Pain Predicted Young Adults Would Start Using Both Alcohol and Cannabis Together | Research

The takeaway

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.

Primary care providers treating young adults with pain, substance use prevention specialists, and pain management researchers.

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Large nationally representative longitudinal study (PATH) with prospective design, providing strong evidence for temporal ordering.

When this study was published

Published 2025, PATH Study Waves 1–5.

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.

Questions still open

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?

Common 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.

Read the original research

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

View on PubMed ↗Publisher’s paper ↗

Citation

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