The anticipated effects of simultaneous alcohol and cannabis use: Initial development and preliminary validation.

Abstract

Social learning theories suggest that outcome expectancies are strong determinants of behavior, and studies find that alcohol and cannabis expectancies are associated with negative substance use outcomes. However, there are no measures to date that assess expectancies for simultaneous alcohol and cannabis use (SAM), often referred to as SAM, despite strong links with negative consequences and rising time trends. The present study sought to provide initial validation of test scores for the Anticipated Effects of Simultaneous Alcohol and Cannabis Use Scale (AE-SAM), using a sample of past month college student simultaneous users (N = 434). Exploratory factor analysis and confirmatory factor analysis conducted in random half samples suggested five expectancy factors, representing high arousal positive, high arousal negative (alcohol driven), high arousal negative (cannabis driven), low arousal positive, and low arousal negative expectancies. The factor structure was invariant across sex, race/ethnicity, and simultaneous use frequency, and demonstrated convergent and discriminant validity with other alcohol/cannabis expectancy measures. AE-SAM high arousal positive expectancies were associated with simultaneous use frequency and heavier drinking/cannabis use, AE-SAM high arousal negative (cannabis driven) expectancies were associated with less frequent simultaneous use and more negative alcohol consequences, and AE-SAM low arousal negative expectancies were associated with less cannabis use. Effects of AE-SAM high arousal positive and high arousal negative (cannabis driven) expectancies remained, above and beyond other expectancy measures, suggesting that AE-SAM expectancies provide additional information beyond single substance expectancies. The results demonstrate the feasibility and utility of assessing simultaneous use expectancies, and lay groundwork for future research on simultaneous use expectancies in relation to alcohol and cannabis couse outcomes. Public Significance StatementThe present study provided initial development and validation of test scores for a five-factor simultaneous alcohol and cannabis expectancies measure that spanned the full range of valence (positive vs. negative) by arousal (high arousal vs. low arousal) affective space. Simultaneous use expectancies were incrementally associated with use behavior and negative substance use outcomes and should be considered in ongoing prevention efforts related to alcohol, cannabis, and couse across the lifespan.

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

“…Participants (N = 443) were college students who simultaneously used alcohol and cannabis recruited from a large southwestern university as part of a study on alcohol and cannabis expectancies (Waddell, King, et al, 2022). The parent study recruited a mix of participants who used alcohol-only and who simultaneously used alcohol and cannabis, totaling N = 657 participants, of whom 496 reported simultaneous use.…”

“…Only one study to our knowledge has queried participants about subjective effects of simultaneous use. This study focused on anticipated effects (Waddell, King, et al, 2022), and exclusively used items from validated alcohol and cannabis expectancy measures. Thus, outside of validated single-substance measures and researcher-selected items (e.g., "drunk," "intoxicated," "euphoria"), little is known about how participants describe the subjective experience of simultaneous use.…”

Assessment of simultaneous alcohol and cannabis use and its related consequences and cognitions in college students: A narrative review

“…Although this article focuses on measures of SAM use‐related consequences and cognitions, we would be remiss to not briefly discuss assessment of SAM use itself. SAM use frequency among college students has been assessed by asking participants about their alcohol and cannabis co‐use, such as, “How often do you use cannabis and alcohol at the same time – that is, so that their effects overlap?” (e.g., Waddell et al., 2022, p. 814), “Do you use marijuana when you are using alcohol?” (Cummings et al., 2019, p. 353), or “indicate … how often you used alcohol and marijuana simultaneously (i.e., during the same session)” (e.g., Bravo et al., 2021, p. 4). These are slightly different interpretations of SAM use (i.e., effects overlapping vs same session), which may lead to differences in results across studies, especially when looking at between‐person effects (i.e., the effects across individuals [e.g., people who tend to engage in more frequent SAM use vs. not] rather than effects one person may have day to day [e.g., on a day someone engages in SAM use vs. not]).…”

“…An average score was calculated. More recently, the Anticipated Effects of Simultaneous Alcohol and Cannabis Use Scale (AE-SAM; Waddell et al, 2022) was developed. The AE-SAM is a 5-factor, 26-item measure developed by combining and reducing the Anticipated Effects of Alcohol Scale (Morean et al, 2012) and the Anticipated Effects of Cannabis Scale (Waddell et al, 2020).…”

“…More psychometric analyses are needed for Barnwell and Earleywine's (2006) expectancy measure, as noted by the authors, and the Lee et al (2017) expectancy measure. Waddell et al (2022) advanced the field of SAM expectancy measurement, specifically for college students, by developing the AE-SAM and supporting multiple forms for validity. Although establishing measurement invariance across sex and frequency of SAM use, the AE-SAM (Waddell et al, 2022) may also benefit from further tests of measurement invariance, specifically examining race across specific groups rather than combining racial/ethnic minority groups as this could mask unique findings specific to one race or ethnicity (Burlew et al, 2019).…”