Blackouts (i.e., alcohol induced memory impairment) are common among college student drinkers, and they are associated with several additional harms. However, alcohol consequences are not perceived universally as negative by the students who experience them, and little is known regarding students' specific thoughts and feelings about blackouts. We conducted a series of single-gender focus groups (8 groups; 5-8 per group; n=50, 56% female) with college student drinkers. Questions focused on: (a) their subjective evaluations of blackouts and (b) factors influencing those evaluations (i.e., what determines whether a blackout is perceived as a negative/ neutral/positive experience). Verbatim transcripts were content analyzed using applied thematic analysis with NVivo software. Evaluations of blackouts were primarily negative, with some notable positive, neutral and mixed reactions. Influences on blackout evaluations included those demonstrated as influential on broader alcohol consequences in prior work (e.g., normative perceptions, social context). However, some contextual influences on evaluations that may be specific to blackouts included pre-blackout events, the objective severity (extent/length) of memory loss, what participants later learned had happened during the blackout, and whether or not they had expected to blackout. Findings provide insight into why some students are not necessarily concerned with blackout experiences.

Objective: Alcohol and cannabis are two of the most commonly used substances among young adults, and most individuals who use both substances use them simultaneously, that is, on the same occasion such that their effects overlap. Given the high prevalence of simultaneous alcohol and cannabis use, it is important to understand the relationship between simultaneous use and consequences. This study presents a qualitative examination of positive and negative consequences of simultaneous use. Method: We conducted individual interviews among 36 young adults who engage in simultaneous use (23 women, 12 men, 1 trans man). Interviews included open-ended questions examining negative and positive consequences of simultaneous use and how simultaneous use differed from single substance use (alcohol only use, cannabis only use). Interviews were analyzed using applied thematic analysis. Results: Young adults reported numerous negative and positive consequences of simultaneous use, many overlapping with single substance use. Yet, they also reported unique combinations of positive consequences not experienced by single substance use. Young adults discussed patterns of use that were sometimes approached intentionally (e.g., quantity of substances used, order) that influenced consequences. Conclusions: Together these findings provide further insight into young adults' simultaneous use experiences. Next steps should include quantitative exploratory research to identify and determine the frequency of specific consequences experienced during simultaneous use and examine the relationship between simultaneous use consequences and particular patterns of use. Public Health Significance StatementThis qualitative study found consequences overlapped between simultaneous alcohol and cannabis use and single substance use occasions, but young adults did discuss unique combinations of positive consequences during simultaneous use. Patterns of use were reported to influence consequences and were sometimes approached intentionally to reduce harms. These findings may inform future quantitative studies such that better quantitative assessment and characterization of simultaneous use consequences may help us to better understand simultaneous use outcomes.

Objective: Blackouts (periods of alcohol-induced anterograde amnesia) are common among young adults and place individuals at significant risk for alcohol-related harm; thus, researchers have advocated for increased efforts to educate young adults on blackouts. This qualitative study examined college student knowledge of blackouts as well as their ideas for intervening on blackout drinking behavior in order to inform prevention and intervention efforts. Method: College students who had experienced a blackout in the past six months participated in eight focus groups, stratified by gender (N=50, 5–8/group, 56% female). Discussions followed a semi-structured agenda. Audio recordings were transcribed verbatim and coded using applied thematic analysis. Themes related to knowledge were reviewed in comparison to the empirical literature. Empirically-derived risk factors for blackouts included biology (e.g., genetics, biological sex), drinking behavior (i.e., rate of consumption), other drug use, and ‘indirect’ influences (e.g., pregaming, drinking location). Results: Participants’ knowledge of the risk factors for blackout was inconsistent and, in some cases, inaccurate. While participants generally understood the behavioral risk factors for blackouts, they demonstrated less understanding of the role of genetics, biological sex, drinking speed (versus quantity), and other drug use. They also identified dehydration and sleep as perceived risk factors for blackout. They suggested avenues for intervention at the policy (e.g., amnesty policies), peer (e.g., expressing concern), and individual level (e.g., education). Conclusions: College students with a history of blackout have limited understanding of the biological risk factors for blackout. These knowledge gaps represent targets for intervention. Findings indicate promise for blackout-specific interventions.

Background Alcohol and cannabis use are common among young adults and most young adults who use both substances have used them simultaneously (i.e., using both substances so their effects overlap). Because simultaneous use is associated with a greater number and severity of consequences than single substance use, research is needed to examine the decision‐making process of engaging in this high‐risk behavior. We conducted a qualitative examination of intentions (i.e., plans) and willingness (i.e., one's openness to engage in the behavior if an opportunity presents itself) to engage in simultaneous use from the perspective of young adults who frequently report this substance use behavior. Methods We recruited 36 young adults who reported simultaneous use and heavy drinking (4+/5+ drinks for women/men; 64% women, ages 18 to 25) to participate in semi‐structured interviews. All interviews were double coded for thematic analysis and both novel and a priori themes were found. Results Young adults distinguished between intending to engage in simultaneous use and being willing to engage in simultaneous use. They reported that intentions and willingness varied from occasion to occasion. They also reported that context and alcohol consumption influenced their willingness to engage in simultaneous use. Peer pressure or offers increased their willingness to use cannabis while drinking and having current or next‐day responsibilities decreased their willingness to engage in simultaneous use. Additionally, planned simultaneous use occasions were characterized as being special events where young adults consumed more substances, but were more likely to monitor their use than unplanned occasions. Conclusions Intentions and willingness may be important proximal predictors of simultaneous use of alcohol and cannabis. Building off this qualitative work, quantitative research should identify which factors influence the decision‐making process to engage in simultaneous use and determine when intentions and willingness are most predictive of risky simultaneous use behavior.