As states legalized marijuana, alcohol use increased: study

Story at a glance

• Over 20 states and Washington, D.C., have legalized recreational adult cannabis use.

• Results of a new study show legalization was linked with increased alcohol use, but not increased rates of binge drinking or heavy drinking.

• Findings also varied based on demographic factors.

Rates of alcohol use have increased alongside policies legalizing recreational marijuana, according to results of a new study that reflect data on over 4 million U.S. adults. 

In 2012, Colorado and Washington became the first states to legalize recreational marijuana, and in the decade since, over 20 states and Washington, D.C., have followed suit. 

The study, published in JAMA Health Forum, found that between 2010 and 2019, recreational cannabis laws were linked with a 0.9 percentage point increase in alcohol use among the entire U.S. population. 

However, the results did not show any associations between legalized cannabis and increases in binge or heavy drinking. Throughout the study period, 10 states and Washington, D.C., legalized recreational cannabis for adults.

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Higher alcohol intake was driven primarily by young adults between the ages 18 and 24, and men, researchers found. These increases were also more common among non-Hispanic white individuals and those without some college education. 

Associations were also greatest within the first year of the law’s implementation, but data show the relationship may diminish over time. No link between cannabis legalization and alcohol use was seen among older adults.

Results are based on responses to the Behavioral Risk Factor Surveillance System, reflecting adult behaviors in all 50 states. The system is an annual, repeated cross-sectional survey conducted by the CDC. 

Alcohol and cannabis are the first and third most-used substances in the country, while in the past decade, the percentage of adult cannabis users has nearly doubled, researchers explained.

On its own, cannabis increases the risk of cannabis use disorder and nausea and could heighten the risk of some mental health conditions, they said, while “co-use of cannabis and alcohol may increase the probability of unsafe driving, beyond the risk associated with consuming either substance alone.” 

Previous studies have suggested cannabis legalization may reduce opioid use and its associated risks, though results are not conclusive. 

“Our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men,” authors cautioned.