A qualitative examination of the decision‐making process of simultaneous alcohol and cannabis use: Intentions and willingness

Abstract

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.

Applying the prototype willingness model to day-level simultaneous alcohol and cannabis use.

“…Willingness fully explained the relationship between perceived vulnerability and simultaneous use, such that lower perceived vulnerability of simultaneous use on a given day leads young adults to feel more willing to engage in simultaneous use, which resulted in an increased likelihood to engage in simultaneous use on that day. Our prior qualitative research (Boyle et al, 2023) found that young adults reported that context influences one’s willingness to engage in simultaneous use. Young adults described being more willing to engage in simultaneous use in locations that were familiar and safe (i.e., friend’s house, one’s home).…”

“…Also, our recent qualitative work with young adults who engage in simultaneous use suggests simultaneous use willingness is often based on immediate contextual factors (i.e., location, who they are with, and availability of substances), which are more likely to be known close in time to the substance use event. Also, our qualitative work suggests one’s intentions or plans for simultaneous use can vary from planning weeks in advance to a short time before actual use (Boyle et al, 2023). Thus, intentions and willingness measured in the evening were assumed to be more proximal to behavior and better reflective of intentions and willingness for that day.…”

Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study

“…Social Cognitive Theory (SCT) [ 39 ] highlights the dynamic interplay of one’s social context (e.g., social roles, social norms) and cognitions such as outcome expectancies (e.g., perceived risks or consequences vs. benefits) in relation to one’s behaviors. For example, an individual’s perceptions of how socially acceptable or normative cannabis use is likely depends on the nature and extent of their exposure to use within their social networks, and these perceptions ultimately impact their personal use [ 9 – 12 , 37 , 40 – 42 ]. Additionally, the expected outcomes of use – either positive or negative – influence whether one uses cannabis; if one expects positive outcomes, like a pleasurably psychological experience, they are more likely to use, while if one expects negative outcomes, like health risks or addiction, they may be less likely to use [ 9 – 12 , 37 , 40 – 42 ].…”

“…For example, an individual’s perceptions of how socially acceptable or normative cannabis use is likely depends on the nature and extent of their exposure to use within their social networks, and these perceptions ultimately impact their personal use [ 9 – 12 , 37 , 40 – 42 ]. Additionally, the expected outcomes of use – either positive or negative – influence whether one uses cannabis; if one expects positive outcomes, like a pleasurably psychological experience, they are more likely to use, while if one expects negative outcomes, like health risks or addiction, they may be less likely to use [ 9 – 12 , 37 , 40 – 42 ]. Moreover, if one perceives negative implications of others (e.g., family members or children in the home) being exposed to cannabis use (e.g., health risks, enticing youth), they may be more likely to implement restrictions about cannabis use in the home or in the presence of children.…”

“…While SCT provides a useful model for identifying factors associated with substance use related outcomes and cannabis use outcomes [ 9 – 12 , 37 , 40 – 42 ], existing literature regarding how adults address cannabis use within their homes or in the presence of children is limited. Furthermore, little cross-country research has examined theory-based constructs related to cannabis-related outcomes in differing sociopolitical contexts.…”