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How do young adults use tobacco, marijuana and alcohol together?

It’s not a surprise that substances can sometimes go hand-in-hand. Just think of someone who has a drink in one hand and a cigarette in the other.

So, what are some common combinations of substance use? The answers are important: understanding how products are commonly used together could help inform efforts to reduce tobacco and substance use in young adults by targeting the most popular and prevalent patterns.  

That is why Truth Initiative® researchers analyzed national data from a group of 18- to 24-year-olds. The research team examined the top 10 most popular patterns of recent alcohol, marijuana and tobacco use across the spectrum of new and emerging tobacco products, like cigars, little cigars, e-cigarettes and hookah.

The study, published in The American Journal on Addictions, found that 31 percent of the young adults had used only alcohol in the past 30 days, 5 percent used alcohol and cigarettes together and 4 percent used alcohol and marijuana together. The most common pattern, endorsed by 42 percent of the sample, was not using any substance during the last 30 days.

E-cigarette use was not common and arose in the least popular pattern. E-cigarettes were never used exclusively, without the combination of alcohol or another tobacco product, in the past 30 days. The popularity of using marijuana alone increased over time, but only 1 percent reported exclusively using marijuana without combining it with either alcohol or tobacco.

“Patterns stress the importance and popularity of alcohol use among young people, suggesting that successful prevention efforts should focus on alcohol’s co-use with a variety of substances,” said Dr. Amy Cohn, research investigator at the Schroeder Institute® for Tobacco Research and Policy Studies at Truth Initiative.

For more on tobacco, substance use and other use patterns, read Truth Initiative’s latest research on patterns of use.

Key takeaways


31% of 18- to 24-year-olds reported using alcohol by itself in the past 30 days


5% of 18- to 24-year-olds reported using alcohol and cigarettes together in the past 30 days


4% of 18- to 24-year-olds reported using alcohol and marijuana together in the past 30 days


42% of 18- to 24-year-olds reported not using any substance in the past 30 days