Ordering in alcohol and cannabis co-use: Impact on daily consumption and consequences

Gunn, Rachel L.; Sokolovsky, Alexander W.; Stevens, Angela K.; Metrik, Jane; White, Helene Raskin; Jackson, Kristina M.

doi:10.1016/j.drugalcdep.2020.108339

Cited by 27 publications

(48 citation statements)

References 48 publications

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“…However, order of substance use did not predict alcohol-related consequences. This work—in addition to that conducted by others 31 , 37 , 38 , 40 —suggests there are clinically meaningful distinctions in the prediction of alcohol use versus alcohol-related problems. Even when cannabis effects are accounted for in the statistical models, alcohol quantity appears to largely drive the association between co-use (or simultaneous use) and alcohol-related consequences.…”

Section: Resultsmentioning

confidence: 53%

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Gunn

2122

ARCR

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PURPOSE The purpose of this review is to discuss the literature regarding the concurrent use (co-use) of alcohol and cannabis and competing hypotheses as to whether cannabis acts as a substitute for (i.e., replacing the effects of alcohol, resulting in decreased use) or a complement to (i.e., used to enhance the effects of alcohol, resulting in increased use) alcohol. The impact of cannabis use on alcohol-related outcomes has received increased attention in the wake of ongoing legalization of cannabis for both medical and recreational purposes. Evidence for both hypotheses exists in the literature across a broad range of data collection methods and samples and is carefully reviewed here. In addition, various mechanisms by which cannabis may act as an alcohol substitute or complement are explored in depth with the goal of better understanding equivocal findings. SEARCH METHODS This review includes articles that were identified from a search for studies on alcohol and cannabis co-use, with a specific focus on studies exploring complementary versus substitution aspects of co-use. Search terms were included in Google Scholar, PsycINFO, MEDLINE, and Web of Science. Eligible studies were those that measured alcohol and cannabis co-use in human samples in laboratory, survey, or ecological momentary assessment studies, or that directly referenced substitution or complementary patterns of use. SEARCH RESULTS Search results returned 650 articles, with 95 meeting inclusion criteria. DISCUSSION AND CONCLUSIONS Results of this review reveal compelling evidence for both substitution and complementary effects, suggesting nuanced yet significant distinctions across different populations examined in these studies. Several mechanisms for the impact of cannabis use on alcohol-related outcomes are identified, including patterns and context of co-use, timing and order of use, cannabinoid formulation, pharmacokinetic interactions, and user characteristics (including diagnostic status), all of which may influence substitution versus complementary effects. This review will inform future research studies examining this topic in both clinical and community samples and aid in the development of treatment and prevention efforts targeting those populations most vulnerable to negative consequences of co-use. Finally, this review highlights the need for additional research in more diverse samples and the use of mixed-methods designs to examine both pharmacological and contextual influences on co-use.

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Section: Resultsmentioning

confidence: 53%

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Gunn

2122

ARCR

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“…Alternatively, future work in this area could identify the social and physical contexts that are most associated with offers for alcohol and cannabis and target these contexts in mobile health (mHealth) interventions to reduce unplanned simultaneous-use events. Planned single-substance use could result in significant ordering effects if another substance is used on that same occasion, with prior work showing that the first substance used on a given simultaneous-use occasion is consumed more heavily than the second substance (Gunn et al, 2021). When only single-substance use is planned, protective behavioral strategies could be tailored to whichever substance the individual intends to use, as it will likely be used first on this occasion.…”

Section: Discussionmentioning

confidence: 99%

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?

Stevens¹,

Gunn²,

Boyle³

et al. 2022

Psychology of Addictive Behaviors

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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. Public Health Significance StatementThis study highlights the importance of understanding predictors and outcomes of planned simultaneous alcohol and cannabis use compared to simultaneous use that was not planned (either no plans for any use or plans for either alcohol or cannabis but not both). Positive-reinforcement motives and socialorientated context may be important targets for risky planned simultaneous use occasions.

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“…Our qualitative findings suggest that alcohol myopia may be one underlying mechanism for simultaneous use (at least on some occasions) among heavy-drinking college students. Though the research is mixed, multiple studies have shown that simultaneous use and alcohol-only days do not differ in terms of negative consequences when controlling for amount of alcohol consumed (Gunn et al, 2021; Lee et al, 2020; Mallett et al, 2019; Sokolovsky et al, 2020). This suggests that alcohol use may drive negative consequences and harms on simultaneous use occasions and thus situations where college students decide to use cannabis because they are already highly intoxicated may be particularly risky.…”

Section: Discussionmentioning

confidence: 99%

Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults.

Boyle¹,

Gunn²,

López³

et al. 2021

Psychology of Addictive Behaviors

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Use of alcohol and cannabis together so their effects overlap (simultaneous use) is common among college students and associated with numerous negative consequences. The aim of this study was to gain insight into college students' recent simultaneous use events in order to inform future studies (i.e., generate hypotheses, inform measures/assessments of simultaneous use, and identify factors influencing simultaneous use). Qualitative interviews of simultaneous use experiences among heavy drinking college students (n = 38) were conducted to better understand reasons for simultaneous use, evaluations of simultaneous use events, and patterns of substance use during simultaneous use events. Findings indicated that students' reasons for simultaneous use included traditional four-factor motive types (i.e., social, conformity, enhancement, and coping), cross-fading motives, harm reduction motives (e.g., to drink less), and reactive/situational reasons (e.g., because it was offered/available). There was variability in participants' subjective evaluations of how positive versus negative simultaneous use events were and how this compared to single-substance events. Evaluation of simultaneous use events depended on patterns of use, external and internal context, and consequences experienced. Additionally, patterns of simultaneous use including order of substances, timing of using each substance, and quantities of substances used were highly variable across participants. Notably, participants endorsed patterns of use they perceived to reduce negative consequences during simultaneous use events. Further research on reasons for simultaneous use and patterns of use may help identify simultaneous use occasions that result in greater risk; identification of high-risk simultaneous use occasions and evaluation of these occasions can then help inform targeted interventions. Public Health Significance StatementThis study highlights variations in reasons for simultaneous alcohol and cannabis use, evaluations for simultaneous use, and patterns of use. Understanding reasons and corresponding patterns of simultaneous use may help to identify risky simultaneous use occasions. Understanding evaluations of these occasions may help to predict future substance use behavior and inform prevention and intervention efforts aimed at reducing simultaneous use and associated harms.

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Ordering in alcohol and cannabis co-use: Impact on daily consumption and consequences

Cited by 27 publications

References 48 publications

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

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?

Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults.

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