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

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.

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.

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.

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.

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.