Pain Predicted Young Adults Would Start Using Both Alcohol and Cannabis Together
In a national study of over 3,500 emerging adults, moderate-to-severe pain significantly predicted starting concurrent alcohol and cannabis co-use, suggesting pain may drive dual-substance use in young people.
Quick Facts
What This Study Found
Moderate/severe pain at baseline prospectively predicted engaging in co-use of alcohol and cannabis among emerging adults aged 18–24. The association persisted after adjusting for demographics and other risk factors. Sex was examined as a potential moderator.
Key Numbers
3,544 emerging adults from PATH study. Ages 18–24. 5 waves of data. Moderate/severe pain predicted alcohol-cannabis co-use prospectively. Co-users experience greater substance-related harm than single-substance users.
How They Did This
Longitudinal analysis of Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study (n=3,544 emerging adults aged 18–24). Unadjusted and adjusted logistic regression examined moderate/severe pain as a predictor of subsequent alcohol-cannabis co-use. Sex tested as moderator.
Why This Research Matters
Alcohol and cannabis co-use is particularly risky — people who combine them use more of each and experience greater harm. If pain is driving this co-use pattern in young adults, pain management could be a key intervention point for preventing dual-substance problems.
The Bigger Picture
Pain is increasingly recognized as an independent risk factor for substance use, not just a consequence. This study extends that finding to the particularly risky pattern of alcohol-cannabis co-use, suggesting that addressing pain in young adults could prevent a cascade of substance-related harms.
What This Study Doesn't Tell Us
PATH data is self-reported. Pain and substance use assessed at intervals — timing of onset may be imprecise. Cannot determine if pain management (successful or failed) moderates the relationship. Co-use definition may vary.
Questions This Raises
- ?Would effective pain treatment in young adults reduce alcohol-cannabis co-use?
- ?Do young adults with pain choose co-use because neither substance alone provides adequate relief?
- ?Should pain screening be part of substance use prevention for emerging adults?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large nationally representative longitudinal study (PATH) with prospective design, providing strong evidence for temporal ordering.
- Study Age:
- Published 2025, PATH Study Waves 1–5.
- Original Title:
- Pain predicts past-month co-use of alcohol and cannabis among emerging adults: Results from the Population Assessment of Tobacco and Health (PATH) Study.
- Published In:
- Alcohol (Fayetteville, N.Y.), 124, 111-119 (2025)
- Authors:
- Williams, Callon M(2), Mastroleo, Nadine R(2), Lenzenweger, Mark F(2), Zale, Emily L
- Database ID:
- RTHC-07951
Evidence Hierarchy
Frequently Asked Questions
Why does pain lead to using both alcohol and cannabis?
Young adults in pain may use multiple substances seeking relief that neither alone provides. The combination may also reflect broader coping patterns — pain can increase stress, anxiety, and sleep problems, all of which are common motives for both alcohol and cannabis use.
Is combining alcohol and cannabis more dangerous than either alone?
Yes — research consistently shows co-use is associated with heavier consumption of both substances and more negative consequences than using either alone.
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Cite This Study
https://rethinkthc.com/research/RTHC-07951APA
Williams, Callon M; Mastroleo, Nadine R; Lenzenweger, Mark F; Zale, Emily L. (2025). Pain predicts past-month co-use of alcohol and cannabis among emerging adults: Results from the Population Assessment of Tobacco and Health (PATH) Study.. Alcohol (Fayetteville, N.Y.), 124, 111-119. https://doi.org/10.1016/j.alcohol.2025.02.003
MLA
Williams, Callon M, et al. "Pain predicts past-month co-use of alcohol and cannabis among emerging adults: Results from the Population Assessment of Tobacco and Health (PATH) Study.." Alcohol (Fayetteville, 2025. https://doi.org/10.1016/j.alcohol.2025.02.003
RethinkTHC
RethinkTHC Research Database. "Pain predicts past-month co-use of alcohol and cannabis amon..." RTHC-07951. Retrieved from https://rethinkthc.com/research/williams-2025-pain-predicts-pastmonth-couse
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.