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Cservenka A, Donahue LC. Emotion Recognition and Self-Reported Emotion Processing in Alcohol and Cannabis Co-Using Young Adults. Behav Sci (Basel) 2024; 14:407. [PMID: 38785898 PMCID: PMC11117838 DOI: 10.3390/bs14050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/26/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Alcohol and cannabis use are each associated with impairments in emotion recognition accuracy, which may promote interpersonal problems. It is unclear if emotion recognition or self-reported emotion processing differs between young adult alcohol and cannabis co-users (ACCs) and healthy controls (HCs). This study examined whether ACCs and HCs differed in their emotion recognition across two different behavioral tasks with static or dynamic faces and determined if there were differences in self-reported socio-emotional processing and alexithymia. 22 ACCs (mean age = 21.27 ± 1.75) and 25 HCs (mean age = 21.48 ± 2.68), matched on age, sex, and IQ, completed the Metrisquare Emotion Recognition Task and CANTAB Emotion Recognition Task. The ACCs and HCs were compared on task accuracy and self-reported measures, including the Social Emotional Questionnaire (SEQ) and the Perth Alexithymia Questionnaire (PAQ). No significant main effects of the Group variable or the Emotion-Group interaction variable were present for either task. The ACCs had lower SEQ (p = 0.014) and higher PAQ (p = 0.024) scores relative to the HCs, indicating greater difficulties in socio-emotional processing and identifying one's own emotions, respectively. Understanding the behavioral correlates of the self-reported difficulties in emotion processing reported by ACCs is needed to develop interventions to reduce these symptoms and promote healthy socio-emotional functioning in this population.
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Affiliation(s)
- Anita Cservenka
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR 97331, USA;
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Nameth K, Ueland E, D'Amico EJ, Osilla KC. Feasibility and acceptability of a web-intervention to prevent alcohol and cannabis-impaired driving among adolescents in driver education. RESEARCH SQUARE 2024:rs.3.rs-4249553. [PMID: 38699323 PMCID: PMC11065077 DOI: 10.21203/rs.3.rs-4249553/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Adolescents increasingly view cannabis as a substance with limited harm. Their propensity to engage in risky driving, combined with their relative driving inexperience, places adolescents at heightened risk for harm resulting from impaired driving. Driver education provides an opportunity to help prevent and reduce these risks, yet few interventions address cannabis-impaired driving, especially impairment from simultaneous use of both cannabis and alcohol. Methods We adapted a single-session primary care brief intervention (CHAT) for driver education programs. First, we conducted two focus groups with adolescents aged 15-17 years (n = 6; n = 5) enrolled in driver education programs. Their feedback was integrated into a prototype of an online intervention called webCHAT that focuses on preventing alcohol and cannabis-impaired driving. Next, we recruited a new sample of adolescents who user tested webCHAT (n = 8) and provided qualitative and survey feedback. We analyzed qualitative data using classic content analysis and grouped themes according to the feasibility and acceptability of webCHAT. Results Participants suggested that webCHAT should have adolescent narrators in short, informal, and interactive videos. In satisfaction surveys (n = 8), 88% of participants would recommend webCHAT to a friend and 88% reported that they learned helpful skills regarding impaired driving. General acceptability was also reflected in interviews (n = 6; 100% would recommend the intervention to a friend, 100% indicated overall positive impressions, and 67% stated it was easy to use). Participants reported that it was helpful to learn about the negative effects of both cannabis and alcohol on driving behavior, voicing that webCHAT would help adolescents make more informed decisions. Conclusions Soliciting adolescent perspectives is critical when developing interventions targeting cannabis use because of increasingly permissive attitudes and perceptions of minimal risk associated with use. The current study highlights how feedback can help increase both the feasibility and acceptability of interventions.
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Pawar AKS, Firmin ES, Wilens TE, Hammond CJ. Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00141-2. [PMID: 38552901 DOI: 10.1016/j.jaac.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/06/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Dramatic changes in state-level cannabis laws (CL) over the past 25 years have shifted societal beliefs throughout the United States, with unknown implications for youth. In the present study, we conducted an updated systematic review and meta-analysis examining estimated effects of medical cannabis legalization (MCL) and recreational cannabis legalization (RCL) on past-month cannabis use among US youth. METHOD A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, followed by a subsequent meta-analysis investigating the associations between state-level cannabis laws (ie, MCL vs non-MCL, and RCL vs non-RCL) and past-month cannabis use prevalence among US adolescents and young adults. Supplemental analyses examined age-group effects and design-related factors. RESULTS Our search identified 4,604 citations, 34 and 30 of which were included in qualitative and quantitative analyses, respectively. Meta-analysis of MCL studies identified no significant association between MCL and change in past-month youth cannabis use (odds ratio [OR] = 0.981, 95% CI = 0.960, 1.003). Meta-analysis of RCL studies showed significantly increased odds of past-month cannabis use (OR = 1.134, 95% CI = 1.116-1.153). Meta-analysis of more recent studies, however, showed a significantly increased odds of past-month cannabis use among both adolescents and young adults (OR = 1.089, 95% CI = 1.015,1.169, and OR = 1.221, 95% CI = 1.188,1.255, respectively). CONCLUSION Cannabis legalization has complex and heterogenous effects on youth use that may differ across law types. Our meta-analytic results showed modest positive effects of RCL on past-month cannabis use (more so in young adults than in adolescents) and minimal effects of MCL on these outcomes in US youth. Given the shift toward recreational legalization, additional focus on RCL effects is warranted.
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Affiliation(s)
- Aditya K S Pawar
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Trinh CD, Girard R, Schick MR, Spillane NS. Positive psychological interventions on alcohol use and consequences: Pilot randomized trial in a young adult cannabis-using sample. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209241. [PMID: 38056630 DOI: 10.1016/j.josat.2023.209241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Young adults exhibit high rates of concurrent alcohol and cannabis use, which is associated with more negative alcohol-related consequences. Positive psychological interventions have successfully been leveraged to target alcohol, cannabis, and nicotine use, as well as substance use disorders, and may be a useful harm reduction approach to reduce alcohol-related consequences. This pilot study sought to generate effect sizes for two positive psychological interventions, Savoring and Three Good Things, on frequency of alcohol use, quantity of alcohol use, and alcohol-related consequences. METHODS The current study used data from a pilot study testing positive psychological interventions to reduce cannabis use and cannabis-related consequences in young adults (ages 18 to 25) who used cannabis at least once per week within the prior month (N = 50, Mage = 22.72, 72 % men, 40 % White). Participants reported baseline alcohol and cannabis use and alcohol-related consequences, then the study randomized them to complete a daily Savoring intervention, Three Good Things, or a control exercise, and completed daily text message surveys for two weeks (i.e., the intervention period) and a follow-up survey. RESULTS Analyses revealed no significant differences across experimental conditions on alcohol use frequency, alcohol use quantity, or alcohol-related consequences at baseline or follow-up. Paired samples t-tests demonstrated that participants in the Savoring group showed large, significant decreases in alcohol-related consequences (t[16] = 2.28, p = .04, gav = 0.54); no decreases occurred in frequency or quantity of alcohol use. The Three Good Things group showed no significant decreases in alcohol-related consequences, frequency of alcohol use, or quantity of alcohol use. CONCLUSIONS Results suggest that a larger scale clinical trial is warranted to determine whether Savoring and Three Good Things might function as harm reduction interventions to reduce alcohol-related consequences in young adults who concurrently use alcohol and cannabis. Future research should use a larger sample, a longer intervention administration period, and a longer follow-up period to examine these positive psychological interventions more rigorously.
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Affiliation(s)
- Catherine D Trinh
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Rachel Girard
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA
| | - Melissa R Schick
- Yale School of Medicine, Division of Prevention and Community Research, New Haven, CT 06511, USA
| | - Nichea S Spillane
- University of Rhode Island, Department of Psychology, Kingston, RI 02881, USA.
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Wilds KM, Riddell JR. Cannabis Policy and Consumption: Taking into account Substitution Effects. Subst Use Misuse 2023; 59:97-109. [PMID: 37781770 DOI: 10.1080/10826084.2023.2262012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Previous studies examining the cannabis-alcohol substitution effect have found that medical cannabis policies may result in substituting the use of cannabis in place of alcohol use. Objectives: This study adds to the literature on cannabis-alcohol substitution by analyzing the effect of decriminalization, medicinal cannabis, and adult-use legalization cannabis policies (2002-2019) on cannabis and alcohol use and substance substitution for all 50 states and the District of Columbia (N=867). Results: Results support the notion that liberalized cannabis policies can increase the prevalence of cannabis use. An adult-use legalization specific analysis yielded findings suggesting a complex and heterogenous effect of such laws on cannabis-alcohol complementation. Conclusion: Given the lack of clarity and heterogenous effects of cannabis laws, policy makers should carefully take into consideration the benefits of medical cannabis laws, along with the risks of decriminalization and adult-use legalization.
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Affiliation(s)
- Katherine M Wilds
- Department of Criminology and Criminal Justice, The University of Texas at Dallas, Richardson, United States
| | - Jordan R Riddell
- School of Criminology and Criminal Justice, Missouri State University, Springfield, United States
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García-Ramírez G, Paschall MJ, Grube JW, Vaeth PAC, Caetano R. Recreational marijuana legalization and marijuana and alcohol co-use among adolescents: Differential associations among racial and ethnic groups. J Ethn Subst Abuse 2023:1-14. [PMID: 37870062 PMCID: PMC11035481 DOI: 10.1080/15332640.2023.2270546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
We examined associations of the 2016 legalization of recreational marijuana (RML) in California with marijuana and alcohol co-use among race/ethnic groups using successive cross-sections from 7th, 9th, and 11th graders (N = 3,319,329) in the 2010-11 to 2018-19 California Healthy Kids Surveys. Multilevel logistic regressions indicated a stronger positive association between RML and co-use among non-Hispanic/Latine White youth (OR = 1.21) relative to Hispanic/Latine (OR = 1.02) or Black youth (OR = 0.85). Among drinkers who had not consumed five or more drinks on any occasion in the past 30-days (non-heavy drinkers), the positive association between RML and co-use was stronger among American Indian/Alaska Native youth (OR = 2.19) compared to non-Hispanic/Latine Whites (OR = 1.56). For heavier drinkers it was stronger for Native Hawaiian/Pacific Islanders (OR = 1.47). Among marijuana users, there was a stronger inverse association between RML and co-use among Black youth (OR = 0.72) compared to non-Hispanic/Latine White youth (OR = 0.84). RML may increase the risk of co-use to a greater extent among non-Hispanic/Latine White youth than other race/ethnic groups in California, but broadly increases the risk among youth who engage in alcohol use or heavy drinking.
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Affiliation(s)
- Grisel García-Ramírez
- Pacific Institute for Research and Evaluation, Berkeley, California
- University of California, Berkeley, California
- Georgia State University, Atlanta, Georgia
| | | | - Joel W Grube
- Pacific Institute for Research and Evaluation, Berkeley, California
- University of California, Berkeley, California
| | | | - Raul Caetano
- Pacific Institute for Research and Evaluation, Berkeley, California
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O’Hara SE, Paschall MJ, Grube JW. Recreational Marijuana Legalization, Local Retail Availability, and Alcohol and Marijuana Use and Co-Use Among California High School Students. J Stud Alcohol Drugs 2023; 84:734-743. [PMID: 37219033 PMCID: PMC10600969 DOI: 10.15288/jsad.22-00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE This study examined whether recreational marijuana legalization (RML) and local retail availability were associated with marijuana and alcohol use and co-use among adolescents. METHOD We investigated associations between RML and past-30-day marijuana and alcohol use and co-use, and moderating effects of retail availability of marijuana and alcohol, using data from the 2010-2011 to 2018-2019 California Healthy Kids Surveys (CHKS) of 9th and 11th grade students in 38 California cities. Multilevel mixed-effects logistic regression analyses were conducted, controlling for secular trends and student and city demographics. Additional analyses examined associations of RML and retail availability with co-use among subgroups of drinkers and marijuana users. RESULTS For the full sample, RML was inversely associated with alcohol use but was not significantly associated with marijuana use or co-use with alcohol. However, significant interactions between RML and marijuana outlet density showed that there were increases in marijuana and alcohol co-use and alcohol following legalization in cities with higher densities of marijuana outlets. RML was positively associated with co-use among non-heavy and heavy drinkers, but inversely related to co-use among occasional and frequent marijuana users. A significant positive interaction between RML and marijuana outlet density indicated that RML was associated with increases in co-use for occasional marijuana users in cities with higher densities of marijuana outlets. CONCLUSIONS RML was associated with increases in marijuana and alcohol co-use and alcohol use among California high school students, particularly those in cities with higher densities of retail cannabis stores, although this varied across alcohol and marijuana use subgroups.
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Affiliation(s)
- Sharon E. O’Hara
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California
| | - Joel W. Grube
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California
- School of Public Health, University of California, Berkeley, Berkeley, California
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Roberts W, Schick MR, Tomko RL, McRae-Clark AL, Pittmann B, Gueorgieva R, McKee SA. Developmental trajectories of alcohol and cannabis concurrent use in a nationally representative sample of United States youths. Drug Alcohol Depend 2023; 248:109908. [PMID: 37149960 PMCID: PMC10330385 DOI: 10.1016/j.drugalcdep.2023.109908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Previous studies have identified common trajectories of single type substance use over the course of adolescence; however, no study to date has examined joint trajectories of cannabis and alcohol concurrent use. Given that expansion of legal cannabis has increased availability, it is important to understand patterns of concurrent use in adolescents and factors that place male and female youth at risk for harmful trajectories of concurrent use. The current study sought to identify joint trajectories of cannabis and alcohol use - and predictors of harmful use trajectories - among male and female adolescents. METHOD We used 4 waves of data from 6997 early adolescent participants (age 12-14 years at Wave 1) in the Population Assessment of Tobacco and Health, a nationally representative longitudinal study in the United States. Participants reported their cannabis and alcohol use reassessed yearly for 5 years (2013-2018). We used joint trajectory growth mixture modeling to identify trajectory groups as defined by changes in alcohol and cannabis use over time. RESULTS Five classes of alcohol and cannabis concurrent use trajectories were identified. Both internalizing and externalizing symptoms at Wave 1 increased the odds of membership in trajectory groups characterized by more harmful use trajectories. Internalizing symptomatology was a stronger predictor of membership in escalating use trajectories among girls, whereas externalizing symptomatology stronger predictor among boys. CONCLUSIONS These findings underscore the utility of jointly considering alcohol and cannabis use when describing common developmental trajectories of use and identifying risk factors for trajectories characterized by harmful use.
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Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University, United States.
| | | | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States; Ralph H. Johnson VA Medical Center, United States
| | - Brian Pittmann
- Department of Biostatistics, Yale University, United States
| | | | - Sherry A McKee
- Department of Psychiatry, Yale University, United States
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Farrelly KN, Wardell JD, Marsden E, Scarfe ML, Najdzionek P, Turna J, MacKillop J. The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review. Subst Abuse 2023; 17:11782218231172054. [PMID: 37187466 PMCID: PMC10176789 DOI: 10.1177/11782218231172054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
Background Recreational cannabis legalization has become more prevalent over the past decade, increasing the need to understand its impact on downstream health-related outcomes. Although prior reviews have broadly summarized research on cannabis liberalization policies (including decriminalization and medical legalization), directed efforts are needed to synthesize the more recent research that focuses on recreational cannabis legalization specifically. Thus, the current review summarizes existing studies using longitudinal designs to evaluate impacts of recreational cannabis legalization on cannabis use and related outcomes. Method A comprehensive bibliographic search strategy revealed 61 studies published from 2016 to 2022 that met criteria for inclusion. The studies were predominantly from the United States (66.2%) and primarily utilized self-report data (for cannabis use and attitudes) or administrative data (for health-related, driving, and crime outcomes). Results Five main categories of outcomes were identified through the review: cannabis and other substance use, attitudes toward cannabis, health-care utilization, driving-related outcomes, and crime-related outcomes. The extant literature revealed mixed findings, including some evidence of negative consequences of legalization (such as increased young adult use, cannabis-related healthcare visits, and impaired driving) and some evidence for minimal impacts (such as little change in adolescent cannabis use rates, substance use rates, and mixed evidence for changes in cannabis-related attitudes). Conclusions Overall, the existing literature reveals a number of negative consequences of legalization, although the findings are mixed and generally do not suggest large magnitude short-term impacts. The review highlights the need for more systematic investigation, particularly across a greater diversity of geographic regions.
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Affiliation(s)
- Kyra N Farrelly
- Department of Psychology, York
University, Toronto, ON, Canada
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jeffrey D Wardell
- Department of Psychology, York
University, Toronto, ON, Canada
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of
Toronto, Toronto, ON, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Molly L Scarfe
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Peter Najdzionek
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
| | - Jasmine Turna
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions
Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON,
Canada
- Michael G. DeGroote Centre for
Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare
Hamilton, Hamilton, ON, Canada
- Homewood Research Institute, Guelph,
ON, Canada
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Gonçalves PD, Levy NS, Segura LE, Bruzelius E, Boustead AE, Hasin DS, Mauro PM, Martins SS. Cannabis Recreational Legalization and Prevalence of Simultaneous Cannabis and Alcohol Use in the United States. J Gen Intern Med 2023; 38:1493-1500. [PMID: 36451010 PMCID: PMC10160263 DOI: 10.1007/s11606-022-07948-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Simultaneous cannabis/alcohol use, using both substances within a short time interval so that their effects overlap, has a greater risk of potential negative consequences than single-substance use and is more common in younger age. Relationships between recreational cannabis laws (RCLs) and changes in simultaneous cannabis/alcohol use prevalence remain untested. OBJECTIVE To examine trends in simultaneous cannabis/alcohol use from 2008 to 2019, and investigate associations between implementation of RCLs (i.e., presence of active legal dispensaries or legal home cultivation) and simultaneous cannabis/alcohol use in the United States (U.S.). DESIGN Repeated cross-sectional samples from the 2008-2019 U.S. National Survey on Drug Use and Health (NSDUH). PARTICIPANTS Respondents (51% female) aged 12 and older. INTERVENTIONS Changes in simultaneous cannabis/alcohol use before and after RCL implementation (controlling for medical cannabis law implementation) were compared in different age groups (12-20, 21-30, 31-40, 41-50, 51+), using adjusted multi-level logistic regression with state random intercepts and an RCL/age group interaction. MEASUREMENTS Self-reported simultaneous cannabis/alcohol use. RESULTS From 2008 to 2019, the overall prevalence of simultaneous cannabis/alcohol use declined among those aged 12-20 but increased in adults aged 21+. Model-based simultaneous cannabis/alcohol use prevalence increased after RCL implementation among respondents aged 21-30 years (+1.2%; aOR= 1.15 [95%CI = 1.04-1.27]), 31-40 years (+1.0; 1.15 [1.04-1.27]), and 41-50 years (+1.75; 1.63 [1.34-1.98]), but not in individuals aged <21 or 51+ years. CONCLUSIONS Implementation of recreational cannabis policies resulted in increased simultaneous use of cannabis and alcohol, supporting the complementarity hypothesis, but only among adults aged 21+. Efforts to minimize harms related to simultaneous cannabis/alcohol use are critical, especially in states with RCLs. Future studies should investigate cultural norms, perceived harm, and motives related to simultaneous use.
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Affiliation(s)
- Priscila Dib Gonçalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, Tucson, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St Room 509, New York, NY, 10032, USA.
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