In a nationally representative sample of over 214,000 U.S. adults, cannabis use clustered with heavy drinking, tobacco, and obesity in distinct gender-specific patterns, with high-substance-use clusters concentrated in adults under 35.
Public health researchers, substance use clinicians, and policymakers interested in polysubstance use patterns.
N = 214,505 adults, 4 risk clusters
What the researchers found
Four clusters with similar profiles emerged for both men and women: heavy-drinking-tobacco-some-cannabis-use-obese, high-substance-use, obese, and relatively-healthy-lifestyle. The high-substance-use group skewed under age 35. Clusters featuring alcohol, tobacco, and cannabis together were more common in midlife men and higher-income individuals. Clustered risk factors were associated with being White and having no college degree.
Why it matters
Most substance use research examines individual substances in isolation, but real-world use involves combinations. Understanding how cannabis clusters with other behavioral risk factors helps design interventions that address multiple behaviors simultaneously.
The numbers in context
N = 214,505 adults. Four common clusters identified for both genders. High-substance-use cluster concentrated in ages under 35. Alcohol-tobacco-cannabis clusters more prevalent in midlife men and higher-income adults of both genders.
How the study worked
Latent class analyses and multinomial/logistic regressions using a nationally representative sample of 214,505 U.S. adults from the 2015-2019 National Survey on Drug Use and Health, stratified by gender.
What this study cannot tell us
Cross-sectional design captures a snapshot, not trajectories. Self-reported substance use may be underestimated. NSDUH excludes institutionalized and homeless populations. Latent class solutions involve researcher judgment.
How to read the evidence
Large nationally representative sample with rigorous latent class methodology, though limited by cross-sectional design and self-report.
When this study was published
2025 publication using 2015-2019 NSDUH data
The bigger picture
The clustering of cannabis with tobacco, alcohol, and obesity suggests that single-substance interventions may miss the broader picture. Tailored multibehavior approaches could be more effective for the significant segment of the population affected by these overlapping risk factors.
Questions still open
- Do people transition between clusters over time? Would multibehavior interventions outperform single-substance programs for people in high-risk clusters?
Common questions
How does cannabis fit into broader substance use patterns?
Did gender affect substance use clustering?
Read the original research
Understanding clustered behavioral risk factors among adults in the United States: A gender-specific analysis of alcohol and other substance use and obesity.
Alcohol, clinical & experimental research, 49(10), 2199-2212
Citation
Cook, Won Kim; Li, Libo; Kerr, William C; Martinez, Priscilla. (2025). Understanding clustered behavioral risk factors among adults in the United States: A gender-specific analysis of alcohol and other substance use and obesity.. Alcohol, clinical & experimental research, 49(10), 2199-2212. https://doi.org/10.1111/acer.70148
Explore the wider topic
- Physical vs Psychological Cannabis Dependence: What Science Actually Shows
- The Gap Between Cannabis Perception and Science: Why What We Believe Outpaces What We Know
- Cannabis Use Disorder: Am I Addicted? Self-Assessment Guide
- Cross-Addiction After Quitting Weed: When One Habit Replaces Another
- Is Weed Addictive? What the Research Actually Shows
- Is Cannabis Addictive? What the DSM-5 and Brain Science Say
- Quitting Weed and Alcohol Together: What to Know About Dual Cessation
- Is Rehab Necessary for Weed? An Honest Assessment
- Signs You May Have Cannabis Use Disorder: An Honest Self-Assessment
- Weed Vape Pen Addiction: Why Vaping Makes It Harder to Quit