Cannabis Use Rose While Tobacco Fell Across All Drinking Levels in the US, 2010-2019 | Research

The takeaway

From 2010 to 2019, cannabis use increased significantly while tobacco use decreased across all alcohol consumption levels in the US, with the fastest cannabis increase among non-drinkers.

Public health researchers, substance use epidemiologists, and policy makers tracking substance use trends.

Cannabis use increased 155% among non-drinkers from 2010 to 2019

What the researchers found

Among 395,256 US adults, tobacco use and nicotine dependence decreased while cannabis use increased across all alcohol consumption levels from 2010-2019. Cannabis use increased fastest among non-drinkers (155%) versus low-risk drinkers (77%) and high-risk drinkers (31%). Among high-risk drinkers, Black individuals were more likely than White to use cannabis and both tobacco and cannabis.

Why it matters

The diverging trends in tobacco (down) and cannabis (up) across all drinking levels suggest these substances are not simply substituting for each other. The faster cannabis increase among non-drinkers is particularly notable, suggesting cannabis is reaching new populations beyond those already using other substances.

The numbers in context

395,256 participants; tobacco decreased across all groups; cannabis increased: 155% in non-drinkers, 77% in low-risk drinkers, 31% in high-risk drinkers; Black individuals at higher odds of polysubstance use among high-risk drinkers

How the study worked

Repeated cross-sectional analysis combining 2010-2019 National Survey on Drug Use and Health data for 395,256 adults aged 18+, examining tobacco and cannabis use trends across alcohol consumption levels using linear time trends and multivariable logistic regression.

What this study cannot tell us

Cross-sectional design cannot track individual behavior changes. Self-reported substance use. Cannot determine causality. Cannabis legalization status not directly analyzed.

How to read the evidence

Large national dataset with a decade of trends, but cross-sectional design limits causal inference.

When this study was published

Published in 2024 with 2010-2019 NSDUH data.

The bigger picture

These trends reflect a fundamental shift in substance use patterns in America. The decoupling of tobacco decline and cannabis increase suggests different drivers for each, and the racial disparities in polysubstance use highlight ongoing health equity concerns.

Questions still open

Is the faster cannabis increase among non-drinkers driven by medical use, recreational normalization, or both?
What explains the racial disparities in polysubstance use among high-risk drinkers?

Common questions

Are people replacing tobacco with cannabis?

Not exactly. Tobacco declined and cannabis increased across all groups, but the patterns are different enough to suggest independent trends rather than simple substitution.

Who is driving the cannabis increase?

The fastest growth was among non-drinkers (155% increase), suggesting cannabis is reaching populations beyond traditional substance users.

Read the original research

Trends in use of tobacco and cannabis across different alcohol consumption levels in the United States, 2010-19.

Alcohol and alcoholism (Oxford, Oxfordshire), 60(1)

View on PubMed ↗Publisher’s paper ↗

Citation

Pham, Huyen; Bui, Thanh C; Glass, Joseph E; Back, Sudie E; Le, Phuc. (2024). Trends in use of tobacco and cannabis across different alcohol consumption levels in the United States, 2010-19.. Alcohol and alcoholism (Oxford, Oxfordshire), 60(1). https://doi.org/10.1093/alcalc/agae091