Elsevier

Drug and Alcohol Dependence

Volume 161, 1 April 2016, Pages 363-367
Drug and Alcohol Dependence

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Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States

https://doi.org/10.1016/j.drugalcdep.2016.01.014Get rights and content

Highlights

  • Cannabis use was associated with increased incidence of alcohol use disorders.

  • Cannabis use predicted persistence of alcohol use disorder three years later.

  • Relationships remained significant controlling for demographics and comorbidities.

  • Integrating assessment of cannabis use into alcohol treatment may be beneficial.

Abstract

Background

The relationship between cannabis use and alcohol use disorders (AUDs) over time remains unclear. The current study used longitudinal data from adults in the United States (U.S.) to investigate the association between cannabis use and risk of onset and persistence of AUDs three years later.

Methods

The study used data from respondents who completed both waves of the National Epidemiological Study of Alcohol Use and Related Disorders (NESARC; Wave 1, 2001–2001; Wave 2, 2004–2005) and for whom the age of first cannabis use preceded the age of any AUD. Incident AUDs were examined among respondents with no lifetime AUD diagnosis at Wave 1 (n = 27,461). Persistent AUDs were examined among respondents with a lifetime AUD diagnosis at Wave 1 (n = 2,121).

Results

Among adults with no history of AUD, cannabis use at Wave 1 was associated with increased incidence of an AUD three years later relative to no cannabis use (Odds Ratio (OR) = 5.43; 95% Confidence Interval (CI) = 4.54–6.49). Among adults with a history of AUD, cannabis use at Wave 1 was associated with increased likelihood of AUD persistence three years later relative to no cannabis use (OR = 1.74; 95% CI = 1.56–1.95). These relationships remained significant after controlling for demographics, psychiatric disorders, and other substance use disorders.

Conclusions

Cannabis use is associated with increased risk of AUD onset and persistence over the course of three years among U.S. adults. Community-based and clinical programs aimed at preventing or treating problematic alcohol use may benefit from integrating information about cannabis use in order to improve outcomes.

Introduction

Alcohol use-related disease and accidents are one of the leading causes of death in the U.S. (CDC, 2004, Stahre et al., 2014). For adults, there is a significant association between alcohol and cannabis use (e.g., Butterworth et al., 2014, Hyggen and Hammer, 2014) and use of alcohol and cannabis, compared to alcohol alone, is associated with heavier alcohol consumption and greater negative alcohol-related consequences (e.g., Hyggen and Hammer, 2014, Midanik et al., 2007, Subbaraman and Kerr, 2015). Less is known about the association between cannabis use and alcohol use disorders (AUDs). In a study using Wave 1 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), cannabis dependence was significantly associated with a reduced likelihood of remission from alcohol dependence in univariate analyses (HR = 0.55, 95% CI = 0.32, 0.94), but this relationship was no longer significant in multivariate analyses (HR = 0.64, 95% CI = 0.37–1.13; Lopez-Quintero et al., 2011). It is not yet clear how cannabis use may be related to the onset and persistence of AUDs over time. Given the relationship of cannabis use to alcohol-related problems, it is important to gain a better understanding these potential relationships.

The current study used longitudinal data from a representative sample of U.S. adults to examine the association between cannabis use and the risk of onset and persistence of AUDs. It was expected that cannabis use among adults with no history of AUDs would be associated with greater risk of onset of an AUD three years later. It was also expected that cannabis use among adults with AUDs would be associated with greater risk of persistence of AUDs three years later. Further, the study explored whether the relationships between cannabis use and AUDs would persist after adjusting for demographics, psychiatric disorders, nicotine dependence, and other illicit drug use disorders.

Section snippets

Data source and study population

The study used two waves of data from the National Epidemiological Study of Alcohol Use and Related Disorders (NESARC; Wave 1, 2001–2001, n = 43,093; Wave 2, 2004–2005, n = 34,653) which surveyed a population representative sample of civilian, non-institutionalized, adults in the U.S. A two-wave multistage stratified design in which primary sampling units, housing units, and group-quarter units were stratified to oversample certain under-represented socio-demographic groups, specifically,

Socio-demographics (Table 1)

Among respondents with no lifetime AUD diagnosis at Wave 1 (n = 27,461), 27,301 respondents (99.3%) reported no cannabis use while 160 respondents (0.7%) reported cannabis use in the year prior to the Wave 1 assessment. Wave 1 past year cannabis use was significantly higher among respondents who were: men, age 18–44, Native American/Alaskan Native, never married, and those who had completed a high school education, compared with those who reported no cannabis use. There was no difference in

Discussion

The results from this study suggest a significant relationship between cannabis use and subsequent increased risk of AUDs for adults without a past AUD and risk of continued AUD for adults with an AUD. These relationships remain robust after controlling for demographics, psychiatric disorders, and other substance use disorders. From a public health standpoint, it may be important to conduct further research on the relationship between cannabis and AUDs as well as other problematic

Conflicts of interest

Dr. Weinberger, Mr. Platt, and Dr. Goodwin have no conflicts of interest to report.

Funding

Funding for this study was provided by the National Institutes of Health grant R01-DA20892 (to Dr. Goodwin). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Dr. Goodwin conceived of the study and wrote sections of the manuscript. Dr. Weinberger helped to design the study, managed the literature searches, and wrote the first draft of the manuscript. Mr. Platt contributed to study design and conducted the statistical analyses. All authors contributed to and approved the final manuscript.

Acknowledgment

The authors thank Sandra Rodgin for her work in obtaining articles for the literature review in this paper.

References (15)

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    A survey of university freshman in the United States found moderate drinkers who reported recent use of cannabis were more likely to drink more than intended and reported more associated problems such as blackouts, injuries and driving while impaired (Haas et al., 2015). A prospective population-level study of adults in the U.S. found that cannabis use was associated with higher rates of alcohol use disorder (AUD) onset and persistence over a three year period (Weinberger, Platt, & Goodwin, 2016). A study of 307 young adults diagnosed with a cannabis use disorder (CUD), AUD, or dual use disorder (DUD, combining both) found that those with DUD reported greater problems with alcohol and/or cannabis than both singly-diagnosed groups (Hayaki, Anderson, & Stein, 2016).

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