Daily Cannabis Use Doubled While Cannabis Use Disorder Rates Dropped Nearly 50% From 2002-2019

What the researchers found

Daily cannabis use prevalence increased 94% (AARC 11.68%). CUD among daily users decreased 47.9% (AARC -10.30%). Individual CUD criteria prevalence decreased 13.4-59.6% among daily users. In contrast, daily alcohol use decreased 10.86% while AUD among daily drinkers decreased only 3.9%. Treatment engagement and perceived need both decreased for cannabis.

Why it matters

The paradox of more daily use but less diagnosed disorder suggests that how people define "problematic" cannabis use is shifting with cultural acceptance. This has profound implications for diagnostic frameworks: if the same behavior is disorder in one cultural context but not another, the diagnostic criteria themselves may need examination.

The numbers in context

Daily cannabis use: +94% (AARC 11.68%). CUD among daily users: -47.9% (AARC -10.30%). Daily alcohol use: -10.86% (AARC -1.90%). AUD among daily drinkers: -3.9% (AARC -0.67%). Individual CUD criteria changes: -13.4% to -59.6%. Treatment engagement decreased for cannabis, increased for alcohol.

How the study worked

Analysis of National Survey on Drug Use and Health data from 2002 to 2019. Computed temporal trends and average annual rates of change for CUD and AUD symptoms, treatment engagement, and perceived treatment need. Compared divergent trajectories of cannabis and alcohol use disorders.

What this study cannot tell us

NSDUH data are cross-sectional and self-reported, with possible changes in reporting honesty over time as cannabis became more accepted. Diagnostic criteria did not change between 2002 and 2019 (transition from DSM-IV to DSM-5 in 2013 may have affected comparability). The study ends in 2019 before the pandemic.

How to read the evidence

Strong: large national dataset spanning nearly two decades with systematic trend analysis comparing cannabis and alcohol as reference substances.

When this study was published

2025 study using 2002-2019 NSDUH data.

The bigger picture

This study raises fundamental questions about how substance use disorders are diagnosed. Many CUD criteria reference "harm" (e.g., continued use despite problems, failure to fulfill obligations). If legalization and normalization reduce the social and legal harms of use, fewer people meet these criteria even while using more cannabis.

Questions still open

• Should CUD diagnostic criteria be revised to account for changing social contexts? Are declining CUD rates a positive sign of reduced harm or a concerning sign of declining treatment engagement?

Common questions

Read the original research

Divergence in cannabis and alcohol use disorder prevalence trends from 2002 to 2019.

Drug and alcohol dependence, 266, 112521

Citation

Acuff, Samuel F; Strickland, Justin C. (2025). Divergence in cannabis and alcohol use disorder prevalence trends from 2002 to 2019.. Drug and alcohol dependence, 266, 112521. https://doi.org/10.1016/j.drugalcdep.2024.112521

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