ArticleAddictive behaviors2025
Does cannabis substitute or complement alcohol after recreational cannabis legalization in the Washington State? A three-level mixed-effects modeling.
Article in Addictive behaviors, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Change of substance-related hospitalisation in adolescents after cannabis legalisation in Thailand in 2022.Addiction (Abingdon, England) · 2026Article
- Co-Use of Alcohol and Cannabis: How Are They Related?The American journal of psychiatry · 2026Article
- Mutual age-varying influences of binge drinking and cannabis use during emerging adulthood in the NCANDA cohort.Alcohol, clinical & experimental research · 2025Article
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Authors and funding
3 authors.
Funding
Abstract
backgroundWhether cannabis substitute or complement alcohol remains inconclusive. Little is known about the daily-level associations between cannabis and alcohol use by cannabis user type (medical vs. recreational use) in people who use alcohol and cannabis within a legalized environment.
methodsAdult participants were from four waves of Washington Panel Survey during 2014-2016, who consumed both cannabis and alcohol in the past six months. Daily measurements of alcohol and cannabis use in the past week were collected at each wave. Our outcome variable was continuous alcoholic drinks, the exposure was any cannabis use. We applied three-level negative binomial models to account for within-person wave-to-wave and between-person variations, deriving pure within-person within-wave associations between cannabis and alcohol use at the daily level. A cross-level interaction between day-level cannabis use and wave-level medical cannabis recommendation investigated the potential differential substitution/complementarity patterns by medical recommendation status.
results259 respondents with 440 person-waves and 3,051 daily observations were included. We found a statistically significant pure Level 1 (within-person daily-level) effect of cannabis use among recreational cannabis users (IRR = 1.37, 95 % CI: 1.05-1.79, p = 0.02), showing a complementary use pattern. We also found a statistically significant cross-level interaction between medical cannabis recommendation and cannabis use at Level 1 (IRR = 0.57, 95 % CI: 0.34-0.96, p = 0.03), indicating that, differently from recreational users, medical cannabis users may have a substitution use pattern.
conclusionsCannabis user type may inform co-use patterns. This study suggested recreational cannabis users tended to use alcohol and cannabis in a complementary manner in Washington State following the legalization of recreational use.
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