Daily tobacco users who also used cannabis weekly had stronger connections between craving, depression, and failed quit attempts

In the overall CUD symptom network, craving, failed quit attempts, neglected responsibilities, and negative social effects were most central. Risky cannabis use was mostly independent of other CUD symptoms. Among daily tobacco co-users (n=789) compared to nondaily co-users (n=428): craving was more strongly linked to negative psychosocial effects, depression and health effects were more central, and negative health effects were more strongly connected to failed quit attempts.

Network analysis comparing CUD symptom configurations between weekly cannabis users who also used tobacco daily (n=789) versus non-daily or never (n=428). Network centrality, bridge symptoms, and between-group differences analyzed.

By mapping how CUD symptoms interconnect differently in tobacco co-users, this study identifies specific targets for intervention. If craving is a bridge symptom connecting use to negative consequences, targeting craving may be more effective than addressing symptoms in isolation.

The synergistic effects of tobacco and cannabis co-use on symptom networks suggest these substances should not be treated in isolation. Integrated cessation programs addressing both substances may be more effective than targeting one at a time.

Cross-sectional network analysis cannot determine causal relationships between symptoms. Self-reported tobacco and cannabis use. Network analysis results can vary with sample size and composition. Cannot distinguish whether tobacco use causes network differences or reflects a different subpopulation.