The co-occurring use and misuse of cannabis and tobacco: a review
Version of Record online: 17 APR 2012
© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction
Volume 107, Issue 7, pages 1221–1233, July 2012
How to Cite
Agrawal, A., Budney, A. J. and Lynskey, M. T. (2012), The co-occurring use and misuse of cannabis and tobacco: a review. Addiction, 107: 1221–1233. doi: 10.1111/j.1360-0443.2012.03837.x
- Issue online: 6 JUN 2012
- Version of Record online: 17 APR 2012
- Accepted manuscript online: 2 FEB 2012 11:33AM EST
- Submitted 26 August 2011; initial review completed 17 October 2011; final version accepted 16 January 2012
Aims Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use.
Methods Selective review of published studies.
Results Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking.
Conclusions There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge.