Abstract
Importance
The number of US adults with alcohol use disorder (AUD) has declined, whereas the number with cannabis use disorder (CUD) has increased. Little is known about how changes in the prevalence and severity of AUD and CUD vary by age and sex.
Objective
To investigate trends in AUD and CUD prevalence and severity by age and sex.
Design, Setting, and Participants
This cross-sectional study examined data from adult participants in the 2021 to 2024 National Surveys on Drug Use and Health. This study was started and completed in March 2026.
Exposure
Alcohol and cannabis use.
Main Outcomes and Measures
Past-year prevalence and severity of AUD and CUD using
DSM-5
criteria.
Results
From 2021 through 2024 among 186 823 participants (51.3% female; 4.9% aged 18-20 years; 24.1% aged 21-34 years; 24.7% aged 35-49 years), past-year CUD prevalence increased among males (from 7.3% [95% CI, 6.6%-8.1%] to 9.3% [95% CI, 8.6%-10.1%];
P
< .001) and females (from 4.5% [95% CI, 4.1%-5.0%] to 5.6% [95% CI, 5.2%-6.1%];
P
= .01). Moderate-to-severe CUD prevalence among males increased from 3.1% (95% CI, 2.8%-3.6%) to 4.1% (95% CI, 3.7%-4.5%) (
P
< .001), especially among males aged 35 to 49 years (from 2.7% [95% CI, 2.0%-3.6%] to 3.9% [95% CI, 3.2%-4.8%];
P
= .01) and males aged 50 years or older (from 0.6% [95% CI, 0.3%-1.0%] to 1.2% [95% CI, 0.8%-1.7%];
P
= .02). Among females, moderate-to-severe CUD prevalence increased from 1.7% (95% CI, 1.5%-2.0%) to 2.5% (95% CI, 2.3%-2.8%) (
P
< .001), specifically for females aged 21 to 34 years (from 4.2% [95% CI, 3.5%-5.1%] to 5.6% [95% CI, 4.8%-6.5%];
P
= .04), 35 to 49 years (from 1.2% [95% CI, 0.8%-1.8%] to 2.0% [95% CI, 1.6%-2.5%];
P
= .01), and 50 years or older (from 0.1% [95% CI, 0.04%-0.3%] to 0.7% [95% CI, 0.5%-1.0%];
P
< .001). Among females with CUD, moderate-to-severe CUD prevalence increased from 37.0% (95% CI, 32.5%-41.8%) to 45.0% (95% CI, 41.1%-49.0%) (
P
= .03). However, moderate-to-severe AUD prevalence remained stable among males overall (except for declines among males aged 21-34 years) and was stable among females overall and within all subgroups. Most males and females aged 18 to 20 years and males aged 21 to 34 years with CUD had moderate-to-severe CUD (eg, 51.0%-61.0% in 2024), with consistent patterns from 2022 through 2024.
Conclusions and Relevance
This cross-sectional study found divergent age- and sex-specific patterns from 2021 through 2024, with moderate-to-severe CUD prevalence increasing and moderate-to-severe AUD prevalence remaining stable across males, females, and most subgroups. The increased prevalence underscores the importance of early detection, routine screening, timely access to evidence-based CUD treatment, and targeted strategies to counter increasing acceptance, availability, and potency of cannabis products. High prevalence of moderate-to-severe CUD among adults who use cannabis challenges the notion that cannabis has low addictive potential.