Objectives
To examine demographic, clinical, and motivational correlates of using marijuana (THC-dominant cannabis) and cannabidiol (CBD) as harm-reduction strategies for reducing alcohol consumption among adults at risk for alcohol use disorder (AUD).

Background
Prior research has suggested that cannabis may serve as a safer or less harmful substitute for alcohol, particularly among adults seeking to reduce consumption or mitigate alcohol-related harms. Cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC)-dominant cannabis (“marijuana”) represent distinct cannabinoid profiles that may differentially influence mood, craving, and risk behaviors. While THC-dominant products may reduce stress or craving acutely, CBD is non-intoxicating and has shown anxiolytic, antidepressant, and anti-craving properties in emerging preclinical and human research. The substitution of cannabis for alcohol—whether intentional or incidental—has been proposed as a harm-reduction pathway that may reduce alcohol intake, lower risk for AUD, and decrease alcohol-attributable morbidity. However, little is known about the characteristics of individuals who use cannabis or CBD for this purpose, their readiness to change drinking behavior, or the psychological and health correlates associated with these choices. This study investigated demographic, psychological, and behavioral predictors of using marijuana, CBD, or both to reduce alcohol consumption among Florida adults at elevated risk for AUD.

Method
Online surveys were distributed via Qualtrics to 451 Florida adults (≥18 years) who consumed ≥5 alcoholic drinks per week and reported any lifetime cannabis use. Measures included comorbid health conditions, alcohol use severity (AUDIT), depressive symptoms (PHQ-8), anxiety (GAD-7), posttraumatic stress symptoms (PC-PTSD), childhood trauma (ACE-Q), and readiness to change (RCQ-12). Chi-square and ANOVA examined differences across AUD risk groups and strategy groups (CBD, marijuana, both, neither). Multivariate logistic regression identified independent predictors of cannabis- and CBD-based alcohol-reduction behavior.

Results
High AUD risk (AUDIT ≥16) was found in 61.4% of men and 40.9% of women. Higher AUD risk was associated with younger age, more depressive and anxiety symptoms, higher ACE-Q scores, PTSD positivity, more comorbid conditions, and greater readiness to change (p < 0.001). Marijuana (37.9%) and CBD (32.2%) were the most frequently reported alcohol-reduction strategies, with higher AUD severity linked to greater perceived effectiveness. Age differed significantly (p < 0.001) among those who had tried CBD (x̄ = 40.6 ± 11.2), marijuana (x̄ = 41.5 ± 11.7), or both (x̄ = 39.6 ± 10.3) compared with those who tried neither (x̄ = 48.1 ± 15.3). Although 16.9% of participants identified as Hispanic, 26.6% of them reported using both CBD and marijuana for alcohol reduction. Moderate to severe depressive (p = 0.02) or anxiety (p < 0.001) symptoms were associated with trying both cannabis products, as was being in an action stage of readiness to change (p < 0.001). Predictors of marijuana use included PTSD positivity (OR = 1.76), more comorbidities (OR = 1.17), action-stage readiness (OR = 1.47), and high AUD risk (OR = 1.83). Predictors of CBD use included higher ACE-Q scores (OR = 1.14), more comorbidities (OR = 1.18), action-stage readiness (OR = 1.50), and high AUD risk (OR = 1.95).

Conclusion
Adults with greater AUD severity, trauma exposure, and comorbid mental health symptoms were more likely to experiment with cannabis-based strategies for reducing alcohol use, particularly those already motivated to change their drinking. Younger, Hispanic younger respondents and people with greater anxiety or depressive symptoms were likely to have tried both CBD- and THC-dominant products in an effort to reduce alcohol consumption. These findings suggest that there may be multiple drivers, including psychological vulnerability (e.g., trauma, PTSD, depressive/anxiety symptoms) and readiness for behavior change, that shape interest in cannabinoid substitution as a harm-reduction approach. From a public health perspective, distinguishing between THC- and CBD-dominant products is critical, as these substances may operate through different mechanisms—such as reducing craving, regulating mood, or substituting non-alcohol reward pathways. Future longitudinal and experimental studies should evaluate whether targeted cannabinoid-based interventions can provide sustainable reductions in alcohol use and related harms. By identifying key clinical and motivational predictors, this study provides a foundation for developing precision harm-reduction strategies that integrate cannabinoid pharmacology with behavioral change models to improve outcomes for individuals at elevated risk for AUD.

Learning Objectives: 

• Patterns of cannabidiol and THC-dominant cannabis use as alcohol harm-reduction strategies among adults at elevated risk for alcohol use disorder (AUD)
  
  
• Key demographic, clinical, and psychological predictors that influence the likelihood of using CBD and/or THC to recue alcohol consumption