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Americans report using marijuana more frequently than alcohol. What are the risks of both?


Daily marijuana use in the United States now outpaces daily drinking. That's according to a recent study that looks at nationwide data on drug use. Researchers examined records of the National Survey on Drug Use and Health from 1979 to 2022, and they found that by 2022, the number of daily or near-daily users of marijuana had skyrocketed, while the number of daily or near-daily drinkers fell. Here to help us understand what we do know is Dr. Godfrey Pearlson. He's a professor of psychiatry and neuroscience at Yale. Dr. Pearlson, welcome to ALL THINGS CONSIDERED.

GODFREY PEARLSON: Thank you. Good to be talking with you.

DETROW: Let's start with the study itself, which got a lot of attention this week. It was published in the journal Addiction. It looks at roughly 40 years of self-reported data on drug, alcohol and tobacco use. And as we said, daily marijuana use now outpaces daily drinking, according to the study. Did that make sense to you when you first saw it?

PEARLSON: Yes, it did. This has been a slow and steady trend. So there's much greater acceptance of cannabis as a recreational drug, and more people now approve of cannabis in that status than approve of same-sex marriage. So compared to 50 years ago, this is an enormous turnaround. And in part, that's due to many people now seeing cannabis as a relatively safe drug, and perception of safety is definitely linked epidemiologically to willingness to consume any drug.

DETROW: Before we get into that, I did want to ask, is there any reason to be skeptical of self-reported data when it comes to drug use and alcohol use? - because this is something that I think a lot of us fudge one way or another in different parts of our life when asked about it.

PEARLSON: Yeah, that's a good point because when cannabis was widely illegal, people were very reluctant to report use of the drug, either to pollsters or epidemiologists or even to their primary care providers in a medical setting. I think now some of the stigma has disappeared, people are more likely to fess up than they would have been in the past.

DETROW: And of course, it's just been a boom of legalization. It's now legal in about half the states in the U.S. Do you think a big part of this is just the access, that it's easier to legally buy marijuana at this point?

PEARLSON: I'm sure that's an important part of it.


PEARLSON: And because the perception of safety is linked to willingness to consume, it is true, from many points of view, that cannabis is a relatively safe drug, although that doesn't mean it's totally devoid of dangers.

DETROW: I do want to talk about that because, of course, we know that drinking alcohol carries a lot of risks, from drunk driving to long-term health issues like liver damage. What do we know - what is our knowledge of the risks of using marijuana, particularly on a daily basis?

PEARLSON: Depends in part on who is using it as much as how much they're using it in terms of frequency and quantity. So the areas of concern, I would say, are pregnant women. There may be some risk to unborn children, particularly women who are using for nausea and vomiting in pregnancy. There's a risk to teens, particularly of psychosis, particularly in teenagers who start early, use cannabis with very high THC content and use on a very frequent basis, like daily, and particularly in those with family histories of psychosis or prior histories of paranoia when they smoke cannabis. Some people have worried about effects on IQ in teenagers who smoke regularly, but those are not well documented. And the more that question has been examined, the more it appears to be no air there, really (ph).


PEARLSON: People intending to drive motor vehicles soon after smoking are at somewhat increased risk, but the risk's probably about 10% more than someone who's not smoking cannabis, compared to 10 to 20 times the risk at the limits of blood alcohol concentration. So it's not a zero risk, but it's not nearly as high as for alcohol.

DETROW: You know, it's interesting. I grew up in the peak D.A.R.E. age in school, and I feel like, you know, my starting point awareness with marijuana was that it's a gateway drug. You do it once, you're setting your life down a downward spiral, very, very dangerous. And I feel like now, at this point, as an adult, the common consensus is actually very little concern. It's much safer than alcohol. Like, which of those two extremes that I feel like our society has veered from is closer to reality? It sounds like you're saying the second, though, of course, there's context.

PEARLSON: Yes, absolutely. So the joke among cannabis researchers is if marijuana is a gateway drug, it's a gateway to your refrigerator. But I think as a society, we've done ourselves no favors through exaggerating the dangers of recreational drugs of all types, including cannabis. Some of the myths are that it causes sterility, it will lead to a huge outbreak of violence. And campaigns such as D.A.R.E. and Just Say No have so exaggerated and twisted the risks that people have naturally become skeptical and are thinking more that there's absolutely no risk. They've argued themselves out of any risk. Risks are there. It's just that they're relatively small compared to other drugs.

DETROW: Bottom line - this shift that we saw in this study, marijuana outpacing alcohol, seems like you're saying it's actually a good thing for our brains and our health if you compare - directly compare the two, assuming both are used in moderation and safely?

PEARLSON: Yeah, I would argue that. I think human beings have a drive to intoxicate themselves and alter their mental states, and if you have to choose a drug to do that, then cannabis is certainly in the running. But alcohol used in moderation is not a bad drug. It's just when quantity and frequency and the strength of the drug all conspire to give people more of the drug than is good for them, then that's never a good thing.

DETROW: But I feel like, Dr. Pearlson, I have not found the cannabis alternative for making a really nice martini at the end of the night and that whole process.


PEARLSON: No, there's no equivalent to a martini. Although, there are infused drinks, but I've never tried one that tasted particularly good.

DETROW: That's Dr. Godfrey Pearlson, professor of psychiatry and neuroscience at Yale University. Thank you so much.

PEARLSON: Thanks, Scott. Pleasure talking to you.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.
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