In 2023, Delaware decriminalized the possession and use of personal quantities of cannabis for those 21 and older. One of the by-products of the widespread legalization of recreational cannabis is a false sense of security when using the substance, which could lead to dangerous consequences. With alcohol and pot both lawful in the state (liquor is likewise legal for those 21 and over), and cannabis becoming increasingly socially acceptable, experts in the field of addiction are increasingly concerned about young adults mixing the two substances.

According to the National Institutes of Health, which looked at the behavior of adults ages 18 to 30, “more than 86% of individuals with a history of cannabis use disorder also meet current criteria for alcohol use disorder.” The practice has both a clinical name—SAM, for simultaneous alcohol and marijuana use—and a colloquial name: cross-fading. But regardless of what you call it, such risky behavior increases the absorption and effects of THC.

“There was a study done on emergency room visits, and basically the combination of the two is more harmful than when used independently,” says Katherine Elder, the co-founder, with her husband Jim Elder, of Delaware Psychological Services, located in Newark and Dewey Beach. The combination also makes recovery more challenging, as Elder explains: “If someone used alcohol and marijuana together regularly, and then they’re recovering from alcohol, it will be complicated if they return to just using marijuana, whereas if they’d only used alcohol, they could possibly use marijuana in their alcohol recovery.”

Elder’s colleague Aviva Zohar notes “increased incidents of impairment and irresponsible behavior” when mixing the two—and sounds an additional warning for users who are also on prescription anti-anxiety and antidepressant meds: “It’s going to amplify the sedative effect. It can be a bad combination.”

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