Cross-sectional study of 186,823 US adults (2021–2024 NSDUH) examining trends in past-year prevalence and severity (DSM-5) of alcohol use disorder (AUD) and cannabis use disorder (CUD), stratified by age group and sex.
Moderate-to-severe CUD prevalence rose in both sexes (males: 3.1%→4.1%, P<.001; females: 1.7%→2.5%, P<.001), with the sharpest increases in older age groups (females ≥50 yrs: 0.1%→0.7%). By contrast, moderate-to-severe AUD prevalence stayed stable across nearly all sex and age subgroups. Among young adults (18–20 yrs) with CUD, 51–61% had moderate-to-severe disorder in 2024.
Cross-sectional design precludes causal inference; self-reported cannabis and alcohol use may underestimate true prevalence; survey data cannot capture unhoused or institutionalized populations.
Routine screening for CUD should be expanded across all adult age groups and sexes, especially in older adults where increases were steepest. Clinicians should not assume cannabis carries low addiction risk—most young adults with CUD already meet criteria for moderate-to-severe disorder.
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