Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences

Abstract

Background: Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students.Methods: Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics.Results: About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for pastyear alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use.Conclusions: Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.

Cannabis and Alcohol: From Basic Science to Public Policy

“…Other gaps in our knowledge include understanding the effects of the quantity of cannabis consumed, route of administration (e.g., smoke, vapor, edible), timing of cannabis and alcohol intake to distinguish simultaneous versus concurrent use, cannabis strain (e.g., indica, sativa), tetrahydrocannabinol/cannabidiol (THC/CBD) ratio, use of cannabis for medical purposes, and the impact of state‐level cannabis regulatory policies. The article in this Virtual Issue that examined state‐level differences in cannabis legislation found limited effects on cannabis use and simultaneous cannabis–alcohol use, relative to perceived peer norms for substance use (White et al., ). However, increased implementation of cannabis legislation and continued monitoring of substance use prevalence may have a future impact on patterns of substance co‐use and dependence diagnoses.…”

“…In the United States, the effect of state‐level laws on the prevalence of and attitudes toward cannabis use among adolescents is mixed (Blevins et al., ; Mason et al., ). In this issue, a cross‐sectional online survey (White et al., ) compared college students ( N = 1389) from 3 states with different cannabis laws (i.e., criminalized, decriminalized, and recreational cannabis use for ages 21+) on the prevalence, negative consequences, and perceived norms associated with simultaneous alcohol and cannabis use. Three‐quarters of the students reported simultaneous use at least once in the past year.…”

“…In support of this interpretation, a student's own simultaneous use was positively associated with perceptions of simultaneous use among peers (which were higher in the decriminalized state relative to the other 2 states). Furthermore, greater simultaneous use was found in Greek members and in nonvarsity sports club athletes, suggesting the potential utility of targeted interventions for specific subgroups to reduce the risk of simultaneous use (White et al., ).…”

A Daily Study Comparing Alcohol‐Related Positive and Negative Consequences for Days With Only Alcohol Use Versus Days With Simultaneous Alcohol and Marijuana Use in a Community Sample of Young Adults

“…Alcohol use is common among young adults, with 82% using alcohol in the past year and 34% engaging in heavy episodic drinking in the past 2 weeks (Schulenberg et al, ), and alcohol use leads to well‐documented risks to individuals and communities (Hingson et al, ; White and Hingson, ; Yi et al, ). Marijuana use is also common among young adults, with 38% using in the past year (Schulenberg et al, ), and prevalence potentially increasing (e.g., White et al, ), especially in states like Washington where recreational marijuana is legal for adults (21+). Most young adults who use marijuana also use alcohol (Patrick et al, ), and recent research indicates simultaneous use of alcohol and marijuana is associated with greater alcohol use compared to drinking occasions without using marijuana among veterans (Metrik et al, ).…”

“…Most young adults who use marijuana also use alcohol (Patrick et al, ), and recent research indicates simultaneous use of alcohol and marijuana is associated with greater alcohol use compared to drinking occasions without using marijuana among veterans (Metrik et al, ). SAM users have been found to be higher on risk factors such as perceived norms of peer SAM use and sensation seeking (e.g., Linden‐Carmichael et al, ; White et al, ).…”