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

The takeaway

Among 413 women, younger women were more likely to replace alcohol with THC (14% vs 7.8%), driven by sleep problems (OR 5.82) and alcohol severity, while older women substituted less frequently with PTSD as the key predictor.

Women's health researchers, addiction medicine specialists, harm reduction advocates

Sleep problems: 5.8x more likely to substitute THC for alcohol in younger women

What the researchers found

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%).

Why it matters

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 numbers in context

n=413 women; younger <56: 14.0% substituted THC (mean age 44.2); older >=56: 7.8% (mean age 62.9); sleep problems predicted THC substitution in younger women OR 5.82; PTSD predicted substitution in older women OR 1.60; older women non-substitution rate 83.5%

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Moderate sample with validated instruments and age-stratified analysis provides preliminary evidence, limited by cross-sectional design and self-selected online sample.

When this study was published

2025 publication

The bigger picture

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.

Questions still open

Does THC substitution for alcohol actually reduce total harm in women with sleep problems? Would addressing sleep disorders directly reduce the motivation to substitute?

Common questions

Why do younger women replace alcohol with cannabis more often?

Younger women reported higher rates of sleep problems, stress, and more severe alcohol use, all of which predicted substitution. Sleep problems were the strongest single predictor, increasing the odds of THC substitution nearly sixfold.

Is substituting cannabis for alcohol actually safer?

This study examined the motivations for substitution, not the health outcomes. While cannabis is generally considered to carry lower overdose and organ damage risk than alcohol, substitution may not address the underlying issues (sleep, PTSD) driving problematic use.

Read the original research

Predictors of Replacing Alcohol With Cannabis Among Adult Women.

Cureus, 17(10), e95821

View on PubMed ↗Publisher’s paper ↗

Citation

Attonito, Jennifer; Mueller, Jocelyn E; Villalba, Karina. (2025). Predictors of Replacing Alcohol With Cannabis Among Adult Women.. Cureus, 17(10), e95821. https://doi.org/10.7759/cureus.95821