Cannabis Use Disorder Rises Among U.S. Adults as Potency Increases, NIDA Study Finds

The number of American adults with cannabis use disorder has risen sharply over the past three years even as alcohol addiction rates have declined, according to new research from the National Institute on Drug Abuse published Wednesday.

The study found that 19.4 million adults met diagnostic criteria for cannabis use disorder in 2024, up from 15.3 million in 2021. During the same period, alcohol use disorder cases fell from 28.8 million to 27.1 million. The contrasting trends highlight how changing drug policies, product potency, and public perception are reshaping the landscape of substance use disorders in the United States.

Higher Potency, Higher Risk

Researchers attribute much of the increase to the rising THC content in cannabis products now available through legal markets. Tetrahydrocannabinol, the primary psychoactive compound in marijuana, has become significantly more concentrated in products ranging from high-potency flower to concentrated extracts.

"The notion that cannabis is not addictive may basically be incorrect," Dr. Nora Volkow, director of the National Institute on Drug Abuse and senior author of the study, told reporters. "The higher the content of the drug, the higher the risk for addiction."

Cannabis use disorder is diagnosed when individuals develop tolerance to the drug, experience cravings and withdrawal symptoms when attempting to stop, and continue using despite negative consequences to their health, work, or relationships. The study found that moderate-to-severe cases rose from 3.1% to 4.1% among men and from 1.7% to 2.5% among women.

Shifting Perceptions, Expanding Access

The increase in problematic cannabis use parallels broader shifts in American drug policy and social attitudes. Since 2021, additional states have legalized recreational marijuana use, while public perception of cannabis risks has declined steadily.

"This study highlights an anticipated consequence of rising levels of use and increasing potency of the product," said Dr. Daniel Myran, an assistant professor of family medicine at the University of Ottawa who studies cannabis use trends. "The product is really changing under enormous pressure from market forces to increase the THC content."

The research analyzed data from the National Surveys on Drug Use and Health conducted between 2021 and 2024, which ask participants about their drug use patterns over the previous 12 months. The findings suggest that as cannabis becomes more accessible and socially accepted, the population experiencing problematic use patterns has grown accordingly.

Treatment Gaps Persist

Unlike opioid use disorder and alcohol use disorder, which have multiple FDA-approved medications for treatment, cannabis use disorder lacks any pharmacological interventions approved by the agency. Available treatments currently focus on cognitive behavioral therapy, addiction support groups, and medications to address specific withdrawal symptoms such as insomnia and anxiety.

The researchers emphasized the need for improved screening protocols in clinical settings and expanded access to evidence-based treatments for those experiencing problematic cannabis use. They also called for public health strategies that address the increasing potency and availability of cannabis products.

"The increased prevalence underscores the importance of early detection, routine screening, timely access to evidence-based treatment, and targeted strategies to counter increasing acceptance, availability, and potency of cannabis products," the authors wrote.

Policy Implications

The findings present a complex challenge for policymakers who have moved toward cannabis legalization and decriminalization in recent years. While these policies aim to reduce criminal justice involvement and generate tax revenue, they also create conditions for increased consumption and, consequently, more cases of use disorders.

Public health officials may need to balance the benefits of legalization against the costs of increased addiction, potentially through potency caps, enhanced warning labels, or dedicated funding for cannabis use disorder treatment programs.

The research arrives as the nation continues grappling with evolving drug policies across multiple substances. While the opioid crisis has driven overdose deaths to historic levels in recent years, alcohol and cannabis represent the most commonly used drugs nationally — and their changing use patterns carry significant public health implications for millions of Americans.