Cannabis Usage

Written By Jack Scharf

The relationship between Alcohol Use Disorder (AUD) and cannabis use is complex, and researchers are still determining exactly how they influence one another. Here’s a clear breakdown:

1. Co-use is common

People with Alcohol Use Disorder often also use cannabis. This is called co-use or polysubstance use. Studies show that individuals with AUD are significantly more likely to use cannabis than the general population.

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2. Three main ways they may interact

a) Substitution (using cannabis instead of alcohol)

Some people reduce alcohol consumption by using cannabis instead.

  • This can sometimes lower alcohol intake and related harms.

  • However, it may lead to Cannabis Use Disorder if cannabis use becomes problematic.

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b) Complementary use (using both together)

Others use cannabis alongside alcohol.

  • This can increase intoxication and impair judgment more than either substance alone.

  • It is associated with higher risks of accidents, impaired driving, risky behaviors, and alcohol-related consequences.

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c) Cross-sensitization

Both substances affect the brain’s reward system, including dopamine pathways.

  • Using one substance may increase craving or sensitivity to the other.

  • This may make quitting either substance more difficult.

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3. Effects on the brain and behavior

Alcohol and cannabis affect overlapping neurological systems.

  • Alcohol: depresses the central nervous system, impairing coordination, reaction time, and decision-making.

  • Cannabis affects memory, attention, perception, and motivation.

Together, they can:

  • Worsen cognitive impairment.

  • Increase risk of dependency and substance use disorders.

  • Heighten anxiety, depression, or other psychiatric symptoms in some individuals.

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4. Mental health connections

Co-use is linked with:

  • Higher rates of anxiety and depression.

  • Greater severity of substance use disorders.

  • More difficulty achieving positive treatment outcomes.

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5. Treatment implications

For people with AUD:

  • Cannabis use can help, hinder, or complicate recovery depending on the frequency and pattern of use.

  • Research suggests cannabis use during alcohol treatment may be associated with poorer alcohol-abstinence outcomes in some individuals.

  • Integrated treatment approaches that address multiple substance-use issues simultaneously generally produce better outcomes than treating them separately.

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Bottom Line

There is no one-size-fits-all answer:

  • Cannabis may reduce alcohol use for some individuals.

  • For others, it may increase risk and worsen treatment outcomes.

  • Overall, regular combined use of alcohol and cannabis is associated with greater impairment, more alcohol-related consequences, increased risk-taking, and more complex recovery challenges than using either substance alone.

Key References

1.      Co-Use of Alcohol and Cannabis: A Review https://pmc.ncbi.nlm.nih.gov/articles/PMC7363401/

2.      Cannabis Use During Treatment for Alcohol Use Disorders Predicts Alcohol Treatment Outcomes https://pubmed.ncbi.nlm.nih.gov/27865015/

3.      Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness https://pmc.ncbi.nlm.nih.gov/articles/PMC7793504/

4.      CDC Cannabis and Public Health https://www.cdc.gov/cannabis/about/index.html

5.      National Institute on Alcohol Abuse and Alcoholism (NIAAA) https://www.niaaa.nih.gov/

6.      Integrated Treatment of Substance Use and Psychiatric Disorders https://pmc.ncbi.nlm.nih.gov/articles/PMC3753025/

Jack Scharf
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