Insights into the context of simultaneous alcohol and cannabis use among young adults

Compliance and response consistency in a lengthy intensive longitudinal data protocol

Research on real-world patterns of substance use increasingly involves intensive longitudinal data (ILD) collection, requiring long assessment windows. The present study extends limited prior research examining event- and person-level influences on compliance and response consistency by investigating how these behaviors are sustained over time in an ILD study of alcohol and cannabis co-use in college students. Participants (n = 316) completed two 28-day bursts of ILD comprising five daily surveys, which included a morning survey of prior-day drinking. We used linear mixed effects models in a multilevel interrupted time series framework to evaluate the associations of time and measurement burst with (a) noncompliance (count of missed surveys) and (b) response consistency (difference between same-day report of drinking and morning report of prior-day drinking). We observed that time was positively associated with noncompliance, with no discontinuity associated with measurement burst. The slope of time was more positive in the second burst. Neither time nor measurement burst were significantly associated with consistent reporting. However, survey nonresponse and consistency of responding appeared to be impacted by the same-day use of substances. Overall, compliance decreased while consistency was stable across the duration of a lengthy ILD protocol. Shorter assessment windows or adaptive prompting strategies may improve overall study compliance. Further work examining daily burden and context is needed to inform future ILD design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the Impact of Simultaneous Alcohol and Cannabis Use on Alcohol Consumption and Consequences: Protocol for an Observational Ambulatory Assessment Study in Young Adults

BACKGROUND

There is significant conflicting evidence as to how using cannabis while drinking alcohol (ie, simultaneous alcohol and cannabis use) impacts alcohol volume consumed, patterns of drinking, and alcohol-related consequences. The impact of simultaneous use on drinking outcomes may be influenced by several within-person (eg, contextual) and between-person (individual) factors.

OBJECTIVE

This study was designed to examine naturalistic patterns of alcohol and cannabis use to understand how simultaneous use may impact drinking outcomes. The primary aims were to understand the following: (1) if simultaneous use is associated with increased alcohol consumption and riskier patterns of drinking, (2) if simultaneous use leads to increased alcohol consequences, and (3) how contextual circumstances moderate the impact of simultaneous use on consumption and consequences.

METHODS

Data collection involves a 28-day ambulatory assessment protocol in which a sample of non-treatment-seeking young adults who report simultaneous use of alcohol and cannabis complete ecological momentary assessments (random, event-contingent, and time-contingent surveys) of alcohol and cannabis use, contexts, motives, and consequences on their personal smartphones while continuously wearing an alcohol biosensor bracelet. Participants also complete a baseline assessment, brief internet-based check-in on day 14, and a final session on day 28. Community-based recruitment strategies (eg, social media and flyers) were used to enroll 95 participants to obtain a target sample of 80, accounting for attrition.

RESULTS

Recruitment and data collection began in May 2021 and continued through June 2024. Initial results for primary aims are expected in October 2024. As of March 2024, the project had recruited 118 eligible participants, of whom 94 (79.7%) completed the study, exceeding initial projections for the study time frame. Remaining recruitment will provide the capacity to probe cross-level interactions that were not initially statistically powered. Strengths of the project include rigorous data collection, good retention and compliance rates, faster-than-expected enrollment procedures, use of a novel alcohol biosensor, and successful adaptation of recruitment and data collection procedures during the COVID-19 pandemic.

CONCLUSIONS

This is the first investigation to assess the key momentary predictors and outcomes of simultaneous use as well as self-reported and objective (via alcohol biosensor) measures of alcohol consumption and patterns. The results of this study will inform prevention efforts and studies of individuals who use cannabis who are engaged in alcohol treatment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58685.

The Interaction of Cannabis Consumption with Heavy Episodic Drinking and Alcohol-induced Blackouts in Relation to Cannabis Use Consequences Among Recent Undergraduate College Cannabis Users

Introduction

Risky alcohol use patterns, characterized by heavy episodic drinking (HED) and alcohol-induced blackout, are prevalent in college students. However, it is not clear if experiencing HED and blackout among college-attending cannabis users heightens risk for adverse cannabis use consequences. The purpose of this study was to examine whether heavy episodic drinking and blackout episodes moderate the relationship between cannabis consumption and cannabis use consequences among college students.

Methods

Undergraduate college students (n = 4331) were recruited from a Midwest University in 2021. This analysis used a subset of data from past 6-month cannabis users (n= 772; 17.8% of the full sample). Among cannabis users, 64.5% identified as female and 87.8% were White with an average age of 19.99 (SD=2.88). A linear regression was conducted with two two-way interactions of cannabis consumption and HED frequency as well as cannabis consumption and alcohol-induced blackout episodes.

Results

Results showed a statistically significant positive association between cannabis consumption and cannabis use consequences (B=0.73, p<.001), adjusting for the other variables in the model. Blackout, but not HED, was a significant moderator (B=0.19, p=.003).

Discussion

The findings of this study indicate that blackout experiences amplify the relationship between cannabis use and cannabis-related consequences among college students. This underscores that blackouts not only signal a risk of problematic drinking but also exacerbate the association between cannabis use and its negative consequences.

Conclusion

Findings may inform college campus interventions targeting cannabis and alcohol concurrent-users who experience alcohol-induced blackouts to reduce their additional risk for cannabis-related consequences.

Subjective effects of simultaneous alcohol and cannabis versus alcohol-only use: A qualitative analysis

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).

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).

Associations between alcohol and cannabis use order, frequency, quantity, and consequences in a college sample of individuals who co-use alcohol and cannabis

BACKGROUND AND OBJECTIVES

Using both alcohol and cannabis (either at the same time or at different times) is common among college students, and is called "co-use." Using these substances simultaneously, such that their effects overlap, is thought to be an especially risky co-use pattern. Gaining a better understanding of how co-use patterns relate to substance use and consequences could aid prevention and intervention efforts.

METHODS

We examined college students (N = 401) who reported using both alcohol and cannabis at least once in the past 30 days. Path analysis was used to explore relations among co-use patterns (number of days in a typical week that participants used both alcohol and cannabis; the number of days using alcohol first, cannabis first, alcohol last, and cannabis last; the number of days of simultaneous use), past-30-day alcohol and cannabis consequences, use frequency, and typical quantities used.

RESULTS

Each additional day of using alcohol first was associated with fewer past-30-day cannabis consequences. Each additional day of using cannabis first was associated with fewer alcohol-related consequences. Each additional day of using alcohol and cannabis on the same day and each additional day of simultaneous use were both associated with less cannabis used and alcohol consumed in a typical week.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

This study is among the first to identify associations between alcohol and cannabis order and outcomes (i.e., consequences and consumption). Results suggest that modifying which substance is used first on a given day could be a practical intervention strategy for individuals who co-use alcohol and cannabis.