Legal recreational cannabis use and binge drinking is on the rise for older adult
Decline in binge drinking among young adults reported in states with recreational cannabis laws
June 15, 2023 --New research at Columbia University Mailman School of Public Health examined changes in binge drinking after the implementation of recreational cannabis laws.
Analysis of national survey data from Americans aged 12 and older showed that past-month binge drinking increased overall among people aged 31 and over from 2008 to 2019. At the same time, binge drinking declined overall among people aged 12-30. The results are published online in the International Journal of Drug Policy.
The most substantial declines in binge drinking were observed among people ages 12-20 (from 17.5 percent in 2008 to 11 percent in 2019), followed by respondents ages 21-30 (from 44 percent to 40 percent). While overall increases in binge drinking were recorded in all U.S. states regardless of cannabis laws among individuals ages 31 and older, the most extensive increases between 2008 and 2019 were noted among people ages 31-40, from 28 percent to 33 percent, followed by those aged 51 and over (from 13 percent to 17 percent).
When investigating binge drinking prevalence before and after implementation of recreational cannabis laws, the authors observed a 4.8 percent decrease in binge drinking among people aged 12-20. However, they also noticed an increase after implementation of recreational cannabis laws among those aged 31 and older (with an increase of 1.7 percent for adults aged 31-40, 2.5 percent for those aged 41-50, and 1.8 percent for those aged 51 and older). Until now, research on the relationship between recreational cannabis laws (RCLs) and binge drinking has been limited to data from just a few states, small study samples, and combined age groups.
The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as 5 or more drinks for men or 4 or more drinks for women per drinking session. Binge drinking has been associated with acute adverse outcomes such as motor vehicle crashes and traffic fatalities, criminal legal system exposure, poor academic achievement, and emergency department visits.
The study, one of the first to report associations between binge drinking and recreational cannabis laws in adolescents and adults at a national level, builds on existing literature by using nationally representative data to investigate the potential effects of the changing cannabis policy landscape in all age groups also adjusting for a comprehensive measure of state alcohol policies.
“Our earlier research showed the impact of legalizing cannabis on the perception and availability of cannabis use and changes in alcohol use patterns,” said Silvia S. Martins, MD, PhD, professor of epidemiology in the Department of Epidemiology at Columbia Mailman School, and senior author. “The current literature supports two possible hypotheses. The complementary is that both cannabis and alcohol use may increase after cannabis legalization as individuals use these substances together. The substitution hypothesis is that alcohol use may decrease after cannabis legalization, as individuals may use cannabis instead of alcohol when both are readily available. Evidence regarding these hypotheses remains inconclusive, especially regarding how cannabis legalization may impact binge drinking across different age groups,” said Priscila Dib Gonçalves, PhD, post-doctoral fellow in the Substance Abuse Epidemiology program in the Department of Epidemiology at Columbia Mailman School, and first author of the study.
The researchers make the point, therefore, that more research is needed to understand the incremental change in binge drinking associated with RCLs using nationally representative data across different age groups. “We believe that future studies should examine the relationship of other environmental and individual factors, such as perceived risk, disapproval, availability, peer drinking, alcohol expectancy, among binge drinking and recreational cannabis laws in this age group,” noted Dib Gonçalves.
“It is worth noting that cannabis legislation is complex, involving multiple policy decisions, including regulations of supply chain and operation: government monopoly, retail sales, legal home cultivation, advertisement, types of products distributed, prices, and taxes, and each state may have different policies when regulating recreational cannabis use,” said Martins. “As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.”
Co-authors are Emilie Bruzelius, Natalie S. Levy, Luis E. Segura, Ofir Livne, Sarah Gutkind, Pia M. Mauro, Columbia University Mailman School of Public Health; Anne E. Boustead and Deborah S. Hasin, Department of Psychiatry, Columbia University Irving Medical Center; Diana Silver, New York University School of Global Public Health; and James Macinko, UCLA Fielding School of Public Health.
The study was funded by grants from the U.S. National Institutes of Health, National Institute on
Drug Abuse, R01DA037866, T32DA031099, R01DA048860, and K01DA045224. This research was supported in part by the National Center for Injury Prevention and Control, Centers for Disease
Control and Prevention, 1 R49 CE002096-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors declare having no conflict of interest.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.publichealth.columbia.edu
JOURNAL
International Journal of Drug Policy
ARTICLE TITLE
Recreational cannabis legislation and binge drinking in U.S. adolescents and adults
Extensive study links cannabis use disorder to mental disorders
A new study suggests that cannabis use disorder leads to an increased risk of developing bipolar disorder and depression
IMAGE: "AS FAR AS WE KNOW, WE’VE CONDUCTED THE WORLD'S LARGEST STUDY OF THE LINK BETWEEN CANNABIS USE DISORDER AND AFFECTIVE DISORDERS," SAYS OSKAR HOUGAARD JEFSEN, A PHD STUDENT FROM THE DEPARTMENT OF CLINICAL MEDICINE AT AARHUS UNIVERSITY. HE IS THE FIRST AUTHOR OF THE STUDY, WHICH INCLUDES REGISTER DATA FROM MORE THAN SIX MILLION DANES. PHOTO: SIMON BYRIAL FISCHEL view more
CREDIT: PHOTO: SIMON BYRIAL FISCHEL
Cannabis is one of the world's most commonly used illegal drugs. New research suggests that cannabis use disorder is more strongly linked with the development of mental disorders than previously assumed.
The study includes register data from more than six million Danes and its findings indicate that cannabis use disorder increases the risk of both psychotic and non-psychotic depression and bipolar disorder.
"When we take differences in gender, age, socioeconomics and family history, and more into account, we see that cannabis use disorder is associated with almost twice the risk of developing depression and a two-to-three-times higher risk of developing bipolar disorder in both men and women," says Oskar Hougaard Jefsen, a PhD student from the Department of Clinical Medicine at Aarhus University. He is the lead author of the study, which has just been published in the scientific journal JAMA Psychiatry.
According to the Danish Health Authority, one in three Danes under the age of 25 has smoked cannabis. However, the new study only focuses on people with a significant consumption of cannabis such that they have been registered with a substance use disorder – e.g. because they have been in contact with the substance abuse treatment system or other parts of the healthcare system.
More countries are legalising cannabis
Several studies have supported the hypothesis that extensive cannabis use is not harmless to human mental health. For example, previous studies suggest that cannabis use disorder can increase the risk of developing schizophrenia. But until now, the risk of other mental disorders has been sparsely studied.
In this study, researchers from Aarhus University and the University of Copenhagen have analysed data from Danish nationwide registers such as the National Patient Register, the Danish Psychiatric Central Research Register and the Danish Register of Pharmaceutical Sales.
"The study is the largest of its kind in the world, and our findings suggests that cannabis use disorder is also associated with an increased risk of developing depression and bipolar disorder. The results recommend caution when it comes to using cannabis. This applies to people with an increased risk of developing mental illness, and to politicians and other decision-makers who are discussing the possibilities of legalising cannabis," says Oskar Hougaard Jefsen.
An increasing number of countries are legalising the production and sale of cannabis for medicinal and recreational use. Since 2018, general practitioners in Denmark have been able to write prescriptions for drugs based on cannabis for patients as part of a trial scheme that also gives companies and individuals the opportunity to produce cannabis for medicinal or industrial use.
Oskar Hougaard Jefsen believes that the results of the study should be considered when it comes to legalising and controlling cannabis use.
"We should conduct more research into whether there are people for whom cannabis is particularly harmful. This could strengthen preventative measures," he says, adding that there is a particular need for more knowledge about the dose-dependent effects of cannabis use on the brain, cognition and behaviour, and for identifying risk factors for the transition from cannabis use disorder to psychiatric disorders.
No conclusive evidence
Oskar Hougaard Jefsen points out that, despite the indications in the study, it does not provide conclusive evidence that cannabis causes these mental disorders.
For example, he cannot rule out that undiagnosed depression or bipolar disorder has led some of the people in the register-based study to develop cannabis use disorder – i.e. the disease resulted in the abuse and not the other way around.
"But when we see an increased disease risk – even ten years after the cannabis use disorder has been registered – I don't think that self-medication can be the only explanation. It seems unlikely that so many people would go undiagnosed for so long," he says.
"Danish register data really gives us a unique opportunity to take into account many of the crucial factors that could affect the results. However, conclusive evidence would require a randomised controlled trial in which a group of people would have to smoke large amounts of cannabis to see if this increased their risk of developing mental illness in the long term, and such a study would of course be unethical," he says.
The research results - more information
- The study is a register-based epidemiological cohort study of 6,651,765 people born in Denmark before 2006, and who lived in Denmark between 1995 and 2021. An equal number of men and women appear in the study.
- The partners are Associate Professor Carsten Hjorthøj, Senior Researcher Annette Erlangsen and Clinical Professor Merete Nordentoft – all three from the University of Copenhagen.
- Read more in the scientific article: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2804862
Contact
Oskar Hougaard Jefsen, PhD student
Aarhus University, Department of Clinical Medicine - Psychoses Research Unit
Telephone: +45 30 11 20 66
Email: oskar.jefsen@clin.au.dk
Ole Mors, professor and consultant
Aarhus University, Department of Clinical Medicine - Psychoses Research Unit
Telephone: +45 29 47 97 80
Email: ole.mors@clin.au.dk
JOURNAL
JAMA Psychiatry
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder
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