As the legalization of medical marijuana and marijuana use are both on the rise in the United States, people are not necessarily using alcohol less and may be unaware of the risks of combining alcohol and marijuana, according to researchers.

A new study from Penn State found that compared to people who only drank alcohol, those who used alcohol and marijuana simultaneously were more likely to drink heavier and more often. They were also more likely to experience alcohol-related problems — like impulsive actions they later regretted.

“The results suggest that individuals who simultaneously use alcohol and marijuana are at a disproportionately higher risk for heavy, frequent and problematic substance use,” said Ashley Linden-Carmichael, assistant research professor at the Edna Bennett Pierce Prevention Research Center at Penn State.

The researchers said the findings — recently published in the journal Substance Use and Misuse — also suggest that prevention and intervention programs should take into account not just alcohol, but also if people are using additional substances, as well.

“Right now, a lot of campus programs focus on whether students are drinking, and while sometimes they are asked about other substances, it’s not necessarily whether they’re using these substances simultaneously,” Linden-Carmichael said. “I think we do need to be asking about whether they’re drinking in combination with other drugs, and educating students about how that exacerbates their risk.”

According to the researchers, marijuana use is at an all-time high among young adults in the U.S., possibly leading to people using marijuana and alcohol simultaneously.

“The problem with simultaneous use is that it can affect people cognitively and perceptually, and also have an impact on motor impairment,” Linden-Carmichael said. “There is a burgeoning area of research that is examining why people are using marijuana and alcohol together and what those effects are.”

Healthline states When it comes to drugs, alcohol and weed are among the most commonly used substances. But what really happens when they team up?   Occasionally mixing alcohol and weed — also known as crossfading — likely won’t lead to major health problems. But there are a lot of variables to consider, including which one you use first and how you consume them.  If you aren’t careful, the duo can lead to a case of the spins or a green out, two reactions that can turn a fun night out into a nauseated night in.  It’s also important to remember that people can have very different reactions to the same mix of alcohol and weed. If you’re out in a group, one person’s reaction might be very different than yours.

Drinking before using weed can intensify weed’s effects. This is because alcohol increases the absorption of weed’s main psychoactive ingredient, delta-9-tetrahydrocannabinol (THC).

This generally results in a stronger high. While this might be nice for some folks, it can cause others to green out. This refers to a range of unpleasant physical symptoms that can result from a strong high.

Symptoms of a green out include:

• sweating
• dizziness
• nausea
• vomiting