Among young adults who frequently use cannabis, drinking alcohol is linked to intensified cannabis cravings in men and reduced cannabis cravings in women, a novel study suggests. The findings potentially illuminate mechanisms driving the combined use of the two substances and could inform sex-specific approaches to preventing or addressing the resulting harms. Young adults commonly use alcohol and cannabis together (i.e., co-use), and people who use both substances experience more negative consequences—including worse outcomes for alcohol use disorder treatment—than those who use one or the other. Co-use may be partially driven “cross-substance-induced” craving, in which the repeated co-use of two substances prompts one to become a trigger for the other. Research on this effect involving alcohol and cannabis—previously limited to laboratory testing and remote monitoring—has hinted at sex differences in these effects. For the study in Alcohol: Clinical Experimental Research, investigators explored cross-substance craving in daily life contexts, the first study of its kind.
Researchers worked with 63 young adults (aged 18–21, predominantly White) who used cannabis frequently. Across two weeks, participants reported their alcohol use and cannabis cravings multiple times each day, a method known as ecological momentary assessment, which yielded more than 3,400 reports. Using statistical analysis, the researchers explored whether drinking was associated with stronger cannabis cravings. They also examined the influence of sex and the amount of drinks consumed on this effect.
Overall, participants used cannabis about 6 days a week and alcohol 2 days a week. Co-use occurred on 27% of days, with similar rates reported by men and women. Among men, drinking alcohol was linked to higher cannabis cravings, implying that the use of alcohol enhanced their desire for cannabis. When women drank, however, they reported somewhat reduced cannabis cravings (this effect was not significant). Levels of alcohol use did not affect men’s cannabis cravings, although higher alcohol consumption was linked to more significant reductions in the desire for cannabis among women.
These findings may reflect differing motives for co-use based on sex. Young men often use substances for social reasons and to enhance positive feelings. In these cases, using one substance may amplify the desire for another to intensify the “high.” In contrast, young women are more likely than men to use substances to cope with negative emotions. For them, one substance may suffice to fulfill this function, reducing the need for additional substance use. Alternatively, young women may consciously seek to avoid the negative consequences of combining substances, which can include sexual assault.
Alcohol and cannabis co-use are likely to continue to increase as cannabis laws become more permissive, and young men may be especially vulnerable to negative outcomes due to heightened susceptibility to cross-substance craving. In contrast, young women may use substances more on a substitution, rather than complementary, basis. As such, restricting cannabis access might lead women to shift toward greater alcohol use instead. This highlights a challenge for policies: efforts to reduce risk for one group could inadvertently increase harm for another. These findings may not generalize to other demographics or to young people who use alcohol and cannabis less frequently. Further research is needed in diverse populations and communities with varying substance use policies.
