Co-use of Alcohol and Cannabis: A Review
Purpose of Review
The purpose of this review is to provide an overview of the existing literature on the relationship between the co-use of cannabis and alcohol including (1) epidemiology, comorbidity, and associated consequences of cannabis and alcohol use disorders; (2) preclinical and clinical laboratory studies examining behavioral pharmacology of cannabis and alcohol co-use; and (3) clinical outcomes related to co-use.
Findings from the literature reviewed suggest that the co-use of alcohol and cannabis is associated with additive performance impairment effects, higher and more frequent consumption levels, increased social and behavioral consequences such as driving while impaired, and greater likelihood of the experiencing comorbid substance use and mental health disorders. Furthermore, co-use may be associated with worse clinical outcomes, yet there are few studies examining the development and evaluation of interventions on reducing the co-use of cannabis and alcohol.
There is a need for more rigorous and longitudinal research studies on the co-use of cannabis and alcohol to glean a more complete understanding of the relationship between the two substances. Findings can be used to develop and refine intervention strategies to successfully reduce cannabis and alcohol co-use.
KeywordsCannabis Alcohol Co-use Behavioral pharmacology Comorbidity Clinical outcomes
Compliance with Ethical Standards
Conflict of Interest
Dr. Ali M. Yurasek declares that she has no conflicts of interest. Dr. Elizabeth R. Aston declares an NIDA grant. Dr. Jane Metrik declares an NIAAA grant.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.Substance Abuse and Mental Health Service Administration (SAMHSA). Results from the 2013 National survey on drug use and health: summary of national findings. NSDUH Series H-48, HHS Publication No.(SMA) 14–4863. Rockville: Substance Abuse and Mental Health Services Administration; 2014.Google Scholar
- 11.Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. (NSDUH Series H-51). Report No.: HHS Publication No. SMA 16–4984; 2016.Google Scholar
- 12.ProCon.org [Internet]. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Available from: http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881 (2016). Cited 2017 Jan 18.
- 16.SAMHSA. Results from the 2010 national survey on drug use and health: summary of national findings, vol NSDUH, Series H-41, HHS Publication No. (SMA) 11–4658. Rockville: Substance Abuse and Mental Health Services Administration; 2011.Google Scholar
- 33.• Terry-McElrath YM, O’Malley PM, Johnston LD. Simultaneous alcohol and marijuana use among U.S. high school seniors from 1976 to 2011: trends, reasons, and situations. Drug Alcohol Depend. 2013;133(1):71–9. This is an important longitudinal study examining trends of co-use and consequences experienced. Findings contributed to research linking co-use to increased consumption levels and related consequences of both alcohol and cannabis CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Pacek LR, Malcolm RJ, Martins SS. Race/ethnicity differences between alcohol, marijuana, and co-occurring alcohol and marijuana use disorders and their association with public health and social problems using a national sample. Am J Addict. 2012;21(5):435–44.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.•• Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, et al. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the national epidemiologic survey on alcohol and related conditions–III. Am J Psychiatry. 2016;173(6):588–99. This important study examined the relationship between cannabis use disorders (CUD) and other psychiatric disorders. The authors concluded that having a CUD is associated with the occurrence of other substance use disorders (SUD), mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and personality disorders CrossRefPubMedGoogle Scholar
- 70.• Hartman RL, Brown TL, Milavetz G, Spurgin A, Pierce RS, Gorelick DA, et al. Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol JAT. 2016;36(11):1418–29. This study investigated the effect of cannabis on driving with and without alcohol on THC blood concentrations in a within-subject study with six conditions. This study added to the co-use literature by suggesting co-use is related to riskier driving behaviors CrossRefPubMedGoogle Scholar
- 71.Lukas SE, Benedikt R, Mendelson JH, Kouri E, Sholar M, Amass L. Marihuana attenuates the rise in plasma ethanol levels in human subjects. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 1992;7(1):77–81.Google Scholar
- 74.•• Hartman RL, Brown TL, Milavetz G, Spurgin A, Gorelick DA, Gaffney G, et al. Controlled cannabis vaporizer administration: blood and plasma cannabinoids with and without alcohol. Clin Chem. 2015;61(6):850–69. This study employed vaporized cannabis administration to investigate the effect of cannabis and alcohol co-use on subsequent cannabinoid plasma levels. Findings indicated that the inclusion of alcohol was related to significantly higher blood cannabinoid levels CrossRefPubMedGoogle Scholar
- 83.Subbaraman MS, Metrik J, Patterson D, Swift R. Cannabis use during treatment for alcohol use disorders predicts alcohol treatment outcomes. Addiction. 2016;112:685–694.Google Scholar
- 89.Budney AJ, Roffman R, Stephens RS, Walker D. Marijuana dependence and its treatment. Alcohol. 2007;50:60.Google Scholar
- 92.Metrik J, Ramesh D. Treatment of marijuana use disorders. In: MacKillop J, Kenna GA, Leggio L, Ray LA, editors. Integrating psychological and pharmacological treatments for addictive disorders: an evidence-based guide. New York: Routledge Press; 2017.Google Scholar
- 102.National Academies of Sciences E. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research [Internet]. Available from: https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state 2017. Cited 2017 Jan 22.
- 103.Palamar JJ, Ompad DC, Petkova E. Correlates of intentions to use cannabis among US high school seniors in the case of cannabis legalization. Int J Drug Policy. 2014;2Google Scholar
- 104.NIH launches landmark study on substance use and adolescent brain development [Internet]. EurekAlert! [cited 2017 Jan 22]. Available from: http://www.eurekalert.org/pub_releases/2015-09/niod-nll092515.php.