Cannabis use disorder climbs, as alcohol use disorder flattens

Clinical takeaway: Consider asking about cannabis use in patients 35 and older, where increases in moderate to severe cases are steepest. Inquire about routes of consumption, since using multiple forms tracks with heavier use, as well as frequency. 

Cannabis use is growing fastest among middle-aged and older adults. The share who develop a disorder from it is increasing in lockstep. This pattern runs against long-standing assumptions that cannabis carries relatively low addictive potential, that dependence usually stays mild when it does develop, and that it mainly occurs in younger adults. 

The number of US adults meeting the criteria for cannabis use disorder rose to 19.4 million in 2024 from 15.3 million in 2021, while the number with alcohol use disorder fell to 27.1 million from 28.8 million. Past-year cannabis use was reported by 25.7% of men and 21.2% of women in 2024. A pair of recent cross-sectional analyses of the National Surveys on Drug Use and Health tracked prevalence and severity by age and sex. 

Moderate to severe cannabis use disorder rose to 4.1% from 3.1% in men and to 2.5% from 1.7% in women, with the steepest increases in adults 35 to 49 and men 50 or older. Among women with cannabis use disorder, the share meeting moderate to severe criteria rose to 45% from 37%. Alcohol use disorder was stable in men and declined in women over the same period, and moderate to severe alcohol use disorder held steady in women while declining among men 21 to 34. 

The second analysis sorted adults who used cannabis in the past 30 days into four groups: primary smoking, smoking plus vaping, mainly edibles, and polymodal use spanning nearly every available form. Cannabis use disorder was most common in the polymodal group, at 67%, compared with 47% of those who smoked and vaped, 36% of primary smokers, and 15% of those who mainly used edibles. About half the polymodal group used cannabis daily. 

Both analyses drew on the National Surveys on Drug Use and Health, a nationally representative survey that relies on self-report. The severity trends came from 186,823 adults surveyed in 2021 through 2024, using DSM-5 criteria, with moderate to severe defined as four or more symptoms. The route analysis covered 17,732 adults who reported using cannabis in the past 30 days in 2022 and 2023. 

The practical bottleneck is not detection but what follows it. Moderate to severe cannabis use disorder warrants treatment, and no medication is approved for it, so the response falls to behavioral treatment, referral, and follow-up in settings where those are already stretched. Treatment rates have declined even as prevalence has risen, according to study authors. 

“Our findings suggest that using cannabis in multiple forms may be a red flag for heavier use and symptoms of addiction,” said study lead author Omar El-Shahawy, MD, PhD, MPH, an assistant professor in the Department of Population Health at NYU Grossman School of Medicine. “Asking patients not only whether but how they use cannabis could help clinicians identify when a fuller assessment may be warranted.” 

Sources: Han B, et al. JAMA Psychiatry. 2026 Aug 19. Trends in the Prevalence and Severity of Alcohol and Cannabis Use Disorders Among US Adults; El-Shahawy O, et al. Addict Behav. 2026 Aug 8. Cannabis use modalities are associated with sociodemographic characteristics and patterns of cannabis use among US adults: A latent class analysis