67% of People Who Drink and Smoke Tobacco Use Both Simultaneously, and Many Add Cannabis | Research

The takeaway

Among 1,300 U.S. adults who use both alcohol and tobacco, 67% used them simultaneously, 56% also used cannabis, and 42% combined tobacco and cannabis at the same time.

Addiction specialists, public health researchers, harm reduction practitioners

67% use alcohol and tobacco simultaneously; 56% also add cannabis

What the researchers found

67% reported simultaneous alcohol and tobacco use. Among these co-users, 55.5% also used cannabis in the past 30 days, 42.1% used tobacco and cannabis simultaneously, 45% mixed them in blunts, 36.5% used alcohol and cannabis simultaneously, and 33.1% combined alcohol with blunts. State cannabis legalization status was not significantly associated with these patterns.

Why it matters

Substance use rarely happens in isolation, yet most research and treatment focuses on single substances. Understanding that the majority of tobacco-and-alcohol co-users are combining these substances in the same session, and many add cannabis, reveals a more complex harm profile.

The numbers in context

1,300 participants; 67% simultaneous alcohol+tobacco; 55.5% also used cannabis; 42.1% simultaneous tobacco+cannabis; 45% used blunts; 36.5% simultaneous alcohol+cannabis; legalization status not significant.

How the study worked

Survey panel of 1,300 U.S. adults reporting past-30-day use of both alcohol and combustible tobacco (June-July 2021). Logistic regression for sociodemographic and legalization status correlates.

What this study cannot tell us

Purposive sample of alcohol/tobacco co-users, not generalizable to all substance users. Self-reported data. Cross-sectional design. Survey conducted during COVID-19 era, which may have affected substance use patterns.

How to read the evidence

Purposive sample survey with self-reported data, limited generalizability but revealing polysubstance patterns.

When this study was published

2025 publication with June-July 2021 data

The bigger picture

Polysubstance simultaneous use creates compounding health risks (combined cardiovascular stress, increased impairment, higher cancer risk) that are not captured by studying substances in isolation. Treatment programs that address only one substance may miss the interconnected nature of these behaviors.

Questions still open

What are the specific additive health risks of simultaneous use of alcohol, tobacco, and cannabis?
Would cessation interventions targeting multiple substances simultaneously be more effective?

Common questions

How common is mixing alcohol, tobacco, and cannabis?

Among people who already use both alcohol and tobacco, this study found 56% also use cannabis. Over 40% combine tobacco and cannabis simultaneously, and 37% use alcohol and cannabis at the same time. Blunts (tobacco-cannabis mix) were used by 45%.

Does cannabis legalization increase polysubstance use?

In this study, state cannabis legalization status was not significantly associated with simultaneous use patterns among alcohol/tobacco co-users, suggesting other factors drive these behaviors.

Read the original research

Rates and correlates of simultaneous use and mixing of alcohol, tobacco, and cannabis among adults who currently use alcohol and tobacco.

Addictive behaviors, 167, 108334

View on PubMed ↗Publisher’s paper ↗

Citation

Kong, Amanda Y; Kowitt, Sarah D; Halstead, Elizabeth O; Jarman, Kristen L; Ranney, Leah M; Goldstein, Adam O; Cox, Melissa J. (2025). Rates and correlates of simultaneous use and mixing of alcohol, tobacco, and cannabis among adults who currently use alcohol and tobacco.. Addictive behaviors, 167, 108334. https://doi.org/10.1016/j.addbeh.2025.108334