Cutting Back on Tobacco Was Linked to Cutting Back on Cannabis Too | Research

The takeaway

In a smoking cessation program, people who reduced their cigarette, e-cigarette, or cigar use also reduced their cannabis use over 3 months, suggesting the substances track together.

Tobacco cessation program designers; researchers studying polysubstance use; public health professionals.

All three tobacco products showed positive associations with cannabis use changes

What the researchers found

Changes in cigarette frequency (β=0.17), e-cigarette frequency (β=0.11), and cigar frequency (β=0.19) were all positively associated with changes in cannabis use frequency over 3 months.

Why it matters

If tobacco and cannabis use genuinely move in tandem, then tobacco cessation programs might produce a secondary benefit of reducing cannabis use, offering a "two-for-one" public health opportunity.

The numbers in context

Sample: 487 participants, mean age 25.4, 39.6% male, 40.3% White. Cigarette-cannabis association: β=0.17 (95% CI 0.10-0.24). E-cigarette: β=0.11 (95% CI 0.05-0.17). Cigar: β=0.19 (95% CI 0.06-0.32). Sexual minority participants and those with high school education or less showed greater increases in cannabis use.

How the study worked

Longitudinal analysis of 487 cigarette smokers (mean age 25.4) enrolled in a 3-month Facebook-based smoking cessation program in the San Francisco Bay Area (2016-2020). Cannabis use frequency was measured at baseline and 3-month follow-up alongside tobacco product use.

What this study cannot tell us

The study was observational within a cessation program, so the association could reflect general motivation to change substance use rather than a direct causal link. The Bay Area sample may not represent other populations. Cannabis use was self-reported.

How to read the evidence

Moderate: prospective data from a real-world cessation program with adequate sample size, though observational and limited to one geographic area.

When this study was published

Published in 2022.

The bigger picture

This aligns with the broader concept that substance use patterns tend to cluster. The finding that all three tobacco product types showed the same association with cannabis strengthens the case that this reflects a real behavioral link rather than a coincidence.

Questions still open

Is the tobacco-cannabis link driven by shared social environments, shared neurobiological pathways, or general motivation to change? Would explicitly addressing cannabis in tobacco cessation programs improve outcomes for both substances?

Common questions

Does quitting tobacco cause people to quit cannabis?

This study found an association, not causation. People who reduced tobacco also tended to reduce cannabis, but the study cannot determine whether one caused the other or whether both reflected a general motivation to change substance use.

Did the cessation program address cannabis use?

No. The program targeted tobacco cessation specifically. The reduction in cannabis use appeared to be a secondary effect rather than a direct program goal.

Read the original research

Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment.

Journal of addiction medicine, 16(4), 413-419

View on PubMed ↗Publisher’s paper ↗

Citation

Nguyen, Nhung; Neilands, Torsten B; Lisha, Nadra E; Lyu, Joanne Chen; Olson, Sarah S; Ling, Pamela M. (2022). Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment.. Journal of addiction medicine, 16(4), 413-419. https://doi.org/10.1097/ADM.0000000000000920