Evaluating the effect of psychological stress on consumption of addictive goods: evidence from the United States

American Journal of Health Behavior. 2026. Vol. 50. No. 3. P. 208–227.

Tatiana Kossova, Elena Kossova, Gergenreter A., Sheluntcova M.

Objectives: We investigate the effect of psychological stress on alcohol, cigarettes, e-cigarettes, and
marijuana consumption for men and women in the United States.

Methods: The database is the National Survey on Drug Use and Health, NSDUH, for 2020-2022. The sample consists of 138492 respondents aged 18–70. We estimate a multivariate ordered probit model to account for endogeneity of psychological stress and to correct for sample selection bias.

Results: Marijuana use increases by 20 percentage points among men and 35 percentage points among women under high levels of stress compared to baseline probabilities. E-cigarette use increases by 15 and 20 percentage points for men and women, respectively. Individuals’ propensity for addictive behavior varies depending on income, employment status, educational level, marital status, race/ethnicity, and community size. The probability of marijuana
and e-cigarette use under severe stress for women is more than three times higher compared to the baseline level and exceeds the corresponding probability for men.

Conclusions: The article presents quantitative estimates of the effect of stress on addictive goods consumption. Psychological stress is a significant predictor of engagement in psychoactive substance use and the development of addictions.

Keywords: the United States, Substance use, Health behaviours, psychological stress, multivariate ordered probit