This event-level study examined within-person differences in consequences for college students who engaged in alcohol-only, marijuana-only, or simultaneous alcohol and marijuana (SAM) use across 18 weekend days. Participants (n ϭ 451) were asked to report consequences they experienced on each occasion across five different types of events: (a) heavier alcohol combined with marijuana; (b) lighter alcohol combined with marijuana; (c) heavier alcohol only; (d) lighter alcohol only; and (e) marijuana only. Occasions involving heavy drinking, alone and in combination with marijuana, were associated with higher rates of consequences relative to lighter alcohol-only occasions, lighter alcohol combined with marijuana occasions, and marijuana-only occasions. Light alcohol-only occasions did not significantly differ on consequences from lighter alcohol combined with marijuana occasions or marijuana-only occasions. Past research has shown SAM use is associated with more consequences compared with alcohol-only use. The current findings suggest that SAM use is not necessarily riskier than drinking or using marijuana alone. Results suggested that on heavy drinking occasions, the number of consequences did not significantly change by also using marijuana. Findings suggest the benefit of targeted intervention strategies to reduce harms associated with heavy drinking occasions with and without SAM use.

While alcohol remains the drug of choice for most college students, national data show that 40% of college students also use other substances (e.g., marijuana, cocaine, etc.). Longitudinal studies indicate that students who report use of both alcohol and other substances experience more consequences (e.g., blackout, arrests). The current study expands upon this research by using a multi-level approach to examine average and event-level alcohol combined with other substance use (ALC+) and its role on consequences experienced. In addition, the research examined which substance combined with alcohol posed the most risk. A total of 461 students reported on alcohol use, substance use, and consequences experienced (e.g., YAACQ) on 12 weekend nights (Thursday, Friday, Saturday) across 4 weekends in an academic year. Multilevel model analyses revealed a positive association between both average and event-level ALC+ use and the number of consequences experienced. A significant cross-level interaction was also revealed indicating students who typically combine alcohol and other substances experienced more consequences on occasions when they use more substances relative to students who typically use alcohol only. Finally, alcohol plus nicotine, or marijuana, or ADHD medications, or cocaine were all significantly positively related to increased consequences. These findings provide consistent evidence that ALC+ use is a highly prevalent behavior among college students that increases risk of problematic consequences.

ABSTRACT. Objective:Despite showing reductions in college student drinking, interventions have shown some inconsistency in their ability to successfully decrease consequences. With the goal of improving prevention efforts, the purpose of this study was to examine the role of consequence-specific constructs, in addition to drinking, that influence students' experiences with alcohol-related problems. The study examined how drinking and protective behaviors mediated the relationships between students' willingness to experience consequences, intentions to avoid them, and four categories of alcohol-related problems (physiological, social, sexual, and academic). Method: First-year college student drinkers (n = 2,024) at a large northeastern university completed surveys during the fall and spring of their freshman year. Results: As expected, different patterns of associations emerged for physiological and nonphysiological consequences. When physiological consequences (e.g., hangover, vomiting) were examined, drinking significantly mediated the effect of willingness on the consequences. Drinking-specific protective behaviors indirectly influenced consequences through drinking behaviors whereas general protective behaviors did not. When nonphysiological (e.g., social, sexual, academic) consequences were examined, drinking and general protective behaviors emerged as significant mediators of the effects of willingness and intentions on the consequences, whereas drinking-specific protective behaviors did not. Conclusions: The results suggest that prevention efforts (e.g., personalized feedback) could be tailored to address specific types of protective behaviors as well as specific types of consequences frequently experienced by college students. (J. Stud. Alcohol Drugs, 76, 862-871, 2015)

Heavy drinking is a risk factor for sexual assault. Although protective behavioral strategies (PBS) tend to be associated with reduced alcohol consumption, there are studies showing differential benefits for using these strategies. The current study extended the research on PBS and drinking by examining daily associations between alcohol consumption and sexual assault PBS (e.g., letting others know one's whereabouts) versus stopping or limiting drinking PBS (e.g., planning to stop drinking at a predetermined time) and manner of drinking PBS (e.g., avoiding mixing alcohol types). Women who are heavy episodic drinkers attending a northeastern university ( = 69) completed 14 daily reports of alcohol consumption and PBS use. Using multilevel modeling, we examined associations between alcohol consumption and PBS types across days and PBS users. Alcohol consumption increased with greater use of sexual assault PBS and decreased with greater use of stopping or limiting drinking and manner of drinking PBS. Findings suggest differential benefits for specific PBS. Clinicians, teachers, and parents can provide a menu of options for reducing sexual assault risk by encouraging women to use sexual assault and drinking PBS together.