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Experts note that people who smoke tend to have higher rates of anxiety and depression. Juan Monino/Getty Images
  • Researchers are reporting that people who use tobacco and cannabis tend to have higher rates of depression and anxiety.
  • Experts note that people who experience depression and anxiety tend to use substances such as tobacco, cannabis, and alcohol.
  • They add that a person can become more dependant on a substance to improve their mental outlook.

A new report shows that tobacco and cannabis users are more likely to experience mental health conditions like anxiety and depression.

The findings were published on September 13 in the journal PLOS ONE.

In the study, a team from the University of California San Francisco said that people using both substances are more likely to report anxiety and depression than those who only used tobacco or those who used neither substance.

The researchers noted that tobacco and cannabis are among the most frequently used substances in the world and that use has become more frequent since the expanding legalization of cannabis.

The team analyzed data on the mental health and substance use of 53,843 adults in the United States who participated in online surveys as part of the COVID-19 Citizens Science Study, which collected data from 2020 to 2022.

The data showed nearly 5% of participants reported only using tobacco, while almost 7% reported only using cannabis, and less than 2% reported using both.

Among those in the group using both, 26% reported experiencing anxiety and 28% reported experiencing depression.

Of people who used neither substance, 10% reported experiencing anxiety and 11% reported experiencing depression.

The study said the likelihood of having these mental health disorders was about almost 2 times greater for co-users than non-users.

Co-use and use of cannabis only were also associated with a higher likelihood of having anxiety compared to using tobacco only.

The authors said the study can’t determine causation. However, they did conclude the co-use of tobacco and cannabis is associated with poor mental health and suggested that integrating mental health support with tobacco and cannabis cessation programs may help address the link.

“Engaging in both tobacco and cannabis is linked to diminished mental well-being,” the researchers said in a press release.

Mental health experts told Healthline they weren’t surprised about the link between using both substances and poor mental health, although they pointed out that the link between smoking and mental health has been more about anxiety than depression in the past.

They also noted much of the data was collected during the COVID-19 pandemic, which brought about other stressors that could’ve intensified both anxiety and depression as well as substance use.

Dr. David Hu is the vice president and medical director of psychiatry for Zinnia Health, a nationwide behavioral health treatment network.

Hu told Healthline the study is consistent with other research and clinical observations.

“The co-occurrence of substance use disorders, depression and anxiety are very high,” Hu said. “Causality is not clear, however. People with depression may be more likely to use tobacco or marijuana to self-medicate their depressed mood.”

However, Hu said a person’s mood appears to become more depressed after the effects of the substances subside. He said people often say that they need marijuana or tobacco to relax and calm anxiety.

“But the anxiety may actually be cravings for the substance,” Hu said. “It might be a chicken or the egg dilemma.”

Avigail Lev, the founder and director of Bay Area CBT Center (cognitive behavioral therapy) in Oakland, CA, told Healthline the study makes sense in concluding people who smoke are more likely to experience anxiety, depression, or both.

“This could be because those who smoke may be less concerned about their health, potentially indicating parasuicidal or passive suicidal tendencies,” Lev said.

“One reason might be that both cannabis and tobacco can regulate the nervous system and mood, enhancing certain pleasurable sensations. Therefore, individuals who smoke might already be experiencing more distress than the average person.”

Lev said the substance use could be a form of self-harm, during which individuals intentionally inflict damage on themselves without a direct intent of suicide.

“Smoking can also be seen as passive suicidal behavior,” Lev added.

“Engaging in the act, despite knowledge of its harmful consequences, may indicate a level of indifference toward one’s own well-being. The temporary relief smoking provides from stress or emotional pain can mirror other behaviors where individuals seek short-term escapes from their internal struggles.”

Dr. Ryan Sultan, a psychiatrist and professor at Columbia University in New York, told Healthline the pleasurable effects of smoking can initially be relaxing.

But the longer someone smokes, the more they need the substance, which increases the chances of mental issues.

“One possible explanation for the observed correlation is that individuals with anxiety or depression might be more likely to turn to substances like tobacco or cannabis as a way to self-medicate,” Sultan said. “While these substances can provide temporary relief, they might exacerbate the underlying issues in the long run.”

“I have a patient ‘Sarah’, who struggles with social anxiety,” Sultan said.

“She might use cannabis before social events to feel more at ease. However, as she became more reliant on the substance to manage her anxiety, she found that her symptoms become more pronounced when she was not under its influence.”

“It’s important to approach the findings of the study with a nuanced understanding,” he added.

“While there’s an association between tobacco, cannabis use, and increased anxiety and depression, the relationship is complex. Factors like self-medication, the brain’s adaptation to regular substance use, and individual differences all play a role.”

Another factor in the study is that its data was collected during the pandemic.

“The pandemic did increase symptoms of depression and anxiety in a significant amount of population however, based on the information I have it seems like pandemic reduced the tobacco smoking in people due to the fear of getting infected with COVID,” Dr. Adil A. Mohammed, a psychiatrist at Harmony United Psychiatric Care, told Healthline.

Dr. Lea McMahon, the chief clinical officer at Symetria Recovery in Illinois and Texas, told Healthline the pandemic heightened people’s stress level while reducing their support systems.

“All of this may have increased an individual’s likelihood to use tobacco, alcohol, or cannabis to manage emotions or as a form of escapism,” McMahon said. “It may also have influenced people in active use to increase consumption.”

McMahon added that after the pandemic, anxiety has become an even bigger problem, especially among young people.

“For this reason, they may use tobacco, alcohol, or cannabis to help alleviate stress in these challenging scenarios,” she said.

“People in active use may also have found it harder to reduce or stop using these substances. It’s difficult to determine the exact effect the pandemic will have had on mental health and tobacco/cannabis use, but it will have affected the numbers on some level.”

McMahon said that getting professional help is key.

“It’s vital for people to learn healthy coping mechanisms, access the right resources, and receive support for conditions such as anxiety and depression,” she said.

“Tobacco and cannabis can seem like a short term-solution, but in the long run, they’re only going to make things worse.