Alcohol, cannabis and other substances in your 20s and 30s

Your 20s are when drinking, cannabis and other drug use tend to peak. For many people, use stays social and causes few problems. For others, it slowly moves from "fun on weekends" to "how I cope," and starts to affect sleep, mood, work and relationships.

This guide looks at what the latest numbers show, how alcohol and cannabis affect mental health, how to tell when use is becoming a problem, and what helps. You do not need to hit "rock bottom" to make a change. Cutting back is a valid goal.

What the numbers show

The 2025 National Survey on Drug Use and Health, released in July 2026, found that among Americans aged 18 to 25:¹

There is good news here. Marijuana use, binge drinking and substance use disorders all went down among 18- to 25-year-olds compared with 2021. Nicotine vaping fell in this group compared with 2022.¹ Among adults 26 and older, marijuana use went up.¹

The hard news is the treatment gap. Only about 1 in 10 young adults who needed substance use treatment received it in 2025.¹

Addiction problems also tend to start at this age. A worldwide review found that for about half of people with a substance use disorder, it began before age 25. The typical age of onset was 25.⁹

What counts as binge drinking?

Binge drinking means drinking enough to raise your blood alcohol level to 0.08% or more. For a typical adult, that is about five or more drinks for men, or four or more for women, in about two hours.⁵ A "standard drink" in the U.S. has 14 grams of pure alcohol.⁵

Binge drinking raises the risk of blackouts, alcohol poisoning, unsafe sex, injuries and car crashes. Drinking twice that amount or more, called high-intensity drinking, peaks around age 21 and is even riskier.⁵

Check your own pattern with our alcohol check or the longer AUDIT alcohol screen. Our alcohol, mood and sleep quiz tests what you know.

Cannabis and mental health

Cannabis (marijuana or weed) is now legal for adults in many U.S. states. Legal does not mean risk-free.

• Addiction. About 3 in 10 people who use cannabis have cannabis use disorder. The risk is higher for those who start young and use often.³
• Stronger products. The THC level (the part of cannabis that makes you high) in cannabis roughly doubled in research samples between 2008 and 2017. There is moderate evidence that high-THC use in young people is linked to ongoing use and later mental health problems.³
• Psychosis. People who use cannabis are more likely to develop psychosis, a condition where a person loses touch with reality, for example by hearing voices or holding fixed false beliefs. The link to schizophrenia is stronger for those who start young and use more often.⁴
• Mood. Cannabis use is linked to depression, anxiety and paranoia, and to suicidal thoughts and attempts.⁴ These are links, not proof that cannabis is the cause.

A large 2025 study from Ontario, Canada followed over 13 million people. Among people treated in a hospital or emergency room for cannabis use disorder, about 9 in 100 later developed schizophrenia, compared with fewer than 1 in 100 in the general population. The share of new schizophrenia cases linked to cannabis use disorder rose from about 4% before legalization to about 10% after. In young men aged 19 to 24, it was about 19%.² This kind of study cannot prove cause and effect, but it adds to growing concern.

Read more on our page about cannabis, sedatives and stimulants and on schizophrenia.

Why use often rises in young adulthood

• Social life. Parties, bars and dating often center on drinking.
• Coping. Alcohol and cannabis can numb stress, loneliness or anxiety for a while, without fixing what caused it.
• Untreated conditions. Depression, PTSD and ADHD raise the risk of alcohol use disorder.⁷
• Family history. Genes and family drinking patterns matter. About 60% of the risk for alcohol use disorder is thought to be inherited.⁷
• Easy access. Legal cannabis stores, delivery apps and vapes make use simple.

Signs that use is becoming a problem

Doctors look at the past 12 months. Signs of a substance use disorder include:^3,7

• Using more, or for longer, than you meant to
• Trying to cut back and not being able to
• Spending a lot of time using, getting it or recovering
• Strong cravings
• Falling behind at work, school or home because of use
• Keeping on using even when it causes fights, health problems or low mood
• Giving up activities you used to enjoy
• Using in risky situations, like before driving
• Needing more to get the same effect, or feeling sick when you stop

Having 2 to 3 of these signs points to a mild disorder, 4 to 5 to moderate, and 6 or more to severe.⁷ Our page on signs of substance use problems has more.

What helps

People with severe alcohol use disorder may need medical help to stop drinking safely, because withdrawal can be dangerous.⁷ Do not quit heavy daily drinking suddenly on your own. Talk with a doctor first.

Practical steps to cut back

1. Track for two weeks. Write down what you use, how much, where, with whom and how you felt before. Patterns often surprise people.
2. Pick a clear goal. For example: no more than two drinks on a night out, no drinking on weeknights, or a 30-day break from cannabis.
3. Plan your "no." Have a ready answer like "I've got an early morning" and a drink in hand, such as sparkling water.
4. Change the setting. Suggest plans that do not center on alcohol, like a game night, a hike or a movie.
5. Find another way to calm down. Try the cyclic sigh, a walk, or calling a friend when stress hits.
6. Keep it out of the house. Fewer cues mean fewer cravings.
7. Tell one person. A friend who knows your goal can support you.
8. Review and adjust. If you keep missing your goal, that is useful information, not failure. It may be time to get help.

For partners, family and friends

• Choose a calm, sober moment to talk. Use "I" statements: "I've been worried since you missed work last week."
• Focus on specific events, not labels like "alcoholic" or "addict."
• Avoid covering for them, like calling in sick on their behalf.
• Look after yourself. Support groups for families can help.
• Learn more in helping someone with substance use.

Special situations

Alcohol, cannabis and anxiety or depression. Using to cope can make anxiety and low mood worse over time. See our guides to anxiety and panic and loneliness.

ADHD. ADHD raises the risk of alcohol problems.⁷ A 2025 Swedish study linked ADHD medicine to less substance misuse.¹⁰ See adult ADHD.

Pregnancy or planning a baby. Talk with your doctor about alcohol and cannabis before and during pregnancy. See new parents and mood.

Opioids and pills. Pills bought outside a pharmacy can contain dangerous drugs. Read our page on opioids and overdose.

Common questions

Is cannabis safer than alcohol?

Each has different risks. Cannabis is linked to psychosis, especially with frequent use and starting young, and about 3 in 10 people who use it have cannabis use disorder.^3,4 "Safer" depends on how much, how often and who you are.

Do I have to quit completely?

Not always. Many people choose to cut back and do well. But if you have tried to cut back and could not, or you have severe symptoms, stopping completely with support is often the safer path. A doctor or counselor can help you decide.

What does the SAMHSA Helpline do?

It is a free, confidential information and referral line in English and Spanish, open 24/7. It can connect you with local treatment, support groups and community services.⁸

Can I get help without my parents or boss finding out?

The SAMHSA Helpline is confidential.⁸ At your first visit with any provider, ask how they protect your privacy and who they can share information with.

When to get help

Reach out for help if:

• You have several of the signs listed above
• You have tried to cut back and could not
• You use to get through the day, or to sleep
• Someone close to you is worried
• You have shakes, sweats or feel very unwell when you stop

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.