Antecedents and consequences of cannabis use among racially diverse cannabis users: an analysis from Ecological Momentary Assessment

Motivational interviewing-based interventions with patients with comorbid anxiety and substance use disorders

Individuals with substance misuse and substance use disorder (SUD) experience especially high rates of elevated anxiety, including anxiety disorders, and the co-occurrence of these conditions is related to worse treatment outcomes. Given that these patients may have little motivation to change their substance misuse if they use substances to cope with their chronically elevated anxiety, interventions that include components that target motivation may be especially useful. Thus, this paper reviews the recent extant literature on treatments developed specifically for these high-risk patients that include motivational interviewing (MI) techniques to increase motivation for behavioral change. Results indicate that two modalities have been tested - in-person therapies and online interventions. The majority use MI techniques to change substance use and some to change anxiety-related behaviors. The majority also incorporate cognitive-behavioral skills to manage substance use and anxiety. Data indicate that MI techniques can be administered in-person and online to decrease substance misuse and anxiety among patients with elevated anxiety and substance misuse.

In harm's way: Do college students' beliefs about cannabis put them at risk for use?

Objective: This study describes beliefs held by college students about cannabis use and examines the association between three specific cannabis beliefs and likelihood of use. Participants: 3,720 undergraduate students ages 18 to 25 attending ten colleges in one state. Methods: Data were gathered via online survey. Results: The majority (80%) of the sample was unsure or believed that cannabis was an effective way to reduce stress; 67% were unsure or believed that cannabis was not related to an increased risk for mental health problems; and 62% were unsure or believed that students who use cannabis are not more academically disengaged. Holding these beliefs, which are not supported by scientific evidence, was associated with a greater likelihood of cannabis use, even after statistically adjusting for covariates. Conclusions: These findings suggest that beliefs unsupported by scientific evidence are widespread among college students. Dispelling misinformation about cannabis might hold promise for reducing use.

Momentary cannabis use motives and associated affective changes in daily life

OBJECTIVE

Cannabis use is prevalent and increasing among adults in the United States. Individuals who use cannabis commonly endorse using cannabis to enhance positive affect (PA) or cope with negative affect (NA). Importantly, enhancement motives are associated with greater frequency of use, and coping motives are associated with cannabis-related problems. We used ecological momentary assessment to test whether daily-life reports of enhancement- and coping-motivated use are associated with improved affective states.

METHOD

Participants (N = 48, Mage = 24.15, 81.3% White, 50.0% female, 45.8% male, 4.2% nonbinary) who reported using cannabis 3+ times per week completed 14 days of ecological momentary assessment, which included random and self-initiated cannabis use surveys. Participants reported PA and NA at every survey and cannabis use motives any time they reported using cannabis. Multilevel models adjusted for last-prompt PA/NA, person-level motives, alcohol use, social context, weekend, time of day, age, and gender.

RESULTS

Higher momentary enhancement motives predicted increased PA from the last survey (b = 0.28, SE = 0.07, p < .001), and higher momentary coping motives predicted increased NA from the last survey (b = 0.07, SE = 0.02, p = .003).

CONCLUSIONS

Findings highlight positive reinforcement purposes of cannabis use and suggest that endorsement of coping motives for cannabis use may be accompanied by exacerbated NA rather than improved NA. Future work should examine the generalizability of these findings in samples with greater representation of diverse ethnic and cultural backgrounds and among individuals who are in or seeking treatment for cannabis-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Savoring in Young Adult Cannabis Use and Associated Consequences: A Replication Study

Young adults exhibit high rates of cannabis use and are at heightened risk of experiencing negative cannabis-associated consequences. The purpose of the present study was to replicate and extend to prior work on savoring, the ability to experience positive experiences/emotions, and cannabis use frequency on cannabis-associated consequences. Young adults (18-25 years old, N = 122, 36.1% women) who reported weekly cannabis use completed self-report surveys. Savoring was significantly associated with cannabis use frequency (r = .28, p < .01) and cannabis-associated consequences (r = -.20, p < .05). Cannabis use frequency was significantly and negatively associated with cannabis-associated consequences (r = -.24, p < .01). However, the interaction between cannabis use frequency and savoring on cannabis-associated consequences was not significant (b = 0.0004, p = .91, 95% CI [-0.007, 0.008]). When the interaction was removed, neither cannabis use frequency (b = -0.14, p = .08, CI [-0.29, -0.02]) nor savoring (b = -0.05, p = .16, CI [-0.13, 0.02]) were associated with cannabis-associated consequences. Results did not replicate previous findings regarding the moderating role of savoring in the relationship between cannabis use frequency and cannabis-associated consequences. Future research may explore why findings did not replicate by using more fine-grained assessment methods and comprehensive measures of cannabis use.

Reasons for multiple tobacco product and cannabis co-use among Texas young adults

OBJECTIVE

This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users.

METHODS

Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use.

RESULTS

26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users.

CONCLUSIONS

Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.

From mood to use: Using ecological momentary assessments to examine how anhedonia and depressed mood impact cannabis use in a depressed sample

Anhedonia and depressed mood are two cardinal symptoms of major depressive disorder (MDD). Prior work has demonstrated that cannabis consumers often endorse anhedonia and depressed mood, which may contribute to greater cannabis use (CU) over time. However, it is unclear (1) how the unique influence of anhedonia and depressed mood affect CU and (2) how these symptoms predict CU over more proximal periods of time, including the next day or week (rather than proceeding weeks or months). The current study used data collected from ecological momentary assessment (EMA) in a sample with MDD (N = 55) and employed mixed effects models to detect and predict weekly and daily CU from anhedonia and depressed mood over 90 days. Results indicated that anhedonia and depressed mood were significantly associated with CU, yet varied at daily and weekly scales. Moreover, these associations varied in both strength and directionality. In weekly models, less anhedonia and greater depressed mood were associated with greater CU, and directionality of associations were reversed in the models looking at any CU (compared to none). Findings provide evidence that anhedonia and depressed mood demonstrate complex associations with CU and emphasize leveraging EMA-based studies to understand these associations with more fine-grained detail.

Situations and roles of cannabis versus cigarette use: Integrating ecological momentary assessment with qualitative mapping interviews

Use of both cannabis and tobacco has surpassed use of tobacco alone among young adults in California. To better understand why, we collected data with 32 young adults ages 18-30 in Northern California who regularly used cigarettes and cannabis and had diverse sexual, gender, racial, and ethnic identities. Geographically-explicit ecological momentary assessment (EMA; 30 days) was integrated with qualitative mapping interviews. We found contrasting situations of use for cannabis (e.g., around other people) versus cigarettes (e.g., recent discrimination) and different reasons for why participants chose one substance over the other (e.g., enhancing experiences vs. stepping away). Understanding when and why diverse young adults choose cannabis versus cigarettes as they navigate everyday environments helps explain how cannabis and tobacco retail markets shape substance use disparities over time.

Alterations in self-reported sensory gating and interoception in individuals frequently using cannabis

Background: Cannabis use is associated with altered processing of external (exteroceptive) and internal (interoceptive) sensory stimuli. However, little research exists on whether subjective experiences of these processes are altered in people who frequently use cannabis. Altered exteroception may influence externally oriented attention, whereas interoceptive differences have implications for intoxication, craving, and withdrawal states.Objectives: The goal of the current study was to investigate subjective experiences of exteroceptive sensory gating and interoception in people frequently using cannabis. We hypothesized subjective impairments in sensory gating and elevations in affect-related interoceptive awareness; furthermore, such deviations would relate to cannabis use patterns.Methods: This cross-sectional study of community adults 18-40 years old included 72 individuals (50% female) who used cannabis at least twice a week (not intoxicated during study) and 78 individuals who did not use cannabis (60% female). Participants completed the Sensory Gating Inventory and the Multidimensional Assessment of Interoceptive Awareness-2 surveys. People using cannabis completed surveys on cannabis use patterns. Analyses tested group differences and associations with cannabis use.Results: People using cannabis reported impaired sensory gating (d = 0.37-0.44; all p values < 0.05) and elevations of interoceptive awareness related to detection and affect (d = 0.21-0.61; all p values < 0.05). Problematic cannabis use was associated with increased sensory gating impairments (r = 0.37, p < .05). Interoceptive awareness was unrelated to cannabis use variables.Conclusion: These findings extend literature on subjective experiences of sensory processing in people using cannabis. Findings may inform inclusion of external attentional tendencies and internal bodily awareness in assessments of risk and novel treatment approaches.

A test of competing mediators linking trouble sleeping to cannabis use in adolescents and emerging adults

This study examined day-level associations between trouble sleeping and three cannabis-use indices (likelihood/quantity of use and impaired control). We evaluated behavioral and cognitive mediators of the association between trouble sleeping and cannabis outcomes. Youth (N = 86, ages 15-24, 48.8% female, 58.8% White, 18.6% Latine) who regularly used cannabis were recruited for an intervention study. This preregistered secondary data analysis leveraged data from a 1-week ecological momentary assessment (EMA) study completed prior to intervention. Trouble sleeping, cannabis use, and impaired control over use were assessed each morning; negative affect, risk-taking propensity, and cannabis craving were assessed multiple times and aggregated to create a daily average. Multilevel structural equation modeling evaluated hypothesized temporally sequenced associations and putative mechanisms at the day (i.e., within) and person (i.e., between) level. In bivariate analyses at the person level, there were large-effect associations between trouble sleeping and craving and negative affect, and between craving and cannabis-use likelihood and quantity (rs from .34 to .48). In multilevel analyses at the day level, participants were less likely to use cannabis the next day after reporting more trouble sleeping (β = -.65, p < .001). Trouble sleeping was not directly associated with subsequent cannabis-use quantity or impaired control, or indirectly via negative affect, risk-taking propensity, or craving. Trouble sleeping had differential relations with cannabis-use indices at the day and person levels. To promote youth health and reduce cannabis use, future research may consider the unique, person- and situation-driven mechanistic processes at play. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Solitary Cannabis Use and Related Consequences Among College Students During the COVID-19 Pandemic

Solitary cannabis use has been associated with greater cannabis problems than social use and may be increasingly prevalent due to pandemic-related isolation. However, little is known about patterns, correlates, and consequences of solitary cannabis use. This study sought to characterize solitary cannabis use since pandemic onset, examine psychosocial risk factors, and examine interactions between solitary and social cannabis use frequency on cannabis consequences. College students (N = 168) who were lifetime cannabis users at a private, northeastern university in the US completed an online cross-sectional survey in fall of 2020. Past-year solitary cannabis use was common among life-time cannabis users (42% past year, 29% monthly or more), especially among past-year regular cannabis users (85% monthly or more). Solitary use frequency was associated with interpersonal sensitivity and pandemic-related stress. Further, solitary use attenuated associations of social use frequency with cannabis consequences, such that social use frequency was associated with greater consequences only among exclusively social users. In contrast, regardless of social use frequency, solitary users reported greater cannabis consequences than exclusively social users. Findings suggest solitary cannabis use is concurrently associated with greater cannabis consequences, and affective risk factors (interpersonal sensitivity, pandemic stress) should be considered for prevention and intervention strategies.

Using EMA to explore the role of Black adolescents' experiences in activity spaces in momentary negative emotion and marijuana use

Research examining the role of place in Black adolescents' health behaviors typically examines neighborhoods, with little attention paid to micro geographies such as activity spaces. Understanding experiences in activity spaces may be especially important for Black adolescents living in neighborhoods traditionally characterized as disadvantaged. The SPIN project recruited 75 Black adolescents living in a single neighborhood to complete ecological momentary assessments (EMA) about the activity spaces they encountered over a month. Perceptions of violence and social support in activity spaces in a day are related to marijuana use during the day, relationships partially explained by negative momentary emotions.

Early life adversity and substance use: The mediating role of mood and the moderating role of impulsivity

INTRODUCTION

Early life adversity (ELA) is a risk factor for substance use and misuse, and multiple factors mediate and moderate this association. We examined whether moods mediate the relationships between ELA and nicotine use, cannabis use, and co-use, and whether these mediation effects varied as a function of delay discounting.

METHODS

A total of 2555 adults completed a delay discounting task and responded to questions related to demographics, ELA, mood, and substance use. Data were analyzed using Pearson correlations and moderated mediation using Hayes' PROCESS macro (V3.4, Model 15).

RESULTS

ELA was positively associated with cannabis use, nicotine use, co-use of both substances, depressed and stressed moods, and it was negatively associated with positive mood. While cannabis use was associated negatively with stressed and depressed moods and positively with positive mood, nicotine use was associated negatively with positive mood. Moderated mediation analyses indicated that positive mood mediated the relationship between ELA and cannabis use for those with average and above average delay discounting. Positive mood also mediated the relationship between ELA and co-use among those with above average delay discounting.

CONCLUSION

The results suggest that ELA's associations with cannabis use and cannabis-nicotine co-use may be partially attributable to ELA's effects on positive mood among those who are predisposed to moderately to highly impulsive decision making.

Examination of the Relationship Between Daily Perceptions of Collective Efficacy and Marijuana Use Among Black Youth: Does the Location of the Perception Matters?

Neighborhood-level collective efficacy protects Black youth from substance use; however, neighborhood research does not account for the entirety of adolescents' exposure or their perceptions of space which may be critical to understanding the role of context in substance use. To address this limitation, the SPIN Project recruited 65 Black adolescents (M(SD) = 15.32(1.06)) to complete four brief surveys each day for a month describing their perceptions of spaces and marijuana use. Multilevel negative binomial models were estimated to test the relationship between an individual's perceptions of collective efficacy and the marijuana used during a day, and if the location of the observations moderated these relationships. Findings indicated that the perceptions of collective efficacy protected adolescents from marijuana use when occurring within their home neighborhood, but not outside of it; thereby suggesting important variations in adolescents' perceptions based on the location that matter for Black youth marijuana use.

Predicting quantity of cannabis smoked in daily life: An exploratory study using machine learning

BACKGROUND

Cannabis use is prevalent in the United States and is associated with a host of negative consequences. Importantly, a robust indicator of negative consequences is the amount of cannabis consumed.

METHODS

Data were obtained from fifty-two adult, regular cannabis flower users (3+ times per week) recruited from the community; participants completed multiple ecological momentary assessment (EMA) surveys each day for 14 days. In this exploratory study, we used various machine learning algorithms to build models to predict the amount of cannabis smoked since participants' last report including forty-three EMA measures of mood, impulsivity, pain, alcohol use, cigarette use, craving, cannabis potency, cannabis use motivation, subjective effects of cannabis, social context, and location in daily life.

RESULTS

Our best-fitting model (Gradient Boosted Trees; 71.15% accuracy, 72.46% precision) found that affects, subjective effects of cannabis, and cannabis use motives were among the best predictors of cannabis use amount in daily life. The social context of being with others, and particularly with a partner or friend, was moderately weighted in the final prediction model, but contextual items reflecting location were not strongly weighted in the final prediction model, the one exception being not at work.

CONCLUSIONS

Machine learning approaches can help identify additional environmental and psychological phenomena that may be clinically-relevant to cannabis use.

Ecological investigation of the co-occurrence of posttraumatic stress disorder symptoms and cannabis use among community women experiencing intimate partner violence

BACKGROUND

Women experiencing intimate partner violence (IPV) are at increased risk for developing hazardous patterns of cannabis use. Research suggests that women experiencing IPV use cannabis to cope with posttraumatic stress disorder (PTSD) symptoms. To advance research, we used experience sampling methods to explicate the within-day concurrent and proximal relations between PTSD symptom clusters and cannabis use among women experiencing IPV.

METHOD

Participants were 145 community women (M age = 40.66, 41.6% white, 31.4% Black, 10.9% Hispanic or Latina, 8% American Indian/Alaska Native, 5.8% Bi-/multi-racial) experiencing IPV and using substances who completed three surveys a day for 30 days.

RESULTS

Externalizing behavior (OR = 1.37, 95% CI [1.15, 1.65], p < 0.001) and dysphoric arousal (OR = 1.27, 95% CI [1.09, 1.49], p = 0.002) PTSD symptom clusters were associated with cannabis use reported in the same survey period. Results from the lagged models found no proximal associations between PTSD symptom clusters and cannabis use.

CONCLUSIONS

Results highlight the acute effects of externalizing behavior and dysphoric arousal PTSD symptoms on cannabis use among women experiencing IPV. These findings may inform prevention and intervention efforts for cannabis use in this population.

Daily-level relationships between negative affect, negative emotion differentiation, and cannabis behaviors among a high-risk sample of young adults

Prior research suggests that higher trait negative emotion differentiation (NED; one's ability to make subtle distinctions between different negative emotional states) is associated with consuming less alcohol when experiencing high negative affect (NA) in daily life. Yet, whether these findings extend to cannabis use behaviors is unclear. The present study used intensive daily data to test whether NED moderated the relationship between NA and cannabis behaviors. A community sample of 409 young adults who used alcohol and cannabis completed a baseline survey and five 2-week bursts of online surveys across two years. Multilevel models tested cross-level interactions between trait NED (person-level) and daily NA (daily-level) predicting cannabis use, hours high, negative consequences, craving, and coping motives. In contrast to expectations, on days with higher reported NA, people with higher NED (compared to those with lower NED) had a greater likelihood of experiencing any cannabis craving, experienced more intense craving, and reported higher cannabis coping motives. NED x NA interaction was not significant for likelihood of cannabis use, hours high, or negative consequences. Post-hoc descriptive analyses suggest notable person-specific heterogeneity in these findings. Individuals with higher ability to differentiate between negative emotions reported higher coping motives and craving when experiencing higher NA. However, these associations were variable for individuals within the sample. It may be that high NED individuals crave and purposefully use cannabis to reduce NA states. Findings are inconsistent with the alcohol literature and have important implications for intervention efforts aimed at reducing coping-motivated cannabis use among young adults.

Discrete emotions and global affect: Applying empirically driven approaches to experience sampling data to model state and trait affective structure and affect-alcohol use associations in a heavy drinking young-adult sample

Affective functioning is central to most contemporary models of alcohol use. However, the affective structure at the within- and between-person levels is rarely investigated nor is the differential predictive value of specific affect dimensions assessed across state and trait formats. We examined a) the structure of state and trait affect using experience sampling methodology (ESM) and b) predictive associations between the empirically derived affect facets and alcohol use. Participants were 92 heavy drinking college students aged 18-25 who completed 8 momentary assessments of their affect and drinking a day for 28-days. We found evidence for a single positive affect factor at both the within- (i.e., state) and between-person (i.e., trait) levels. We found a hierarchical factor structure for negative affect, represented by a general, superordinate dimension as well as facet-level sadness, anxiety, and anger dimensions. Associations between affect and alcohol use differed across trait and state levels and across specific types of negative affect. Lagged state positive affect and sadness as well as trait positive affect and sadness were inversely associated with drinking. Lagged state anxiety and trait general negative affect were positively associated with drinking. Thus, our study demonstrates how associations between drinking and affect can be studied in relation to general (e.g., general negative affect) and more specific aspects of affective experiences (e.g., sadness versus anxiety) concurrently within the same study and across trait and state levels of assessment.

Results of a pilot study examining the effect of positive psychology interventions on cannabis use and related consequences

BACKGROUND

Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) have shown promise in targeting other substance use behaviors. This pilot study sought to provide an initial test of PPIs to reduce young adult cannabis use and consequences.

METHODS

Adults (18-25 years old) who endorsed at least weekly past-month cannabis use (N = 59, 69.6% men, 41.1% White) reported their baseline cannabis use and consequences. Participants were randomized to complete one of three daily exercises (Savoring, Three Good Things, or a control) along with daily text message surveys for two weeks, then completed a follow-up survey at the end of the two weeks.

RESULTS

Paired samples t-tests indicated that participants in the Three Good Things group showed medium to large reductions in frequency of weekly cannabis use (p = .08, gav = -0.57) and cannabis-associated consequences (p = .08, gav = -0.57) from baseline to follow-up. In the Savoring and control groups, there were not significant changes in frequency of weekly cannabis use (Savoring: p = .39, gav = 0.20; Control: p = .96, gav = 0.01) nor cannabis-associated consequences (Savoring: p = .84, gav = 0.05; Control: p = .45, gav = -0.18). Participants in both positive psychology conditions reported the exercises were easy to complete, providing evidence for acceptability.

DISCUSSION

Results provide initial support for the feasibility and potential promise of a text-message based PPI as a harm reduction approach for cannabis users. A larger clinical trial is warranted to test the effects of such interventions with adequate statistical power.

Differentiating people who use cannabis heavily through latent class analysis

BACKGROUND

People who use cannabis daily or near-daily vary considerably in their daily dosage and use frequency, impacting both experienced effects and adverse consequences. This study identified heavy cannabis user groups according to consumption patterns and factors associated with class membership.

METHODS

We conducted a cross-sectional study of 380 Spanish residents (61.8% male; average age = 30.3 years) who had used cannabis ≥ 3 days/week throughout the past year. Participants were recruited through chain referral and cannabis social clubs. We applied latent class analysis (LCA) to cluster participants according to use intensity. LCA indicators included frequency of weekly cannabis use, joints smoked each day, cannabis dosage, and if cannabis was consumed throughout the day or only at specific times. Associations between class membership and socio-demographics, use patterns, motives, supply sources, adverse outcomes, and use of other substances were measured using ANOVA and chi-squared tests. Multinomial regression identified the factors associated with latent class membership.

RESULTS

Three latent classes (moderately heavy: 21.8%, heavy: 68.2%, very heavy: 10%) had average weekly cannabis intakes of 2.4, 5.5, and 18.3 g, respectively. Very heavy users were older ([Formula: see text]=17.77, p < 0.01), less educated [Formula: see text]=36.80, p < 0.001), and had used cannabis for longer (F = 4.62, p = 0.01). CAST scores (F = 26.51, p < 0.001) increased across the classes. The prevalence of past-month alcohol use was lower among the heaviest users ([Formula: see text]=5.95, p = 0.05). Cannabis was usually obtained from a club by very heavy users ([Formula: see text]=20.95, p < 0.001).

CONCLUSIONS

People who use cannabis heavily present three groups according to frequency and quantity of cannabis consumption. Use intensity is associated with increased cannabis-related problems. Differences among heavy users must be considered in harm reduction interventions in cannabis clubs and indicated prevention.

Feasibility study of using mobile phone-based experience sampling to assess drug checking by opioid street drug users

BACKGROUND

To date, evaluations of take-home fentanyl (and/or benzodiazepine) test strip use - the most common form of drug checking services - and potential effects on overdose risk have relied on retrospective accounts for some preceding time period, usually a week to several months. Such accounts, however, are subject to recall and memory biases. This pilot study assessed the feasibility of using experiential sampling to collect daily information in situ on drug checking and associated overdose risk reduction - the primary outcomes - among a sample of street opioid users and compared the results to retrospective reports.

METHODS

We recruited 12 participants from a Chicago-based syringe services program. Participants were 18 years of age or older, reported using opioids purchased on the street 3 + times per week in the past month, and had an available Android mobile phone. A phone-based app was programmed to collect daily drug checking information and provided to each participant along with a supply of fentanyl and benzodiazepine test strips and instructions for use over 21 days. Comparable retrospective data were collected via follow-up in-person surveys at the conclusion of daily report collection.

RESULTS

We found a reasonably high rate of daily reporting (63.5%) with participants submitting reports on 160 "person-days" out of 252 possible days. Participants submitted daily reports an average of 13 of 21 days. Reports of test strip use frequency varied between the retrospective and daily reports with a relatively higher percentage of days/time using test strips obtained from the daily reports. We also found higher proportions reporting overdose risk reduction behaviors on the daily reports compared with the retrospective reviews.

CONCLUSIONS

We believe the results support using daily experience sampling to collect information on drug checking behaviors among street drug users. Although resource intensive in comparison to retrospective reports, daily reporting potentially provides more detailed information on test strip use and its association with overdose risk reduction and, ultimately, fewer overdoses. Needed are larger trials and validation studies of daily experience sampling to identify the optimum protocol for collecting accurate information on drug checking and overdose risk reduction behavior.

Latent profiles of cannabis use, protective behavioral strategies, and health beliefs in college students

College student cannabis use is prevalent and heterogeneous, with some students experiencing cannabis-related problems. Cannabis protective behavioral strategies (PBS) are cognitive-behavioral strategies associated with reduced cannabis use and problems. There is a need for theory-informed and person-centered research to better understand cannabis PBS. The current study applied the health belief model (HBM) and latent profile analysis to discern patterns of cannabis use, PBS, and health beliefs among college students. Students (n = 164; M_age = 18.8; 53% female) who endorsed past-month cannabis use completed an online survey between September and November 2017. The 3-profile model best fit the data. Profile 1 (24.3%) represents the "infrequent use/high protection" profile characterized by using cannabis about 1-9 times, high PBS use, high perceived threat and benefits, and moderate perceived barriers. Profile 2 (38.1%) represents the "occasional use/moderate protection" profile characterized by using cannabis about 20-59 times, moderate PBS use, moderate perceived threat and benefits, and low perceived barriers. Profile 3 (37.6%) represents the "frequent use/low protection" profile characterized by using cannabis about 80 or more times, low PBS use, low perceived threat and benefits, and high perceived barriers. Profiles did not differ by age, ethnicity/race, sex, or college year, though varied significantly by age at first cannabis use, cannabis availability, cannabis problems, use frequency, and use context. Results provide preliminary support for distinct patterns of cannabis use, PBS, and health beliefs that align with the HBM. Results highlight the importance of considering how students perceive cannabis PBS and problems and how those beliefs may influence their PBS and cannabis use.

Young Adult Physical, Social, and Temporal Contexts of Simultaneous Alcohol and Marijuana Use

OBJECTIVE

Simultaneous alcohol and marijuana (SAM) use is reported to be associated with heavier alcohol and marijuana use and more negative consequences, but less is known about the social, physical, and temporal contexts of SAM use.

METHOD

Young adults (N = 326, 51.2% male, 49.1% White non-Hispanic) who reported past-month SAM use completed up to 14 daily surveys across five bursts that assessed SAM use and negative consequences and social, physical, and temporal contexts. We used multilevel models to examine SAM use contexts' associations with alcohol/marijuana quantity and consequences.

RESULTS

The social context of alone only (vs. with others only) was associated with consuming fewer drinks. Physical contexts that included using both at home and outside the home (vs. only at home) were associated with greater alcohol and marijuana quantity and negative consequences (but not after controlling for alcohol quantity); use outside the home only (vs. only at home) was associated with more alcohol use, more alcohol consequences (but not after controlling for alcohol quantity), and fewer marijuana consequences (even after controlling for marijuana quantity). The temporal context of first engaging in SAM use before 6 P.M. (vs. after 9 P.M.) was associated with greater alcohol and marijuana quantity and more marijuana consequences (but not after controlling for number of hours high), and first engaging in SAM use between 6 and 9 P.M. was associated with more hours high.

CONCLUSIONS

SAM use contexts such as using with others, using outside the home, and using earlier in the evening are typically associated with greater alcohol/marijuana quantity and consequences.

Exploring associations between affect and marijuana use in everyday life via specification curve analysis

Although frequently hypothesized, the evidence for associations between affect and marijuana use in everyday life remains ambiguous. Inconsistent findings across existing work may be due, in part, to differences in study design and analytic decisions, such as study inclusion criteria, the operationalization of affect, or the timing of affect assessment. We used specification curves to assess the robustness of the evidence for affect predicting same-day marijuana use and marijuana use predicting next-day affect across several hundred models that varied in terms of decisions that reflect those typical in this literature (e.g., whether to average affect prior to marijuana use or select the affect report closest in time to marijuana use). We fitted these curves to data from two ecological momentary assessment studies of regular marijuana and/or alcohol using college students (N = 287). Results provided robust evidence that marijuana use was slightly less likely following experiences of negative affect and slightly more likely following positive affect. Specification curves suggested that differences in previous findings are most likely a function of the specific emotion items used to represent affect rather than differences in inclusion criteria, the temporal assessment and modeling of affect, or the covariates added to the model. There was little evidence for an association between marijuana use and next-day affect. Overall, our findings provide evidence against the predictions made by affect reinforcement models in college students and suggest that future research should model the associations of marijuana use with discrete emotional states rather than general negative and positive affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Expectancies that Predict Cannabis Initiation in Response to Legalization

Background: Recent and prospective changes to nonmedical/recreational cannabis laws in the United States and abroad raise questions about how legalization may influence cannabis use behaviors. Objectives: In the current study, we examined links between legalization, context-specific likelihood of using cannabis, and cannabis expectancies using cross-sectional survey data from 121 college students who had never used or were abstaining from cannabis in a U.S. state where laws prohibit nonmedical cannabis. Results: We found that across scenarios, 61% of students reported they would be more likely to use cannabis if it were legal. Social/sexual facilitation expectancies predicted a higher likelihood of using cannabis after legalization in a social context. Relaxation/tension reduction expectancies predicted a higher likelihood of using in an anxiety relief context. Perceptual/cognitive enhancement expectancies predicted a higher likelihood of using in a pain relief context. Cognitive/behavioral impairment expectancies predicted a lower likelihood of using in social, pain relief, relaxation, and concert contexts. Global negative effects expectancies predicted a lower likelihood of using in relaxation and concert contexts. Conclusions: Our findings suggest that among college students who do not use cannabis, expectancies are linked to cannabis use likelihood in certain contexts if cannabis were legal. This work highlights cannabis expectancies and contexts as possible targets for evidence-based public health education and clinical prevention initiatives related to the potential increase in cannabis use associated with cannabis policy implementation. College students may benefit from initiatives that address cannabis expectancies and enhance harm reduction skills to help them effectively navigate contexts in which cannabis is available to them.

Association between affect and cannabis use varies by social context

BACKGROUND

Cannabis use is rising globally, underscoring the importance of understanding contextual factors related to cannabis use. Although much work has retrospectively examined cannabis use patterns and effects, fewer studies have evaluated cannabis use in natural environments.

METHODS

The present study used ecological momentary assessment (EMA) to examine the subjective experience of cannabis use (i.e., positive and negative affect) and how cannabis' mood effects are modified by the social context, defined as being alone or with others, in which use occurs. Associations between cannabis' mood effects and cannabis use disorder symptomatology were additionally examined. Participants (N = 200) completed baseline assessments and two 7-day waves of EMA data collection. Mixed-effects models examined between- and within-subject effects for positive and negative affect at cannabis use and nonuse times and interactions between cannabis use and social context.

RESULTS

Positive affect was elevated at cannabis use times, compared to nonuse times, regardless of social context. The relationship between cannabis use and negative affect was moderated by social context, such that negative affect was elevated at cannabis use times when participants were alone and reduced at cannabis use times when participants were with others. Higher levels of cannabis use disorder symptomatology and cannabis use frequency were both associated with lower negative affect at cannabis use times.

CONCLUSIONS

These results suggest that elevated positive affect is consistent across cannabis use times regardless of social context, but negative affect may vary more by the presence of others.

Feasibility Study of Using Mobile Phone-Based Experience Sampling to Assess Drug Checking by Opioid Street Drug Users

Background: To date, evaluations of take-home fentanyl (and/or benzodiazepine) test strip use - the most common form of drug checking services - and potential effects on overdose risk have relied on retrospective accounts for some preceding time period, usually a week to several months. Such accounts, however, are subject to recall and memory biases. This pilot study assessed the feasibility of using experiential sampling to collect daily information in situ on drug checking and associated overdose risk reduction - the primary outcomes - among a sample of street opioid users and compared the results to retrospective reports. Methods: We recruited 12 participants from a Chicago-based syringe services program. Participants were 18 years of age or older, reported using opioids purchased on the street 3+ times per week in the past month, and had an available Android mobile phone. A phone-based app was programmed to collect daily drug checking information and provided to each participant along with a supply of fentanyl and benzodiazepine test strips and instructions for use over 21 days. Comparable retrospective data were collected via follow-up in-person surveys at the conclusion of daily report collection. Results: We found a reasonably high rate of daily reporting (63.5%) with participants submitting reports on 160 "person-days" out of 252 possible days. Participants submitted daily reports an average of 13 of 21 days. Reports of test strip use frequency varied between the retrospective and daily reports with a relatively higher percentage of days/time using test strips obtained from the daily reports. We also found higher proportions reporting overdose risk reduction behaviors on the daily reports compared with the retrospective reviews. Conclusions: We believe the results support using daily experience sampling to collect information on drug checking behaviors among street drug users. Although resource intensive in comparison to retrospective reports, daily reporting potentially provides more detailed information on test strip use and its association with overdose risk reduction and, ultimately, fewer overdoses. Needed are larger trials and validation studies of daily experience sampling to identify the optimum protocol for collecting accurate information on drug checking and overdose risk reduction behavior.

Ecological Momentary Assessment of Cannabis Use and Affect Among Adolescents Following Psychiatric Discharge

OBJECTIVE

Affect regulation is central to multiple theoretical models that explain cannabis use (CU) behavior. However, much of the research has been conducted with adults, leaving unanswered questions about the nature of associations among adolescents, especially those with affective disorders. Using clinical interviews and ecological momentary assessment (EMA), we assessed rates of adolescent CU and momentary associations with affect following psychiatric discharge among youth hospitalized for suicidal thoughts and behaviors.

METHOD

Participants were 13- to 18-year-olds (N = 62; 64.5% female) recruited from an inpatient psychiatric hospital who reported having ever used cannabis. Participants completed clinical interviews during hospitalization. EMA was conducted for 21 days upon discharge.

RESULTS

Concurrent use of other drugs was associated with greater odds of CU (odds ratio = 27.63). Momentary CU was associated with higher levels of positive affect and lower levels of anger/irritability, but not with negative affect. The effect of momentary CU on positive affect was greater among youth with a diagnosis of posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD).

CONCLUSIONS

Findings suggest that adolescents may use cannabis to enhance positive emotion, especially those with PTSD/GAD. Results highlight the importance of tailored interventions that focus on providing alternative and adaptive methods to enhance positive affect.

Why Use Cannabis? Examining Motives for Cannabis Use in Individuals with Anxiety Disorders

This study examined cannabis use motives in individuals with anxiety disorders and compared motives between infrequent and frequent cannabis users. It was hypothesised that coping motives would be endorsed at a significantly higher rate than other motives, and that frequent cannabis users would endorse coping motives significantly more than infrequent users. Participants were 144 adults seeking clinical services for anxiety disorders who reported using cannabis. Cannabis use was categorized by infrequent (n = 54) and frequent (n = 90) use. Anxiety symptoms were assessed and deemed clinically significant. Participants completed measures of cannabis use motives, cannabis use patterns, and cannabis use disorder symptoms, cross-sectionally. Cannabis use motives were examined for the entire sample and compared between frequent and infrequent users. In general, cannabis users endorsed coping (i.e., use for managing distress) and enhancement (i.e., use for fun, pleasant feeling, or the high) motives at equal rates (p = .265) and more than other motives (p < .001). Frequent users reported using cannabis for coping and expansion motives (i.e., use to change one's thinking) significantly more than infrequent users. These results indicate that individuals with anxiety disorders use cannabis for various reasons, some of which may not be directly related to their mental health symptoms. Future research is needed to compare motives for cannabis use in those with anxiety disorders, other mental health populations, and the general population, as well as examine motives for cannabis use within specific anxiety disorders.

Academic factors associated with college students' prescription stimulant misuse in daily life: An ecological analysis of multiple levels

ObjectiveTo identify academic factors pertaining to college students, calendar timing, and particular moments that are uniquely associated with elevated likelihood of prescription stimulant misuse (intentions and actual behavior) in daily life. Participants: Participants were 297 freshmen and sophomores at a large public university in the United States in 2017-2019. Methods: Participants completed survey measures during lab visits and ecological momentary assessment procedures in daily life. Hypotheses were tested using multilevel models that accounted for the nested data and demographic covariates. Results: Student, calendar-based, and momentary academic factors were uniquely associated with stimulant misuse intentions in daily life. Real-time academic events, beyond the proportion of academic events experienced, emerged as a robust predictor of misuse behavior. Within-person links between real-time momentary predictors and misuse behavior were moderated by finals week timing. Conclusions: Findings offer implications for prevention and intervention strategies for college students at risk for prescription drug misuse.

Abstinence phobia among adult African American/Black cannabis users

OBJECTIVE

African American/Black individuals experience significant health disparities, particularly as it relates to cannabis use. As such, there is a need to identify intrapersonal factors related to more severe patterns of use among this subpopulation. Worry about quitting or reducing cannabis as a result of the anticipated anxiety-related states during deprivation (i.e., abstinence phobia) is one factor that is theoretically important in the context of cannabis-related disparities.

METHOD

The current study sought to examine the cross-sectional association between abstinence phobia and cannabis use problems, perceived barriers for cannabis cessation, and cannabis withdrawal symptoms. Participants included 83 African American/Black cannabis users (31.3% female, M_age = 38.12, SD = 10.42).

RESULTS

Cannabis abstinence phobia was associated with greater severity of cannabis use problems, more perceived barriers for quitting cannabis use, and more severe cannabis withdrawal symptoms.

CONCLUSIONS

Abstinence phobia may represent an underrecognized intervention target for addressing cannabis use problems and quit success.

Motives, Frequency, and Consequences of Cannabis Use Among College Students

We investigated profiles of cannabis use motives among current cannabis-consuming college students. Then we assessed profile differences in demographic characteristics, social contexts of use, regulatory environment, alcohol use, negative affect, negative consequences, and cannabis use. Participants ( N = 1, 213) were from three universities in states with different cannabis legislation. Six profiles emerged: Low Motives, Low to Moderate Enhance, High Enhance, High Enhance & Social + Moderate Expand, High Enhance & Cope, and High Motives. Profiles differed in social contexts of use, sex, alcohol use, negative affect, and regulatory environment. Profiles endorsing high and multiple motives had higher cannabis use and negative consequences, relative to profiles with low or fewer motives. Profiles characterized by high avoidance motives (i.e., coping) had the highest cannabis use and consequences. Interventions targeting types and intensity of motives for cannabis-use may help reduce use and related consequences among college students who use cannabis.

Cannabis use as a predictor and outcome of positive and negative affect in college students: An ecological momentary assessment study

BACKGROUND

Reinforcement models identify negative affect (NA) and positive affect (PA) to be important momentary determinants and outcomes of cannabis use. Sensitization and allostatic models further suggest that these mood-cannabis associations are stronger among individuals with more cannabis-related problems. Despite this theoretical background and the fact that cannabis is commonly used for its mood-enhancing effects among college students, surprisingly, little is known about the momentary associations between mood and cannabis use in this population.

AIMS

To examine the associations between (a) momentary within-person variations in NA (worried, stressed, nervous) and PA (happy, enthusiastic, proud, excited) and intention to use cannabis within the next hour, (b) the within-person variations in time elapsed since last cannabis use, amount used and momentary NA and PA, and (c) to test whether cannabis-related problems moderate the stated associations.

METHOD

Eighty, more-than-weekly, cannabis using students at the University of Amsterdam reported on cannabis use, NA and PA three times daily for 14 consecutive days. Mixed-effects models were performed to analyze the dataset.

RESULTS

Within-persons, relatively high PA and low NA were associated with a higher likelihood of intending to use cannabis. Within-persons, more recent and greater amounts of cannabis use were associated with relatively high PA. More recent cannabis use was associated with relatively low NA. Cannabis-related problems did not moderate the associations.

CONCLUSIONS

While recent cannabis use related to higher PA and lower NA, high PA but low NA preceded use, supporting positive reinforcement rather than negative reinforcement in this college sample of regular cannabis users.

Mood, sleep and pain comorbidity outcomes in cannabis dependent patients: Findings from a nabiximols versus placebo randomised controlled trial

BACKGROUND

Mood, sleep and pain problems are common comorbidities among treatment-seeking cannabis-dependent patients. There is limited evidence suggesting treatment for cannabis dependence is associated with their improvement. This study explored the impact of cannabis dependence treatment on these comorbidities.

METHODS

This is a secondary analysis from a 12-week double-blind placebo-controlled trial testing the efficacy of a cannabis agonist (nabiximols) against placebo in reducing illicit cannabis use in 128 cannabis-dependent participants. Outcome measurements including DASS-21 (Depression, Anxiety, and Stress subscales); Insomnia Severity Index (ISI); and Brief Pain Inventory (BPI), were performed at weeks 0, 4, 8, 12 and 24. Each was analysed as continuous outcomes and as binary cases based on validated clinical cut-offs.

RESULTS

Among those whose DASS and ISI scores were in the moderate to severe range at baseline, after controlling for cannabis use, there was a gradual decrease in severity of symptoms over the course of the trial. BPI decreased significantly until week 12 and then rose again in the post-treatment period during weeks 12-24. Neither pharmacotherapy type (nabiximols vs placebo) nor number of counselling sessions contributed significant explanatory power to any of the models and were excluded from the final analyses for both continuous and categorical outcomes.

CONCLUSIONS

Participants in this trial who qualified as cases at baseline had elevated comorbidity symptoms. There was no evidence that nabiximols treatment is a barrier to achieving reductions in the comorbid symptoms examined. Cannabis dependence treatment reduced illicit cannabis use and improved comorbidity symptoms, even when complete abstinence was not achieved.

Focus on Rural Adolescent Cannabis Use and Abuse: Ignored Epidemiologic Trends, Unique Risks, Long-Term Concerns, and Hope

Cannabis-related issues for adolescents and young adults are emerging from the shadow of rural opioid addiction and deaths. The rural pediatric population has multiple risk factors putting them at increased risk for adverse consequences with the expansion of cannabis legalization across the United States. Research in this area is rich but scattered across professional disciplines. Differences in demographics and cultures between rural and urban youth are gaining attention. Epidemiological factors relevant to rurality as a risk for cannabis and other substance use are considered for formulating clinical care, public policymakers, and future research. Race, culture, community stability, basic demographics of age, gender, educational status, and demands for more and better, accessible services for rural, nonmetropolitan areas comprise factors for consideration and are detailed. Research findings provide direction for policymakers and clinicians for prevention and intervention efforts to improve care for rural populations, validating and expanding upon insights gained to date.

Momentary patterns of alcohol and cannabis co-use in college students: Assessing the temporal association with anxiety

Using ecological momentary assessment (EMA), we assessed momentary patterns of alcohol and cannabis co-use in college students and whether state-level and baseline reports of anxiety varied based on type of substance(s) consumed. Students (N=109) reporting regular cannabis use completed a baseline assessment and two-week signal-contingent EMA, with three random prompts/day. At each EMA instance, we categorized instances of substance "usage" as: 1) no use, 2) cannabis-only, 3) alcohol-only, or 4) co-use of alcohol and cannabis (i.e., reports of alcohol and cannabis use within the same prompt). Using temporal sequenced data, we explored how state-level anxiety varied before and after usage type using multiple multilevel structural equation models (MSEMs) and whether baseline factors (general anxiety, social anxiety, and sex) influenced the relation between usage type and state-level anxiety. Participants were 63.3% White, 58.7% female, used cannabis near-daily, and commonly reported co-use. Models examining whether usage type predicted subsequent state-level anxiety were predominantly significant, with the majority of relationships being more pronounced for participants with higher baseline general anxiety. In examining whether momentary state-level anxiety predicted usage type, in instances when participants reported higher levels of momentary anxiety, they were more likely to report no use compared to co-use and cannabis-only, with sex moderating some of the relationships. Social anxiety did not moderate any of the within-person associations between state-level anxiety and usage type. This study provides preliminary evidence that report of momentary anxiety varies based on substance type. Future research is needed to establish co-use related synergistic effects and correlates.

Associations of mode of administration on cannabis consumption and subjective intoxication in daily life

OBJECTIVE

As cannabis products are becoming increasingly available and young adults are increasingly using vaporizers to consume cannabis, there is a need to understand how this population is using different modes of administration and the extent to which specific modes are associated with differential cannabis use outcomes. Toward this end, the current study characterized predictors of cannabis mode of administration and examined how consumption levels and subjective intoxication vary as a function of mode of administration in daily life.

METHOD

Participants were 106 young adult cannabis and heavy alcohol users (51% female) who completed up to 14 daily diaries (n = 1,405 person days). Each day, participants reported whether they used any cannabis and, if any, which mode(s) were used, number of hits used per mode, overall subjective intoxication, and the socio-environmental context in which they used cannabis.

RESULTS

Across all cannabis use days, Bong-Only and Vape-Only days were the most common, followed by Multimode, Joint-, Pipe-, and Blunt-Only days. Participants reporting a greater proportion of cannabis use days were more likely to report Bong-Only and Multimode days than Vape-Only days. Compared to Vape-Only days, participants reported fewer hits on Bong-Only days and more hits on Blunt-Only, Pipe-Only, and Multimode days. Participants felt more intoxicated on Bong-Only days than Vape-Only days.

CONCLUSIONS

Mode-specific associations with cannabis consumption and subjective intoxication levels suggest assessing modes of administration may be a meaningful way to guide individual and public health intervention efforts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Applications of technology in the assessment and treatment of cannabis use disorder

Cannabis use and Cannabis Use Disorder (CUD) have been increasing. There are no FDA approved medications and evidence-based psychotherapy is limited by insufficient providers, serving very few patients effectively. The lack of resources for prevention and treatment of CUD has resulted in a significant gap between the need for services and access to treatment. The creation of a scalable system to prevent, screen, refer and provide treatment for a chronic, relapsing diagnosis like CUD could be achieved through the application of technology. Many studies have utilized ecological momentary assessments (EMA) in treatment seeking and non-treatment seeking cannabis users. EMA allows for repeated, intensive, longitudinal data collection in vivo. EMA has been studied in cannabis use and its association with affect, craving, withdrawal, other substances, impulsivity, and interpersonal behaviors. EMA has the potential to serve as a valuable monitoring tool in prevention, screening, and treatment for CUD. Research has also focused on the development of internet and application-based treatments for CUD, including a currently available prescription digital therapeutic. Treatment options have expanded to more broadly incorporate telehealth as an option for CUD treatment with broad acceptance and change in regulation following the COVID-19 pandemic. While technology has limitations, including cost, privacy concerns, and issues with engagement, it will be a necessary medium to meet societal health needs as a consequence of an ever-changing cannabis regulatory landscape. Future work should focus on improving existing platforms while ethically incorporating other functions (e.g., sensors) to optimize a public and clinical health approach to CUD.

Predicting college student prescription stimulant misuse: An analysis from ecological momentary assessment

Prescription stimulant misuse (PSM) is common in young adult college students, at over 10% in the past year, and it is associated with other substance use and risk behaviors. Research focused on the real-time drivers of PSM is absent, impeding prevention and intervention. This research aimed to fill that gap by examining the relationships between affect, global stress, or academic stress and PSM via ecological momentary assessment (EMA); we also investigated baseline predictors of PSM frequency during the 21-day EMA period. Forty-one full-time college students (mean age: 20.5, 66% female) who endorsed current PSM (≥ 6 past-year episodes) participated. Participants were asked to complete EMA questions in response to 3 daily investigator-initiated prompts and after every PSM episode. Assessments were selected based on affect regulation (e.g., positive affect [PA], negative affect [NA]) and drug instrumentalization (e.g., academic stress and/or demands) theories of substance use. Mixed-effects linear models examined EMA data, and negative binomial regression analyses examined baseline predictors of PSM episode frequency. PA was higher on PSM days and increased post-PSM, whereas NA was unrelated to PSM. Although global and academic stress were largely unrelated to PSM, when the motive endorsed for PSM was "to study," pre-PSM ratings of academic demand and stress were significantly higher. Finally, a history of recreational motives (e.g., to get high) or higher levels of attention-deficit/hyperactivity disorder symptoms predicted a greater number of PSM episodes over the EMA period. The results offered mixed support for both affect regulation and instrumentalization as applied to PSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between simultaneous alcohol and cannabis use and next-day negative affect among young adults: The role of sex and trait anxiety

BACKGROUND AND AIMS

The simultaneous use of alcohol and cannabis ("simultaneous alcohol and marijuana [SAM] use") is common among young adults and associated with negative substance-related consequences. SAM use may be tied to fluctuating mood states such as negative affect and individual characteristics including trait level of anxiety and sex. However, little is understood about their collective role. In this study, we sought to understand the daily link between SAM use and negative affect and whether this link might differ by both trait anxiety and sex.

METHOD

Participants were 154 young adults (57.8% female, 72.7% White, M age = 20.2) who completed baseline surveys on trait anxiety symptoms and up to 14 consecutive daily surveys on their substance use and affective states.

RESULTS

Multilevel models tested for associations of type of substance use day (i.e., alcohol-only days, cannabis-only days, and no use days relative to SAM use days) with next-day negative affect. Three-way and lower order interactions were tested for substance use day type, anxiety, and sex. Two three-way interactions between cannabis-only days, anxiety, and sex and between alcohol-only days, anxiety, and sex emerged such that SAM use was associated with greater next-day negative affect relative to single substance use days particularly among female participants with elevated anxiety.

CONCLUSIONS

Anxiety and sex are salient factors in the link between SAM use relative to single-substance use and daily negative affect. Study findings reinforce the need to account for all of these factors in order to develop maximally efficacious substance use interventions.

Real-world simultaneous alcohol and cannabis use: An ecological study of situational motives and social and physical contexts

OBJECTIVE

Given the adverse outcomes associated with simultaneous alcohol and marijuana (SAM) use, understanding factors that give rise to occasions of simultaneous use is critical. This study examines the relationships between situational motives and contexts and three situational outcomes: simultaneous alcohol and marijuana use (SAM) use versus cannabis-only use, number of cannabis uses, and subjective effects.

METHOD

Past-month SAM users (n = 341; 52% female; 75% White; 10% Latinx/Hispanic; age 18-24) from three U.S. college campuses completed 8 weeks of surveys up to five times a day. Three-level generalized linear mixed-effects models tested the effects of situational motives and social and physical contexts on occasion type (SAM vs. cannabis-only), cannabis use, and subjective effects.

RESULTS

Situational social and enhancement motives were related to greater odds of SAM relative to cannabis-only use; expansion motives were reported more often on cannabis-only occasions. Using with others and at friends' places, being with others consuming cannabis, and being with others who are intoxicated were more likely when combining alcohol with cannabis. Increased number of cannabis uses and subjective effects in a social context were evident only on cannabis-only occasions. Using alone and using at home were greater on cannabis-only occasions and were associated with lower cannabis use and subjective effects.

CONCLUSIONS

The combination of alcohol and cannabis use occurs during social situations and when motivated by positive reinforcement but number of cannabis uses is not increased when consuming cannabis with alcohol in social situations. Characterizing the complex interplay of situational factors that contribute to risky use will inform interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Association between coping strategies and drug use in a large cohort of students from a northern Italian University

BACKGROUND AND AIM OF THE WORK

Illicit drug (ID) use/abuse represent a social and economic burden for most countries worldwide which, in spite of the efforts to prevent this phenomena, is often a growing habit especially in the young adults. Preventive measurements, are needed to reduce the adverse health and social consequences of ID use/abuse.

METHODS

This study investigated the relationship between coping strategies and ID use in students (N=12316) from the University of Parma, Italy. Information about the ID use in the past 12 months and coping strategies were collected with a cross-sectional research design using an online questionnaire.

RESULTS

More than 25% of the participants used ID in the past year; men were more likely to use drugs than female; the likelihood of using drugs was inversely related to age. The relationship between coping strategies and ID use was analyzed with a multilevel logistic model taking into account the within-department nested structure of data. Analysis revealed that transcendence-orientation and problem-orientation were associated with a reduction of the likelihood to have used drugs. Conversely, avoidance and positive attitude were associated with an increase of the likelihood to have used drugs. Finally, seeking social support revealed a positive but modest association with increasing in drug use.

CONCLUSIONS

The ID use association factors identified in this study could be utilized by the appropriate institutions/authorities as a critical review in order to develop relevant public health policies and preventive measures aimed at minimizing the use of ID in this critical age group.

Combined pharmacotherapy and evidence-based psychosocial Cannabis treatment for youth and selection of cannabis-using friends

BACKGROUND

Theoretical models of behavior change argue that youth should decrease their time with cannabis-using friends and increase their time with non-using friends during treatment. Informed by behavior-change models of recovery and socialization and selection peer-influence models, the current study examined whether combining evidence-based psychosocial treatment with adjunctive pharmacotherapy helps youth decrease their affiliations with cannabis-using friends and increase their affiliations with non-using friends during cannabis misuse treatment.

METHODS

Youth ages 15-24 years (51 % male), participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapy (MET-CBT) plus topiramate (N = 39) or placebo (N = 26) on cannabis craving and use. Ecological momentary assessment data, collected via smartphones throughout the six-week intervention, assessed youths' time with cannabis-using and non-using friends, cannabis use, and craving in daily life. Multiple group multilevel structural equation modeling tested study hypotheses.

RESULTS

Across the topiramate (48 % completion rate) and placebo (77 % completion rate) conditions, greater time spent with cannabis-using friends promoted greater next day cannabis use and craving (socialization effect). In turn, cannabis craving, but not use, promoted continued selection of cannabis-using friends. This indirect effect was only supported in the placebo condition due to the selection piece of this cycle not being significant for youth who received topiramate. Neither cannabis craving nor use were associated with time with non-using friends the next day.

CONCLUSIONS

MET-CBT and adjunctive topiramate pharmacotherapy interrupted youth selection processes. This finding suggests that changing peer affiliations could be one mechanism by which treatments can work.

Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment

The motivational model of substance use posits four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to impact decisions about substance use. Yet, prior studies assessing the motivational model have relied on between-person, cross-sectional evaluations of trait motives. We systematically reviewed ecological momentary assessments (EMA) studies (N=64) on motives for substance use to examine: methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model, and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates most studies have not examined the momentary and dynamic nature of the motivational model and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.

Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping

Although research has only recently started to examine the impact of cannabis use on stress response, there is some evidence that indicates acute and chronic impacts of cannabis on these processes. In this paper, we review processes involved in regulating the stress response and we review the influence of acute and chronic exposure to cannabis on patterns and regulation of the stress response. We also highlight the role of stress as a risk factor for initiation and maintenance of cannabis use. In this context, we examine moderating variables, including sex and life adversity. In light of recent observations indicating increasing prevalence of cannabis use during pregnancy, we provide additional focus on cannabis use in this vulnerable population, including how acute and chronic stress may predispose some individuals to use cannabis during pregnancy. While this line of research is in its infancy, we review available articles that focus on the perinatal period and that examined the association between cannabis use and various life stressors, including partner violence, job loss, and lack of housing. We also review psychiatric co-morbidities (e.g., post-traumatic stress disorder, anxiety). A better understanding of the way stress and cannabis use relate within the general population, as well as within certain subgroups that may be at a greater risk of using and/or at greater risk for adverse outcomes of use, may lead to the development of novel prevention and intervention approaches.

Craving management: Exploring factors that influence momentary craving-related risk of cannabis use among young adults

Young adult frequent cannabis use has increased in prevalence and some frequent users have problems reducing their use. A strong link between momentary craving and subsequent use behaviors among individuals with problematic cannabis use has been reported in the literature, including young adults. In treatment contexts, interventions based on associative learning and reinforcement aim to reduce the prevalence of problematic substance use by altering the association between craving and use by increasing craving management skills such as mindfulness and reducing unhelpful responding such as avoidance or suppression. However, this model has not been tested among young adult cannabis users. The current study examined the influence of trait and state craving management strategies (mindfulness, coping style, experiential avoidance, and craving beliefs) on the link between momentary craving and use, using ecological momentary assessment in a sample of young adults with problematic use interested in reducing their use. Results demonstrated that two craving management constructs were associated with use: non-reactivity (p = 0.02) and non-judgment (p < 0.01). Interactions with momentary craving were observed for two constructs: non-judgmentalness (p = 0.02) and craving beliefs (p < 0.01). Findings suggest that treatments that increase non-reactivity and non-judgmentalness may reduce the occurrence of cannabis use for young adults contemplating reduction during an important period of biopsychosocial development by mitigating the impact of craving or directly reducing use. Additionally, negative beliefs about craving may serve a protective function during acute periods of elevation in momentary craving, an unexpected finding deserving further investigation.

Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use

Background: There is a high rate of marijuana use among young sexual and gender minorities (SGM) and, as a result of recent state-level, fragmented marijuana laws, there is also likely high variability in their perceptions of marijuana decriminalization (PMD). Methods: Data came from two cohorts of young SGM (aged 16-29) in Chicago, RADAR and FAB400, recruited from 2015 to 2017 (N=1,114). We developed a measure to assess PMD among this population, performed initial validation, and assessed its relationship to longitudinal changes in patterns of marijuana use and geographic distribution. Results: In multivariable models, mean PMD score was prospectively associated with general (adjusted odds ratio [aOR]=2.00; 95% confidence interval [CI]: 1.46-2.77), but not problematic marijuana use. An increase in perceived decriminalization also predicted a significant increase in odds of general (aOR=1.67; 95% CI: 1.18-2.39) marijuana use. Significant concentrations of high PMD scores existed in across the city. Conclusion: These results suggest further study of longitudinal changes in marijuana use as decriminalization or legalization increases in the U.S. to better understand shifting trends in use.

Depression and ADHD-Related Risk for Substance Use in Adolescence and Early Adulthood: Concurrent and Prospective Associations in the MTA

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study

Background

Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts.

Objective

The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey.

Methods

An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred.

Results

Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study.

Conclusions

The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.

Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life

Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).