Growing public support for marijuana legalization in the U.S. has led to public debate about whether marijuana is "safer" than other substances, such as alcohol. In January, President Obama also publically stated he is not convinced that marijuana is more dangerous than alcohol. Despite the recent shift in views toward marijuana, the harms of use as compared to alcohol use are not well understood.
Now a new study "Adverse Psychosocial Outcomes Associated with Drug Use among US High School Seniors: A Comparison of Alcohol and Marijuana," by researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR) published in the American Journal of Drug and Alcohol Abuse, (on-line ahead of print) September 1, 2014, analyzed data from a nationally representative sample of high school seniors in the Monitoring the Future (MTF) study. MTF is a nation-wide ongoing annual study of the behaviors, attitudes, and values of American secondary school students. Students were asked to indicate whether they experienced various adverse psychosocial outcomes resulting from use of each substance. The authors analyzed data from 7,437 students (modal age: 18) from cohorts assessed from 2007 through 2011 who reported using alcohol or marijuana in their lifetime.
"The paucity of research is of particular public health concern as alcohol and marijuana are the two most commonly used psychoactive substances among adolescents," said Joseph J. Palamar, PhD, MPH, a CDUHR affiliated researcher and an assistant professor of Population Health at NYU Langone Medical Center (NYULMC). "Nearly half of high school seniors have used marijuana in their lifetime and over two-thirds have used alcohol, but few studies have compared adverse psychosocial outcomes of alcohol and marijuana directly resulting from use."
"The most alarming finding was that alcohol use was highly associated with unsafe driving, especially among frequent drinkers," said Dr. Palamar. "Compared to non-drinkers, frequent drinkers were over 13 times more likely to report that their alcohol use has led to unsafe driving. Marijuana users, compared to non-users, were three times more likely to report unsafe driving as a direct result of use."
The researchers also found that alcohol use was more commonly reported to compromise relationships with friends and significant others (e.g., boyfriends); it was also reported to lead to more regret, particularly among females. Marijuana use on the other hand was more commonly reported to compromise relationships with teachers or supervisors, result in less energy or interest, and result in lower school or job performance.
Females in particular were more likely to report engaging in behaviors they regretted after using alcohol. They were also more likely than males to report feeling less emotionally stable, and not being able to think as clearly due to alcohol use. White students were more likely to report various adverse outcomes resulting from alcohol use such as engaging in behavior that one regrets, inability to think clearly, and driving unsafely. Interestingly, researchers found that both frequent and infrequent marijuana users were more likely to report no adverse outcomes associated with marijuana use.
"Not unexpectedly, we found that the higher the frequency of use, the higher the risk of reporting an adverse outcome," said Dr. Palamar. "In particular, the relationship between frequent alcohol use and regret was much stronger than the relationship between frequent marijuana use and regret."
Overall, females were at higher risk for reporting the majority of adverse outcomes assessed by MTF. Racial or ethnic minorities (most often black students) were at decreased risk for many adverse outcomes, and this "protective" effect tended to be more pronounced for alcohol than marijuana.
The researchers found that marijuana users are more likely than those who drink alcohol to face negative perceptions, possibly even more so from authoritative figures. Marijuana use was more associated with reports of being involved with "bad" influences, possibly because marijuana use is illegal and thus peers who use or sell may also be subject to the disapproval and/or stigma.
The researchers did not find significant differences between alcohol and marijuana use with regard to general lifetime use and trouble with police. However, not surprisingly, compared to alcohol, frequent marijuana users (i.e., used >40 times) were 23 times more likely to report getting into trouble with the police.
"As a controlled substance, mere possession of marijuana may increase the risk of significant legal consequences compared to an age-restricted legal substance such as alcohol, so this was not unexpected," said Dr. Palamar. "Smoking marijuana also tends to leave a strong odor, which can easily draw attention to authorities. However, we found no racial differences with regard to getting in trouble with police because of marijuana use. Results might have been different if we focused on older individuals or only those who reside in big cities."
The researchers stress that marijuana and alcohol are associated with unique adverse outcomes in teens. Outcomes differ by sex and race/ethnicity, and perception or experience of adverse outcomes may also be related to legal status and associated stigma. Public health interventions may be more effective by focusing on prevention and harm reduction strategies for these drug-specific outcomes.
"We hope that the findings of this study will contribute to the ongoing debate on marijuana policy and its perceived harm when compared to alcohol," concluded Dr. Palamar.
Researcher Affiliations: Joseph J. Palamar, PhD, MPH--NYULMC, Department of Population Health and Center for Health, Identity, Behavior, and Prevention Studies; NYU CDUHR; Dimita Kamboukos, PhD--NYULMC, Department of Population Health; Danielle C. Ompad, PhD, MHS--NYULMC Center for Health, Identity, Behavior, and Prevention Studies; CDUHR; Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development; Charles M. Cleland, PhD-- Department of Nutrition, Food Studies and Public Health; Steinhardt School of Culture, Education and Human Development, and College of Nursing, New York University; Michael Fenstermaker, B.A. Medical Student and Michael Weitzman, MD, NYULMC, Departments of Pediatrics and Environmental Medicine.
Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Acknowledgements: This project was not funded. The National Institute on Drug Abuse, Inter-university Consortium for Political and Social Research, and Monitoring the Future principal investigators, had no role in analysis, interpretation of results, or in the decision to submit the manuscript for publication. Monitoring the Future data were collected through a research grant (R01 DA-01411) from the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the principal investigators, NIH or NIDA
The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit http://www.
About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https:/
About NYU Langone Medical Center
NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals--Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center's dedicated inpatient orthopaedic hospital; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the Medical Center--plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to http://www.