Researchers observed a notable shift in Americans’ habits recently when–for the first time–cannabis overtook alcohol as the most widely used substance in the U.S. A new study published in May 2024 in the peer-reviewed journal Addiction analyzed self-reported survey data of 1.6 million participants across 27 surveys from 1979 to 2022 to determine their results.
The trend follows a larger public policy wave that’s made the cannabis plant more accessible in 38 U.S. states and counting. What does that mean for the future of these two very different mind-bending pastimes? We’ll explore the landscape:
What’s the Problem with Alcohol?
A popular meme originated by Ditch Pony (@molly7anne on X) circulated in 2021 read: “can’t believe alcohol is the legal one. when I get too drunk I want to make the worst decisions of my life. when I get too high I want to mix all the dipping sauces together and be a better friend.”
Beyond our witty social media revelations, science backs up why alcohol is the worst of the two. Fat deposits develop in your liver if you drink too much alcohol. This can inflame the liver and cause alcoholic hepatitis, which can result in liver failure and death. Heavy alcohol use causes 9,000 deaths per year from heart disease and stroke. Even light to moderate amounts of alcohol consumption (.2 drinks to 2.2 drinks per day, according to the National Institutes of Health) has been linked to an increased risk for health issues like liver disease and some cancers.
Where limited studies indicate alcohol may in moderate amounts contribute to better cardiovascular health, the evidence of such is scant. A very clear link exists, however, between regularly drinking too much alcohol and having high blood pressure. Over time, high blood pressure puts strain on the heart and can lead to cardiovascular disease (CVD), increasing your risk of a heart attack or stroke.
On the other hand, cannabis has killed no one as far as we know. Where few recorded cases of people dying from possible cannabis-induced complications of an existing medical condition, these remain inconclusive. The Centers for Disease Control and Prevention and the Drug Enforcement Administration have never reported a single death linked to cannabis consumption. Experts say a fatal ingestion of cannabis would need to be at least 1,500 lbs.–an impossible feat.
How Did Alcohol Become the Legal One?
At one point in U.S. history, the narrative about the relative harms of these two substances was flipped. It’s believed that after the Mexican Revolution of 1910, Mexican immigrants flooded into the U.S., introducing Americans to cannabis. During the next decade, its use increased but fear of the substance ramped up among government officials citing crime, violence, and “socially deviant behaviors” especially in what they called “racially inferior” communities.
In 1930, Harry Anslinger became the first commissioner of the Federal Bureau of Narcotics, a position he held until 1962. Anslinger made it his mission to rid the U.S. of cannabis. By 1931, 21 states passed laws banning cannabis. Anslinger further influenced the Marijuana Tax Act of 1937, outlawing possessing and selling the substance across the U.S.
1919: Volstead Act Makes Alcohol Illegal
In October 1919 Congress passed the Volstead Act as a response to pre-existing social issues like domestic violence and child abandonment whose presumed cause was alcohol. The Prohibition Era began in 1920 as the 18th Amendment to the U.S. Constitution.
On March 22, 1933, President Franklin Roosevelt signed into law the Cullen–Harrison Act, re-legalizing beer with an alcohol content of 3.2% and wine of a similarly low alcohol content. On December 5, 1933 the Twenty-first Amendment repealed the Eighteenth Amendment.
America changed its mind on alcohol prohibition not because it wasn’t dangerous or held any known health benefits. Alcohol prohibition ended because of rampant crime, lack of enforcement, and the loss of taxes alcohol sales raked in.
Where cannabis differs from alcohol is in the body of evidence of therapeutic use in dozens of medical conditions. In about half of our U.S. states now, re-legalization of cannabis occurred because of its proven benefits to medicine.
Does Either Substance Enhance the Effects of the Other?
Lots of our popular music today seems to indicate these substances are the two key cohesive units that make up a good party. Colloquially, using both in tandem is known by the term crossfading. Where lots of people use them together, it doesn’t mean it’s safe to do so. Research indicates people who use both alcohol and cannabis together tend to consume more of both. There are health risks to consider, including which one you use first and how you consume them. If you aren’t careful, the combo can lead to unintended consequences.
While some research has concluded that alcohol has little impact on THC levels, other more recent studies indicate they can amplify each other’s effects on the body, leading to increased impairment. According to Medical News Today, alcohol widens the blood vessels in the gastrointestinal tract, allowing THC to be more quickly absorbed. This can influence the potency and length of one’s high, especially with edibles.
Currently, US and state laws outlaw combining alcoholic drinks with THC. Where beverage corporations are setting their eyes on a future that combines these two substances, advocates aren’t so sure it’ll even be popular. Further, trends indicate that young people are drinking less alcohol than a decade ago, possibly partly due to their access to alternatives like THC beverages.
Could using cannabis help you replace alcohol or reduce your intake? MedicateOH wrote more on that topic here in 2021.
Has Cannabis Been Blamed for the Effects that Alcohol Created?
Bob Marley once said: “Herb is the healing of the nation, alcohol is the destruction.” Certainly, without a doubt, cannabis has gotten blamed for the misdeeds of its sibling alcohol, much like the naughty kid acting up in class and blaming the best friend. Research-community reports and observational studies suggest a linkage with cannabis use and ER visits, but in most of these cases it’s not clear whether alcohol or other drugs also played a role.
Where cannabis is arguably safer than alcohol, both substances can be used in excess leading to unwanted consequences. If you think you may be suffering from substance abuse, there are resources that can help. SAMHSA’s National Helpline 1-800-662-HELP (4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
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