Cannabis Use Disorder Cases Rise from 15.3M to 19.4M While Alcohol Use Disorder Falls from 28.8M to 27.1M (2021-2024 NSDUH)

The JAMA Psychiatry analysis of 186,823 NSDUH respondents showed cannabis use disorder climbing across sexes and age bands, with the sharpest relative gains among adults 35-49 and those 50+, including a sevenfold rise in moderate-to-severe cases among older women. Alcohol use disorder declined modestly overall, driven by drops among women 21-49 and younger men. These opposing trajectories occurred amid rising THC potency in commercial products and expanded state legalization, patterns documented in prior NIDA reports linking higher-potency cannabis to elevated dependence risk.

Prior NSDUH waves and a 2023 Lancet Psychiatry meta-analysis had under-emphasized age-by-sex stratification, masking how middle-aged and older cohorts now account for disproportionate CUD growth. The current study corrects that gap by reporting both prevalence and severity metrics conditional on past-year use. Declining AUD may partly reflect reduced per-capita consumption post-pandemic plus expanded pharmacotherapy access, yet cannabis messaging continues to downplay dependence liability despite 30% of users meeting disorder criteria in NIDA estimates.

Clinicians will need integrated screening protocols that capture older adults and women, groups historically viewed as low-risk. Treatment capacity for CUD remains limited compared with AUD programs; next steps require randomized trials of behavioral and pharmacologic interventions tailored to these demographics. Without such data, policy shifts toward commercialization risk outpacing evidence-based response.