Survey Among College Students Finds Associations Between Substance Use and Mental Health

How does the use of cannabis and alcohol affect the mental health of college students? Researchers in a recently published study noted the need for more studies on the relationship between substance use in college students and depression, anxiety, and stress among this population (1). This cross-sectional survey study examined simultaneous cannabis and alcohol (SCA) use specifically and mental health outcomes. Additionally, the researchers examined the effects of SCA use among male and female students, hypothesizing the potential of sex-related outcomes. Studies on these topics could help guide clinical interventions for young adults and for individuals seeking mental health treatment. The study, “Monthly simultaneous cannabis and alcohol use: effects on depression, anxiety, and stress in male and female college students,” was published in the Journal of Cannabis Research in November 2025.

How Substance Use and Mental Health were Studied

The online survey included responses from 367 college students (245 females and 122 males), ages 18–25 from a university psychology student research pool. The survey included questions on monthly SCA use and symptoms of depression, anxiety, and stress. Demographics were also included, and the students resided in the state of Colorado. Based on their responses, the participants were grouped by monthly or greater SCA use and less than monthly SCA use.

To measure alcohol consumption patterns, the Alcohol Use Disorders Identification Test (AUDIT) was used. To measure cannabis consumption and administration, the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory was used.

Co-use is commonly defined at using cannabis and alcohol and experiencing the intoxicating effects within the same timeframe.

Results: Positive Predictions but No Significant Sex Differences

The monthly use of alcohol and cannabis was positively associated with mental health outcomes in some cases, most positively with depression. The groups also significantly differed on typical alcohol use frequency and on most recent cannabis use occasion.

Highlighted results include:

• Monthly or greater SCA use predicted depression in both male and female students, with no significant difference in relation of SCA use between the sexes
• Anxiety and stress in were predicted by monthly or greater SCA use in males but not in females, though the relations between SCA use and these outcomes was not significantly different between the sexes
• Alcohol use frequency negatively predicted stress, anxiety, and depression among males but not females

Analyses indicated that based on the sample size, the study was not adequately powered to detect sex differences between SCA use and stress and anxiety. For the relationship between SCA use and depression, increasing the sample size in simulations was not enough to improve the power, which may suggest a sex difference may not be present.

One limitations to the study was using survey questions that asked about frequent alcohol use, yet asked about most recent cannabis use. Additionally, the results of the study are limited in their generalizability due to the narrow demographics and location of the sample.

Impact on Mental Health Intervention and Future Research

Ultimately, the researchers concluded that the results provided additional insight into the connection between substance use in college students and the effect on their mental health. Programs aiming to prevent depression could also be particularly applicable for male students, they noted.

“Mental health providers working with college students may wish to consider incorporating detailed assessments of alcohol and cannabis co-use, as SCA use may be a useful intervention target,” the researchers stated. “SCA use could also be an important factor to assess in a prevention or mental health promotion context.”

Future research in this area should incorporate more representative sample populations, deeper assessments of substance co-use, and longitudinal designs in order to further examine the connection between the simultaneous use of alcohol and cannabis and mental health, they added.

References

1. Hetelekides, EM.; McMichael, T.; Tyskiewicz, AJ.; Prince, MA.; Emery, NN; Conner, BT.; Karoly, H. Monthly simultaneous cannabis and alcohol use: effects on depression, anxiety, and stress in male and female college students. J Cannabis Res 2025, 7(87). DOI: 10.1186/s42238-025-00347-y