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2026 IAVA FINDINGS RELATED TO ALCOHOL, TOBACCO AND CANNABIS USE
2026 IAVA FINDINGS RELATED TO ALCOHOL, TOBACCO AND CANNABIS USE
Prepared by Dane Rivas-Koehl and Ryan Gilfillan
Executive Summary
IAVA gathered information on members’ experiences with alcohol, tobacco and nicotine, and cannabis. The survey helps IAVA understand substance use patterns, efforts to reduce or stop use, and views on cannabis policy, medical use, and research among respondents.
IAVA received 493 survey responses. After removing one respondent who did not provide consent and responses with fewer than 10% of the survey completed, the final analytic sample included n = 470 respondents. Because the survey used skip logic, the number of respondents varied across questions.
- Alcohol use was common, with 76% of respondents reporting alcohol use during the past year. Of those who reported drinking in the past year, 61% reported binge drinking and 20% reported alcohol interfered with work or personal obligations. Out of the full sample, 27% indicated that someone suggested they seek help for alcohol use or misuse.
- Tobacco and nicotine use showed both persistence and change. Most respondents (70%) reported that they have used tobacco or nicotine products sometime in their life. Almost one fourth of the sample (23%, n=111) currently used tobacco or nicotine products, and among this subset, daily use was common (77%). At the same time, 72% of current users reported attempting to quit or switching tobacco or nicotine products tied to health or harm-reduction.
- Findings related to cannabis support were strongest around medical use and research. Support was higher for medicinal cannabis, medicinal research, and VA research than for recreational use and legalization.
- A provider conversation gap was clear when it came to medical cannabis. Among respondents who were interested in cannabis as a medical treatment option (n=212), 70% reported that they would be comfortable discussing medical cannabis with a primary care doctor. However, only 29% had actually had that conversation.
I. Purpose and Scope
This report summarizes IAVA’s survey on members’ experiences with alcohol, tobacco and nicotine, and cannabis. It highlights key patterns and areas relevant to IAVA’s research, advocacy, education, and support efforts. It focuses on members’ use, views, and cessation efforts related to these substances. While many questions were asked, this report emphasizes findings that explain members’ experiences with alcohol, nicotine, tobacco, and cannabis.
II. Who We Heard From
The analytic sample included 470 respondents. Respondents with available age data ranged from 32 to 85 years old, with an average age of 50.05. Most respondents lived in a U.S. state; respondents represented 47 states, and Washington, D.C., Virginia, and Texas were the most frequently represented states, followed by California and Florida.
Respondents were geographically diverse across community type: 48% lived in suburban communities, 29% in rural areas, and 24% in urban areas. Most respondents identified as men, White, heterosexual or straight, married, and having an honorable discharge. About two-thirds reported having a bachelor’s degree or higher.
Most respondents identified as White. Because respondents could select more than one racial identity, race percentages can exceed 100%.
| Demographic Category | Summary |
| Age | Mean = 50.05 years; range = 32–85 |
| Location | 96% lived in a U.S. state; 47 states and Washington, D.C. represented |
| Community type | 48% suburban; 29% rural; 24% urban |
| Gender | 86% men; 13% women |
| Education | 68% bachelor’s degree or higher |
| Income | 48% expected personal income of $100,000 or more in 2026 |
| Relationship and family | 70% married; 74% reported having children |
| Ethnicity | 11% Hispanic or Latino/a/x or of Spanish origin |
| Sexual orientation | 90% heterosexual or straight |
| Discharge status | 98% honorable discharge |
| Race Identity selected | n | % |
| White | 389 | 86% |
| Other | 29 | 6% |
| Black or African American | 25 | 6% |
| Asian | 18 | 4% |
| American Indian or Alaska Native | 17 | 4% |
| Native Hawaiian or Pacific Islander | 4 | 1% |
| Multiracial | 24 | 5% |
III. Key Findings at a Glance
| Topic | Main Finding |
| Alcohol | 76% reported drinking in the past year; 61% of respondents answering the binge-drinking item reported at least one episode in the past year. |
| Tobacco and nicotine | 71% had used tobacco or nicotine products in their lifetime. Among current users, 72% used daily and 74% reported a quit attempt. |
| Cannabis | 86% supported medicinal legalization, 91% supported medicinal research, and 88% supported VA research. |
| Provider communication | Among respondents interested in cannabis as a treatment option, 70% were comfortable discussing it with a primary care doctor, yet 29% had done so. |
IV. Alcohol Use
The alcohol section asked respondents about their experiences with alcohol use during the past 12 months, including how often they drank, how many drinks they typically had on days when they drank, and how often they consumed four or five or more drinks within a two-hour period. Respondents who reported past-year alcohol use were also asked whether alcohol had interfered with their personal or professional obligations. The section also asked whether anyone had ever suggested they seek help for alcohol use or abuse and whether they had ever attempted to quit drinking.
Alcohol use was common among respondents. Of the 470 respondents in the analytic sample, 76% reported drinking alcohol in the past 12 months, while 21% reported that they did not drink in the past year but had done so in the past, and 3% reported never drinking alcohol.
Among respondents who drank in the past year, drinking frequency varied. About half of past-year drinkers reported drinking at least weekly. Typical consumption was most often one or two drinks (55%), though nearly one-quarter reported usually having five or more drinks on a typical drinking day.
The most concerning alcohol finding was episodic heavy drinking, or binge drinking. Binge drinking is when a person has 5 or more drinks for men or 4 or more drinks for women containing any kind of alcohol within a two-hour period. Among those answering the binge-drinking item, 61% reported at least one episode in the past year, and 29% reported this pattern at least monthly. Alcohol-related interference with obligations was less common but still present, with 20% reporting that alcohol had interfered with professional or personal obligations at least once in the past year. More than one-quarter (27%) of respondents reported that someone had suggested they seek help for alcohol use or abuse.
Overall, the alcohol findings suggest that IAVA should not treat alcohol use as a single pattern. Most respondents did not report frequent alcohol-related interference, but a meaningful subgroup reported indicators that may warrant continued attention, resource development, or future research.
V. Tobacco and Nicotine Use
The tobacco and nicotine section asked respondents about lifetime and current use of tobacco or nicotine products, including cigarettes, cigars, smokeless tobacco, vapes, e-cigarettes, nicotine pouches, nicotine gum, pipe tobacco, and other products. Respondents who currently used tobacco or nicotine products were asked what forms they used, how often they used them, whether they had ever attempted to quit, and whether they had changed their primary method of tobacco use. Respondents who had changed products were also asked whether the change was motivated by health or harm-reduction reasons, such as reducing potential health risks without necessarily stopping use completely.
Tobacco and nicotine use was common. Among respondents who answered the lifetime-use question, 71% reported having ever used tobacco or nicotine products. Among those asked about current use, 34% reported that they currently use tobacco or nicotine products.
Among current users, use was frequent, with 72% reporting daily use. Current users also reported a history of attempts to change their use. Forty-two percent reported attempting to quit without successfully quitting, and 32% reported successfully quitting at some point. Nearly half reported changing their primary method of tobacco or nicotine use, and among those who changed methods (n=56), 74% said they changed for health or harm-reduction reasons.
The tobacco product question was a multiple-selection item. The most frequently selected products among current users were cigarettes, cigars, nicotine pouches, dip or snuff, and vapes. Respondents could select more than one tobacco or nicotine product; therefore, percentages in this table sum to more than 100%.
| Product selected among current users | N | % of current users |
| Cigarettes | 49 | 45% |
| Cigars | 46 | 42% |
| Nicotine pouches | 45 | 41% |
| Dip or snuff | 36 | 33% |
| Vapes | 34 | 31% |
| Chewing tobacco | 27 | 25% |
| Nicotine gum | 20 | 18% |
| Pipe tobacco | 15 | 14% |
| E-cigarettes | 11 | 10% |
| Other | 2 | 2% |
| Heated/toasted tobacco products | 1 | 1% |
Taken together, these results suggest that tobacco and nicotine use is not only a use-prevalence issue. It is also a cessation and harm-reduction issue, with many respondents reporting attempts to stop, reduce risk, or change product use.
VI. Cannabis Use, Policy, and Treatment Perspectives
The cannabis section asked respondents about cannabis and cannabinoid products, including marijuana, THC, CBD, edibles, vapes, oils, and other cannabis-based products. Respondents were asked about awareness of and agreement with the federal reclassification of cannabis from Schedule I to Schedule III, as well as their views on recreational legalization, medicinal legalization, medicinal cannabis research, and whether the VA should allow research into cannabis as a treatment option. The section also asked about prior recreational and medicinal cannabis use. Respondents with prior cannabis or cannabinoid use were asked about their interest in cannabis as a treatment option, and those who expressed interest were asked how comfortable they would be discussing medical cannabis with their primary care doctor and whether they had already had that conversation.
Cannabis produced the clearest policy findings in the survey. Nearly three-quarters of respondents were aware of the proposed federal reclassification of cannabis described in the survey, and 69% agreed with reclassifying cannabis from Schedule I to Schedule III in recognition of its medical value.
Support was strongest when cannabis was framed around medical use and research. Respondents were more supportive of medicinal legalization and cannabis research than recreational legalization.
| Cannabis policy or research statement | Agree or strongly agree |
| Cannabis should be legal for recreational purposes | 61% |
| Cannabis should be legal for medicinal purposes | 87% |
| Cannabis should be researched for medicinal uses | 91% |
| The VA should allow research into cannabis as a treatment option | 88% |
Cannabis use itself was also relatively common, with 271 respondents reporting past recreational use and 179 reporting past medicinal use. Among respondents with prior recreational or medicinal cannabis use, 72% were somewhat or very interested in using cannabis or cannabinoid products as a treatment option if available. Among those interested, 70% said they were somewhat or extremely comfortable discussing medical cannabis with a primary care doctor, but only 29% had discussed medical cannabis with their current primary care doctor.
The cannabis findings show a consistent pattern: respondents were particularly supportive of research and medical applications, and there may be unmet need for clearer information, stronger evidence, and more comfortable provider conversations.
VII. Implications for Policy
Findings from IAVA’s survey to understand members’ experiences with alcohol, tobacco and nicotine, and cannabis show clear policy implications. The clearest is regarding medical use and medical research related to cannabis and other cannabinoids, including additional funding for medical research related to the use of cannabis and other cannabinoids in treatment of mental health, long-term pain, PTSD, and other medical symptoms that are common in the veteran population.
Consistent with IAVA member survey findings, policy efforts should prioritize increased federal investment in rigorous, veteran-specific research to better understand the safety, effectiveness, and potential long-term health implications of cannabis-based treatments. Research should also examine the relationship between medicinal cannabis use and reliance on other substances, including prescription opioids, benzodiazepines, and alcohol, as well as potential impacts on suicide-related risk factors and overall quality of life.
The VA Medicinal Cannabis Research Act of 2026 (H.R. 10655) would advance these objectives by directing VA to conduct observational research and, subject to applicable feasibility and safety requirements, clinical trials examining cannabis use among veterans with chronic pain and PTSD. IAVA supports efforts to strengthen the evidence base through research that considers both potential therapeutic benefits and adverse outcomes, allowing veterans and their health care providers to make more informed decisions about available treatment options.
Beyond research, IAVA members have expressed a desire to engage in open, informed conversations with their medical providers regarding medicinal cannabis. Although current VA policy permits discussions about cannabis use, VA clinicians remain restricted from recommending medical cannabis or completing documentation required for participation in state-authorized programs. The Veterans Equal Access Act (H.R. 1384) would address these limitations by authorizing VA providers to offer recommendations and complete necessary documentation for veterans participating in state medical cannabis programs. Similarly, the Veterans Cannabis Use for Safe Healing Act (H.R. 966) would establish statutory protections against denial of VA benefits based on participation in state-authorized medical cannabis programs while strengthening requirements for clinical discussions and informed treatment planning.
IAVA supports legislative efforts that facilitate transparent, evidence-informed conversations between veterans and their providers, protect continuity of care, and ensure that veterans are not discouraged from disclosing cannabis use or exploring legally available treatment options.
These efforts should be accompanied by the development and dissemination of VA-validated, evidence-based clinical resources to help providers discuss the potential benefits, risks, drug interactions, and limitations of medicinal cannabis and other cannabinoids with their veteran patients.
Policy efforts to address alcohol, tobacco, and nicotine should prioritize evidence-based harm-reduction strategies, particularly for those engaging in binge drinking or seeking to reduce, change methods, or discontinue tobacco or nicotine use. These efforts should extend beyond addressing the substance use itself and should also consider the underlying factors that contribute to unhealthy patterns of use (ie service-related experiences, behavioral health challenges, or barriers to accessing effective support or alternative options). Policy should also identify and strengthen protective factors and systems that promote positive, sustained change and improved long-term health outcomes for veterans.
The Veterans’ Mental Health and Other Care Improvements Act of 2008 (P.L. 110-387) established the foundation for comprehensive substance use disorder treatment within the VA, but is limited to VA-enrolled veterans who require services for substance use disorder (SUD), which is a formal diagnosis recognized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Under current law, access to SUD treatment within the VA includes a continuum of services including screening, counseling, medication, residential treatment, relapse prevention, and coordinated care for co-occurring mental health conditions.
Future policy efforts should seek to modernize and expand this framework by:
- Establishing a broader continuum of prevention, early intervention, harm-reduction, cessation, and recovery (including for veterans who have not received a formal SUD diagnosis). Recognizing that progress may take many different forms, policy should support meaningful reductions in harmful substance use and sustained behavioral health change over emphasizing abstinence as the only metric for success;
- Addressing the needs of veterans who receive health care outside of the VA system (including VA community care). State initiates in Massachusetts, Texas, and Virginia highlight opportunities to expand access to veteran-focused substance-use and harm-reduction services through community-based providers and state partnerships. Federal policy can build upon this approach by establishing dedicated funding and coordination mechanisms that support alcohol and tobacco cessation and harm-reduction efforts regardless of VA enrollment status.
Of note, the House-passed FY27 NDAA includes Section 707, which authorizes a smoke-free cessation pilot to evaluate contemporary smoke-free alternatives in comparison to traditional nicotine replacement therapies. This initiative allows active-duty service members who use combustible tobacco products to participate in trials involving e-cigarettes, oral nicotine pouches, and heat-not-burn products as potential harm-reduction transition tools. IAVA wholly supports the inclusion of this provision in the final FY27 NDAA and future policy efforts should monitor the progress and results of this pilot for consideration to expand to the veteran population.
Ultimately, IAVA supports a modernized, veteran-centered approach that shifts federal policy beyond treatment of established substance use disorders toward a comprehensive continuum of prevention, harm-reduction, treatment, and recovery. Congressional action should prioritize meaningful expansion of services, dedicated implementation resources, and measurable improvements in access, behavioral health, and suicide-related risk factors across the broader veteran population.
VIII. Methods and Notes
The AOD Survey was administered online. Participation was voluntary, and respondents could skip any question or section. IAVA received 493 responses. One respondent did not provide consent, and responses with fewer than 10% of the survey completed were omitted, leaving a final analytic sample of n = 470 for the majority of the questionnaire.
Percentages use question-level denominators. Because the survey used display logic, we showed alcohol, tobacco, and cannabis follow-up questions only to eligible respondents.
Thank you to Ryan Gilfillan for running all descriptive statistics for the AOD data summary and to Columbia University and the Center for Veteran Transition and Integration for providing survey support.
Download a PDF of the report here:
Contact Information:
Dane Rivas-Koehl
Research and Program Lead
Email: research@iava.org
Website: IAVA.org
