Monthly simultaneous cannabis and alcohol use predicted depression in both male and female college students, with possible sex differences for anxiety and stress that need larger studies to confirm.
College health professionals, substance use counselors, young adult mental health researchers
What the researchers found
Among 367 college students, monthly simultaneous cannabis and alcohol (SCA) use significantly predicted depression in both males (beta=0.322) and females (beta=0.296). SCA use also predicted anxiety (beta=0.323) and stress (beta=0.369) among males but not females, though these sex differences were not statistically significant. The depression finding held after controlling for age, most recent cannabis use, and typical alcohol frequency.
Why it matters
Simultaneous use of cannabis and alcohol is common among college students but understudied. The finding that combined use predicts depression independent of individual substance frequency highlights the importance of assessing polysubstance patterns rather than each substance in isolation.
The numbers in context
367 college students; monthly SCA predicted depression in males (beta=0.322) and females (beta=0.296); anxiety in males only (beta=0.323); stress in males only (beta=0.369); sex differences not statistically significant
How the study worked
Cross-sectional survey of 367 college students. Multigroup path analysis compared male and female students on relationships between monthly SCA use (vs less than monthly) and depression, anxiety, and stress, controlling for age, recent cannabis use, and alcohol frequency.
What this study cannot tell us
Cross-sectional design cannot establish causation. Relatively small sample, particularly for sex-stratified analyses. Self-report measures. Monte Carlo simulation confirmed the study was underpowered for detecting sex differences. Cannot distinguish effects of SCA from general heavier substance use patterns.
How to read the evidence
Preliminary: cross-sectional design, moderate sample size, underpowered for sex-stratified analyses.
When this study was published
2025 publication
The bigger picture
College mental health services often assess alcohol and cannabis use separately. This study suggests the simultaneous use pattern carries unique risks for depression that may be missed by screening for each substance individually.
Questions still open
- Would interventions targeting SCA specifically reduce depression risk more than targeting either substance alone?
- Do the suggested sex differences in anxiety/stress hold in larger samples?
Read the original research
Monthly simultaneous cannabis and alcohol use: effects on depression, anxiety, and stress in male and female college students.
Journal of cannabis research, 7(1), 87
Citation
Hetelekides, Eleftherios M; McMichael, Tabitha; Tyskiewicz, Alexander J; Prince, Mark A; Emery, Noah N; Conner, Bradley T; Karoly, Hollis C. (2025). Monthly simultaneous cannabis and alcohol use: effects on depression, anxiety, and stress in male and female college students.. Journal of cannabis research, 7(1), 87. https://doi.org/10.1186/s42238-025-00347-y
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