5.31 Other drug use

Last updated April 2012 

As noted in Section 5.5, tobacco use in adolescence is associated with other risky behaviours, including other drug use. Australian and international research consistently shows that smokers are more likely than non-smokers to drink alcohol (including frequent binge drinking),1 use cannabis and other illicit drugs2–4 and sniff glue or petrol.5

Concurrent use of tobacco and alcohol appears to affect the quantity of consumption. For example, in recent research among US college students who were both smokers and drinkers, (mean age 20 years) students drank more while smoking and smoked three times as many cigarettes, on average, during drinking episodes.6 Smoking while drinking was more likely when students were with others at a party or a bar, while increased stress between assessments predicted a greater likelihood of smoking while drinking.6 High rates of drinking common among young adults may contribute to the transition from less-than-daily to daily cigarette smoking, for example by altering the subjective effects of smoking such as satisfaction and enjoyment; preliminary research among young adults found that alcohol consumption was associated with a reduction in some of the negative effects associated with smoking and with an increase in subsequent smoking levels.7

Recent evidence from a US longitudinal study among young adults followed over three years suggests that even occasional smoking is predictive of hazardous drinking and alcohol use disorders, after controlling for baseline drinking behaviours.8 Concurrent tobacco and alcohol use among young people aged 15 years has been associated with greater nicotine dependence, significantly higher levels of consumption and more excessive use of alcohol, earlier drinking uptake, and more cannabis use, compared with those who consumed only alcohol. Similarly, compared with those who used tobacco only, concurrent users reported higher nicotine dependence and more cannabis use.9 The severity of nicotine dependence has also been found to significantly predict alcohol-related problems among adolescent smokers in a smoking cessation clinical trial.10

In Australia, in a 2007 study of Australians aged between 12 and 19 years who were former or current smokers or drinkers, the average age at which they had their first cigarette or full glass of alcohol was very similar, at about 14.5 years of age.11 For young people in the same age bracket, initiation of cannabis use among those who had had a 'hit' occurred at an average age of about 15 years, and first use of ecstasy occurred at an average age of 16.3 years.11 Up to almost half of those using illicit drugs have on occasion used tobacco at the same time: in 2008, among Australian secondary school children aged 12–17 years who reported having used other substances in the previous 12 months, 49% who had taken ecstasy, 48% of cannabis users, 43% who had used amphetamines and 37% who had used hallucinogens reported also using tobacco at the same time.12

A recent survey among over 29 000 young French people aged 17 years revealed that the likelihood of first initiating tobacco was far greater than the likelihood of initiating cannabis, while the risk of experimentation with cannabis or tobacco was much greater once a student had experimented with one of these substances.13 Recent research among some groups of US youth has found the association between trajectories of tobacco and cannabis use from adolescence into adulthood to be quite high,14 with some evidence that 'smoking' may represent a social construct and an activity domain within which the use of cigarettes or cigars containing tobacco and/or cannabis is somewhat interchangeable.15

In some settings, however, it appears that it is the wish to use cannabis that leads to tobacco addiction, tobacco being used initially as a means of facilitating cannabis smoking16, 17 (see Chapter 6, Section 6.10). This pattern of use has been reported among some Aboriginal and Torres Strait Islander populations18 (see Chapter 8, Section 8.11.2). Similarly, recent Swiss research among young cannabis users found the mixing of tobacco and cannabis in cannabis cigarettes to be very common, especially among daily tobacco smokers,19,20 with some current and former cannabis users perceiving cannabis to be more natural, less harmful and less addictive than tobacco.19

Cannabis use has been linked with the transition from experimental to daily tobacco smoking in late teenage and early adult years.21 There is also evidence from a large school survey among Canadian adolescents that, compared with cannabis non-users, cannabis users were almost six times more likely to be current tobacco smokers, while those adolescents who concurrently use tobacco and cannabis may be more tobacco dependent.22 Victorian research found that adolescents and young adults who use cannabis on a regular basis are more likely to progress to tobacco initiation and dependence, even after controlling for obvious potential confounding factors such as peer group and family influences.23 The authors of this study suggest a number of reasons why the behaviours may be interlinked, including the propensity for tobacco and tobacco to be used in combination, biological mechanisms, and nicotine functioning as a way of ameliorating symptoms of withdrawal from cannabis use. Recent research among Finnish twins suggests that several common genetic influences may be related to tobacco and cannabis (and other illicit drug) use; common and unique environmental factors were also very important, while the direct impact of tobacco smoking uptake explained most of the variation in the initiation of illicit drug use.24

The connection between smoking and the use of other drugs is likely to be due to a combination of individual, social and environmental factors, including temperamental characteristics.25 For example, recent evidence from The Netherlands suggests young adolescents who report higher levels of hopelessness and sensation seeking are at higher risk for an early onset of substance and poly-substance use (including alcohol, tobacco and cannabis).26

There is also some evidence that the biological changes in the brain caused by early exposure to nicotine may also influence neurological response to other drugs, such as alcohol and cannabis, and other drugs of abuse, leading to a greater risk of ongoing use and addiction.4

Recent news and research

For recent news items and research on this topic, click here (Last updated March 2018)  


1. Hughes S, Hughes K, Atkinson A, Bellis M and Smallthwaite L. Smoking behaviours, access to cigarettes and relationships with alcohol in 15- and 16-year-old schoolchildren. European Journal of Public Health 2010;21(1):8-14. Available from: http://eurpub.oxfordjournals.org/cgi/content/full/ckp234v1

2. Fuller E. Smoking, drinking and drug use among young people in England in 2006. A survey carried out for The Information Centre for health and social care by the National Centre for Social Research and the National Foundation for Educational Research. London: The Information Centre, 2007. Available from: http://www.ic.nhs.uk/webfiles/publications/smokedrinkdrug06/Smoking%20Drinking%20and%20Drug%20Use%20among%20Young%20People%20in%20England%20in%202006%20%20full%20report.pdf

3. Tyas S and Pederson L. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tobacco Control 1999;7(4):409–20. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/7/4/409

4. The National Centre on Addiction and Substance Abuse at Columbia University. Tobacco: the smoking gun. New York: CASA, prepared for The Citizens' Commission to Protect the Truth, 2007. Available from: http://www.casacolumbia.org/absolutenm/articlefiles/380-Tobacco-%20The%20Smoking%20Gun%20final.pdf

5. Conwell L, O'Callaghan M, Andersen M, Bor W, Najman J and Williams G. Early adolescent smoking and a web of personal and social disadvantage. Journal of Paediatric Child Health 2003;39:580-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14629522

6. Witkiewitz K, Desai S, Steckler G, Jackson K, Bowen S, Leigh B, et al. Concurrent drinking and smoking among college students: an event-level analysis. Psychology of Addictive Behaviors 2011; [Epub ahead of print]. Available from: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2011-20051-001

7. McKee S, Harrison E and Shi J. Alcohol expectancy increases positive responses to cigarettes in young, escalating smokers. Psychopharmacology 2010;210(3):355-64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20352411

8. Harrison E and McKee S. Non-daily smoking predicts hazardous drinking and alcohol use disorders in young adults in a longitudinal US sample. Drug and Alcohol Dependence 2011;118(1):78-82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21441000

9. Schmid B, Hohm E, Blomeyer D, Zimmermann U, Schmidt M, Esser G, et al. Concurrent alcohol and tobacco use during early adolescence characterizes a group at risk. Alcohol and Alcoholism 2007;42(3):219–25. Available from: http://alcalc.oxfordjournals.org/cgi/content/full/42/3/219

10. Leeman R, Schepis T, Cavallo D, McFetridge A, Liss T and Krishnan-Sarin S. Nicotine dependence severity as a cross-sectional predictor of alcohol-related problems in a sample of adolescent smokers. Nicotine & Tobacco Research 2010;12(5):521-4. Available from: http://ntr.oxfordjournals.org/cgi/content/full/ntq024v1

11. Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: first results. Drug statistics series no. 20 AIHW cat. no. PHE 98. Canberra: AIHW, 2008. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10579

12. White V and Smith G. Australian secondary school students' use of tobacco, alcohol, and over-the-counter and illicit substances in 2008. Canberra: Drug Strategy Branch, Australian Government Department of Health and Ageing, 2009. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/2C4E3D846787E47BCA2577E600173CBE/$File/school08.pdf

13. Mayet A, Legleye S, Chau N and Falissard B. Transitions between tobacco and cannabis use among adolescents: a multi-state modeling of progression from onset to daily use. Addictive Behaviors 2011;36(11):1101–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21794987

14. Brook J, Lee J, Finch S and Brown E. Course of comorbidity of tobacco and marijuana use: psychosocial risk factors. Nicotine & Tobacco Research 2010;12(5):474-82. Available from: http://ntr.oxfordjournals.org/cgi/content/full/ntq027v1

15. Lee J, Battle R, Lipton R and Soller B. 'Smoking': use of cigarettes, cigars and blunts among Southeast Asian American youth and young adults. Health Education Research 2010;25(1):83–96. Available from: http://her.oxfordjournals.org/cgi/content/full/25/1/83

16. Amos A, Wiltshire S, Bostock Y, Haw S and McNeill A. 'You can't go without a fag. You need it for your hash'-a qualitative exploration of smoking, cannabis and young people. Addiction 2004;99:5-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14678065

17. Tullis L, DuPont R, Frost-Pineda K and Gold M. Marijuana and tobacco: a major connection? Journal of Addictive Diseases 2003;22:51-62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14621344

18. Lindorff K. Tobacco – time for action. National Aboriginal and Torres Strait Islander Tobacco Control Project - final report. Canberra: National Aboriginal Community Controlled Health Organisation, 2002. Available from: http://www.weftweb.net/naccho/Files/NACCHO_Tobacco_report.pdf

19. Akre C, Michaud P, Berchtold A and Suris J. Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents. Health Education Research 2010;25(1):74–82. Available from: http://her.oxfordjournals.org/cgi/content/full/25/1/74

20. Belanger R, Akre C, Kuntsche E, Gmel G and Suris J. Adding tobacco to cannabis: its frequency and likely implications. Nicotine & Tobacco Research 2011;13(8):746-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21454910

21. Park S, Weaver T and Romer D. Predictors of the transition from experimental to daily smoking in late adolescence and young adulthood. Journal of Drug Education 2010;40(2):125–41. Available from: http://www.ncbi.nlm.nih.gov/PubMed/21133327

22. Okoli CTC, Richardson CG, Ratner PA and Johnson JL. An examination of the smoking identities and taxonomies of smoking behaviour of youth. Tobacco Control 2008;17(3):151-8. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/17/3/151

23. Patton G, Coffey C, Carlin J, Sawyer S and Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 2005;100(10):1518-25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16185213

24. Huizink A, Levalahti E, Korhonen T, Dick D, Pulkkinen L, Rose R, et al. Tobacco, cannabis, and other illicit drug use among Finnish adolescent twins: causal relationship or correlated liabilities? Journal of Studies on Alcohol and Drugs 2010;71(1):5–14. Available from: http://www.jsad.com/jsad/article/Tobacco_Cannabis_and_Other_Illicit_Drug_Use_Among_Finnish_Adolescent_Twin/4408.html

25. Creemers H, Korhonen T, Kaprio J, Vollebergh W, Ormel J, Verhulst F, et al. The role of temperament in the relationship between early onset of tobacco and cannabis use: the TRAILS study. Drug and Alcohol Dependence 2009;104(1–2):113–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19482444

26. Malmberg M, Overbeek G, Monshouwer K, Lammers J, Vollebergh W and Engels R. Substance use risk profiles and associations with early substance use in adolescence. Journal of Behavioral Medicine 2010;33(6):474-85. Available from: http://www.springerlink.com/content/j6390u85812663x8/fulltext.html

      Previous Chapter