Alcohol and cannabis problems initially predicted better sleep, but later predicted worse sleep in national US study
In a nationally representative US sample tracked over five years, alcohol and cannabis use problems were associated with fewer sleep problems in earlier waves but more sleep problems in later waves, while people who co-used both substances consistently reported more sleep problems than the general population.
Quick Facts
What This Study Found
Individual-level alcohol and cannabis use problems were associated with lower likelihood of sleep problems in earlier waves but greater likelihood of sleep problems in later waves. Co-use problems and sleep problems were not related across time points. However, participants reporting co-use consistently reported more sleep problems than the general population.
Key Numbers
26,072 adults across 4 waves (2013-2018). Alcohol and cannabis problems predicted lower sleep problems in earlier waves. Both predicted higher sleep problems in later waves. Co-users consistently had more sleep problems than the general population regardless of time point.
How They Did This
Secondary analysis of nationally representative adults (N=26,072 unweighted) from the first four waves (2013-2018) of the PATH Study. Three random intercept cross-lagged panel models investigated within-person bidirectional relations between sleep problems and alcohol problems, cannabis problems, and co-use problems.
Why This Research Matters
Many adults use alcohol and cannabis specifically to help with sleep, but this longitudinal data suggests the relationship reverses over time: what initially seems helpful eventually becomes associated with worse sleep. This temporal pattern could explain why people keep using substances for sleep despite worsening outcomes.
The Bigger Picture
The early improvement followed by later worsening mirrors the tolerance and rebound patterns seen with many sedating substances. If alcohol and cannabis temporarily improve sleep but ultimately worsen it, people may increase their use to recapture the initial benefit, creating a cycle that leads to both substance use and sleep disorders worsening together.
What This Study Doesn't Tell Us
PATH Study focused on tobacco and health, so sleep and other substance measures may not be as detailed as dedicated studies. Within-person effects do not imply causation. Sleep problems were measured broadly and may capture various sleep disorders. Four waves over five years provide limited temporal resolution.
Questions This Raises
- ?At what point does the shift from sleep improvement to sleep worsening occur?
- ?Does this pattern differ by type or frequency of use?
- ?Would targeted sleep interventions reduce substance use, or vice versa?
Trust & Context
- Key Stat:
- Substance use problems predicted better sleep early but worse sleep later in a 5-year study
- Evidence Grade:
- Large nationally representative longitudinal study with within-person modeling, though limited by broad sleep measures and four assessment waves.
- Study Age:
- Published in 2025, using 2013-2018 PATH data.
- Original Title:
- Within-Person Bidirectional Relations Between Sleep Problems and Alcohol, Cannabis, and Co-Use Problems in a Representative U.S. Sample.
- Published In:
- Substance use & misuse, 60(12), 1923-1932 (2025)
- Authors:
- Drazdowski, Tess K(2), Kelly, Lourah(2), Livingston, Nicholas R(3), Sheidow, Ashli J, McCart, Michael R
- Database ID:
- RTHC-06370
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does cannabis help with sleep or not?
This study suggests it may help initially but worsen sleep over time. In the earlier waves, cannabis problems were associated with fewer sleep problems, but by later waves, the association reversed. This pattern is consistent with tolerance and rebound effects.
Is combining alcohol and cannabis worse for sleep?
People who co-used alcohol and cannabis consistently reported more sleep problems than the general population at every time point, suggesting co-use is particularly problematic for sleep.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06370APA
Drazdowski, Tess K; Kelly, Lourah; Livingston, Nicholas R; Sheidow, Ashli J; McCart, Michael R. (2025). Within-Person Bidirectional Relations Between Sleep Problems and Alcohol, Cannabis, and Co-Use Problems in a Representative U.S. Sample.. Substance use & misuse, 60(12), 1923-1932. https://doi.org/10.1080/10826084.2025.2523458
MLA
Drazdowski, Tess K, et al. "Within-Person Bidirectional Relations Between Sleep Problems and Alcohol, Cannabis, and Co-Use Problems in a Representative U.S. Sample.." Substance use & misuse, 2025. https://doi.org/10.1080/10826084.2025.2523458
RethinkTHC
RethinkTHC Research Database. "Within-Person Bidirectional Relations Between Sleep Problems..." RTHC-06370. Retrieved from https://rethinkthc.com/research/drazdowski-2025-withinperson-bidirectional-relations-between
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.