Sexual Risk Behavior and Heavy Drinking Among Weekly Marijuana Users

Abstract

Sexual behavior that incurs increased risk for sexually transmitted infections and HIV incidence is associated with both heavy alcohol and marijuana use. Whereas detrimental effects of alcohol on increased sexual risk have been documented in event-level and laboratory studies, less is known about the combined use of alcohol and marijuana and their relative impact on sexual risk behavior. We examined the degree to which both heavy drinking and marijuana use were associated with condomless sexual intercourse with casual versus main partners in a sample of weekly marijuana smokers. Method: Participants reported substance use and sexual activity using a 60-day Timeline Followback interview method (n = 112). Results: Results of generalized estimating equations indicated that both alcohol and marijuana use were independently associated with greater odds of having sexual intercourse but were not associated with greater odds of unprotected sex with a casual partner. Heavy drinking on a given day was associated with increased odds of having casual protected sex. Using both substances synergistically increased the likelihood of unprotected sex with a main partner. Conclusions: Findings suggest that behaviors posing higher sexual risk (condomless intercourse or sex with casual partners) occur on days when alcohol use exceeds moderate drinking guidelines. Interventions designed to reduce sexual risk behaviors may need to specifi cally target heavy drinking alone or when used with marijuana.

Cannabis use during treatment for alcohol use disorders predicts alcohol treatment outcomes

“…However, any speculation regarding substitution/complementarity is limited by the nature of the data in that it is unknown whether participants were using cannabis on the actual days that they were drinking. To date, the bulk of published literature regarding event‐level alcohol and cannabis use appears to focus on the relationship between substance use and sexual risk behaviors . To our knowledge, no prior study has collected daily cannabis and alcohol use data from individuals in AUD treatment.…”

Cannabis use during alcohol treatment is associated with alcohol-related problems one-year post-treatment

“…Furthermore, those with more than 10-days of cannabis use in the past 30-days appeared to have more problems than less frequent cannabis users (Keith et al, 2015). Similarly, a study of weekly cannabis users found that heavy drinking and cannabis use synergistically increased the likelihood of unprotected sex (Metrik et al, 2016). A study of female cannabis users not seeking treatment found that alcohol use potentiated cannabis problem severity, which includes having problems with sleep (another physical consequence) or with low self-esteem attributed to cannabis use (Stein et al, 2014).…”

“…We also do not know how much cannabis individuals were using, the potency of the cannabis, the method of ingestion, the prevalence of cannabis use disorder in this sample, or whether participants were using cannabis on the actual days that they experienced alcohol-related problems, let alone when those problems occurred relative to last cannabis use episode. Currently, event-level literature regarding alcohol-related problems is concentrated on substance use and sexual risk behaviors (Hensel et al, 2011; Kerr et al, 2015; Metrik et al, 2016; Rendina et al, 2015; Walsh et al, 2014). One event-level study examined daily associations between marijuana and alcohol use and the extent to which the associations differed as a function of cannabis use disorder (CUD) and/or AUD diagnosis.…”

Dual use of alcohol and marijuana and condomless sex in young adult men and women: A within‐subject day‐level analysis

“…One study of college students found that, although alcohol intoxication and marijuana use intensity were each uniquely associated with unprotected sex, dual use, contrary to hypothesis, did not produce any interactive effects; however, this study did not conduct a within‐subject analysis. Metrik et al used an event‐level design to assess the effects of alcohol, marijuana, and both substances on unprotected sex in a sample of community adults. When combined with heavy alcohol consumption, marijuana use increased the odds of unprotected sex, though the analysis was restricted to sex with main, not casual, partners.…”