A qualitative examination of positive and negative consequences young adults experience from simultaneous alcohol and cannabis use

Day-level associations among alcohol use, simultaneous alcohol and cannabis use, and both regretted and positive romantic/sexual experiences

BACKGROUND

Young adults who drink heavily, including those who simultaneously use cannabis, experience both positive and regretted romantic/sexual experiences. Both gender and past sexual assault severity may also play a role in the valence of romantic/sexual experiences. The current study focuses on day-level correlates of romantic/sexual experiences, assessing whether: (1) number of drinks or simultaneous alcohol and cannabis use (vs. alcohol only) are associated with likelihood of regretted or positive romantic/sexual experiences and (2) past sexual assault severity or gender moderate these associations.

METHODS

Two hundred and one young adults (Mage = 22.06) reporting high intensity drinking (8+/10+ drinks for females/males) completed baseline and 28 daily assessments of alcohol use, simultaneous use, and romantic/sexual experiences.

RESULTS

Consumption of more drinks increased likelihood of both positive and regretted romantic/sexual experiences. Simultaneous alcohol and cannabis use had no effect on positive romantic/sexual experiences. There was a significant interaction between simultaneous use and gender in the prediction of a regretted romantic/sexual experience when controlling for number of drinks. Among women, simultaneous use (vs. alcohol only) significantly decreased likelihood of regretted romantic/sexual experiences. Among men, simultaneous use was unrelated to likelihood of regretted romantic/sexual experiences. Past sexual assault was not a significant moderator of effects of either number of drinks or simultaneous use.

CONCLUSIONS

Among heavy-drinking young adults, a greater number of drinks is associated with both more regretted and positive romantic/sexual experiences. Findings highlight a unique protective effect of simultaneous use for women, even when controlling for how much alcohol is being consumed.

Alcohol and cannabis use in daily lives of college-attending young adults: Does co-use correspond to greater reported pleasure?

Co-use of alcohol and cannabis is prevalent and linked with heightened risk for substance-related harms. The current study investigated the role of substance-related pleasure as a reinforcing factor for co-use relative to alcohol or cannabis use. Specifically, we used data from a 21-day diary study of college students to examine day-level associations between co-use and self-reported substance-related pleasure (any, level of pleasure). Participants were 237 college students (65 % female sex at birth, ages 18-24) who reported 1+ alcohol and cannabis co-use occasion. Participants completed daily surveys across 21 consecutive days about yesterday's substance use and experiences of pleasure, yielding 2,086 daily surveys involving alcohol and/or cannabis use. Multilevel models indicated that odds of substance-related pleasure were higher on days with co-use relative to days with single-substance use, and level of pleasure was higher on co-use days relative to cannabis but not alcohol use days. Pleasure may serve as a reinforcing property of co-use that may be related to continued use despite experience of negative consequences. Intensity of pleasure related to co-use appears to be largely driven by use of alcohol. However, given mixed findings concerning level of pleasure, individuals may report co-use increases feelings of pleasure but do not actually experience more pleasure. Pleasure may serve as a viable target in future prevention and intervention programming targeting co-use.

Alcohol use and cannabis craving in daily life: Sex differences and associations among young adults

BACKGROUND

Alcohol and cannabis are commonly used together by young adults. With frequent pairings, use of one substance may become a conditioned cue for use of a second, commonly co-used substance. Although this has been examined for alcohol and cannabis in laboratory conditions and with remote monitoring, no research has examined whether pharmacologically induced cross-substance craving occurs in naturalistic conditions.

METHODS

In a sample of 63 frequent cannabis-using young adults (54% female) who completed 2 weeks of ecological momentary assessment, we tested whether alcohol use was associated with stronger in-the-moment cannabis craving. We also examined whether sex moderated this association and whether cannabis craving was stronger at higher levels of alcohol consumption.

RESULTS

Although alcohol use and cannabis craving were not significantly associated at the momentary level, there was evidence that this relation significantly differed by sex. Among female participants, there was a negative association between alcohol use since the last prompt and momentary cannabis craving (b = -0.33, SE = 0.14, p = 0.02), while the association among male participants was positive (b = 0.32, SE = 0.13, p = 0.01). Similarly, alcohol quantity was negatively associated with cannabis craving at the momentary level for female participants (b = -0.10, SE = 0.04, p = 0.009) but was not significantly associated for male participants (b = 0.05, SE = 0.04, p = 0.18).

CONCLUSIONS

Alcohol may enhance cannabis craving among male individuals but reduce desire for cannabis among female individuals. This may point to differing functions of co-use by sex, highlighting a need for research to elucidate the mechanisms underlying this increasingly common pattern of substance use.

Simultaneous Substance Use With Alcohol in a Community-Based Sample of Young Adults

Objective: Simultaneous substance use is associated with worse outcomes than concurrent use. Further investigations into simultaneous use are warranted because there is limited knowledge about the co-use of substances other than alcohol and cannabis. Study aims were to examine: (1) the prevalence of simultaneous use of substances with alcohol, (2) the extent to which use patterns are related to key correlates (i.e., psychological functioning, sensation seeking), and (3) differences by college status. Methods: Participants were 623 young adult drinkers who were recruited online to complete a one-time survey. Results: Cannabis (54.3%), tobacco (53.7%), and stimulants (46.5%) were most frequently used with alcohol. Moderation analyses showed the positive association between simultaneous use and psychological distress was stronger for students whereas the positive association with sensation seeking was stronger for nonstudents. Conclusions: Results highlight the need for future research and intervention efforts that consider the link between simultaneous use and psychological wellbeing while acknowledging that educational attainment may differentially influence these factors.

Assessment of simultaneous alcohol and cannabis use and its related consequences and cognitions in college students: A narrative review

As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM-related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations for future directions of assessment. We conclude that the assessment of SAM use is limited by difficulties in the assessment of cannabis quantity and potency. However, and the lack of a psychometrically validated measure of SAM consequences. However, measures of SAM motives and expectancies have been published with support from psychometric examinations such as exploratory factor analysis, confirmatory factor analysis, and measurement invariance. Research is needed that incorporates qualitative approaches in the development of SAM use measures so that unique items specific to SAM use rather than single-substance use can be identified. Additionally, validation of these measures is needed across different samples that vary demographically, such as by race and gender or sex. Future research should consider the development of a measure of protective behavioral strategies  specific to SAM use to inform interventions that target the reduction of negative consequences of SAM use.

Characterizing Alcohol Consumption and Positive and Negative Consequences During Simultaneous Alcohol and Cannabis Use Events

OBJECTIVE

Young adults who engage in simultaneous alcohol and cannabis use report heavy use of both substances. Event-level studies examining differences between consequences experienced on simultaneous use compared with single substance use days have been mixed. Although studies often control for alcohol use levels, few have examined how quantity of alcohol may influence consequences experienced on simultaneous use days. Furthermore, little research has examined the relationship between simultaneous use and positive consequences or explored individual consequences. This study examined differences in consequences experienced on simultaneous use versus single substance use days (alcohol-only, cannabis-only) including endorsement of specific consequences and examined the relationship among simultaneous use, consequences, and alcohol consumption.

METHOD

Young adults who engage in simultaneous use (N = 86) completed 30 days of daily surveys reporting substance use and positive and negative consequences.

RESULTS

Simultaneous use days were associated with more negative and positive consequences than single substance use (alcohol-only and cannabis-only) days. We also examined endorsement of specific positive and negative consequences on alcohol-only, cannabis-only, and simultaneous use days. The effect of day type (simultaneous use vs. alcohol-only) on consequences was moderated by alcohol quantity. On lighter drinking days, more positive and negative consequences were endorsed if it was a simultaneous use versus alcohol-only day. On heavier drinking days, number of consequences did not differ between simultaneous use and alcohol-only days.

CONCLUSIONS

Findings from this study point to simultaneous use as both reinforcing and high risk and highlight the importance of intervening even on lighter drinking simultaneous use occasions to reduce harms.

Applying the prototype willingness model to day-level simultaneous alcohol and cannabis use

OBJECTIVE

The prototype willingness model (PWM) provides a framework for understanding simultaneous alcohol and cannabis use by highlighting important psychosocial (e.g., attitudes, norms) predictors of and pathways (via willingness and/or intentions) to simultaneous use. We examined both the PWM reasoned and social reaction pathways in relation to simultaneous use.

METHOD

Eighty-nine young adults self-monitored alcohol, cannabis, and simultaneous use and related constructs for 30 days via daily assessments.

RESULTS

Day-level simultaneous use specific attitudes, norms, perceived vulnerability, intentions, and willingness each predicted simultaneous use, while only day-level intentions and willingness predicted number of negative consequences. We observed significant indirect effects for the two social reaction pathways examined (from descriptive norms to willingness to simultaneous use; from perceived vulnerability to willingness to simultaneous use). Only direct effects were seen for the cognitions in the reasoned pathway; injunctive norms predicted simultaneous use, and attitudes predicted simultaneous use with no mediation by intentions.

CONCLUSIONS

Findings support applying the PWM to event-level simultaneous use among young adults. Future work should establish if PWM day-level constructs are modifiable targets that may be utilized in intervention work focused on reducing simultaneous use and related harms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).