Young adults may seem healthy on the outside, but pain – both chronic and acute – is quietly influencing their choices.
New research from Binghamton University reveals that pain is a powerful predictor of cannabis and even alcohol-cannabis co-use among emerging adults. As legalization expands and cultural perceptions shift, these findings uncover a hidden link between pain and substance use that challenges common assumptions and could reshape how clinicians approach treatment and prevention strategies.
Pain Isn’t Just for the Old
Many people assume young adults are mostly pain-free, but in reality, they can experience significant acute and even chronic pain. That pain may also influence their decisions about substance use, including cannabis.
Researchers from Binghamton University’s Psychology Department recently explored this connection in two new studies. The first, “Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study” was recently published in Behavioral Medicine. The second, “Pain Predicts Past-Month Co-Use of Alcohol and Cannabis Among Emerging Adults” was published in the journal Alcohol.
Both studies stem from the doctoral research of lead author Callon Williams, now a postdoctoral fellow at Toronto General Hospital. Co-authors include Professor Nadine R. Mastroleo, Distinguished Professor Mark F. Lenzenweger, and Assistant Professor Emily L. Zale, who served as Williams’ advisor.
Pain as a Hidden Predictor
“Emerging adults are thought of as a healthy, pain-free population, and there’s a lot of normative substance use that occurs. And yet, pain is still predictive of cannabis initiation among this group,” said Williams ’17, MS ’21, PhD ’24, who currently has a postdoctoral fellowship at Toronto General Hospital.
The research focuses on emerging adults, the period between ages 18 and 25, using data from PATH, an epidemiological survey that provides nationally representative data concerning substance use and health-related behaviors among youth and adults. The study includes 45,971 adults and youth in the United States, a sizeable research sample, from 2013 to 2019.
During that period, cannabis was legalized for medicinal or recreational use in an additional 15 and nine states, respectively. Because of this, the definition of cannabis use expanded over subsequent waves of the survey, to include smoking, vaping and using hash oils, although edibles weren’t included.
Coping Strategies
It’s a common misconception that pain — acute or chronic — is limited to older adults. Instead, rates of some pain conditions pain in younger population mirror those in older populations around the world.
“We know that the prevalence of certain chronic pain conditions reaches its peak and then remains stable past emerging adulthood,” Zale explained. “They don’t necessarily get the same attention because the expectation is they’re young and healthy, but we are able to consistently replicate rates of both acute and chronic pain in our emerging adult samples that we would expect based on world-wide data.”
How Pain Predicts Cannabis Use
The survey relies on the 10-point pain rating scale common in doctors’ offices. The research in both articles focuses on moderate to severe pain, with a score of 4 or greater.
What Williams found is that individuals with moderate to severe pain were more likely to start using cannabis over a four-year period, and to take it up earlier during that period, than those with low or no pain at baseline. They were also 1.4 times more likely to use both alcohol and cannabis together, a riskier behavior associated with heavier use of both substances and more consequences, such as impaired driving, risky sexual behavior or impaired mental health.
Implications for Intervention
While the published studies don’t determine whether cannabis use, alone or with alcohol, persists or worsens over time, other research indicates that this is likely the case, Zale said.
Clinicians and other practitioners who work in substance use intervention among emerging adults may consider assessing patients’ pain levels to ascertain whether they are using cannabis and/or alcohol as a coping strategy, Williams noted.
Pain as a Decision Driver
“When we do substance use work with emerging adults, we need to know how much pain is a factor in their decisions,” she said. “This research provides a starting point for pain as a predictor of initiation.”
References:
“Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study” by Callon M. Williams, Nadine R. Mastroleo, Mark F. Lenzenweger and Emily L. Zale, 26 February 2025, Behavioral Medicine.
DOI: 10.1080/08964289.2025.2465525
“Pain predicts past-month co-use of alcohol and cannabis among emerging adults: Results from the Population Assessment of Tobacco and Health (PATH) Study” by Callon M. Williams, Nadine R. Mastroleo, Mark F. Lenzenweger and Emily L. Zale, 25 February 2025, Alcohol.
DOI: 10.1016/j.alcohol.2025.02.003
Never miss a breakthrough: Join the SciTechDaily newsletter.
Follow us on Google and Google News.
7 Comments
Having experienced similar if not identical pain, briefly, at twenty years of age in 1964 and chronically since thirty-seven years of age in early 1981, with learning of fundamental differences between the two in late 1981 and mid-2000, it appears I am uniquely qualified to comment on some youthful pain and some adult pain. In 1964, as a recruit and then a dental apprentice in the US Navy, I was simply excessively ingesting then undiagnosed real-food allergens in the mess-hall three times a day (hungry or not, usually hungry). In late 1981 I finally learned of my having multiple food and food additive allergies through shortly thereafter medically abandoned “cytotoxic blood testing for food allergies.” And, in the summer of 2000, I finally learned of the true toxicity of added MSG (FDA approved for expanded use in 1980) from another adult male victim of the early 1980s. Skin-prick testing in 1973 and RAST IgE antibody allergy testing in 2009 both failed to indicate for any foods or food additives. In my “experience-based” lay (as opposed to fatally-flawed “evidence-based” professional) findings, young adults are probably turning to alcohol and/or marijuana to alleviate pain unknowingly caused to them by FDA approved food poisoning aggravating their still undiagnosed food allergy reactions; namely soy, TBHQ and added MSG, all FDA approved by 1980, two and a half generations ago.
Charles I would like to know what foods would not have msg or the thing you have food allergies to because I can’t afford a test for my allergies but I would like to know what you have found to be safe food as I do believe this to be my problem as well thank you for your time
Crystal, thanks for the reply, not a problem to try to help you and I hope your allergy/additive problems are not as serious as mine. First, I regret to inform you that I still know of no affordable, convenient and/or reliable laboratory allergy testing or online community to recommend, to anyone. However, There are ways to test yourself at-home and/or deal with undiagnosed allergies on your own or with lay and/or professional help. First, a book, “The Pulse Test” by Dr. Arthur F. Coca, 1956, free online in PDF format: https://soilandhealth.org/wp-content/uploads/02/0201hyglibcat/020108.coca.pdf
Next, sad to say, I don’t yet know of any brand of commercially prepared foods that is truly safe. Too many people keep buying the lies. And, a lot of the symptomology can be easily confused with common ailments and/or natural aging. With even some bulk food products (e.g., pork sausage, minimally) being adulterated with MSG, even cooking at-home without carefully reading the labels can be risky. And, MSG may not be the worst of the problem, as ubiquitous to the food supply as soy and the cooking oil preservative TBHQ (e.g., microwave popcorn, Cheez-It snack crackers, etc.) have now become. Basically, for a ‘worse’ but not ‘worst’ case scenario like myself, preparing everything from scratch at-home with as natural organic staples as possible is advisable. However, through at-home experimentation I’ve found I can stay relatively healthy and active through partial avoidance, some alternating and/or rotating of known allergens and toxins, some intermittent fasting and taking some targeted nutritional supplements to compensate for what I may inadvertently avoid from good source allergens (e.g., dairy and meats, minimally). A daily diet diary of what you ingest and how it makes you feel can also help to identify some sensitivities. I hope these comments help some.
Right.. the report proved zero and this article said zero.. but you thought you would post it anyway.. it’s common knowledge that cannabis is good for you.. in spite of the refer madness fear mongering
Sounds as if the Journal of Alcohol is like the Journal of Forensic Science where the DEA pays their bills and the articles reflect it.
Need to change the headline makes it sound like cannabis use causes pain but for other set above yeah this article was a waste of time.
This article spent about 7 paragraphs just stating peoples credentials with absolutely no substance otherwise. This article is a waste of everyones time.