Cannabis and tobacco use signal underlying social hardship even at low frequency | Research

The takeaway

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.

Primary care providers, social workers, public health professionals, and healthcare systems designing integrated screening approaches.

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Large nationally representative sample with appropriate statistical adjustments, though cross-sectional design limits causal interpretation.

When this study was published

2025 publication using 2022 survey data.

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.

Questions still open

Would integrating social needs screening with substance use screening in healthcare improve outcomes?
Does addressing social needs reduce substance use, or vice versa?

Common 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.

Read the original research

Binge Drinking, Cannabis, and Tobacco Use and Modifiable Social Risks Among Adults Who Used Health Care.

Journal of general internal medicine

View on PubMed ↗Publisher’s paper ↗

Citation

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