Why Do Young Adults Use Cannabis and Alcohol?

Summary: Many young adults use cannabis and alcohol to get to sleep. There are a variety of reasons young adults use cannabis and alcohol, including for recreational reasons, social reasons, and to manage daily stress.

Key Points:

• In 2024, 24.1% of young adults 18-25 reported past-month cannabis use, and 17.8% of young adults 18-25 had cannabis use disorder.
• In 2024, 47.5% of young adults 18-25 reported past-month alcohol use, and 14.4% of young adults 18-25 had alcohol use disorder.
• Close to 1/3^rd of adults in the U.S. report sleep difficulties.
• The use of substances – alcohol, cannabis, or other – to get to sleep increases risk of developing long-term physical, behavioral, and mental health disorders
• Understanding usage patterns and reasons for use can help clinicians provide comprehensive mental health support for young adults.

Cannabis, Alcohol, and Getting to Sleep

Studies show that 29.8 percent of adults in the U.S. report having trouble sleeping and trouble getting to sleep. Among U.S. adults, it’s not uncommon to use cannabis or alcohol to get to sleep. However, this habit, which is akin to self-medication with substances or alcohol to manage uncomfortable or difficult emotions, may cause more problems than it solves. Chronic use can lead to tolerance, which can lead to increased use to achieve the same effect – in this case, to get to sleep.

Increased use due to tolerance can lead to the following problems:

• Escalating sleep problems
  • Health problems caused by sleep deficit/sleep deprivation
• Cannabis use disorder
  • Health problems caused by cannabis use disorder
• Alcohol use disorder
  • Health problems caused by alcohol use disorder

A new research letter published by the Journal of the American Medical Association (JAMA) called “Cannabis and Alcohol Use to Initiate Sleep Among Young Adults” analyzed data from the 2022-2023 Monitoring the Future (MTF) Panel Survey to identify the prevalence of cannabis and alcohol use to fall asleep among young adults age 18-25.

Here’s how the research team explains the need for this specific analysis of young adult behavior:

“Young adulthood is a critical developmental period for both substance use risk and sleep problems, underscoring the need for national data on alcohol use for sleep.”

Let’s take a look at how they conducted the analysis.

Past Year, Past Month, Daily, Near Daily Use of Cannabis and Alcohol Among Adults 18-25

To address their primary research goal – identify the reasons why young adults use cannabis and alcohol – the researchers analyzed data from 1,473 young adults with the following demographic characteristics:

Gender:

• 51.0% female
• 44.7% male
• 4.2% another gender

By Race/ethnicity:

• Black: 11.2%
• Hispanic: 25.4%
• White: 54.8%
• Other: 8.5%

Participants answered yes or no to the following questions, phrased as “In the past 12 months, have you used cannabis/alcohol…” or “In the past 30 days, have you used cannabis/alcohol…” Here’s a complete list of the cannabis/alcohol topics/questions:

• Past 12-month use of cannabis
• Past 12-month use of alcohol
• Past 12-month use of both cannabis and alcohol
• Past 30-day daily or near-daily use of cannabis (>20 times/month)
• Past 30-day daily or near-daily use of alcohol (>20 times/month)
• Past 30-day daily or near-daily use of both cannabis and alcohol (>20 times/month)
• Past 30-day non-daily use of cannabis (<20 times/month)
• Past 30-day non-daily use of alcohol (<20 times/month)
• Past 30-day non-daily use of both cannabis and alcohol (<20 times/month)
• Past-two-week binge drinking
• No cannabis or alcohol use

Participants who answered yes to any past 12-month cannabis/alcohol use also answered questions about why they used cannabis/alcohol, with to get to sleep as one possible answer.

Let’s take a look at what they found.

Cannabis and Alcohol Use Among Young Adults: Prevalence and Reasons for Use

The researchers collated the responses on cannabis and alcohol use with responses that included ‘used alcohol/cannabis to get to sleep’ to identify the prevalence and association with sleep and sleep difficulties.

First, we’ll report the top-line data on using cannabis or alcohol to get to sleep:

Used cannabis or alcohol to get to sleep:

• Total: 22.4%

Used cannabis and alcohol to get to sleep:

• Total: 7.1%

Next, they analyzed usage patterns in light of reasons for use and demographic characteristics. We’ll start with cannabis

Used cannabis to get to sleep:

• Total: 18.3%
• Among those reporting past 12-month cannabis use: 41.4%
• Among those reporting past 12-month cannabis and alcohol use: 42.1%
• By detailed use pattern:
  • No use: 20.5%
  • Nondaily use: 39.3%
  • Near-daily use: 67.3%

Here’s the demographic breakdown.

Used cannabis to get to sleep in past 12 months:

• By Gender:
  • Female: 45%
  • Male: 34.9%
  • Other: 62.4%
• By race/ethnicity:
  • Black: 36.3%
  • Hispanic: 45.7%
  • White: 41.4%
  • Other: 37.0%

Here are the same data sets for alcohol, rather than cannabis.

Used alcohol to get to sleep:

• Total: 7.2%
• Among those reporting past 12-month alcohol use: 8.6%
• Among those reporting past 12-month alcohol and cannabis use: 10.9%
• By use pattern:
  • No use: 7.9%
  • Nondaily use: 8.0%
  • Near-daily use: 23.5%

And here’s the demographic breakdown.

Used alcohol to get to sleep in past 12 months:

• By Gender:
  • Female: 8.1%
  • Male: 8.5%
  • Other: 17.2%
• By race/ethnicity:
  • Black: 18.8%
  • Hispanic: 7.8%
  • White: 7.7%
  • Other: 7.1%

Reviewing these results, we see that half of cannabis users reported using cannabis to get to sleep sometimes. This use pattern for cannabis is far more common than for alcohol: young adults used cannabis to get to sleep than they used alcohol to get to sleep. In addition, the data show that women were more likely to use cannabis to get to sleep than men, and that young Black adults used alcohol to get to sleep more frequently than young White, Hispanic, or young adults.

That’s the data, which is the first time these various sets have been analyzed together. But why is this information important?

The Consequences of Cannabis and Alcohol Use

This information is of vital importance because of the potential risks of the use patterns we outline in the introduction and clarify with facts and figures in the data section. In a nutshell, it matters for the following reason:

Using cannabis and/or alcohol to fall asleep can lead to tolerance, increased use, and chronic disordered use, which elevates risk of a host of negative outcomes.

First, we’ll review the negative outcomes associated with cannabis use, as reported in a publication written by the Director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow, called “Adverse Health Effects of Marijuana Use.”

Cannabis: Problems Associated with Short-Term Use

• Short-term memory impairment
• Decreased motor coordination
• Poor decision-making/impaired judgment
• Risk of cannabis-induced psychosis

Cannabis: Problems Associated with Long-Term Use

• Development of cannabis use disorder
• Impaired neurological development:
  • Learning and memory deficits
  • Executive function deficits
  • Impulse control difficulty
  • Decision-making deficits
• Attenuated academic performance/achievement
• Impaired cognitive function
• Decreased IQ

Those outcomes are serious, and should cause any young adult who uses cannabis to fall asleep to reconsider their usage pattern, particularly young adults who use cannabis daily.

Now let’s look at the negative outcomes associated with alcohol use, as reported by the Centers for Disease Control (CDC).

Alcohol Use: General Negative Outcomes

1. Increased risk of chronic diseases including cancer, heart disease, liver disease, high blood pressure, and some forms of cancer.
2. Increased chance of risky sexual behavior, associated with unplanned pregnancy and elevated risk of sexually transmitted diseases, including HIV.
3. Elevated risk of automobile related injury, accidents, and death.
4. Elevated risk of sexual assault and intimate partner violence.

Recent studies also show connections between alcohol consumption and cancer risk.

Alcohol Use: Increased Risk of Cancer

The National Cancer Institute indicates alcohol use is associated with higher risk of the following types of cancer, even at low levels of consumption, i.e. 1-2 servings per day:

• Mouth/Pharynx
• Larynx
• Esophagus
• Breast
• Colorectal
• Liver

The risks associated with chronic cannabis and alcohol use are serious. To conclude this article, we’ll discuss the implications of the relationship between these significant health risks and using cannabis and/or alcohol to fall asleep.

The Consequences of Using Cannabis or Alcohol to Fall Asleep

The consequences of using cannabis or alcohol to fall asleep are numerous and severe. Most of the negative outcomes are associated with use that increases to chronic use, then disordered use, then long-term use, then chronic, long-term, disordered use. That’s what we can justifiably call a slippery slope that can begin with little harm or consequence and end with severe, life-changing consequences.

Here’s how the study authors view the importance of their data and this vein of research:

“Raising awareness about the intersection of substance use and sleep problems is critical in the screening, diagnosis, and treatment planning process for young adults with sleep problems, cannabis use disorder, and alcohol use disorder.”

We concur.

For instance, the information we report above can help clinicians identify the presence of insomnia, with or without substance use. Once identified, they can collaborate with patients to explore the root cause of insomnia, which could be stress, recent or childhood trauma, or the presence of a mental health disorder such as anxiety, depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, or borderline personality disorder.

Any of these causes merit professional mental health support, as does a standalone case of insomnia. Increasing the breadth of cannabis and alcohol screenings to include reasons why can help patients get a accurate diagnosis – and appropriate treatment – sooner rather than later, which can significantly improve treatment outcomes and long-term health and wellness.