity fits with broader cognitive-affective models in which emotion regulation depends on core executive functions such as working memory, inhibitory control and cognitive flexibility, processes that frequent cannabis users are known to show subtle deficits in. A major meta-analysis of youth cannabis users reported small deficits in executive functioning, learning and memory that largely dissipated with abstinence, though it did not extend to emotion regulation specifically. Neuroimaging studies outside this review also report altered activation in prefrontal and anterior cingulate regions among regular users, strengthening the theoretical plausibility that regulation difficulties may stem from disruptions in control systems involved in both cognition and affect.

The review’s authors are careful to stress that these findings should be interpreted as strictly associations. It remains unclear whether emotion regulation differences precede cannabis involvement, arise from it, or reflect underlying characteristics common to both. None of the included studies examined emotion regulation in the context of polysubstance use, despite cannabis frequently co-occurring with alcohol, nicotine and stimulants in this age group. No studies reported or controlled for psychiatric comorbidity, even though depression, anxiety and attention-deficit disorders are independently associated with emotion dysregulation. No studies incorporated neurocognitive, behavioural or imaging investigations alongside the prespecified questionnaires. The reliance on cross-sectional self-report designs, variation in how cannabis exposure was defined, the absence of potency or cumulative-use data, and a dependence on university-based convenience samples further restrict generalisability. As sex differences were identified within a single large-scale study, it also remains unclear whether the female-specific pattern reflects sample-specific variation or a more generalised phenomenon requiring extensive investigation.

Even within these constraints, the association between cannabis use and specific regulation difficulties was replicated in all four studies, and the authors argue it carries potential clinical and developmental relevance. The findings are consistent with the idea that cannabis may function as a maladaptive strategy to manage distress or suppress unwanted emotions, and they point toward interventions that enhance regulatory flexibility, such as reappraisal training, mindfulness-based relapse prevention and structured emotion regulation skills programmes, as candidates for reducing reliance on cannabis during adolescence and early adulthood. The developmental focus on ages 12 to 30 captures a critical window in which both emotion regulation and substance-use behaviours are still forming, making the findings particularly relevant to prevention and early intervention. Future longitudinal and experimental studies are needed to clarify causal directions, delineate recovery trajectories following abstinence and identify moderators such as age of onset and psychiatric comorbidity. For now, the message is preliminary but pointed: cannabis use in youth appears linked not to a wholesale breakdown of emotional control, but to specific cracks in the regulatory system, and those cracks may be exactly where prevention efforts should aim.

Subject of Research: A systematic review finds that cannabis use in adolescents and young adults is associated with specific emotion regulation difficulties, particularly impulse control, goal-directed behaviour and non-acceptance of emotions, with evidence limited to four cross-sectional studies.

Article Title: Emotion regulation and cannabis use in young people: a systematic review

Article References: Fleury, R., Riaz, S., O’Higgins, F., Anih, A. N., Dooley, N., Staines, L., Healy, C., Gillan, D., Smyth, B., & Cannon, M. (2026). Emotion regulation and cannabis use in young people: a systematic review. Frontiers in Adolescent Medicine, 4, Article 1766637. https://doi.org/10.3389/fradm.2026.1766637

Image Credits: AI Generated

DOI: 10.3389/fradm.2026.1766637

Keywords: cannabis, emotion regulation, adolescence, systematic review, mental health, impulse control, young adults, addiction, Emotion, regulation, young, people