14.1 Million US Adults Report Simultaneous Alcohol-Cannabis Use

Among US adults who used both alcohol and cannabis in the past month, 49.0% reported simultaneous use, according to a cross-sectional research letter published in JAMA Network Open by investigators from the National Institute on Drug Abuse (NIDA).

The investigators noted that prior studies compared simultaneous alcohol-cannabis use with alcohol-only use or with heterogeneous groups. To clarify use patterns and risk factors, they compared adults who use the substances simultaneously with adults who use them separately.

The analysis included 186 823 adults who completed the 2021-2024 National Surveys on Drug Use and Health (NSDUH). Simultaneous use was defined as using cannabis while drinking or within a couple of hours of drinking during the last drinking episode in the past month. Overall, 11.2% of US adults used both substances in the past month. Of these, 49.0%, or an estimated 14.1 million adults, reported simultaneous use. Prevalence was highest among adults aged 50 years or older with cannabis use disorder (CUD), at 82.0%.

In age-stratified analyses, CUD was associated with simultaneous use in every age group, with adjusted prevalence ratios (APRs) of 2.09 to 2.14. High school graduates also had higher prevalence across age groups. Among adults aged 50 years or older, simultaneous use was more prevalent among males (APR, 1.32; 95% CI, 1.20-1.45) and those with a past-year major depressive episode (APR, 1.45; 95% CI, 1.23-1.70). No sex or depression association was observed among adults aged 18 to 29 years.

The authors noted that prevalence may have been underestimated because NSDUH excludes people experiencing unsheltered homelessness or incarceration and asks about cannabis use only during the last drinking episode. They said the findings highlight the need for age-specific screening, interventions, and risk-focused counseling.

Source: Han B, Hobin JA, Compton WM. Simultaneous cannabis and alcohol use from nationally representative data. JAMA Netw Open. 2026;9(9):e2635815. doi:10.1001/jamanetworkopen.2026.35815