Cannabis Legalization and the Aging Binge Drinker

A new study by researchers 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 18 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, 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,” added Priscila Dib Gonçalves, post-doctoral fellow in the Substance Abuse Epidemiology program in the Department of Epidemiology at Columbia Mailman School, and first author of the study.   

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 (DA037866, DA031099, DA048860, DA045224). This research was supported in part by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (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.