The Effects of Marijuana Use on Transitions through Stages of Alcohol Involvement for Men and Women in the NESARC I and II

Frequency matters: Relations among alcohol and cannabis co-use frequency and alcohol use disorder symptoms in emerging adults

Emerging adult alcohol and cannabis co-use is on the rise and enacts risk for alcohol misuse/alcohol use disorder (AUD). However, few studies have differentiated whether levels of cannabis use (rather than any cannabis use) moderate between-person risk. Considering low-frequency co-users may use both substances via substitution, low-risk/frequency co-use may not enact the same risk for AUD as higher risk co-use. The present study sought to test this assertion. Public access data on emerging adults from the National Study on Drug Use and Health were used (2002-2019; N = 231,681). Participants reported on their past year alcohol use, cannabis use, as well as AUD symptoms. Regression models tested whether levels of cannabis use frequency moderated the association between alcohol use frequency and AUD symptom counts. A significant interaction of cannabis use frequency by alcohol use frequency predicting AUD symptoms was detected. Individuals who co-used alcohol and cannabis reported more AUD symptoms than those who only used alcohol at the same frequency or less. However, co-use was associated with lower AUD symptom counts than alcohol-only use at higher frequency. Findings suggest that all co-users (and alcohol-only users) are not necessarily created equal, and that relations among co-use and risk for AUD symptoms are complex. Rather than a dichotomy of co-users versus alcohol-only users, between-group risk may depend on frequency of both alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alcohol and cannabis co-use: Receptiveness to treatments and application to intervention planning

Given the prevalence of alcohol and cannabis co-use among college students, prevention for co-use is crucial. We examined hypothetical receptiveness to substance-specific interventions among students who reported co-use. Students who use alcohol and cannabis were more receptive to alcohol interventions than cannabis interventions. Campus prevention experts should consider offering evidence-based alcohol-focused interventions as a potential pathway for decreasing substance use among college students who engage in co-use.

Age, sex, and race-varying rates of alcohol use, cannabis use, and alcohol and cannabis co-use in veterans vs. non-veterans

BACKGROUND

Military veterans are a high-risk group for health risk behaviors, including alcohol and cannabis use. However, research on veteran vs. non-veteran rates of alcohol/cannabis use are inconsistent across studies. Further, no research has investigated veteran vs. non-veteran rates of alcohol and cannabis co-use, and few studies have tested whether demographic variables, particularly race/ethnicity, moderate group differences. Therefore, the current study tested whether 1) veteran vs. non-veterans differed in rates of alcohol use, cannabis use, and alcohol and cannabis co-use, and 2) whether demographic covariates (age, sex, race/ethnicity) moderated associations.

METHODS

Data on adults (N = 706,897; 53.4% female) were derived from the 2002-2019 National Study on Drug Use and Health. Participant demographics, alcohol use frequency, drinking quantity, and cannabis use frequency were self-reported.

RESULTS

Non-veterans reported higher drinking quantity, cannabis frequency, and co-use. However, being a veteran was a risk factor for heavier drinking for women, ethnic/racial minoritized participants, and adults under the age of 50. Additionally, veteran status was a risk factor for cannabis use frequency in racial/ethnic minoritized participants and women. Similarly, being a veteran was a risk factor for alcohol and cannabis co-use for racial/ethnic minoritized participants, and the buffering effect of being a Veteran on co-use was reduced for older participants and women.

CONCLUSIONS

Results suggest that, at the population level, non-veterans may be heavier alcohol/cannabis users. However, moderating analyses suggested that being a veteran is a risk factor for women, racial/ethnic minoritized individuals, and younger individuals. Findings are discussed in terms of public health implications.

The role of alcohol and cannabis co-use in drinking rate and its impact on consequences

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 (M_age  = 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.

Impact of Early, Weekly Drinking on Latent Classes of Alcohol Involvement Progression and Recovery: Evidence from the NESARC Waves 1 and 2

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Weekly drinking before age 18 seems to impact alcohol progression over time.

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For females, extreme transitions from no problems to severe problems were impacted.

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For males, transitions from moderate to severe alcohol problems were impacted.

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Early, weekly drinking also predicted increased recovery for males.

Introduction

Early drinkers have been found to have higher risk of developing alcohol use disorder; however, the association of early drinking with progression to problematic alcohol involvement that does not meet disorder criteria (i.e., subclinical problems) or to severe stages of alcohol involvement, sex-specific associations, and relationship of early drinking with alcohol recovery have rarely been investigated.

Methods

Using data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we applied latent transition analyses to investigate the impact of weekly drinking before age 18 on alcohol progression and recovery operationalized as three classes of alcohol involvement using abuse and dependence indicators. We analyzed data separately for male (n = 12,276) and female (n = 14,750) drinkers and applied propensity score methods to address confounding.

Results

We observed significant associations between early, weekly drinking and alcohol involvement class membership at Wave 1 for both males and females. For males, early, weekly drinking was also associated with greater odds of transitioning from moderate to severe alcohol problems (aOR = 3.19, 95% CI = 1.72, 5.35). For females, early, weekly drinking predicted the transition from no to severe problems (aOR = 2.98, 95% CI = 1.11–8.00). Contrary to our hypothesis, early, weekly drinking was associated with greater likelihood of transition from severe to no problems for males (aOR = 3.23, 95% CI = 1.26, 8.26).

Discussion

Frequent, early drinking seems to be an important indicator of drinking progression with differential associations by sex. This information is useful to identify those at greater risk of progressing to severe drinking problems to intervene appropriately.

Drinking less on cannabis use days: The moderating role of UPPS-P impulsive personality traits

Objective: Several studies suggest that alcohol and cannabis co-users are heavier drinkers and experience more alcohol-related consequences. However, day-level associations between co-use and drinking levels are mixed. One reason may be that individual characteristics moderate the daily impact of using alcohol alone or in conjunction with cannabis. The theory would suggest that highly impulsive individuals may drink more on co-use days, yet this assertion remains untested. Therefore, the current study tested whether impulsivity moderated the effect of co-use on same-day drinking quantity within veterans, a high-risk sample for substance use and impulsivity. Method: In a longitudinal observational study, co-using veterans (N = 139) completed three semi-annual assessments reporting on their daily drinking quantity and cannabis use via Timeline Followback (Observations = 19,245) and impulsivity via the UPPS-P. Mixed effect modeling was used to test hypotheses that co-use (compared to alcohol-only) days would be associated with heavier drinking for those high (but not low) in positive and negative urgency. Results: Significant interactions were found for positive urgency (PU) and lack of perseverance (LP), such that individuals at mean and low levels of PU and LP drank less on co-use (compared to alcohol-only) days. There were no significant interactions for other UPPS-P impulsivity facets. Conclusion: Findings are consistent with a substitution/compensatory effect for individuals at mean and low levels of both UPPS-P facets, and may be a byproduct of frequent cannabis use in veterans. In contrast, findings suggest that co-use and alcohol-only days may be characterized by similarly high levels of drinking for highly impulsive individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relations between impulsive personality traits, alcohol and cannabis co-use, and negative alcohol consequences: A test of cognitive and behavioral mediators

OBJECTIVE

Alcohol and cannabis co-users experience more negative alcohol consequences, but distal and mediating mechanisms of this association remain largely unstudied. Considering research suggests that individuals high in impulsivity and sensation seeking are more likely to be co-users, it is possible that co-users have more positive expectancies and become heavier drinkers, which confer risk for future negative consequences. Therefore, the current study tested prospective mediation models in which impulsive personality traits indirectly predicted negative consequences through co-use, heavier drinking, and expectancies.

METHODS

The current study used data from a study of familial AUD spanning 3 waves (1995-2010). Participants (N = 567) reported on impulsivity (via the Eysenck Personality Inventory and Sensation Seeking Scale) alcohol and cannabis use, alcohol expectancies, and negative consequences. Models tested the factor structure of impulsive personality traits and whether these traits predicted future negative consequences through past-year co-use and drinking/expectancies.

RESULTS

Factor analysis suggested two factors, sensation seeking and lack of premeditation. Sensation seeking was associated with future negative consequences indirectly through co-use and both drinking quantity and positive expectancies. Lack of premeditation was not associated with co-use, but indirectly predicted negative consequences through positive expectancies, above and beyond co-use. Sensation seeking directly predicted negative expectancies, but negative expectancies did not predict negative consequences.

CONCLUSIONS

Impulsive personality traits in co-users, particularly sensation seeking, explained variance in future negative alcohol consequences via heavier drinking (behavior) and positive expectancies (cognition). Personalized interventions targeting a lack of premeditation, and sensation seeking in co-users, may interrupt a developmental trajectory toward problem drinking.

Adverse childhood experiences (ACEs) and transitions in stages of alcohol involvement among US adults: Progression and regression

BACKGROUND

Adverse childhood experiences (ACEs) are associated with a number of medical comorbidities. However, there is a paucity of data on the role ACEs play in transitions in stages of alcohol involvement.

OBJECTIVE

To examine the association between ACEs and transitions in alcohol problems progression and regression between No Problems, Moderate Problems and Severe Problems stages.

PARTICIPANTS AND SETTING

Data from 14,363 male and 19,774 female participants in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

METHODS

We used latent transition analysis (LTA) with propensity score adjustment to estimate the odds of transitioning across stages of alcohol involvement, between waves, based on the number of types of ACEs experienced. We hypothesized that ACEs would be associated with increased risk of progression and decreased risk of regression.

RESULTS

ACEs were associated with progression to higher alcohol involvement stages, with greatest likelihood of progression from No Problems to Severe Problems for those reporting ≥3 ACEs (males: aOR = 4.78 [CI (1.84-12.44)]; females: aOR = 3.81 [CI (1.69-8.57)]). ACEs were also associated with decreased odds of regression to less problematic alcohol involvement stages, with some distinctive patterns of associations in males and in females.

CONCLUSIONS

This study suggests that ACEs impact transitions in alcohol involvement in both males and females, affecting both progression and regression. The association is magnified for those with multiple types of ACE exposures. These results highlight the need for prevention, early identification and intervention to mitigate the risks associated with childhood maltreatment.

Does Cannabis Use Predict More Severe Types of Alcohol Consequences? Longitudinal Associations in a 3-Year Study of College Students

BACKGROUND

Prior research shows that negative drinking outcomes among young adults may be exacerbated by cannabis use. However, to date, there have been few longitudinal studies of associations between cannabis use and negative alcohol-related consequences. This study examined longitudinal within-person associations between cannabis use and several domains of negative alcohol consequences among young adults and explored the moderating role of sex.

METHOD

We analyzed data from N = 997 students assessed 4 times per year over the first 3 years of university. At each time point, participants completed measures of past-month cannabis use frequency, typical weekly number of drinks, and 8 domains of negative alcohol consequences. Longitudinal associations were examined in multilevel models.

RESULTS

Within-person changes in frequency of cannabis use were not uniquely associated with changes in total alcohol consequences aggregated across several alcohol consequence domains. However, when examining alcohol consequence domains separately, within-person increases in cannabis use frequency were specifically associated with increases in some (but not all) of the more severe types of alcohol consequences, including risky behaviors, poor self-care, and alcohol dependence symptoms. No support was observed for the moderating role of sex in the longitudinal within-person associations between cannabis use and alcohol consequence domains.

CONCLUSIONS

Findings suggest that within-person changes in cannabis use frequency among young adults are associated with corresponding changes in some domains of alcohol consequences (but not others) when examined over the course of several years. Results may inform targeted harm reduction interventions for young adult drinkers who use cannabis, although future research is needed to clarify the mechanisms of the observed associations.

Marijuana Use for Women: To Prescribe or Not to Prescribe

The marijuana policy varies greatly worldwide. Marijuana use is illegal in most countries. Nevertheless, the medical potentials of marijuana have been increasingly uncovered, and its use by women is increasing. Objectives: Herein we aimed to share some of our perspectives on the hot important topic: marijuana use for women. Methods: We reviewed publications indexed in PubMed reporting the benefits and harms regarding the medical use of marijuana for women and its impact on offspring. Results: For non-pregnant women with some long-lasting conditions refractory to regular management, marijuana could be prescribed as potential new hope with acceptable safety profile based on current evidence. However, the side-effects especially long-term consequences are cautionary. For instance, for adolescents and young women, cannabis might affect their neuronal development and increase stroke risk. Notably, cannabinoids might promote proliferation of breast cancer cells. The potential harms should be carefully weighed against the benefits associated with cannabis. Cannabis use in pregnant or lactating women increases the risks of offspring exposures, and should be mostly avoided. Prenatal marijuana exposure might affect fetal growth and be teratogenic. The psychoactive cannabinoid tetrahydrocannabinol (THC), a partial agonist of human endocannabinoid system, could cross placental barrier, and adversely affect fetus brain development. THC could also affect the maturation of multiple neurotransmitter systems. The neurobehavioral consequences include impaired arousal and psychomotor functions at birth and disturbed sleep and higher-order executive functions in childhood. For mothers, the short-term and long-term side-effects, withdrawal syndromes, and use disorder associated with use of marijuana especially high-potency cannabis could all adversely affect their ability to care children and thus child development and safety. However, if the disease itself more dramatically tortures maternal behavior which could otherwise be alleviated by marijuana, then the use could somehow be justified. Conclusions: Benefits and risks for both the patient and the offspring especially in the long term regarding marijuana use should be carefully weighed for each specific case. Standardized dosing and duration of treatment need to be determined. Recommendations should be made by physicians with expert training and after careful patient evaluation for fully informed patients, whose preference should be respected. Legislations should encourage more active basic, translational, and clinical studies.