Cannabis Use Disorder Creates the Biggest Barriers to Quitting Smoking

Q: Does cannabis use make it harder to quit smoking?

It depends — smokers with cannabis use disorder face the highest barriers to quitting across all domains, while those who use cannabis without CUD report lower interest in quitting but similar readiness and confidence.

Q: Should tobacco cessation programs address cannabis use too?

This study suggests yes, especially for people with cannabis use disorder, who face significantly higher addiction, internal, and external barriers to quitting smoking compared to non-cannabis users.

Smokers with cannabis use disorder reported the highest barriers to quitting tobacco across addiction, internal, and external domains, while smokers using cannabis without CUD had the lowest interest in quitting.

Graham, Francis Julian L et al.·Addictive behaviors·2026·Moderate EvidenceCross-Sectional

tobacco (19)cannabis-use-disorder (30)cessation (3)co-use (20)

Quick Facts

Study Type

Cross-Sectional

Evidence

Moderate Evidence

Sample

N=2,271

What This Study Found

Adults with CUD had the highest total barriers to smoking cessation (score 20.3 vs. 15.2 for cannabis without CUD vs. 16.4 for no cannabis use), with significantly higher scores across addiction (p=0.03), external (p=0.02), and internal (p<0.001) barrier subscales.

Key Numbers

n=2,271 current smokers; total barrier scores: CUD 20.3, cannabis without CUD 15.2, no cannabis 16.4; CUD higher on all subscales (Addiction p=0.03, External p=0.02, Internal p<0.001); readiness/confidence similar across groups

How They Did This

National online survey of 2,271 US adults currently smoking cigarettes in 2023, examining associations between past 30-day cannabis use (with and without CUD) and smoking cessation outcomes using the Barriers to Cessation Scale.

Why This Research Matters

As cannabis and tobacco co-use increases, understanding how cannabis use disorder specifically amplifies barriers to quitting smoking can help design targeted dual-use interventions.

The Bigger Picture

The distinct patterns — lower interest in quitting among cannabis users without CUD vs. higher barriers among those with CUD — suggest these groups need different intervention approaches.

What This Study Doesn't Tell Us

Cross-sectional design; self-reported cannabis use and CUD; online convenience sample; cannabis use measured as past 30 days only; CUD assessment may not capture full spectrum; barriers measured don't include all possible factors.

Questions This Raises

?Would treating CUD improve tobacco cessation outcomes?
?Do integrated cannabis+tobacco cessation programs outperform tobacco-only approaches?
?Does cannabis route of administration (e.g., blunts) affect cessation barriers?

Trust & Context

Key Stat:
Evidence Grade:: Large national survey with validated instruments, but cross-sectional design and self-report measures limit causal inference.
Study Age:: Published 2026; survey conducted in 2023.
Original Title:: The impact of cannabis co-use and cannabis use disorder on interest in and barriers to tobacco cessation.
Published In:: Addictive behaviors, 175, 108609 (2026)
Authors:: Graham, Francis Julian L(3), Pravosud, Vira(4), Keyhani, Salomeh(22), Hoggatt, Katherine J, Ling, Pamela, Hasin, Deborah, Nguyen, Nhung, Cohen, Beth E
Database ID:: RTHC-08294

Evidence Hierarchy

Meta-Analysis / Systematic Review

Randomized Controlled Trial

Cohort / Case-Control

Cross-Sectional / ObservationalSnapshot without intervening

This study

Case Report / Animal Study

A snapshot of a population at one point in time.

What do these levels mean? →

Frequently Asked Questions

Does cannabis use make it harder to quit smoking?

It depends — smokers with cannabis use disorder face the highest barriers to quitting across all domains, while those who use cannabis without CUD report lower interest in quitting but similar readiness and confidence.

Should tobacco cessation programs address cannabis use too?

This study suggests yes, especially for people with cannabis use disorder, who face significantly higher addiction, internal, and external barriers to quitting smoking compared to non-cannabis users.

Cite This Study

RTHC-08294·https://rethinkthc.com/research/RTHC-08294

APA

Graham, Francis Julian L; Pravosud, Vira; Keyhani, Salomeh; Hoggatt, Katherine J; Ling, Pamela; Hasin, Deborah; Nguyen, Nhung; Cohen, Beth E. (2026). The impact of cannabis co-use and cannabis use disorder on interest in and barriers to tobacco cessation.. Addictive behaviors, 175, 108609. https://doi.org/10.1016/j.addbeh.2026.108609

MLA

Graham, Francis Julian L, et al. "The impact of cannabis co-use and cannabis use disorder on interest in and barriers to tobacco cessation.." Addictive behaviors, 2026. https://doi.org/10.1016/j.addbeh.2026.108609

RethinkTHC

RethinkTHC Research Database. "The impact of cannabis co-use and cannabis use disorder on i..." RTHC-08294. Retrieved from https://rethinkthc.com/research/graham-2026-the-impact-of-cannabis

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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.

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