Georg Henrik Wrede

Simultaneous Use of Alcohol and Cannabis (SAM)

International Trends

Internationally, there are significant changes in the legal status of cannabis, or at least discussion on the topic. Since alcohol and cannabis are often used together, this has increased interest in understanding the combination of these substances and their unique role in substance-related harms. This is commonly abbreviated as “SAM” (simultaneous alcohol and marijuana use).

Research shows that individuals who use both alcohol and cannabis have an increased risk of substance-related harms, such as driving under the influence, blackouts, and cognitive problems, compared to those who use only one of the substances. Simultaneous use, in particular, increases the risk of negative consequences.

Statistics on drug use, especially if it is prohibited, are not reliable. Among young adults in the US who drink alcohol, approximately 30% of 19–22-year-olds and 20–25% of 23–30-year-olds reported using alcohol and cannabis simultaneously in the past year. As simultaneous use is increasing among young adults, it is important to understand the patterns, causes, and consequences in order to develop preventive interventions. There is thus a clear need for more research on the simultaneous use of alcohol and cannabis. There is also a need for more standardized definitions of simultaneous use and more comprehensive studies of the effects of different cannabinoids (THC and CBD). This is needed, among other things, to develop and improve effective preventive interventions.

Risks of Simultaneous Use

Simultaneous use of alcohol and cannabis is associated with unique characteristics, causes, consequences, and psychological processes compared to the use of a single substance. There is a need to examine in more detail the pharmacological, psychological, and social factors that influence this combination.

Studies have shown that simultaneous use does not necessarily lead to higher cannabis consumption compared to cannabis use alone. However, it can increase the risk of sexual assault, especially in social contexts where there are individuals at increased risk of committing such crimes.

The Situation in Finland

In Finland, the connection between alcohol and cannabis use is strong. According to a recent study, over half of those who have tried cannabis at some point in their lives were under the influence of alcohol the first time. Alcohol was also common in later cannabis use situations. In 2022, approximately 300,000 people reported using cannabis in the past 12 months. Of these, 78% reported using alcohol simultaneously, and 27% that they always or most often did so.

Cannabis is the most common illegal drug in Finland. There are approximately 16,000 daily users, and use is most common among 25–34-year-olds. The majority of Finnish cannabis users use it on weekends (65%) and evenings (67%). Common usage situations are parties, social gatherings, games, and hobbies. Almost 45% use cannabis at home, while use in public places is less common.

Approximately one million Finns have tried cannabis at some point. As previously noted, about 300,000 have tried it in the past 12 months. The number of those who report monthly use is 150,000, and 16,000 report using cannabis daily. Cannabis use has increased among young people, especially boys, during the 2010s.

It is possible to get cannabis prescribed by a specialist doctor for certain illnesses, but this is rare in Finland. The view of the risks of trying and using cannabis has become milder in all age groups. At the same time, the use of cannabis and other drugs is less accepted than alcohol, which is often involved in the first drug experiments.

Situation i EU

In the new report from EUDA we can see that survey respondents from reported cannabis as their most frequently used illicit drug — 59 % of them reported use in the last year, followed by MDMA/ecstasy (30 %) and cocaine (29 %). The most common pattern of drug use reported through the survey was “polysubstance” use, the use of two or more psychoactive substances (licit or illicit), simultaneously or sequentially.  The new (Feb 25, 2025) report can be found here. https://www.euda.europa.eu/ewsd2024_en