Younger women substituted THC for alcohol driven by sleep problems, while older women substituted less and were driven by PTSD

Younger women (<56) were significantly more likely to substitute THC for alcohol (14.0% vs 7.8%) and reported higher rates of sleep problems, stress, and scores on AUDIT, PTSD, GAD, and PHQ instruments. Sleep problems strongly predicted THC substitution in younger women (OR 5.82). Among older women (>=56), PTSD symptoms predicted substitution of both CBD and THC (OR 1.60), and sleep problems predicted THC substitution (OR 3.05). Older women were more likely to not substitute at all (83.5% vs 71.0%).

Cross-sectional online survey of 413 women aged 18+ who reported lifetime cannabis use. Stratified into younger (<56) and older (>=56) groups. Validated scales for alcohol use disorders, PTSD, anxiety, and depression. Logistic regression identified predictors of CBD, THC, or combined substitution for alcohol.

Cannabis substitution for alcohol is increasingly discussed as harm reduction, but this study shows the drivers differ dramatically by age. Sleep problems drive younger women toward THC substitution, while PTSD drives older women, suggesting age-specific approaches are needed.

The substitution versus complementary use debate assumes cannabis and alcohol users are a homogeneous group. This study reveals that substitution is a nuanced phenomenon driven by different clinical needs at different life stages, with sleep and trauma as key motivators.

Cross-sectional online survey with self-selected participants. Cannot establish whether substitution actually reduces alcohol-related harm. Age cutoff of 56 is somewhat arbitrary. Cannot verify actual substitution behavior versus self-reported intention.