TOPLINE

The prevalence of moderate-to-severe cannabis use disorder (CUD) increased among adults in the US from 2021 to 2024, particularly in men aged 35 years or older, and in women aged 21 years or older, but that of moderate-to-severe alcohol use disorder (AUD) remained stable or declined, a cross-sectional study showed. 

METHODOLOGY

• A cross-sectional study analyzed data from 186,823 adults (51.3% women; 4.9% aged 18-20 years; 24.1% aged 21-34 years; 24.7% aged 35-49 years) from the civilian, non-institutionalized US population.
• Data were obtained from the National Surveys on Drug Use and Health between 2021 and 2024.
• Researchers examined past-year prevalence and severity of CUD and AUD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, with moderate-to-severe disorder defined as four or more symptoms.
• The analysis focused on trends by age and sex, with particular attention to divergent patterns between CUD and AUD.

TAKEAWAY

• Past-year prevalence of CUD increased significantly among men (7.3% to 9.3%; P <.001) and women (4.5% to 5.6%; P = .01). The prevalence of CUD increased among men who used cannabis (32.9% to 36.2%; P = .02). Cannabis use increased significantly among men (22.2% to 25.7%; P = .001) and women (17.7% to 21.2%; P < .001), particularly those aged 35 years or older. 
• The prevalence of moderate-to-severe CUD increased among men (3.1% to 4.1%; P < .001), especially among those aged 35 to 49 years (2.7% to 3.9%; P = .01) and those aged 50 years or older (0.6% to 1.2%; P = .02). Among women, the prevalence of moderate-to-severe CUD increased from 1.7% to 2.5%; P < .001), especially in those aged 21 to 34 years (4.2% to 5.6%; P = .04), 35 to 49 years (1.2% to 2%; P = .01), and 50 years or older (0.1% to 0.7%; P < .001). The prevalence of moderate-to-severe CUD increased among women with CUD (37% to 45%; P = .03). In 2024, more than half of men (51.5%) and women (61%) aged 18 to 20 years and men aged 21 to 34 years (51%) with CUD had moderate-to-severe CUD.
• Overall AUD prevalence declined among women (9.7% to 8.2%, P=.02), especially in women aged 21-34 years (15% to 12.6%, P=.02) and 35-49 years (11.1%to 8.9%, P=.04). Among 18- to 20-year-old adults in 2024, the prevalence of CUD exceeded that of AUD (14.5%-14.9% vs 10.3%-10.4%), despite a higher prevalence of alcohol use than cannabis use (47.7%-50.5% vs 29.8%-30.7%). 
• Moderate-to-severe AUD prevalence remained stable overall among men and women overall and among women within all subgroups, except for a decline among men aged 21 to 34 years (from 9.4% to 6.8%; P < .001).

IN PRACTICE

"The increased prevalence underscores the importance of early detection, routine screening, timely access to evidence-based CUD treatment, and targeted strategies to counter increasing acceptance, availability, and potency of cannabis products. High prevalence of moderate-to severe CUD among adults who use cannabis challenges the notion that cannabis has low addictive potential," the investigators wrote.

SOURCE

The study was led by Beth Han, MD, PhD, MPH, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland. It was published online on August 19 in JAMA Psychiatry.

LIMITATIONS

The study may have underestimated the prevalence and severity of CUD and AUD as unsheltered individuals and incarcerated populations were excluded. The survey relied on self-reported data, leading to potential social-desirability bias. Lastly, multiple-comparison corrections were not applied.

DISCLOSURES

The study was funded by the National Institute on Drug Abuse of the National Institutes of Health. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.