A new study shows that a major amount of Americans were toking up in 2012 and 2013 compared to 10 years ago, and not particularity for medical reasons.

The study published this week in Jama Psychiatry, a monthly journal published by the American Medical Association, found that 9.5 percent of American adults used marijuana, compared to 4.1 percent in 2001 and 2002. It was based on in-person interviews with more than 36,000 Americans over the age of 18.

In addition, the study shows an increase in “marijuana use disorders.” Yet authors of the study say, “The prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2013.”

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On the other hand, the attitude toward marijuana has shifted in the United States, as are the laws governing its use. Just years ago, public perceptions about pot went from alarming warnings such as “reefer madness” to growing acceptance of medical marijuana and the legalization of the drug for recreational use. The study notes that 23 states now allow the use of marijuana for medical reason, but only four of those states allow recreational use of the drug.

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“Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals and the public is needed,” the study said.