Simultaneous polydrug use among teens: prevalence and predictors

Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida

BACKGROUND

Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients.

METHODS

Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis.

RESULTS

Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use.

CONCLUSIONS

High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.

The effects of simultaneous alcohol and cannabis use on subjective drug effects: A narrative review across methodologies

Over 75% of young adults who use cannabis also report drinking alcohol, leading to increased risks that include impaired cognition, substance use disorders, and more heavy and frequent substance use. Studies suggest that subjective responses to either alcohol or cannabis can serve as a valuable indicator for identifying individuals at risk of prolonged substance use and use disorder. While laboratory studies show additive effects when alcohol and cannabis are used together, the impact of co-using these substances, specifically with respect to cannabidiol, on an individual's subjective experience remains unclear. This narrative review explores the effects of simultaneous alcohol and cannabis (SAM) use on subjective drug effects, drawing from qualitative research, laboratory experiments, and naturalistic studies. Experimental findings are inconsistent regarding the combined effects of alcohol and cannabis, likely influenced by factors such as dosage, method of administration, and individual substance use histories. Similarly, findings from qualitative and naturalistic studies are mixed regarding subjective drug effects following SAM use. These discrepancies may be due to recall biases, variations in assessment methods, and the measurement in real-world contexts of patterns of SAM use and related experiences. Overall, this narrative review highlights the need for more comprehensive research to understand more fully subjective drug effects of SAM use in diverse populations and settings, emphasizing the importance of frequent and nuanced assessment of SAM use and subjective responses in naturalistic settings.

Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study

INTRODUCTION

In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis.

METHODS

Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019.

RESULTS

The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark.

DISCUSSION AND CONCLUSIONS

We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Positive psychological interventions on alcohol use and consequences: Pilot randomized trial in a young adult cannabis-using sample

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.

Sex and Gender Differences in Simultaneous Alcohol and Cannabis Use: a Narrative Review

Purpose of Review

The aim is to review recent literature on sex and gender differences in patterns of use, motives, pharmacological effects, and consequences of simultaneous alcohol and cannabis use (SAC).

Recent Findings

Men engage in SAC more frequently than women. Women may have more substance-specific motives for use, while men tend to consistently endorse social/enhancement motives for both alcohol and cannabis. Regarding pharmacological effects, women experience the same subjective effects as men do at lower levels of use, with some evidence that women modulate cannabis use during simultaneous use episodes to avoid greater subjective intoxication. Finally, women appear more vulnerable to experiencing a range of positive and negative consequences from SAC relative to men.

Summary

Research has identified several important sex/gender differences in SAC and its correlates and consequences. However, research has primarily focused on white and cisgender populations, with a need for more research among racial/ethnic and gender minorities.

Longitudinal patterns of polysubstance use throughout adolescence: association with adult substance use and psychosocial outcomes controlling for preadolescent risk factors in a male cohort

PURPOSE

Inconsistent reports raise the question of the extent to which poor adult outcomes are associated with adolescent polysubstance use (PSU: alcohol, marijuana, other illicit drugs) above and beyond earlier risk factors.

METHODS

Early adulthood substance-related and psychosocial outcomes were examined in association with age 13 to 17 developmental patterns of PSU in boys from urban, low SES neighborhoods (N = 926). Three classes obtained by latent growth modeling described low/non-users (N = 565, 61.0%), lower risk PSU (later onset, occasional use, 2 ≤ substances; N = 223, 24.1%), and higher risk PSU (earlier onset, frequent use, 3 ≥ substances; N = 138, 14.9%). Preadolescent individual, familial and social predictors of adolescent PSU patterns were used as covariates.

RESULTS

Adolescent PSU contributed to both age-24 substance-related outcomes (frequency of alcohol, drug use, and getting drunk, risky behaviors under influence, and use-related problems) and psychosocial outcomes (no high school diploma, professional or financial strain, ASP symptoms, criminal record) over and above preadolescent risk factors. Controlling for preadolescent risk factors, adolescent PSU made a more important contribution to adult substance use outcomes (increasing the risk by about 110%) than to psychosocial outcomes (16.8% risk increase). PSU classes showed poorer adjustment for all age-24 substance use, and for various psychosocial outcomes than low/non-users. Higher risk polysubstance users also reported poorer outcomes than their lower risk peers for most substance use outcomes, and for professional or financial strain and criminal record.

CONCLUSION

Findings highlight the contribution of adolescent PSU in a dose-response fashion, over and above preadolescent risk factors, on both homotypic and heterotypic outcomes in early adulthood.

Compositional associations of time spent in sleep, screen time, and physical activity with polysubstance use in adolescents

This study of grade 6-10 students used compositional analysis to examine the relationship between the movement behavior composition (time in sleep, screen time, and physical activity) and polysubstance use (frequency of using cigarettes, alternative tobacco products, alcohol, cannabis, and illicit drugs). In grades 6-8 students and grades 9-10 girls: 1) sleep was negatively associated with polysubstance use, 2) screen time was positively associated with polysubstance use, and 3) reallocating physical activity or screen time into sleep was associated with lower polysubstance use. In grades 9-10 boys, reallocating 60 min/day from physical activity into screen time or sleep was associated with greater polysubstance use.

Alcohol, Marijuana and Other Illicit Drugs Use Throughout Adolescence: Co-occurring Courses and Preadolescent Risk-Factors

This study examined developmental patterns of co-occurrent alcohol, marijuana, and other illicit drugs use during adolescence and the associated preadolescent risk factors in a longitudinal sample of 926 boys from low-socioeconomic, urban neighborhoods. Latent growth mixture modeling revealed six developmental patterns: non-/low-alcohol and non-illicit drug users (61% sample) and five polysubstance user-groups varying in severity based on onset, frequency and type of substances used. In comparisons with non-/low-users, several preadolescent risk factors were associated with increasing severity of polysubstance use. Higher sensation-seeking and lower anxiety were associated with all user-groups. Low self-esteem and family-related risk factors differentiated all user-groups from later-onset users. Higher impulsivity and school problems characterized early-onset and frequent polysubstance users. Impulsive sensation-seekers with lower anxiety and self-esteem cumulated a larger number and higher severity of risk factors and were at risk of early-onset frequent polysubstance use, emphasising the importance of indicated prevention for these high-risk boys.

Polydrug Definition and Assessment: The State of the Art

Polydrug use is a very common phenomenon and represents an important public health problem. The definition of the term has varied since its inception, and consequently so have forms of self-report evaluation. The aim of this review is to offer an overview of how the concept has evolved and its forms of evaluation through self-reporting. A search of the term polydrug was conducted on the PubMed portal up to August 2022, with a total of 2076 publications detected containing the word polydrug in their title, abstract or keywords. This includes publications that represent an advance in the definition and assessment of this construct through self-reports, which may be useful for researchers carrying out future studies in the field. The importance of distinguishing between concurrent and simultaneous polydrug use and the need to employ comparable measures in parameters for the frequency, magnitude and combination of psychoactive substances involved in polydrug use are two of the main recommendations emerging from this review.

Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica

BACKGROUND

In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica.

METHODS

This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans.

RESULTS

19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use.

CONCLUSIONS

One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.

Sex moderates effects of alcohol and cannabis co-use on alcohol and stress reactivity

BACKGROUND

Simultaneous or concurrent use (co-use) of alcohol and cannabis is associated with greater use of both substances over time, academic difficulties, more severe substance use consequences, and adverse impacts on cognitive functioning than the use of a single substance or no substance use. This study examined potential neural mechanisms underlying co-use behaviors in comparison to single substance use. Specifically, we compared alcohol cue reactivity and stress-cue reactivity among individuals who reported frequent same-day co-use of alcohol and cannabis and individuals who reported only alcohol use.

METHODS

The sample included 88 individuals (41 women) who reported only alcohol use and 24 individuals (8 women) who reported co-use of alcohol and cannabis on at least 50% of drinking occasions. All participants completed fMRI stress and alcohol cue reactivity tasks. Because of known sex effects on stress reactivity and alcohol cue reactivity, we tested sex by co-use interactions.

RESULTS

During alcohol cue presentation, co-users had less activation in the thalamus and dorsomedial prefrontal cortex than alcohol-only users, effects that were driven by differences in responses to neutral cues. Examination of stress cue reactivity revealed sex by co-use interactions in the lingual gyrus, with women co-users showing a greater difference between negative and neutral cue reactivity than all other groups. In addition, women co-users had greater connectivity between the nucleus accumbens and both the medial orbitofrontal cortex and the rostral anterior cingulate cortex during negative cue presentation than the other groups.

CONCLUSIONS

These results provide preliminary evidence of enhanced stress cue reactivity in individuals reporting co-use of alcohol and cannabis, particularly women co-users.

A Scoping Review of Gender, Sex and Sexuality Differences in Polysubstance Use in Adolescents and Adults

BACKGROUND

Polysubstance use is a common, problematic behavior that increases risk of harm to self and others. Research suggests that rates may vary based on gender, sex and sexuality. Understanding the current state of this literature may inform prevention and treatment of polysubstance use, leading to reduced public health burden.

OBJECTIVES

This review aimed to synthesize research on gender, sex and sexuality differences in polysubstance use in adults and adolescents.

METHODS

A scoping review was conducted using all EBSCO databases, PubMed and Google Scholar to identify articles examining the effects of gender, sex and sexuality on polysubstance use. Polysubstance use was defined broadly as the use of any combination of substances over any time period and included licit (alcohol, tobacco) and illicit substances, concurrent and simultaneous use, from lifetime to daily use and use at any frequency. Studies were considered if they were published in peer-reviewed journals between January 1990 and October 2020 and were written in English. Publicly available data sources were also utilized to fully capture prevalence data that has not been published elsewhere.

RESULTS

Findings were mostly inconsistent and often conflicting. Only two findings were generally consistent: adult men were overall more likely to report polysubstance use than adult women, and sexual and gender minorities report more frequent polysubstance use than non-minorities.

CONCLUSIONS

Research has been unable to clearly elucidate differences in polysubstance use prevalence and patterns according to gender, sex and sexuality. Several recommendations are offered to advance future research and address limitations of current research.

A Systematic Review on Sexual Health and Drug Use Prevention Interventions for Black Girls

BACKGROUND

The relationship between drug use and poor sexual health outcomes in Black adolescent females such as diagnoses of sexually transmitted infections, HIV, and early/unwanted pregnancy has been established in the literature. Yet, very few interventions have been successful in reducing the risk of poor sexual health outcomes and drug use for adolescent girls. Even more rare are interventions that are catered to specifically to Black girls in the United States, which is a group that has the highest rates of poorer sexual health outcomes and negative consequences associated with drug use. Therefore, this systematic review sought to identify and organize interventions that are focused on preventing HIV, STIs, early pregnancy and drug use for and include large samples of Black girls. Fifteen interventions were identified that met the review's search criteria.

RESULTS

A total of 15 interventions that were published between 2005 and 2020 were included in the review. While all but one intervention focused on sexual health outcomes, two interventions infused drug use education for girls.

CONCLUSION

This review provides recommendations for sexual health and drug use prevention researchers to engage in an intersectional framework and concludes with a summary of next steps to guide future research and policy work to address disparities that impact Black girls.

The Effects of Alcohol and Cannabis Co-Use on Neurocognitive Function, Brain Structure, and Brain Function

Purpose of review

Given increases in the rates of alcohol and cannabis co-use among adolescents and young adults, this review aims to summarize literature on the effects of alcohol and cannabis co-use on neurocognitive functioning, brain structure, and brain function.

Recent findings

The limited existing studies examining concurrent, recent, and lifetime alcohol and cannabis co-use suggest effects on the brain are likely multifaceted. The majority of studies report that co-use is associated with negative outcomes such as impaired cognitive function and significant alterations in key structural and functional regions of the brain, while others report null effects of co-use compared to non-substance using control and single-substance use groups.

Summary

Current studies lack a general consensus on methodology, definitions of concurrent and simultaneous use, and neuroimaging approaches, which makes it challenging to draw strong conclusions about the effects of co-use. More studies are needed to explore the effects of co-use in the context of simultaneous alcohol and cannabis use.

Combined use of alcohol and cannabis: Introduction to the special issue

OBJECTIVE

Combined use of alcohol and cannabis has increased in recent years among certain age groups, and it is well established that individuals who use both alcohol and cannabis (especially if they use both at the same time) are at increased risk for substance-related harms relative to individuals who use only one substance. Far less attention has been placed on the patterns, predictors, and psychological processes associated with alcohol and cannabis co-use, which may inform prevention and intervention programming. Accordingly, this special issue was assembled to advance our understanding of the characteristics and consequences of combined use of alcohol and cannabis.

METHOD

In this introductory article, the Guest Editors present the background for this work and provide an overview of the 14 articles that comprise this special issue.

RESULTS

Studies contained in this special issue capitalize on a variety of methodologies, with a particular focus on investigating typologies of alcohol and cannabis co-use, clarifying motivational and social contexts of co-use, and tracking co-use in daily life via daily diary and ecological momentary assessment designs. Experimental and neuroimaging examinations of co-use are also included. Collectively, the studies generally provide evidence that combined use of alcohol and cannabis is associated with unique characteristics, predictors, consequences, and psychological processes relative to single-substance use.

CONCLUSIONS

The studies in this special issue provide new insight into combined use of alcohol and cannabis. They also highlight a number of promising avenues for future inquiry as the literature on alcohol and cannabis co-use continues to grow. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

New psychoactives within polydrug use trajectories-evidence from a mixed-method longitudinal study

AIMS

To provide public health-related research evidence on types and usage patterns of new psychoactive substances (NPS), developmental pathways into NPS and decision-making factors for, and associated harms of, NPS use.

DESIGN

Three-phase mixed-methods design, including a latent class analysis (LCA) of the longitudinal Belfast Youth Development Study (BYDS), a narrative analysis of interviews with NPS users and a three-step approach manual method modelling using regressions to reveal classes of substance use and their associated predictors and outcomes.

SETTING

Northern Ireland.

PARTICIPANTS

A total of 2039 people who responded to the questions on 'ever use' of the drug variables included at wave 7 (aged 21 years) of the BYDS. Eighty-four narrative interviews with NPS users.

MEASUREMENTS

Categories of drug use identified by LCA. Predictors and outcomes included measures of family, partners, peers, substance use, school, delinquency and mental health.

FINDINGS

A four-class solution provided the best fit for the data: alcohol; alcohol and tobacco; alcohol, tobacco and cannabis; and polydrug (the latter including NPS). The qualitative analysis yielded a taxonomy that distinguished how NPS operate within a wider range of drug repertoires from experimental to problematic.

CONCLUSIONS

In Northern Ireland, new psychoactive substances appear to be a feature of broader polydrug use rather than a standalone class of drug use.

Preadult polytoxicomania-strong environmental underpinnings and first genetic hints

Considering the immense societal and personal costs and suffering associated with multiple drug use or "polytoxicomania", better understanding of environmental and genetic causes is crucial. While previous studies focused on single risk factors and selected drugs, effects of early-accumulated environmental risks on polytoxicomania were never addressed. Similarly, evidence of genetic susceptibility to particular drugs is abundant, while genetic predisposition to polytoxicomania is unexplored. We exploited the GRAS data collection, comprising information on N~2000 deep-phenotyped schizophrenia patients, to investigate effects of early-life environmental risk accumulation on polytoxicomania and additionally provide first genetic insight. Preadult accumulation of environmental risks (physical or sexual abuse, urbanicity, migration, cannabis, alcohol) was strongly associated with lifetime polytoxicomania (p  = 1.5 × 10^-45; OR = 31.4), preadult polytoxicomania with OR = 226.6 (p = 1.0 × 10^-33) and adult polytoxicomania with OR = 17.5 (p = 3.4 × 10^-24). Parallel accessibility of genetic data from GRAS patients and N~2100 controls for genome-wide association (GWAS) and phenotype-based genetic association studies (PGAS) permitted the creation of a novel multiple GWAS-PGAS approach. This approach yielded 41 intuitively interesting SNPs, potentially conferring liability to preadult polytoxicomania, which await replication upon availability of suitable deep-phenotyped cohorts anywhere world-wide. Concisely, juvenile environmental risk accumulation, including cannabis and alcohol as starter/gateway drugs, strongly predicts polytoxicomania during adolescence and adulthood. This pivotal message should launch more effective sociopolitical measures to prevent this deleterious psychiatric condition.

Parental Monitoring of Computer Use and its Association with Drug Use among Students in Southern Brazil

BACKGROUND

Parental control is considered important in preventing drug use among adolescents.

OBJECTIVE

This study aimed to explore the association between the perception of parental monitoring of computer use and drug use among adolescent students.

METHODS

A cross-sectional school-based study was conducted in 2012 among 2,980 students aged 12-17 years from Southern Brazil. The outcomes investigated were the use of tobacco, alcohol, cannabis, and other illicit drugs in the previous year. The main exposure was the self-reported perception of parental monitoring of computer use. Poisson regression with robust variance was used for the multivariable analysis.

RESULTS

The prevalence rates of drugs used were 48.3% (95% confidence interval[CI]: 46.5-50.0) for alcohol, 9.7% (95%CI: 8.7-10.7) for tobacco, 5.1% (95%CI: 4.3-5.9) for cannabis, and 8.7% (95%CI: 7.7-9.7) for other illicit drugs. The absence of monitoring of computer use was reported by 44.3% (95%CI: 42.5-46.1) of the students. After adjusting for potential confounders, we found that students aged 12 to 14 years who reported no parental monitoring of computer use had a higher probability of alcohol (Prevalence Ratio[PR] = 1.26, 95%CI:1.07-1.49) and cannabis use (PR = 3.25, 95%CI:1.11-9.53). In addition, a higher consumption of tobacco was observed among students aged 15 to 17 years who reported no parental monitoring of computer use (PR = 1.75, 95%CI:1.17-2.63). In both age groups, psychiatric morbidity was a covariate significantly associated with drug use throughout analysis.

CONCLUSIONS

Parental monitoring of computer use was significantly associated with adolescent drug use, suggesting its importance in preventing drug use.

PTSD as a Risk Factor Predicting Polydrug Use: A Dual Systems of Self-Control Mediation Model

Post-traumatic stress disorder (PTSD) is associated with increased risk for polydrug use. Low self-control is a key characteristic of the disorder and is predictive of polydrug use. However, there is a dearth of research focused on the relevance of a dual systems model delineation of self-control into the constructs of risk-seeking and impulsivity as it pertains to polydrug use and PTSD. This study tested dual systems mediation of this relationship. Generalized structural equation modeling was used to test for mediation effects. Results indicated that more PTSD symptoms predicted increased drug use variety (coefficient = 0.024; confidence interval [CI] = [0.001, 0.046]). Inclusion of dual systems constructs fully attenuated this relationship. The total indirect effect achieved marginal significance (coefficient = 0.005; CI = [>−0.001, 0.009]). Sensitivity analyses of the specific indirect effect of impulsivity as the sole mediator indicated significant mediation. These results provide some indication that impulsivity-based programming may help to treat polydrug use among those with severe PTSD.

Alcohol and marijuana co-use: Consequences, subjective intoxication, and the operationalization of simultaneous use

BACKGROUND

Alcohol and marijuana are frequently co-used with overlapping effects. However, the absence of consistent operational definitions delineating simultaneous alcohol and marijuana use (SAM) from concurrent use (CAM) challenges consistent inferences about these behaviors. This study first examined whether daily alcohol and marijuana co-use predicted substance-use related consequences and subjective intoxication; and then evaluated whether competing operationalizations of SAM and CAM were associated with differences in these outcomes on co-use days.

METHODS

A sample of 341 young adult college students who reported past-month use of both alcohol and marijuana "at the same time so that their effects overlapped" completed a two-wave survey with paired 28-day daily experience sampling bursts examining alcohol and marijuana co-use. Outcomes were (a) daily substance-use related consequences; and (b) daily subjective intoxication. Focal predictors were daily drinks and marijuana uses; daily co-use versus single-substance use (Aim 1) or CAM versus SAM (Aim 2); and their interaction.

RESULTS

Participants reported more negative consequences on co-use days versus marijuana-only days and greater subjective intoxication relative to alcohol or marijuana-only days. Competing operationalizations of SAM, defined as daily co-use occurring within 1-240 min in increments of 1 min, found no difference in consequences or subjective intoxication regardless of operationalization.

CONCLUSION

Co-use days involve greater risk than alcohol-only or marijuana-only days. Although there was no evidence of additional daily risk from simultaneous use regardless of the timeframe used to operationalize it, investigating these effects remains challenging due to the generally small timeframe between substances on co-use days in this sample.

Consequences of alcohol and marijuana use among college students: Prevalence rates and attributions to substance-specific versus simultaneous use

College students who use alcohol and marijuana often use them simultaneously, so that their effects overlap. The present study examined whether negative consequences experienced by simultaneous alcohol and marijuana (SAM) users vary from those experienced by individuals who use alcohol and marijuana concurrently but not simultaneously (CAM) or single-substance users. We considered 9 types of consequences: cognitive, blackout, vomiting, academic/occupational, social, self-care, physical dependence, risky behaviors, and driving under the influence (DUI). Further, we examined whether consequences experienced by SAM users are attributed to using alcohol, marijuana, or both simultaneously. The sample included past-year alcohol and marijuana users age 18-24 (N = 1,390; 62% female; 69% White; 12% Hispanic) recruited from 3 U.S. college campuses. SAM users experienced a greater overall number of consequences than CAM or alcohol-only users, even controlling for frequency and intensity of alcohol and marijuana use and potentially confounding psychosocial and sociodemographic factors. Experiencing specific consequences differed between simultaneous and concurrent users, but after adjusting for consumption and other covariates, only blackouts differed. In contrast, SAM users were more likely to experience each consequence than alcohol-only users, with strongest effects for DUI, blackouts, and cognitive consequences. Among SAM users, consequences were most likely to be attributed to alcohol and were rarely attributed to simultaneous use. Being a user of both alcohol and marijuana and using alcohol and marijuana together so that their effects overlap each contribute to risk, suggesting there is value in targeting the mechanisms underlying type of user as well as those underlying type of use. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences

BACKGROUND

Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students.

METHODS

Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics.

RESULTS

About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for past-year alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use.

CONCLUSIONS

Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.

Is the Sum Greater than its Parts? Variations in Substance-Related Consequences by Conjoint Alcohol-Marijuana Use Patterns

Alcohol and marijuana are the most commonly used substances for college-attending young adults. This study evaluated differences in substance-specific consequence attribution by alcohol-marijuana use patterns (concurrent alcohol and marijuana [CAM; use of both substances, not at same time] and simultaneous [SAM; use of both, at same time]) as well as alcohol-only (AO). First-year college students with prior alcohol use (N = 610, 50.9% women, 71% White, M_age = 18) completed an online assessment of past-three-month substance use, including SAM, and related consequences. Results indicated that polydrug (SAM and CAM) users reported greater alcohol involvement and earlier alcohol initiation than AO, and polydrug use was associated with more alcohol-related problems, including sexual risk taking and alcohol-related blackouts. When restricted to SAM/CAM users, logistic regressions indicated that SAM users reported an increased incidence in two marijuana-related problems relative to CAM (driving after using and academic difficulties), but lower rates of social problems. SAM users were also less likely to attribute substance-related social problems to alcohol. Overall, findings highlight variations that exist within alcohol-marijuana polydrug users and show areas to consider for intervention development and future research.

Specificity of expectancies prospectively predicting alcohol and marijuana use in adulthood in the Pittsburgh ADHD longitudinal study

Alcohol and marijuana use expectancies are presumed to be drug-specific, but prospective study of this assumption is lacking. In addition, these associations may operate differently for adults with attention-deficit/hyperactivity disorder (ADHD) histories, as expectancies have been found to be less associated with alcohol and marijuana use among this population. The first aim of the present study was to investigate whether associations between alcohol and marijuana expectancies and substance use were specific to the substances they assess. The second aim was to determine whether these associations differed as a function of ADHD history. Participants (N = 491; 281 ADHD, 210 non-ADHD) were young adults followed longitudinally between ages 21 to 23 and 29 as part of the Pittsburgh ADHD Longitudinal Study (PALS). Autoregressive models were estimated separately for positive and negative expectancies for frequency of alcohol and marijuana use and compared between ADHD groups. Although there were exceptions, results generally support the specificity of associations between outcome expectancies and respective substance use both concurrently and prospectively, but this specificity was primarily present for those without a history of ADHD. These findings suggest that young adults perceive and respond distinctly to the effects of alcohol and marijuana, but a history of ADHD may interfere with this process. These findings also extend our prior cross-sectional findings that expectancies are less associated with alcohol and marijuana use for individuals with ADHD histories. Additional research examining implicit cognitions is needed to further examine risk for substance use among those with ADHD histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Simultaneous alcohol and marijuana use among underage young adults in the United States

OBJECTIVE

The current study examines the prevalence, stability, and correlates of simultaneous alcohol and marijuana (SAM) use among underage US young adults, a population at high risk for participating in this behavior.

METHOD

Analyses used data from 1719 respondents (46.8% men) who participated in the nationally representative 12th-grade Monitoring the Future study and provided responses to SAM use items at longitudinal follow-up at modal ages 19/20 between 2007 and 2016. Prevalence estimates and covariate associations with SAM use were estimated.

RESULTS

SAM use prevalence at modal age 19/20 was 22.5%. Multivariable models indicated that odds of age 19/20 SAM use were significantly (p < .05) higher for men (vs. women) and for respondents who started alcohol use by age 18 (vs. those who delayed uptake until after high school). Odds of SAM use were especially high for individuals attending college full-time and not living with parents. Among those who reported SAM use at modal age 18, 56.2% continued to report SAM use at modal age 19/20. Among those who did not report SAM use at modal age 18, only 14.2% reported SAM use at modal age 19/20.

CONCLUSIONS

SAM use among young adults aged 19/20 in the US is relatively common, but especially so for those who began such use by age 18, highlighting the early onset and stability of this behavior. Among underage drinkers, SAM risk varies by sex, race/ethnicity, college status, and living arrangements.

Elevated Behavioral Economic Demand for Alcohol in Co-Users of Alcohol and Cannabis

OBJECTIVE

Co-use of cannabis and alcohol is associated with increased drinking and other negative consequences relative to use of alcohol alone. One potential explanation for these differences is overvaluation of alcohol (e.g., alcohol demand) among co-users, similar to established overvaluation of alcohol among tobacco and alcohol co-users. This study examined differences in alcohol demand between an alcohol and cannabis co-user group and an alcohol-only group.

METHOD

A large sample of adult drinkers (n = 1,643, 54% female) was recruited through an online crowdsourcing site (Amazon Mechanical Turk). Of the full sample, 476 participants reported weekly or greater cannabis use in the past 6 months (co-user group); 888 reported never using cannabis in the past 6 months (alcohol-only group). Assessments included a validated alcohol purchase task and self-report measures of alcohol and cannabis use.

RESULTS

Co-users reported significantly higher alcohol consumption across the elastic portion of the alcohol demand curve (i.e., $1.50-$9.00/drink). Analyses of covariance controlling for alcohol use and demographics revealed significantly higher breakpoint (p = .025) and Omax (p = .002) and significantly lower elasticity (p < .003) in the co-user group. Intensity and Pmax did not significantly differ between groups.

CONCLUSIONS

Co-users of cannabis and alcohol overvalue alcohol compared with individuals who drink alcohol but do not use cannabis. This study is generally consistent with prior studies on alcohol and tobacco co-users, providing converging evidence that polysubstance use is associated with overvaluation of alcohol. These findings have important implications for treatment and prevention, particularly in the context of changes in cannabis legalization.

Simultaneous Alcohol and Marijuana Use Among Young Adult Drinkers: Age-Specific Changes in Prevalence from 1977 to 2016

BACKGROUND

The overall prevalence of U.S. young adult alcohol use has decreased, but little is known about historical change in related behaviors such as simultaneous alcohol and marijuana (SAM) use that may increase alcohol-related risks and societal costs. The purpose of this paper was to examine historical change in SAM use prevalence among U.S. young adult alcohol users from 1977 to 2016, and consider the extent to which observed historical change in SAM use among alcohol users reflects co-occurring change in marijuana use during these years.

METHODS

Data on past 12-month alcohol, marijuana, and SAM use at up to 6 modal ages (19/20, 21/22, 23/24, 25/26, 27/28, and 29/30) were collected from 11,789 individuals (45.0% men) participating in the Monitoring the Future panel study. Annual prevalence estimates within modal age group were obtained; historical SAM use trends among alcohol and marijuana users were estimated.

RESULTS

From 2014 to 2016, SAM use was reported by approximately 30% of alcohol users aged 19/20 and 21/22, and 20 to 25% of alcohol users aged 23/24 through 29/30. Since the mid-1990s, age-specific historical trends in SAM use prevalence among alcohol users followed 1 of 4 patterns: significant increase followed by oscillating increases/decreases (at modal age 19/20), consistent and significant increases (at modal ages 21/22, 23/24, and 25/26), stability followed by increase (at modal ages 27/28), or stability (at modal ages 29/30). In contrast, SAM use trends among marijuana users primarily reflected stability, with some evidence of a decrease across time at modal ages 19/20 and 23/24. Historical change in SAM prevalence among alcohol users was strongly and positively correlated with changes in overall marijuana use prevalence.

CONCLUSIONS

A growing proportion of early and mid-young adult alcohol users reported SAM use, with the highest risk among those in the early years of young adulthood. Young adult SAM use may continue to increase in proportion to the degree that young adult marijuana use continues to increase.

The long-term cognitive consequences of adolescent exposure to recreational drugs of abuse

During adolescence, the brain continues to undergo vital developmental processes. In turn, complex behavioral and cognitive skills emerge. Unfortunately, neurobiological development during adolescence can be influenced by environmental factors such as drug exposure. Engaging in drug use during adolescence has been a long-standing health concern, especially how it predicts or relates to drug using behavior later in life. However, recent findings suggest that other behavioral domains, such as learning and memory, are also vulnerable to adolescent drug use. Moreover, it is becoming increasingly apparent that deficits in learning and memory following adolescent drug use endure into adulthood, well after drug exposure has subsided. Although persistent effects suggest an interaction between drug exposure and ongoing development during adolescence, the exact acute and long-term consequences of adolescent drug exposure on substrates of learning and memory are not fully understood. Thus, this review will summarize human and animal findings on the enduring cognitive deficits due to adolescent drug exposure. Moreover, due to the fact that adolescents are more likely to consume drugs of abuse legally available to adults, this review will focus on alcohol, nicotine, and marijuana. Further, given the critical role of the frontal cortex and hippocampus in various learning and memory domains, the impact adolescent use of the previous listed drugs on the neurobiology within these regions will also be discussed.

Buprenorphine MAT as an Imperfect Fix

Expanding buprenorphine access in the United States requires evidence-based decision-making that considers both the drug's potential dangers and its potential benefits. Risks associated with buprenorphine misuse and diversion highlight the need for careful, ongoing evaluation during each stage of increased access.

Examining the relationships between life satisfaction and alcohol, tobacco and marijuana use among school-aged children

Background

There are many known risk factors associated with youth substance use. Nonetheless, the impact of life satisfaction (LS) on the use of alcohol, tobacco and marijuana by adolescents still remains largely unknown.

Methods

The present analysis utilized data from the Health Behavior in School-Aged Children 2009–10 US study. Multilevel logistic regression models were used to assess the relationship between LS and individual substance use. Multilevel multinomial regression models examined the relationship with total number of substances used.

Results

After controlling for numerous variables associated with substance use, individuals reporting low LS were significantly more likely to ever use tobacco (OR = 1.34, 95% CI = [1.01, 1.78]), alcohol (OR = 1.45, 95% CI = [1.10, 1.92]) and marijuana (OR = 1.98, 95% CI = [1.39, 2.82]). Additionally, students with low LS were significantly more likely to use two substances (OR = 1.90, 95% CI = [1.15, 3.14]) and three substances concurrently (OR = 2.00, 95% CI = [1.27, 3.16]).

Conclusions

The present study identified strong associations between LS and individual, as well as concurrent, substance use among adolescents. Interventions aiming to reduce adolescent substance use may benefit from incorporating components to improve LS.

Are changes in drinking related to changes in cannabis use among Swedish adolescents? A time-series analysis for the period 1989-2016

AIMS

To examine if changes in alcohol consumption are associated with changes in cannabis use among Swedish adolescents in a period of diverging trends, and to investigate if cannabis and alcohol act as complements or substitutes.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Data comprise a nationally representative annual school survey of alcohol and drug habits among Swedish 9th-grade students (aged 15-16 years) covering years 1989-2016 (n = 149 603). Alcohol and cannabis use were measured concurrently and alcohol consumption was measured in litres of 100% alcohol per year. Frequency of cannabis use was transformed into a mean using category mid-points. Autoregressive integrated moving average (ARIMA) time-series analysis was used to estimate the association between cannabis and alcohol use. To elucidate changes in the association during the study period, two subperiods (2000-16 and 1989-99) were analysed.

FINDINGS

There was a positive and statistically significant association between changes in alcohol consumption and changes in frequency of cannabis use among cannabis users for the period 1989-2016. A 1-litre increase in mean alcohol consumption was associated with a 0.28 increase in frequency of cannabis use (P = 0.010). The corresponding increase for the period 1989-99 was 0.52 (P = 0.003). When restricting the analysis to 2000-16, the association was not statistically significant (P = 0.735). When analysing all adolescents we found no statistically significant association between changes in alcohol consumption and changes in frequency of cannabis use.

CONCLUSIONS

From 1989 to 2016 there appears to be a positive association between alcohol and cannabis consumption among Swedish adolescents who use cannabis. This association seems to have become weaker over time, suggesting that alcohol and cannabis are neither substitutes nor complements among Swedish adolescents and that the recent decline in youth drinking is not associated with the increase in frequency of cannabis use.

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents

BACKGROUND

Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use.

OBJECTIVES

This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents.

METHODS

Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use.

RESULTS

A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans.

CONCLUSIONS

Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.

Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity

Substance use during adolescence is a public health concern due to associated physical and behavioral health consequences. Such consequences are amplified among concurrent substance users. Although sex and racial/ethnic differences in single-substance use have been observed, the current literature is inconclusive as to whether differences exist in the prevalence of concurrent use. The current study used data from the 2011-2014 National Survey on Drug Use and Health to examine typologies (single and concurrent patterns) of alcohol, marijuana, and cigarette use among current adolescent users age 12-18 by sex and race/ethnicity. Participants were 14,667 White, Hispanic, African American, Asian, and Native American adolescents. The most common typology was alcohol only, followed by concurrent use of alcohol and marijuana. Weighted prevalence estimates indicated that adolescent females were more likely to be current users of alcohol only, whereas male adolescents were more likely to belong to all other typologies. Compared to Whites, racial/ethnic minorities had larger proportions of marijuana only users and were generally less likely than or equally likely to be concurrent users. One exception was for African American adolescents, who were more likely to be alcohol and marijuana users than their White counterparts. Results suggest that concurrent substance use is common among U.S. adolescents, making up over 40% of past-month use, but typologies of use vary by sex and race/ethnicity. Preventive interventions should consider all typologies of use rather than only single substance exposures and address patterns of use that are most pertinent to adolescents based on sex and race/ethnicity.

High-intensity and simultaneous alcohol and marijuana use among high school seniors in the United States

BACKGROUND

Simultaneous alcohol and marijuana (SAM) use poses threats to health, particularly among adolescents. These risks would be exacerbated to the extent that high-intensity drinking (e.g., 10+ drinks in a row) and marijuana use (e.g., 1+ joints per day) are associated with a higher likelihood of SAM use. The current study examines the extent to which the intensity of alcohol use and of marijuana use are associated with adolescent SAM use prevalence, and whether associations remain after controlling for key covariates known to associate with both alcohol and marijuana use; it identifies alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use.

METHODS

Data come from nationally representative samples of US 12th graders who participated in the Monitoring the Future study from 2005 to 2014 (N = 24,203 respondents; 48.4% boys, 51.6% girls).

RESULTS

SAM use during the past year was reported by 20% of 12th graders overall. SAM use prevalence was strongly and positively associated with alcohol and marijuana use intensity even after controlling for covariates. High school seniors at highest risk for engaging in SAM use were those who reported 10+ drinks and those smoking at least 1 joint/day. Approximately 60% of those who had 10-14 or 15+ drinks in a row during the past 2 weeks and 76%-80% of those who had 1 or 2+ joints per day on average during the past 30 days reported SAM use.

CONCLUSIONS

Results suggest that high school seniors who consume high quantities of alcohol and marijuana are very likely to consume these substances so that their effects overlap.

Co-use of Alcohol and Cannabis: A Review

PURPOSE OF REVIEW

The purpose of this review is to provide an overview of the existing literature on the relationship between the co-use of cannabis and alcohol including (1) epidemiology, comorbidity, and associated consequences of cannabis and alcohol use disorders; (2) preclinical and clinical laboratory studies examining behavioral pharmacology of cannabis and alcohol co-use; and (3) clinical outcomes related to co-use.

RECENT FINDINGS

Findings from the literature reviewed suggest that the co-use of alcohol and cannabis is associated with additive performance impairment effects, higher and more frequent consumption levels, increased social and behavioral consequences such as driving while impaired, and greater likelihood of the experiencing comorbid substance use and mental health disorders. Furthermore, co-use may be associated with worse clinical outcomes, yet there are few studies examining the development and evaluation of interventions on reducing the co-use of cannabis and alcohol.

SUMMARY

There is a need for more rigorous and longitudinal research studies on the co-use of cannabis and alcohol to glean a more complete understanding of the relationship between the two substances. Findings can be used to develop and refine intervention strategies to successfully reduce cannabis and alcohol co-use.

Polydrug use by European adolescents in the context of other problem behaviours

Aim

Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents.

Methods

Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses.

Results

Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems.

Conclusion

An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Concurrent polysubstance use in a longitudinal study of US youth: associations with sexual orientation

AIMS

To estimate longitudinal associations between self-reported sexual orientation and past-year polysubstance use among youth, and test how gender, age and early onset of tobacco and alcohol use contributed to variation in polysubstance use.

DESIGN

Longitudinal community-based cohort of US adolescents from the Growing Up Today Study (GUTS 1) (n = 16 873) followed from ages 12-29 years.

SETTING

United States of America.

PARTICIPANTS

A total of 13 519 individuals (7839 females; 5680 males) who responded to at least one of five self-administered questionnaires from 1999 to 2010. Ninety-three per cent reported their race/ethnicity as non-Hispanic white.

MEASUREMENTS

Multivariable repeated measures generalized estimating equations estimated relative risks (RRs) of concurrent polysubstance use (i.e. past 12-month use of three or more substances) comparing sexual orientation minority youth [i.e. mostly heterosexual (MH), bisexual (BI), gay/lesbian (GL)] to their same-gender, completely heterosexual (CH) counterparts. Mediation analyses tested whether early onset of tobacco and/or alcohol use explained relationships between sexual orientation and concurrent polysubstance use.

FINDINGS

Compared with their same-gender CH peers, sexual minorities evidenced higher risk for concurrent polysubstance use over all repeated measures [risk ratios (RRs) for sexual minority subgroups: from 1.63-2.91, P-values: <0.001] and for all age groups (RRs: from 1.50-4.04, P-values: < 0.05-< 0.001), except GL males aged 18-20 years. Differences between sexual minorities and CHs were larger among females than males (P-values for sexual orientation × gender interactions were < 0.05 for MHs and BIs), and among younger versus older ages (P-values for sexual orientation × age interactions were < 0.05, except for BI males). Sexual minorities' younger age of smoking and/or drinking initiation contributed to their elevated polysubstance use (% of effect explained was between 9.4-24.3, P-values: 0.04-< 0.001), except among GL males.

CONCLUSIONS

Sexual minority youth in the United States, and in particular younger females, appear to be at disproportionate risk for concurrent past-year polysubstance use. Early onset of smoking and drinking may contribute to elevated risk of polysubstance use among sexual minorities.

Substance use Trajectories from Early Adolescence to Emerging Adulthood: A Comparison of Smoking, Binge Drinking, and Marijuana use

Over the past several years, there has been growing interest in identifying distinct developmental trajectories of substance use. Using data from the RAND Adolescent/Young Adult Panel Study (N = 6,527), we synthesize our prior findings on patterns of smoking, binge drinking, and marijuana use from early adolescence (age 13) to emerging adulthood (age 23). We also present new data on how these trajectory classes compare on key psychosocial and behavioral outcomes during emerging adulthood. For each type of substance use, we found two periods of vulnerability: early adolescence and the transition to emerging adulthood. As expected, early users were at relatively high risk for poor outcomes at age 23 compared to consistent low-level users and abstainers, even if they reduced their use during adolescence. However, youths who were not early users, but steadily increased their use over time, also tended to be at relatively high risk. Results suggest that multiple prevention approaches might be needed to successfully reach at-risk youths.

Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey

BACKGROUND

Cannabis is the most commonly used drug among those who drink, yet no study has directly compared those who use cannabis and alcohol simultaneously versus concurrently (i.e., separately) in the adult general population. Here, we assess differences in demographics, alcohol-related social consequences, harms to self, and drunk driving across simultaneous, concurrent, and alcohol-only using groups.

METHODS

Secondary analyses of the 2005 and 2010 National Alcohol Survey (N = 8,626; 4,522 female, 4,104 male), a Computer Assisted Telephone Interview survey of individuals aged 18 and older from all 50 states and DC. Blacks and Hispanics are over-sampled. Data were collected using list-assisted Random Digit Dialing. Multinomial and multivariable logistic regressions were used for analyses.

RESULTS

The prevalence of simultaneous use was almost twice as high as concurrent use, implying that individuals who use both cannabis and alcohol tend to use them at the same time. Furthermore, simultaneous use was associated with increased frequency and quantity of alcohol use. Simultaneous use was also the most detrimental: compared to alcohol only, simultaneous use approximately doubled the odds of drunk driving, social consequences, and harms to self. The magnitudes of differences in problems remained when comparing drunk driving among simultaneous users to concurrent users.

CONCLUSIONS

The overall set of results is particularly important to bear in mind when studying and/or treating problems among alcohol/cannabis co-users because they demonstrate that in the general population, co-users are a heterogeneous group who experience different likelihoods of problems relative to co-use patterns.

Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health

BACKGROUND

Smoking marijuana in a cigar (blunt use) is gaining popularity in the U.S. Research suggests that blunt users differ from exclusive cigar or marijuana users on a variety of demographic and substance use factors. Misreporting of blunts and cigars is also common, particularly among young people, and may lead to inaccurate prevalence estimates. To determine subtype differences, this study investigated the prevalence and demographic, mental health, and substance use correlates of four mutually-exclusive groups of blunt, cigar, and marijuana past 30-day users (cigar-only, blunt-only, non-blunt marijuana, or dual cigar-blunt).

METHOD

Data were analyzed from the 2013 National Survey of Drug Use and Health.

RESULTS

In weighted multinomial logistic regression models, respondents who were younger, Black, and who had used tobacco, alcohol, or other drugs in the past 30-days had the highest odds of reporting blunt-only or dual cigar-blunt use. Those reporting blunt-only and dual cigar-blunt use also endorsed a greater number of marijuana and alcohol use disorder symptoms compared to those reporting cigar-only and non-blunt marijuana use. Lower marijuana risk perceptions were associated with increased odds of marijuana use with or without blunts. Major depressive episode was uniquely associated with non-blunt marijuana use. With respect to misclassifiers, respondents who reported past 30-day blunt use but not past 30-day marijuana use were younger, Black, female, and had lower education and income.

DISCUSSION

Those who report blunt-only and dual cigar-blunt use showed the most severe risk profiles. Communicating health consequences and risks of blunt use should be directed toward specific subgroups.

Association between maltreatment and polydrug use among adolescents

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.

Using Attitudes, Age and Gender to Estimate an Adolescent's Substance Use Risk

PURPOSE

The purpose of this paper is to present a strategy for estimating an individual's risk of alcohol, cigarette and cannabis use that relies on an assessment of an adolescent's age, gender and attitude.

METHODOLOGY

The authors assembled surveys from 35,987 11 through 17 year-olds assembled from 36 databases were analysed to examine the relationship between attitude and behaviour.

FINDINGS

Attitudes were strongly correlated with concurrent use of alcohol, drunkenness, smoking, and cannabis, with point biserial correlations of -0.555, -0.517, -0.552 and -0.476, respectively. Logistic regression provided a means for using age, gender and attitudes to estimate an individual's risk of engaging in substance use behaviour. Developmental changes in attitudes were estimated by analysing changes in scores associated with percentile rankings for each age and gender group. Projected year-to-year changes in attitude were used as a heuristic for estimating future risk.

RESEARCH LIMITATIONS

Analyses relied on cross-sectional panel data. Analyses would benefit from longitudinal data in which age-related changes in attitudes could be more precisely modelled.

PRACTICAL IMPLICATIONS

Information about estimated current and future risk may use useful for motivating the adoption and implementation of effective prevention approaches by parents and care providers.

ORIGINALITY

The authors present a novel method for estimating an individual's risk of substance use knowing attitude, age and gender.

Polysubstance Use among Minority Adolescent Males Incarcerated for Serious Offenses

BACKGROUND

Adolescent juvenile offenders are at high risk for problems associated with drug use, including polysubstance use (i.e., use of a variety of drugs). The combination of juvenile offending and polysubstance use presents a significant public and child health concern.

OBJECTIVE

This study explored polysubstance use among a sample of youth incarcerated for serious offenses. We examined several risk factors for substance use and delinquency (i.e., early and frequent substance use, prior history of arrests, school expulsion, Black ethnicity), as well as the association between aggression and polysubstance use.

METHODS

Data were collected via questionnaires from 373 serious male juvenile offenders upon intake into a secure locked facility. Youth were on average 16 years old, and minority youth were overrepresented (28.1% Black, 53.1% Latino). Poisson regressions were used to assess the associations between the risk factors, aggression, and polysubstance use.

RESULTS

Consistent with the literature, Black youth reported less polysubstance use and later age of drug use onset than White and Latino youth. Findings suggest that Latino juvenile offenders and those with an early and problematic pattern of substance use are at heightened risk for polysubstance use. Aggression was not significantly related to polysubstance use, over and above the risk factors.

CONCLUSIONS

Given that Latino youth experience low rates of treatment for substance use, the development of culturally-sensitive interventions for these youth is needed. Interventions should also be multifaceted to address the multitude of risk factors associated with polysubstance use among juvenile offenders.

Simultaneous co-ingestion of prescription stimulants, alcohol and other drugs: a multi-cohort national study of US adolescents

OBJECTIVE

To determine the past-year prevalence rates and correlates of simultaneous co-ingestion of prescription stimulants and other substances among US high school seniors.

METHODS

Nationally representative probability samples of US high school seniors were surveyed as a part of the Monitoring the Future study. The sample consisted of five cohorts including a total of 12,431 high school seniors (modal age: 18 years) and represented a population that was 53% female.

RESULTS

Among past-year nonmedical users of prescription stimulants (n = 835), the estimated prevalence of any past-year simultaneous co-ingestion of prescription stimulants and other substances was 64.4%. The substances most commonly co-ingested with prescription stimulants included marijuana (51.1%) and alcohol (48.4%). Nonmedical users who co-ingested prescription stimulants with other substances were more likely to report non-oral routes of administration, recreational motives and greater subjective high when using prescription stimulants than nonmedical users who did not co-ingest prescription stimulants with other substances.

CONCLUSIONS

The majority of past-year nonmedical users of prescription stimulants reported simultaneous co-ingestion of prescription stimulants and other substances. The findings indicate that co-ingestion of prescription stimulants and other substances is a pervasive behavior among US adolescents who engage in nonmedical use of prescription stimulants and should be carefully considered in future clinical practice and research.

Alcohol and marijuana use patterns associated with unsafe driving among U.S. high school seniors: high use frequency, concurrent use, and simultaneous use

OBJECTIVE

This article examines noncausal associations between high school seniors' alcohol and marijuana use status and rates of self-reported unsafe driving in the past 12 months.

METHOD

Analyses used data from 72,053 students collected through annual surveys of nationally representative cross-sectional samples of U.S. 12th-grade students from 1976 to 2011. Two aspects of past-12-month alcohol and marijuana use were examined: (a) use frequency and (b) status as a nonuser, single substance user, concurrent user, or simultaneous user. Measures of past-12-month unsafe driving included any tickets/warnings or accidents, as well as tickets/warnings or accidents following alcohol or marijuana use. Analyses explored whether an individual's substance use frequency and simultaneous use status had differential associations with their rate of unsafe driving.

RESULTS

Higher substance use frequency (primarily alcohol use frequency) was significantly and positively associated with unsafe driving. The rate of engaging in any unsafe driving was also significantly and positively associated with simultaneous use status, with the highest rate associated with simultaneous use, followed by concurrent use, followed by use of alcohol alone. Individuals who reported simultaneous use most or every time they used marijuana had the highest likelihood of reporting unsafe driving following either alcohol or marijuana use.

CONCLUSIONS

This article expands the knowledge on individual risk factors associated with unsafe driving among teens. Efforts to educate U.S. high school students (especially substance users), parents, and individuals involved in prevention programming and driver's education about the increased risks associated with various forms of drug use status may be useful.

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use

BACKGROUND

Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk.

METHODS

We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a).

RESULTS

In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers.

CONCLUSIONS

In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

Combinations of prescription drug misuse and illicit drugs among young adults

BACKGROUND

Prescription drug misuse remains a critical drug trend. Data indicate that young adults in nightlife scenes misuse prescription drugs at high rates. As such, continued surveillance of the patterns of prescription drug misuse among young adults is necessary, particularly assessments that spotlight specific areas of risk, such as polydrug use.

METHODS

Prevalence and correlates of recent combinations of prescription drugs and other substances among urban young adults recruited at nightlife venues using time-space sampling are assessed via prevalence estimates and logistic regression analyses.

RESULTS

Overall, 16.4% of the sample reported combining illicit drug use with prescription drug misuse. Of those who reported any prescription drug misuse, 65.9% used prescription drugs in combination with at least one of the illicit drugs assessed. The most common combination was marijuana, followed by alcohol, cocaine, ecstasy, and psychedelics. Being male and identifying as gay, lesbian, or bisexual predicted the combination of prescription drugs with ecstasy, cocaine, and psychedelics.

CONCLUSIONS

Rates of combining alcohol and illicit drug use with prescription drug misuse were high, especially among men and those identified as a sexual minority. These rates are alarming in light of the host of negative health outcomes associated with combining prescription and illicit drugs.

Alcohol use potentiates marijuana problem severity in young adult women

BACKGROUND

Most young adult women who smoke marijuana also drink alcohol. Marijuana-related problems are associated with marijuana use frequency. We hypothesized that increased alcohol use frequency potentiates the association between frequency of marijuana use and marijuana-related problem severity.

METHODS

We recruited women aged 18 to 24 who smoked marijuana at least monthly and were not treatment seeking. Marijuana and alcohol use were measured using the timeline follow-back method. Problems associated with marijuana use were assessed using the Marijuana Problems Scale.

FINDINGS

Participants (n = 332) averaged 20.5 ± 1.8 years of age, were 66.7% non-Hispanic White, and reported using marijuana on 51.5 ± 30.6 and alcohol on 18.9 ± 16.8 of the 90 previous days. Controlling for education, ethnicity, years of marijuana use, and other drug use, frequency of marijuana use (b = .22; p < .01) and frequency of alcohol use (b = 0.13; p < .05) had significant, positive effects on marijuana problem severity. In a separate multivariate model, the linear by linear interaction of marijuana by alcohol use frequency was significant (b = 0.18; p < .01), consistent with the hypothesis.

CONCLUSIONS

Concurrent alcohol use impacts the experience of negative consequences from marijuana use in a community sample of young women. Discussions of marijuana use in young adults should consider the possible potentiating effects of alcohol use.