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Data were collected online from English\u2010 and Dutch\u2010speaking participants across multiple countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Main outcome measures included self\u2010reported severity of mental health symptoms (DSM\u2010Level 1\u2010Cross\u2010Cutting Symptom Measure), quantity\/frequency and problematic use of cannabis (Cannabis Use Disorder Identification Test \u2010 Revised) and alcohol (Alcohol Use Disorder Identification Test). Using a network approach, interactions between mental health symptoms (12 nodes) were compared between alcohol users and alcohol and cannabis co\u2010users. In co\u2010users, we incorporated detailed measures of alcohol and cannabis use (6 nodes) in the network and assessed the moderating role of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      The alcohol and cannabis co\u2010use group was characterized by higher quantity\/frequency of use, problematic use and severity for all mental health symptoms compared with the alcohol group (\n                      <jats:italic>P<\/jats:italic>\n                      s \u2264 0.001). Still, the alcohol use and alcohol\u2010cannabis co\u2010use networks did not statistically significantly differ (network invariance test: maximum difference in edge weights\u2009=\u20090.167,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.611, global strength invariance test: global strength difference statistic\u2009=\u20090.265,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.470), with both showing strong connections between anxiety, personality functioning and depression. However, the centrality invariance test revealed a statistically significantly (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) higher strength of somatic symptoms in co\u2010use (strength\u2009=\u20091.31) compared with alcohol use (strength\u2009=\u20090.17). When substance use outcomes were included in the co\u2010use network, distinct associations emerged: alcohol\u2010related problems were uniquely linked to anxiety, impaired personality functioning and suicidal ideation (partial cor. = 0.03, 0.01 and 0.01, respectively), while cannabis\u2010related problems were associated with mania and dissociation (partial cor. = 0.05 and 0.02). Age did not moderate these relationships.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Alcohol use and alcohol\u2010cannabis co\u2010use appear to be associated with a range of mental health symptoms, including overlapping and distinct symptom patterns that are similar regardless of age.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70324","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:07:32Z","timestamp":1768813652000},"page":"1421-1433","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the interplay between alcohol use, cannabis use and mental health across the lifespan: A network analysis"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4792-9864","authenticated-orcid":false,"given":"In\u00eas","family":"Macedo","sequence":"first","affiliation":[{"name":"Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences University of Porto  Porto Portugal"},{"name":"Addiction Biology Group i3S \u2010 Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1803-9336","authenticated-orcid":false,"given":"Emese","family":"Kroon","sequence":"additional","affiliation":[{"name":"Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research, Department of Psychology, Education and Child Studies Erasmus University Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karis","family":"Colyer\u2010Patel","sequence":"additional","affiliation":[{"name":"Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research, Department of Psychology, Education and Child Studies Erasmus University Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Freichel","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0729-7068","authenticated-orcid":false,"given":"Christophe","family":"Romein","sequence":"additional","affiliation":[{"name":"Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research, Department of Psychology, Education and Child Studies Erasmus University Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Pasion","sequence":"additional","affiliation":[{"name":"Digital Human\u2010Environment Interaction Labs (HEI\u2010Lab) Lus\u00f3fona University  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7699-2582","authenticated-orcid":false,"given":"Janna","family":"Cousijn","sequence":"additional","affiliation":[{"name":"Neuroscience of Addiction Lab, Center for Substance Use and Addiction Research, Department of Psychology, Education and Child Studies Erasmus University Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.35946\/arcr.v42.1.04"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2008.11.002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40429-017-0149-8"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.0584"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15735"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.09.016"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2020.11.002"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.06.034"},{"key":"e_1_2_10_10_1","unstructured":"National Institutes on Drug Abuse (US).Common Comorbidities with Substance Use Disorders Research Report [Internet]. 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