Cannabis and tobacco use signal underlying social hardship even at low frequency
Among 77,000 healthcare users, cannabis and tobacco use at any frequency were associated with elevated social risks like food insecurity and inability to pay bills, while binge drinking showed this pattern only at daily frequency.
Quick Facts
What This Study Found
42.1% of past-month cannabis users and 42.6% of tobacco users had at least one social risk, compared to 30.9% overall. Binge drinking was not associated with elevated social risks unless it occurred daily (29.3% for any frequency). Social risk probability increased with the number of substances used.
Key Numbers
76,891 respondents. 30.9% reported at least one social risk. Food difficulty most common at 12.4%. Cannabis users: 42.1% with social risks. Tobacco: 42.6%. Binge drinking: 29.3% (but elevated with daily use). Risk increased with number of substances.
How They Did This
Cross-sectional analysis of 76,891 US adults from the 2022 BRFSS survey who had a healthcare visit in the past 2 years. Social risks included employment loss, food stamp receipt, food insecurity, bill-paying difficulty, utility shutoff threats, and unreliable transportation.
Why This Research Matters
Screening for substance use in healthcare settings already happens. This study suggests that positive screens for cannabis or tobacco should also prompt assessment of social needs, since these substances may be markers of broader social vulnerability.
The Bigger Picture
The finding that cannabis and tobacco signal social risks while occasional binge drinking does not challenges assumptions about which substance use patterns indicate broader vulnerability. Alcohol use may be more socioeconomically distributed while cannabis and tobacco concentrate among those facing hardship.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine whether substance use causes social problems or vice versa. Self-reported data. BRFSS survey methods may underrepresent the most vulnerable populations.
Questions This Raises
- ?Would integrating social needs screening with substance use screening in healthcare improve outcomes?
- ?Does addressing social needs reduce substance use, or vice versa?
Trust & Context
- Key Stat:
- of past-month cannabis users had at least one social risk factor, vs 30.9% overall
- Evidence Grade:
- Large nationally representative sample with appropriate statistical adjustments, though cross-sectional design limits causal interpretation.
- Study Age:
- 2025 publication using 2022 survey data.
- Original Title:
- Binge Drinking, Cannabis, and Tobacco Use and Modifiable Social Risks Among Adults Who Used Health Care.
- Published In:
- Journal of general internal medicine (2025)
- Authors:
- Glass, Joseph E(6), Oh, Hans Y, Besecker, Megan, Blosnich, John R, Wong, Edwin S
- Database ID:
- RTHC-06547
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why are cannabis and tobacco linked to social risks but occasional drinking is not?
Alcohol use, including occasional binge drinking, is more evenly distributed across socioeconomic groups. Cannabis and tobacco use tend to concentrate more among populations experiencing financial hardship, employment instability, and other social challenges.
Should doctors screen for social needs when patients report cannabis use?
This study suggests cannabis use may be a useful clinical signal for underlying social vulnerability. Integrating substance use screening with social needs assessment could help identify patients who would benefit from social services.
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Cite This Study
https://rethinkthc.com/research/RTHC-06547APA
Glass, Joseph E; Oh, Hans Y; Besecker, Megan; Blosnich, John R; Wong, Edwin S. (2025). Binge Drinking, Cannabis, and Tobacco Use and Modifiable Social Risks Among Adults Who Used Health Care.. Journal of general internal medicine. https://doi.org/10.1007/s11606-025-10036-4
MLA
Glass, Joseph E, et al. "Binge Drinking, Cannabis, and Tobacco Use and Modifiable Social Risks Among Adults Who Used Health Care.." Journal of general internal medicine, 2025. https://doi.org/10.1007/s11606-025-10036-4
RethinkTHC
RethinkTHC Research Database. "Binge Drinking, Cannabis, and Tobacco Use and Modifiable Soc..." RTHC-06547. Retrieved from https://rethinkthc.com/research/glass-2025-binge-drinking-cannabis-and
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.