A startling shift has occurred in the United States—from use of alcohol to use of cannabis, THC, and cannabis-infused beverages. The percentage of drinking adults in the US has been dropping since 2010, and the trend away from alcohol is accelerating. Consumer enthusiasm is growing for drinks infused with cannabis, primarily Δ9-tetrahydrocannabinol (THC).

The cannabis products are marketed as “better for you,” without hangovers, with fewer calories or less intoxication (depending on dosage). As I have noted earlier, Gen Z and millennials are using less alcohol and more cannabis, often edibles. Some commentators describe this cultural shift as the adoption of the “California sober” mindset—consuming cannabis or THC-infused beverages rather than alcohol.

In states where hemp-derived THC is loosely regulated, consumption of THC beverages, including seltzers and “hemp elixirs,” has rapidly increased. Major cannabis companies launched THC drink lines, promoting them as modern alternatives to alcohol and targeting consumers cutting back on drinking or who no longer drink at all.

While the focus has been on Gen Z and millennials, more recently, some baby boomers are also switching to cannabis from alcohol, because of recent studies challenging decades of alcohol benefits and raising alarm over drinking. In contrast, cannabis is perceived as safer, without causing liver damage, cancers, or the cognitive decline linked to alcohol. Cannabis also has a particular appeal for older adults who want fewer hangover effects and a drink fitting wellness-oriented senior lifestyles.

However, some THC drinks reach alarming potency, up to 100 mg of THC per serving. Such concentrations triggered regulatory concerns this year. Until recently, hemp-derived THC products, including drinks, exploited a gray area created by the 2018 Farm Bill. However, in November 2025, new legislation enacted by Congress redefined “hemp,” and it will ban most hemp-derived THC beverages and edibles late in 2026.

Consumable “hemp-derived cannabinoid products” will be limited to ≤ 0.4 mg total THC per container, a threshold far lower than current doses in THC drinks. This means, unless new laws/regulations pass, most THC-infused drinks sold today will become illegal nationwide by late 2026.

THC Reduces Alcohol Self-Administration

There has long been speculation that cannabis legalization would reduce alcohol consumption. A new randomized controlled crossover trial, led by Jane Metrik, Ph.D., and colleagues at Brown University’s Center for Alcohol and Addiction Studies (CAAS), provides the first evidence that cannabis with active THC does in fact reduce alcohol consumption.

Investigators enrolled 157 participants who used alcohol and cannabis heavily (at least twice weekly). Participants completed three sessions in which they smoked cannabis with either 7.2% THC, 3.1% THC, or a placebo (0.03% THC). After smoking, subjects were exposed to neutral cues and personalized alcohol cues before engaging in an alcohol self-administration task. Subjects could consume their preferred alcoholic beverage or receive small cash payments for abstaining.

Participants receiving cannabis containing 3.1% THC consumed about 19% less alcohol compared to placebo. Those who received 7.2% THC consumed 27% less alcohol. However, as the authors emphasized, the study evaluated acute—not chronic—effects; participants were already cannabis users, and the experimental setting may not mirror real-world variability in cannabis potency, social cues, or available beverages.

THC is not unique, as multiple pharmacologic agents also reduce alcohol self-administration and drinking behavior: naltrexone, acamprosate, topiramate, baclofen, GLP-1 receptor agonists such as semaglutide, and several investigational compounds. There is strong evidence that naltrexone reduces heavy-drinking episodes. GLP-1 receptor agonists seem particularly promising since a recent randomized controlled trial showed that semaglutide reduced alcohol craving, number of drinks consumed per day, and laboratory self-administration.

GLPs are so promising for treating alcohol use disorder (AUD) that pharmaceutical company Eli Lilly is investing in a dual GIP/GLP-1 receptor agonist drug. Unlike semaglutide or tirzepatide (designed primarily to treat type-2 diabetes), brenipatide is optimized for blood-brain barrier penetration and direct modulation of the reward circuitry. The company is now in phase-3 clinical trials for brenipatide and phase-2 trials for another drug, mazdutide. Lilly is clearly making a serious investment in AUD treatment innovation through GLPs.

Longer-Term Questions

Suppose many more individuals substitute most alcohol with THC beverages. Would the change result in improved well-being, health, cardiovascular and vascular physiology, cognitive performance, and reduced long-term neurologic risks? These are unanswered but key questions.

Dose remains a pressing variable. THC beverages (for now) exhibit astonishing dose variability—from products with 2–5 mg THC to those containing 50–100 mg per serving. It’s not obvious to consumers what constitutes an intoxicating dose, nor do many understand the differences between smoked and orally ingested cannabinoids.

Substituting alcohol with THC beverages may reduce some alcohol-related harms (hangovers, hepatotoxicity, cirrhosis risk), but also introduces new risks: THC intoxication; psychiatric, cognitive, and behavioral effects; and cardiovascular/vascular effects, as well as, for some, addiction.

One study showed that cannabis users had about a six-fold increase in heart attack risk, four-fold increase in ischemic stroke risk, and double the heart-failure risk versus non-users. Cannabis use is also associated with twice the risk of dying from cardiovascular disease, along with significantly increased risks of stroke and acute coronary syndrome, a sudden reduction in or blockage of blood flow to the heart.

THC and especially CBD interfere with liver enzymes, which can raise or lower many medication levels, including anticoagulants (warfarin, increasing bleeding risk), antiepileptics, antidepressants, antipsychotics, benzodiazepines, and opioids. THC also may increase heart rate and blood pressure and interact with beta-blockers, anti-arrhythmics, and stimulants.

Cannabis and other sedating or psychoactive drugs may worsen falls and confusion, impair driving, increase workplace accidents, and cause respiratory suppression (with opioids) and prolonged sedation. Cannabis hyperemesis syndrome (CHS), a recurrent disorder of severe nausea, vomiting, and abdominal pain in chronic, heavy-THC users is Increasingly common, Emergency room staff call it “scromiting”—pot users admitted screaming, doubled over with abdominal pain, and vomiting.

Conclusion

The rise of THC-infused beverages represents a significant shift from the alcohol-only landscape of social substance use in the US. The substitution of alcohol with THC beverages changes—but does not eliminate—risks associated with recreational intoxicants.

Low-dose chronic THC is likely to impair attention, increase impaired driving risks, and produce dependency, withdrawal, anxiety, and tachycardia. Reward deficiency or depression is likely. High-dose or heavy use would likely increase addiction risk, cannabis hyperemesis, arrhythmias, respiratory issues (if smoked), acute panic, psychosis, cognitive decline, accidents, and intoxication emergencies.

More research is needed, particularly studies in addiction and other at-risk populations. After decades of promised treatments, cannabis has disappointed. A recent JAMA review of the evidence from randomized clinical trials does not support cannabis or cannabinoids for most conditions for which it is promoted.