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Ayyagari MM, Heim D, Sumnall HR, Monk RL. Contextual factors associated with subjective effects of cannabis: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 164:105822. [PMID: 39059675 DOI: 10.1016/j.neubiorev.2024.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/05/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cannabis is consumed in various social and environmental settings, and such contexts may be important predictors of subjective effects. The aim of this systematic review and meta-analysis was to examine the relationship between contextual factors and subjective effects of cannabis. METHODS A PRISMA-guided search of MEDLINE, Embase, PsycINFO, Global Health, and Google Scholar yielded 29 studies. RESULTS Study type (Ecological Momentary Assessment or Experimental) was a significant predictor of intoxication effects, and experimental studies had a greater pooled effect size (z =.296,95 % CI [.132,.478], p=.004) than Ecological Momentary Assessment (EMA) studies (z =.071,95 % CI [.011,.130], p =.02). Contextual conditions (environment, social group, expectancy, time of day, day of week) were not significant predictors of cannabis effects. CONCLUSION Findings did not point to a significant association between contextual conditions and subjective effects. However, as current literature is methodologically weak, it may be premature to conclude that subjective effects are not shaped by contextual factors. In view of policy and therapeutic implications, replications and study refinements are recommended.
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Affiliation(s)
| | - Derek Heim
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Harry R Sumnall
- School of Psychology & Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rebecca L Monk
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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2
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Huh J, Blevins B, Wong K, Lee R, Herzig SE, Unger JB, Oh H. The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review. Drug Alcohol Depend 2024; 262:111391. [PMID: 39047639 DOI: 10.1016/j.drugalcdep.2024.111391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status. METHODS Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings. RESULTS The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults. CONCLUSIONS The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.
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Affiliation(s)
- Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA.
| | - Brittany Blevins
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Kelly Wong
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Shirin E Herzig
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (USC), USA
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, USC, USA
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Pragst F, Niebel A, Thurmann D, Dullin M, Eichberg S, Mörlein F, Hartwig S. Is there a relationship between abuse of alcohol and illicit drugs seen in hair results? Drug Test Anal 2024. [PMID: 38686500 DOI: 10.1002/dta.3702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Combined use of alcohol and illicit drugs is a serious health and social problem. In this study, it was examined, whether a relationship between alcohol and drug abuse can be ascertained by comparison of alcohol marker and drug concentrations in hair. In the frame of a social support system for families with parental abuse of illicit drugs, hair samples were analyzed between 2011 and 2022 for methadone, heroin (6-acetylmorphine), cocaine, amphetamine, ecstasy (MDMA), cannabinoids (THC), and the alcohol markers ethyl glucuronide (EtG) and ethyl palmitate (EtPa). For 1314 hair samples from adolescent and adult family members, the hair results show a prevalence of combined occasional or regular drug use and social or abusive alcohol use of 41%-60% except heroin (35%). The drug concentrations were statistically compared in the three categories of abstinence or moderate drinking, social drinking, and alcohol abuse. For the most frequently detected drug cocaine (n = 703), a significant increase of the concentrations with rising alcohol consumption was found. The frequent detection of cocaethylene proved the preferred simultaneous intake of both substances. For THC (n = 489), no significant difference between the alcohol consumer groups was seen. Concerning the less frequently detected methadone (n = 89), 6-acetylmorphine (n = 92), amphetamine (n = 123), and MDMA (n = 105), no clear trend between drug and alcohol marker results was determined. It is concluded that the evaluation of hair results is an appropriate way to study the extent of combined drug-alcohol consumption and complements other studies based on acquisition of consumption data by interview or questionnaire.
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Affiliation(s)
- Fritz Pragst
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - André Niebel
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Denise Thurmann
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Monique Dullin
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Susann Eichberg
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Frederike Mörlein
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Sven Hartwig
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
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Waddell JT, Corbin WR. Do Subjective Effects from Alcohol and Cannabis Predict Simultaneous Use During a Decision-Making Task? Subst Use Misuse 2024; 59:1020-1030. [PMID: 38441633 PMCID: PMC11232501 DOI: 10.1080/10826084.2024.2320366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background: Simultaneous alcohol and cannabis use is associated with negative outcomes, yet little is known about what motivates the decision of simultaneous use. One possibility is that early-episode subjective effects motivate simultaneous use to complement or replace the first substance's effects. The current study used a hypothetical decision-making task to test this hypothesis. Objectives: College students (N = 486) were presented eight scenarios characterized by alcohol/cannabis subjective effects (i.e., high/low arousal positive [e.g., excited, relaxed], high/low arousal negative [e.g., aggressive, dizzy]) and asked their likelihood of simultaneously using the other substance per scenario. Multilevel modeling tested whether subjective effect scenarios predicted a higher likelihood of simultaneous use and whether ordering moderated this association. Results: Task-based simultaneous use likelihood was associated with self-reported simultaneous use, showing task validity. Scenarios characterized by high/low arousal positive effects were associated with higher likelihood of simultaneous use, whereas high/low arousal negative scenarios were associated with lower likelihood. Alcohol vs. cannabis-first scenarios were associated with higher likelihood of simultaneous use, and significant interactions were observed for high/low arousal positive and high arousal negative effects. High arousal positive scenarios were associated with higher likelihood of simultaneous use when cannabis was used first, low arousal positive scenarios with higher likelihood when alcohol was used first, and high arousal negative scenarios with lower likelihood when cannabis was used first. Conclusions: Beginning-of-episode subjective substance effects may be a promising event-level predictor of simultaneous use, and just-in-time interventions may benefit from targeting the ordering and subjective experiences of alcohol and cannabis use.
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Affiliation(s)
- Jack T Waddell
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - William R Corbin
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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Gette JA, Sokolovsky AW, Gunn RL, Boyle HK, Jackson KM, White HR. Latent Classes of Simultaneous Alcohol and Cannabis Use and Associations with Consequences using Daily Data. CANNABIS (ALBUQUERQUE, N.M.) 2024; 6:33-48. [PMID: 38883280 PMCID: PMC11178057 DOI: 10.26828/cannabis/2023/000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Objective Simultaneous alcohol and cannabis use (i.e., marijuana, [SAM], using alcohol and cannabis so effects overlap) is associated with increased consumption and consequences compared to single-substance use. SAM use prevalence is increasing, yet there is heterogeneity in use patterns among those engaging in SAM use, which may lead to differential consequences. Method This study drew on daily data to characterize latent profiles of cannabis, alcohol, and SAM use patterns and to test class differences on related consequences after 3 months among college students engaging in SAM use (77.08% White, 51.67% female). Class indicators were 10 person-level substance use variables derived from repeated daily surveys. Results Results yielded a three-class solution: Heavy Alcohol, Cannabis, and SAM (Heavy Use, n = 105); Heavy Alcohol-Light Cannabis (n = 75); and Light Alcohol-Heavy Cannabis (n = 60). There were significant person-level differences between classes on all substance use indicators (e.g., quantity and frequency of alcohol, cannabis, and SAM) but not sex or race/ethnicity. At 3-month follow-up, the Heavy Use class endorsed more SAM consequences than the other classes. The Heavy Use class did not differ on alcohol or cannabis consequences compared to the Heavy Alcohol-Light Cannabis or Light Alcohol-Heavy Cannabis classes, respectively. The Light Alcohol-Heavy Cannabis class endorsed the fewest alcohol consequences. The Heavy Alcohol-Light Cannabis class endorsed the fewest cannabis consequences. Conclusions Findings highlight distinct patterns of co-use and their association with consequences at follow-up. Heavy alcohol or cannabis use was associated with consequences for that substance, but heavy use of only one substance was not indicative of SAM-specific consequences.
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Affiliation(s)
- Jordan A Gette
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | | | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Holly K Boyle
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Helene R White
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Gray BA, Bolts OL, Fitzke RE, Douglass MA, Pedersen ER, Prince MA. Using Latent Profile Analysis to Examine Cannabis Use Contexts: Associations with Use, Consequences, and Protective Behaviors. Subst Use Misuse 2023; 59:208-217. [PMID: 37846065 DOI: 10.1080/10826084.2023.2267112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVE College students represent a large portion of the population, and report high rates of cannabis use and related negative outcomes, including interpersonal problems, risky behaviors, or physical dependency. The contexts in which students use cannabis (e.g., at a party, when feeling down or depressed, after a fight with a loved one) likely affect their risk of experiencing consequences. We aimed to discern profiles of cannabis use contexts and compare profiles on use frequency, consequences, and the use of cannabis protective behavioral strategies (PBS). METHOD College students were surveyed regarding their cannabis use contexts, frequency, consequences, and PBS use (n = 265; female = 72.8%). We used Latent Profile Analysis to identify patterns of cannabis use contexts and auxiliary testing to compare profiles on use frequency, consequences, and PBS use. RESULTS Our examination revealed three latent profiles of cannabis use. The Social Use Profile was associated with use in predominantly social/uplifting contexts. The Physical & Emotional Pain Profile was also associated with use in these contexts but was defined by additional use in response to pain. The All Contexts Profile was associated with frequent use in all contexts, including those that were least endorsed by the other profiles. Profiles differed in cannabis use frequency, PBS use, and the number of consequences experienced, such that profiles were more likely to be associated with more frequent cannabis use, higher risk of experiencing use-consequences, and using fewer PBS as the number of use contexts increased across the profiles. CONCLUSIONS The contexts in which people use cannabis are associated with cannabis risk and protection. Prevention and intervention efforts may benefit from considering contexts of cannabis use.
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Affiliation(s)
- Bethany A Gray
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Olivia L Bolts
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, University of Southern California; Keck School of Medicine, Los Angeles, California, USA
| | - Morgan A Douglass
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, University of Southern California; Keck School of Medicine, Los Angeles, California, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
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Litt DM, Zhou Z, Fairlie AM, King KM, Cross A, Kannard E, Geusens F, Lewis MA. Daily level examination indicates that positive affect, but not negative affect, is associated with alcohol and marijuana use among adolescents and young adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:1030-1038. [PMID: 37471009 PMCID: PMC10799183 DOI: 10.1037/adb0000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Although there is growing evidence that alcohol use at the daily level is associated with positive but not negative affect, results are mixed when examining marijuana use and simultaneous alcohol and marijuana (SAM) use (i.e., use with overlapping effects). In addition, less is known about these daily level associations among diverse samples of adolescents and young adults. The present study will address these gaps. METHOD Participants (N = 1,006; 57.3% female, 43.1% White, Non-Hispanic, ages 15-25; Mage = 20.0) were part of a study on substance use that consisted of a 3-week ecological momentary assessment (EMA) burst design (eight surveys per week, up to 2×/day) that was repeated quarterly over a 12-month period. RESULTS Within-person results indicated that on days with elevated positive affect, participants reported consuming more drinks, whereas positive affect was not significant for hours high from marijuana. In addition, on days with elevated negative affect, participants reported fewer hours high from marijuana. No association was found between negative affect and number of drinks. Finally, within-person results indicated that on alcohol or marijuana days with elevated positive affect, individuals were more likely to report SAM use. There was no association found between negative affect and SAM use. CONCLUSIONS Results have implications such that in-the-moment interventions for alcohol and SAM use may be more salient when individuals have higher positive affect than average, whereas such interventions may be more relevant for marijuana use when negative affect is lower compared to average levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dana M. Litt
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Zhengyang Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Anne M. Fairlie
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Kevin M. King
- Department of Psychology, University of Washington, Seattle, Washington
| | - Allison Cross
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Emma Kannard
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Femke Geusens
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Melissa A. Lewis
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
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Muzumdar N, Jackson KM, Buckman JF, Spaeth AM, Sokolovsky AW, Pawlak AP, White HR. Dose-dependent Relationships of Same-day and Typical Substance Use to Sleep Duration in College Cannabis and Alcohol Users: A Multilevel Modeling Approach Using Daily Diary Data. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:49-63. [PMID: 38035172 PMCID: PMC10683747 DOI: 10.26828/cannabis/2023/000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
This study characterized how quantities of cannabis and alcohol use affect sleep. Single-day and typical cannabis and alcohol use patterns were considered to assess acute-chronic use interactions. Linear and non-linear associations assessed dose-dependence. College students (n=337; 52% female) provided 11,417 days of data, with up to five time points per day. Daily self-reported sleep duration, cannabis use quantity, and alcohol use quantity were subjected to linear mixed modeling to capture linear and curvilinear associations between single-day and typical use on same-night and typical sleep. Sleep duration (difference between bedtime and waketime) was the outcome. Quantity of cannabis used each day andtypical quantity used across all days were predictors in the cannabis models. Parallel single-day and typical alcohol variables were predictors in the alcohol models. Follow-up analyses excluded days with alcohol-cannabis co-use. Main effects of single-day and typical cannabis quantity on sleep duration were observed when all cannabis-use days were modeled. Higher than typical doses of single-day and typical cannabis were associated with longer sleep durations, but only to a point; at the highest doses, cannabis shortened sleep. A main effect of single-day alcohol quantity and two interactions (single-day use with both linear and curvilinear typical use) on sleep duration were observed when all alcohol-use days were modeled. Greater alcohol consumption on a given day led to shorter same-night sleep, but typically heavier drinkers required higher doses than typically lighter drinkers to experience these adverse effects. Follow-up models suggested alcohol co-use may contribute to the purported sleep-promoting effects of cannabis.
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Affiliation(s)
- Neel Muzumdar
- Department of Kinesiology and Health, Rutgers University – New Brunswick
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, School of Public Health
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University – New Brunswick
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Andrea M. Spaeth
- Department of Kinesiology and Health, Rutgers University – New Brunswick
| | | | - Anthony P. Pawlak
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Helene R. White
- Center for Alcohol and Substance Use Studies, Rutgers University – New Brunswick
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Waddell JT, Merrill JE, Okey SA, Woods-Gonzalez R, Corbin WR. Subjective effects of simultaneous alcohol and cannabis versus alcohol-only use: A qualitative analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:906-917. [PMID: 36757980 PMCID: PMC10409872 DOI: 10.1037/adb0000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Theoretical models of addictive behavior suggest that subjective effects serve as a mechanism through which substance use disorders develop. However, little is known about the subjective effects of simultaneous alcohol and cannabis use, particularly whether simultaneous use (a) heightens specific subjective effects or (b) is related to unique subjective effects relative to single-substance effects. The present study used formative, qualitative data analysis to examine patterns of responses within open-answer text response data on subjective effects of simultaneous use. METHOD College students who simultaneously use alcohol and cannabis (N = 443; 68.2% female) were asked to describe how alcohol effects differ on simultaneous alcohol and cannabis use versus alcohol-only use days. RESULTS Conventional content analysis revealed nine concepts related to simultaneous (vs. alcohol-only) use subjective effects including as follows: (a) increased/decreased impairment, (b) low arousal/relaxation, (c) balancing/replacement effects, (d) "cross-faded" effects, (e) little-to-no differences, (f) altered sensation and perception, (g) increased negative affective states, (h) increased appetite, and (i) increased/decreased negative consequences. Increased impairment (N = 191) and increased relaxation (N = 110) were the most often endorsed subjective effects, followed by decreased impairment (N = 55), balancing/replacement effects (N = 50) and cross-faded/enhancement effects (N = 44). CONCLUSIONS Subjective effects from simultaneous use largely map onto domains of single-substance alcohol and cannabis effects (e.g., relaxation, sociability, cognitive/behavioral impairment), but also include distinct domains related to simultaneous use (e.g., balancing/replacement effects, altered sensation and perception). Future quantitative research is needed to validate measures of subjective effects from simultaneous use and their relations with use behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Sokolovsky AW, Rubenstein D, Gunn RL, White HR, Jackson KM. Associations of daily alcohol, cannabis, combustible tobacco, and e-cigarette use with same-day co-use and poly-use of the other substances. Drug Alcohol Depend 2023; 251:110922. [PMID: 37625332 PMCID: PMC10538395 DOI: 10.1016/j.drugalcdep.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Young adults frequently use alcohol, cannabis, and tobacco together. Given the increased prevalence of e-cigarette use and recreational cannabis use, we investigated daily patterns of alcohol, cannabis, and tobacco use and distinguished combustible tobacco from e-cigarettes. METHODS Young adult college students (N=341) reporting past-month alcohol and cannabis use "at the same time so that their effects overlapped" completed two 28-day bursts of repeated daily surveys. Exposures were day- and person-level use of each substance. Outcomes were (1) same-day co-use of each remaining substance or (2) poly-use of the other substances. RESULTS Daily use of alcohol, cannabis, combustible cigarettes, and e-cigarettes increased the odds of same-day co-use of the other substances (except combustible tobacco with e-cigarettes) and each poly-use outcome. The influence of person-level substance use on daily substance use was less consistent. Only e-cigarette use increased the odds of daily alcohol use. Use of either tobacco product but not alcohol increased the odds of daily cannabis use. Person-level alcohol and cannabis use increased the odds of daily use of either tobacco product but use of one tobacco product was not associated with daily use of the other product. CONCLUSIONS These findings increase our understanding of emerging daily patterns of alcohol, cannabis, and tobacco co-use, and the impact of different tobacco products. Future work is needed to extend this research into non-college samples and people who use tobacco but do not use alcohol and cannabis simultaneously, and examine daily chronologies of multiple substances that could serve as dynamic markers of risk.
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Affiliation(s)
- Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States.
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2400 Pratt Street, Durham, NC 27705, United States
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
| | - Helene R White
- Rutgers Center of Alcohol and Substance Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854-8001, United States
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
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Gómez-Núñez MI, Molla-Esparza C, Gandia Carbonell N, Badenes Ribera L. Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: A Systematic Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2503-2526. [PMID: 36897426 PMCID: PMC10501956 DOI: 10.1007/s10508-023-02572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of acquiring sexually-transmitted diseases. This systematic review and meta-analysis of three scientific databases examined the prevalence of the use of intoxicating substances, those tending to excite or stupefy the user on a psychoactive level, before or during sex, among young adults (18-29 years old). A total of 55 unique empirical studies met the inclusion criteria (48,145 individuals; 39% males), were assessed for risk of bias using the tools of Hoy et al. (2012), and were analyzed via a generalized linear mixed-effects model. The results produced a global mean prevalence of this sexual risk behavior of 36.98% (95% CI: 28.28%, 46.63%). Nonetheless, significant differences were identified between different intoxicating substances, with the use of alcohol (35.10%; 95% CI: 27.68%, 43.31%), marijuana (27.80%; 95% CI: 18.24%, 39.92%), and ecstasy (20.90%; 95% CI: 14.34%, 29.45%) significantly more prevalent than that of cocaine (4.32%; 95% CI: 3.64%, 5.11%), heroin (.67%; 95% CI: .09%, 4.65%), methamphetamine (7.10%; 95% CI: 4.57%, 10.88%), and GHB (6.55%; 95% CI: 4.21%, 10.05%). Moderator analyses showed that the prevalence of alcohol use before or during sex differed according to geographical sample origin, and increased as the proportion of ethnic whites in samples increased. The remaining demographic (e.g., gender, age, reference population), sexual (e.g., sexual orientation, sexual activity), health (e.g., drug consumption, STI/STD status), methodological (e.g., sampling technique), and measurement (e.g., timeframe) variables that were examined did not moderate prevalence estimates. Implications for sexual development interventions were discussed.
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Affiliation(s)
- María Isabel Gómez-Núñez
- Department of Research Methods and Diagnostics in Education, International University of La Rioja, UNIR, Logroño, La Rioja, Spain
| | - Cristian Molla-Esparza
- Department of Research Methods and Diagnostics in Education, University of Valencia, UVEG, Av. de Blasco Ibáñez, 30, 46010, Valencia, Spain.
| | - Natalia Gandia Carbonell
- Llaurant la Llum Therapeutic Community, Center for the Treatment, Withdrawal and Detoxification of Addictions and Other Associated Disorders, Valencia, Spain
- Department of Psychobiology and Health Sciences Methodology, Autonomous University of Barcelona, UAB, Bellaterra, Spain
| | - Laura Badenes Ribera
- Department of Methodology of the Behavioural Sciences, University of Valencia, UVEG, Valencia, Spain
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Graupensperger S, Calhoun BH, Fleming CN, Patrick ME, Lee CM. Longitudinal examination of high-risk drinking contexts: Daytime drinking, pregaming, and drinking games linked to high-risk alcohol use and negative consequences in young adults. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1364-1376. [PMID: 37128660 PMCID: PMC10760786 DOI: 10.1111/acer.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The contexts in which young adults drink alcohol play a salient role in alcohol-related outcomes and negative consequences at an event-level, but less is known about longitudinal risks. We collected longitudinal monthly data across 2 years on (a) daytime drinking, (b) pregaming/pre-partying, and (c) playing drinking games. We then examined associations between drinking in these contexts and within-person variability in alcohol consumption, consequences, and simultaneous alcohol and marijuana (SAM) use in a given month. We also examined the extent to which drinking in these contexts predicted hazardous drinking (using Alcohol Use Disorders Identification Test (AUDIT) scores) at a distal follow-up timepoint, controlling for baseline AUDIT scores. METHOD A community sample of 759 young adults (Mage = 21.1 years; 56.4% female) completed monthly surveys for 24 consecutive months and a distal 30-month follow-up. Multilevel models estimated within- and between-person associations between drinking context frequencies (daytime drinking, pregaming, drinking games) and alcohol-related outcomes (weekly consumption, consequences, SAM use). A single-level negative binomial regression tested associations between drinking context frequency averages across a two-year period and changes in AUDIT scores from baseline to a follow-up 2.5 years later. RESULTS Over 75% of the sample of non-abstaining young adults reported drinking in each of the three contexts at least once during the 24-month period. Within-persons, young adults reported greater consumption, more negative consequences, and increased likelihood of SAM use during months that they drank in these contexts more often than usual. Each context was associated with negative consequences, even when controlling for alcohol use frequency. More frequent daytime drinking and pregaming, but not drinking games, were associated with increases in AUDIT scores at the 30-month follow-up, suggesting that there are potential long-term risks of drinking in these contexts. CONCLUSIONS Findings suggest that daytime drinking, pregaming, and playing drinking games are high-risk contexts in terms of month-to-month and long-term risks. Additional research is needed on the various contexts in which young adults drink alcohol and the extent to which contextual factors interact with one another to amplify/reduce risks and harms.
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Affiliation(s)
| | - Brian H. Calhoun
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Charles N. Fleming
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Christine M. Lee
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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13
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Boyle HK, Singh S, López G, Jackson KM, Carey KB, Merrill JE. Insights into the context of simultaneous alcohol and cannabis use among young adults. Exp Clin Psychopharmacol 2023; 31:662-673. [PMID: 36174141 PMCID: PMC10201978 DOI: 10.1037/pha0000607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Simultaneous alcohol and cannabis use (simultaneous use) is common among young adults and is associated with a greater number of substance use-related consequences compared to single substance use. Understanding what drives simultaneous use among young adults is crucial. This study aimed to gather qualitative data on physical, social, and situational characteristics of simultaneous use among young adults. Participants were 36 heavy drinking young adults (Mage = 21.79) who engaged in simultaneous use at least twice during the past 30 days. Individual semistructured interviews were conducted via Zoom videoconferencing. Thematic analyses were used to analyze interview data. Findings indicated that young adults are selective of where and with whom they engage in simultaneous use with. Physical characteristics associated with simultaneous use included being in familiar and safe locations. Young adults were less likely to engage in simultaneous use in public spaces. Social characteristics associated with simultaneous use included being at parties, being around close peers, and if others are approving of and/or also using alcohol and cannabis so their effects overlap. Being around family or being alone decreased the likelihood of simultaneous use. Situational characteristics associated with simultaneous use included having access to alcohol and/or cannabis, being a weekend and/or evening, pregaming, and using cannabis at the end of a drinking occasion. Young adults based their decision to engage in simultaneous use on a range of physical, social, and situational contextual factors. Future research should examine multiple characteristics of the context in order to identify specific context with an increased risk of simultaneous use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Holly K Boyle
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Samyukta Singh
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Gabriela López
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Kristina M Jackson
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Kate B Carey
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
| | - Jennifer E Merrill
- Department of Behavioral and Social Sciences, School of Public Health, Center for Alcohol and Addiction Studies, Brown University
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14
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Sartor CE, O'Malley SS, Krishnan-Sarin S, Foster DW. In what settings and social contexts do young adults vape or smoke cannabis? Findings from a web-based diary pilot study. Addict Behav 2023; 144:107753. [PMID: 37210830 DOI: 10.1016/j.addbeh.2023.107753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Vaping is an increasingly common mode of cannabis use among young adults. Despite potential to inform targeted prevention, settings and social contexts where young adults vape and/or smoke cannabis have rarely been investigated. We addressed this question in a diverse young adult sample. METHODS Data were collected weekly in a web-based daily diary format for six weeks. The analytic sample consisted of the 108 participants (of the 119 enrolled) who used cannabis during the assessment period (mean age = 22.06; 23.78% college students; 65.74% female; 5.56% Asian, 22.22% Black, 16.67% Latinx, 2.78% Multi-racial or Other and 52.77% White). Cannabis use was queried separately for vaping and smoking; respondents reported all settings (14 options) and social contexts (7 options) where they used. RESULTS For both vaping and smoking cannabis, the most common settings were home (vaping: 56.97%, smoking: 68.72% [significantly lower for vaping]), friend's home (vaping: 22.49%, smoking: 21.49%), and car (vaping: 18.80%, smoking: 12.99%). The most common social contexts were with friends (vaping: 55.96%, smoking: 50.61%), with significant other (vaping: 25.19%, smoking: 28.53%), and alone (vaping: 25.92%, smoking: 22.62%). Compared to non-students, college students reported vaping on a significantly higher proportion (27.88% vs. 16.50%) of cannabis use days. CONCLUSIONS Very similar patterns in settings and social contexts were observed for vaping as smoking and in prevalence of vaping and smoking cannabis across demographic groups. The few notable exceptions have implications for vaping related public health measures: targeting reducing vaping outside the home, particularly in cars, and implementing prevention programming on college campuses.
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Affiliation(s)
- Carolyn E Sartor
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson Street, New Brunswick, NJ 08901, United States.
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06508, United States
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06508, United States
| | - Dawn W Foster
- Department of Psychiatry, Yale School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06508, United States
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15
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Arterberry BJ, Calhoun BH, Lee CM, Patrick ME. Young Adult Physical, Social, and Temporal Contexts of Simultaneous Alcohol and Marijuana Use. J Stud Alcohol Drugs 2023; 84:398-406. [PMID: 36971726 PMCID: PMC10364780 DOI: 10.15288/jsad.22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/01/2022] [Indexed: 07/20/2023] Open
Abstract
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.
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Affiliation(s)
| | - Brian H. Calhoun
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Megan E. Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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16
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Maynard M, Burr EK, Allen Q, Dvorak RD, Paulson D. Loss-of-Control-Eating Mediates the Relationship between Cannabis-Related Problems and Eating Pathology. Psychol Rep 2023:332941231161999. [PMID: 36921084 DOI: 10.1177/00332941231161999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The prevalence of eating pathology among college students has increased significantly in recent years. This coincides with increases in the use of cannabis, both nationally, but also among college students. Problematic cannabis use has been linked to eating pathology in prior research. Research also shows that cannabis may affect appetitive drives linked to food consumption. The current study tested the hypothesis that the association between problem cannabis use and eating pathology was mediated by greater loss of control eating. Cross-sectional data were collected from a sample of 805 college student cannabis users at a large Southeastern university in the U.S. The sample were primarily Caucasian (76%) and female (65.22%) with an average age of 20.15 (SD = 3.91). Participants completed surveys assessing eating outcomes (loss of control eating and eating pathology), cannabis use, and cannabis-related problems. The analysis used an observed variable path model. After controlling for cannabis use, cannabis-related problems were indirectly linked to eating pathology via loss of control eating (B = 0.109, SE = 0.025, p < .001), supporting the primary hypothesis. The direct relationship between cannabis-related problems and eating pathology was fully accounted for (B = 0.010, SE = 0.028, p = .724) by the indirect effect of loss of control eating. These data suggest that the association between problematic forms of cannabis use and eating pathology may be due to the association between cannabis problems and loss of control eating. While this may be due to changes in appetite and food evaluation as a function of more problematic use patterns, it may also be that individuals with problematic cannabis use have more problematic eating patterns due to deficits in adaptive coping strategies. Future research should seek to parse out these different potential explanations.
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Affiliation(s)
| | - Emily K Burr
- 6243The University of Central Florida, Orlando, FL, USA
| | - Quinn Allen
- 6243The University of Central Florida, Orlando, FL, USA
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17
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Drohan MM, Stevens AK, Gunn RL, Sokolovsky AW, White HR, Jackson KM. Acute Consequences Associated With Co-use of Alcohol and Cannabis: A Daily Survey Analysis. J Stud Alcohol Drugs 2023; 84:208-213. [PMID: 36971729 PMCID: PMC10171256 DOI: 10.15288/jsad.22-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Co-use of alcohol and cannabis has been associated with more total negative consequences than single-substance use, but results have been mixed depending on whether the single substance was alcohol or cannabis. The present study used within-person analyses to examine whether co-use increased the risk for experiencing specific acute negative consequences. METHOD College students who were co-users of alcohol and cannabis (N = 341; M age = 19.8 years; 51.3% female; 74.8% White) completed 56 days of five daily surveys across two bursts. We used generalized linear mixed effects models to examine the effects of type of substance use day on specific negative consequences, controlling for consumption and covariates. RESULTS Relative to both alcohol-only and co-use days, cannabis-only days were associated with decreased likelihood of experiencing hangover, blackout, nausea/vomiting, injury, rude/aggressive behavior, and unwanted sex. Relative to alcohol-only days, cannabis-only and co-use days were associated with an increased likelihood of driving high/drunk. Finally, there was an increased likelihood of hangovers on alcohol-only days compared with co-use days. CONCLUSIONS Days with different types of substance use differed in specific consequences. Most of the negative co-use consequences investigated here appear to be driven by alcohol consumption rather than cannabis use. The results also indicated that these young adults were more likely to endorse driving under the influence of cannabis than alcohol. Interventions for co-use should target alcohol consumption to reduce negative consequences such as blackout, injury, rude/aggressive behavior, and unwanted sex and highlight the dangers of driving under the influence of cannabis.
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Affiliation(s)
- Megan M. Drohan
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
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18
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Characteristics of drinking episodes associated with simultaneous alcohol and cannabis use among underage drinkers in the United States. Addict Behav 2023; 136:107501. [PMID: 36181745 DOI: 10.1016/j.addbeh.2022.107501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Simultaneous alcohol and cannabis (SAC) use is associated with more negative consequences than independent use of alcohol or cannabis. Contextual characteristics of drinking episodes are associated with the quantity of alcohol consumed and related risk. This study examined whether drinking contexts may also be associated with SAC use. METHODS National Survey on Drug Use and Health (NSDUH) 2010-2019 data from past 30-day drinkers aged 12-20 (n = 39,456) were used. A weighted multivariable logistic regression model examined associations between contextual characteristics (alcohol source, number of people, drinking location) and SAC use during their most recent drinking occasion. Models adjusted for survey year, heavy episodic drinking, age, sex, race/ethnicity, student status, and metropolitan area status. RESULTS More than one-in-five drinkers reported SAC use. Compared to getting alcohol from parents/family, those who took it from a home (OR = 1.51,95 %CI = 1.24,1.84), got it for free another way (OR = 2.30,95 %CI = 2.05,2.59), paid someone else for it (OR = 2.83,95 %CI = 2.46,3.25), or purchased it themselves (OR = 3.12,95 %CI = 2.66,3.67) had higher odds of SAC use. Compared to drinking alone, drinking with more than one person was associated with higher odds of SAC use (OR = 1.36,95 %CI = 1.12,1.66). Compared to drinking in their home, drinking in a bar (OR = 0.51,95 %CI = 0.41,0.64) had lower odds of SAC use, whereas drinking in someone else's home (OR = 1.12,95 %CI = 1.02,1.22), a car (OR = 1.36,95 %CI = 1.04,1.77), or multiple locations (OR = 1.29,95 %CI = 1.09,1.53) had higher odds of SAC use. CONCLUSIONS Findings suggest that alcohol-related contextual characteristics are associated with SAC use among underage drinkers. Laws addressing underage alcohol consumption, including social host liability and sales to minors laws, may also decrease simultaneous cannabis use.
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19
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Boyle HK, Singh S, López G, Carey KB, Jackson KM, Merrill JE. A qualitative examination of the decision-making process of simultaneous alcohol and cannabis use: Intentions and willingness. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:168-179. [PMID: 36480451 PMCID: PMC10275144 DOI: 10.1111/acer.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol and cannabis use are common among young adults and most young adults who use both substances have used them simultaneously (i.e., using both substances so their effects overlap). Because simultaneous use is associated with a greater number and severity of consequences than single substance use, research is needed to examine the decision-making process of engaging in this high-risk behavior. We conducted a qualitative examination of intentions (i.e., plans) and willingness (i.e., one's openness to engage in the behavior if an opportunity presents itself) to engage in simultaneous use from the perspective of young adults who frequently report this substance use behavior. METHODS We recruited 36 young adults who reported simultaneous use and heavy drinking (4+/5+ drinks for women/men; 64% women, ages 18 to 25) to participate in semi-structured interviews. All interviews were double coded for thematic analysis and both novel and a priori themes were found. RESULTS Young adults distinguished between intending to engage in simultaneous use and being willing to engage in simultaneous use. They reported that intentions and willingness varied from occasion to occasion. They also reported that context and alcohol consumption influenced their willingness to engage in simultaneous use. Peer pressure or offers increased their willingness to use cannabis while drinking and having current or next-day responsibilities decreased their willingness to engage in simultaneous use. Additionally, planned simultaneous use occasions were characterized as being special events where young adults consumed more substances, but were more likely to monitor their use than unplanned occasions. CONCLUSIONS Intentions and willingness may be important proximal predictors of simultaneous use of alcohol and cannabis. Building off this qualitative work, quantitative research should identify which factors influence the decision-making process to engage in simultaneous use and determine when intentions and willingness are most predictive of risky simultaneous use behavior.
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Affiliation(s)
- Holly K Boyle
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Samyukta Singh
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Gabriela López
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, Rhode Island, USA
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20
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Dyar C. A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors. CURRENT ADDICTION REPORTS 2022; 9:589-597. [PMID: 37637872 PMCID: PMC10449003 DOI: 10.1007/s40429-022-00452-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review Sexual and gender minorities (SGM) appear to be at elevated risk for cannabis use (CU) and cannabis use disorder (CUD) compared to cisgender heterosexuals. However, risk factors remain understudied among SGM. This review aims to summarize evidence for disparities in CU and CUD affecting SGM and factors contributing to these disparities. Recent Findings We found strong evidence that sexual minorities are at elevated risk for CU and CUD is elevated for sexual minority women. Evidence supports a concurrent association between minority stress and CUD symptoms. There is robust support for coping motives as a mechanism linking minority stress to subsequent CU and CUD. Studies also point to CU norms and contexts as potential risk factors. Summary SGM are at high risk for CU and CUD, and minority stress, CU norms, and contextual factors are implicated. Additional research is needed on CU among gender minorities, prospective effects of risk factors, and interventions for SGM.
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21
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Gunn RL, Sokolovsky AW, Drohan MM, Boyle HK, Stevens AK, White HR, Jackson K. The role of alcohol and cannabis co-use in drinking rate and its impact on consequences. Alcohol Clin Exp Res 2022; 46:2110-2120. [PMID: 36124876 PMCID: PMC9968512 DOI: 10.1111/acer.14946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of alcohol and cannabis co-use on college student drinking and related outcomes is complex. Specific characteristics or patterns of co-use events beyond drinking quantity may be important to the experience of consequences. The present study used repeated daily surveys to examine the association between co-use (versus use of alcohol only) and drinking rate on negative consequences. METHODS The sample included 318 college students (Mage = 19.8, 47% female, 76% non-Hispanic White) who were co-users of alcohol and cannabis, recruited from three U.S. college campuses. Participants completed 56 days of data collection (number of drinking days ranged from 1 to 38). Two measures of drinking rate were examined: (1) daily rate (number of drinks divided by number of hours spent drinking per day); and (2) peak hour rate (maximum number of drinks consumed in a single hour) to account for anomalous drinking days of long duration. Generalized linear mixed models examined: (1) associations of co-use with peak hour rate (model 1a) and daily rate (model 1b); (2) associations of peak hour rate (model 2a) and daily rate (model 2b) with experiencing any negative consequence; and (3) interactions of co-use with peak hour rate (model 3a) and daily rate (model 3b) on experiencing a consequence. RESULTS Co-use was positively associated with peak hour rate but not daily rate. Both peak hour and daily rate positively predicted likelihood of experiencing a negative consequence. The interaction of both peak hour and daily rate by co-use was significant such that the association of rate with experiencing a consequence was stronger on alcohol-only days compared to co-use days. CONCLUSIONS Daily drinking rate and peak hour drinking rate are unique and should be considered when discussing drinking patterns. Both predict negative consequences and may be important aspects of interventions for negative drinking-related outcomes among college students.
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Affiliation(s)
- Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexander W. Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Megan M. Drohan
- University of Rhode Island, South Kingstown, Rhode Island, USA
| | - Holly K. Boyle
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Helene R. White
- Center of Alcohol and Substance Studies, Rutgers University, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Kristina Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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22
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Cox MJ, Stevens AK, Janssen T, Jackson KM. Event-level contextual predictors of high-intensity drinking events among young adults. Drug Alcohol Depend 2022; 239:109590. [PMID: 35944417 PMCID: PMC10404138 DOI: 10.1016/j.drugalcdep.2022.109590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Drinking events are characterized by social and physical contexts that are associated with level of alcohol consumption. Ecologically valid data is needed to delineate aspects of the drinking context that are most likely to precipitate excessive alcohol consumption. METHODS We utilized event-level data from a longitudinal study that included repeated daily surveys administered in two 28-day bursts. Data from 341 college student past-month alcohol and cannabis users (Mage=19.79; 53 % women; 74 % White) produced a total of 4107 alcohol use days. Generalized linear mixed effects models were used to predict drinking level (moderate: 1-3/1-4 for women/men; heavy-episodic drinking (HED): 4-7/5-9; high-intensity drinking (HID), 8+/10+) by social (e.g., with friends) and physical (e.g., at a party) contexts. We conducted analyses for the first and last drink reported, controlling demographic and study characteristics. RESULTS Being at a party, friend's house, or with strangers at the last drink reported were associated with HID compared to HED, while being at home, alone, or with family were protective for HID. No first drink contexts were associated with HID relative to HED. Witnessing others who were intoxicated was consistently associated with HID. CONCLUSIONS Social settings such as parties and those with intoxicated persons were associated with risk for HID. The context of drinks at the end of an event are salient signals of level of alcohol consumption. Preventive interventions, particularly those that deliver strategies in real time, should consider accounting for contextual risk factors to reduce harms associated with excessive alcohol consumption.
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Affiliation(s)
- Melissa J Cox
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Angela K Stevens
- Center for Alcohol and Addiction Studies, Brown University of Public Health, Providence, RI, USA
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University of Public Health, Providence, RI, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University of Public Health, Providence, RI, USA
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23
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Metrik J, Patel S. Alcohol and Cannabinoids - From the Editors. Alcohol Res 2022; 42:10. [PMID: 35821767 PMCID: PMC9232221 DOI: 10.35946/arcr.v42.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island,Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Sachin Patel
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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24
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Lanza ST, Sokolovsky AW, Linden-Carmichael AN, White HR, Jackson KM. Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data. J Stud Alcohol Drugs 2022; 83:358-363. [PMID: 35590176 PMCID: PMC9134998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/02/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. METHOD College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. RESULTS Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. CONCLUSIONS College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.
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Affiliation(s)
- Stephanie T. Lanza
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | | | - Ashley N. Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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Stevens AK, Gunn RL, Boyle HK, White HR, Jackson KM. Unplanned versus planned simultaneous alcohol and cannabis use in the daily lives of a predominantly white college student sample: What are the motives, contexts, and outcomes? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:243-253. [PMID: 35113586 PMCID: PMC9106840 DOI: 10.1037/adb0000813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Simultaneous alcohol and cannabis use is common among college students and associated with more consumption and consequences compared to single-substance use. This study examined occasions of simultaneous use and compared planned occasions to unplanned occasions with respect to motives, contexts, consumption, and consequences. METHOD College student simultaneous users (N = 341; 53% women; 74% White) completed five daily surveys for 54 days. Mixed-effects models examined motives and contexts of simultaneous use occasions as a function of whether alcohol and cannabis use were (a) both planned versus (b) unplanned, no use planned, or (c) unplanned, single-substance use planned and whether alcohol and cannabis consumption and negative simultaneous use-related consequences varied across planned versus unplanned occasions. RESULTS Social and enhancement motives were related to planned simultaneous use; offered and coping motives were associated with planned single-substance use that became simultaneous use (vs. planned simultaneous use). Compared to unplanned use, planned simultaneous use was negatively associated with using at home or alone, and positively associated with using with others, more intoxicated people, and more people using cannabis. Planned simultaneous use was associated with more alcohol and cannabis consumption. No significant differences were found for negative consequences. CONCLUSIONS Planned simultaneous use was motivated by social and enhancement reasons, whereas planned single-substance use that became simultaneous use was more likely motivated by offers or for coping. Planned simultaneous use resulted in greater consumption, but not negative consequences. Results provide specific motives and contexts associated with unplanned and planned simultaneous use to be incorporated into real-time interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Angela K Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Holly K Boyle
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Helene R White
- Center of Alcohol and Substance Studies, Rutgers, The State University of New Jersey
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
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Lanza ST, Sokolovsky AW, Linden-Carmichael AN, White HR, Jackson KM. Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data. J Stud Alcohol Drugs 2022; 83:358-363. [PMID: 35590176 PMCID: PMC9134998 DOI: 10.15288/jsad.2022.83.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/02/2021] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. METHOD College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. RESULTS Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. CONCLUSIONS College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.
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Affiliation(s)
- Stephanie T. Lanza
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | | | - Ashley N. Linden-Carmichael
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania
| | - Helene R. White
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kristina M. Jackson
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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Stevens AK, Blanchard BE, Sokolovsky AW, Gunn RL, White HR, Jackson KM. Forgoing plans for alcohol and cannabis use in daily life: Examining reasons for nonuse when use was planned in a predominantly white college student sample. Alcohol Clin Exp Res 2021; 45:2167-2178. [PMID: 34762304 DOI: 10.1111/acer.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/18/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The reasons for college students to abstain from alcohol and cannabis use on a given day can inform efforts to prevent or intervene in those behaviors. Research on reasons for alcohol nonuse remains in its nascent stages and no study to date has examined reasons for cannabis nonuse on a given day. Here we examine reasons for nonuse among college students after they planned to use alcohol and/or cannabis. METHODS College students (N = 341; Mage = 19.79; 53% women; 74% White) from 3 universities completed 54 days of data collection across which approximately 50% were nonuse days. Each morning, participants indicated whether they planned to use that day; nonuse reasons were assessed the next morning, if applicable. Generalized linear mixed-effects models were used to disentangle within- and between-person effects. RESULTS On a given nonuse day (at the within-person level), "work" and "school" were reasons associated with having no plan to use alcohol and "to feel in control" was linked to having no plan to use cannabis. "Did not want to get high" was related to forgoing plans (did not use when originally planned) for alcohol use at the within-person level. At the between-person level, "no desire" was associated with no plans for alcohol or cannabis use and "did not want to get high" was related to no plans for cannabis use. "School" and "could not get" were related to forgoing plans for alcohol and cannabis use, respectively, at the between-person level. CONCLUSION An examination of earlier intentions for alcohol and/or cannabis use on nonuse days yielded novel findings on the intention-behavior gap. Reasons for nonuse can inform intervention and prevention strategies (e.g., those involving social norms or just-in-time adaptive efforts) for alcohol and cannabis use on college campuses.
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Affiliation(s)
- Angela K Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Helene R White
- Center of Alcohol and Substance Use Studies, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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Linden-Carmichael AN, Wardell JD. Combined use of alcohol and cannabis: Introduction to the special issue. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:621-627. [PMID: 34591513 DOI: 10.1037/adb0000772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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).
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