Recreational cannabis legislation and binge drinking in U.S. adolescents and adults

Abstract

Background: Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.).

Methods: We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies.

Results: Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30.

Conclusions: Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.

Keywords: Adolescence; Binge drinking; Recreational cannabis laws (RCLs); State alcohol policies.

Figure 1.

Trends in prevalences of past month binge drinking by status of cannabis law implementation during 2008–2019. Note: State-level cannabis law status was classified by 2019 and categorized as a time-invariant the following three-level variable: (1) No MCL nor RCL – refers to states that have never implemented medical cannabis laws or recreational cannabis laws (e.g., Alabama, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming); (2) MCL only – refers to states that only implemented medical cannabis laws (e.g., Arizona [2011], Arkansas [2019], Connecticut [2015], Delaware [2015], Florida [2017], Hawaii [2000], Illinois [2016], Maine [1999], Maryland [2018], Michigan [2009], Minnesota [2016], Missouri [2019], Montana [2004], New Hampshire [2016], New Jersey [2013], New Mexico [2008], New York [2016], North Dakota [2019], Ohio [2019], Oklahoma [2019], Pennsylvania [2018], Rhode Island [2006], and West Virginia [2019]); and (3) MCL and RCL – refers to states implemented Recreational Cannabis Laws (e.g., Alaska [2015], California [2017], Colorado [2013], Massachusetts [2017], Nevada [2017], Oregon [2016], Vermont [2019], Washington [2013] and District of Columbia [2015]).