Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth

Schuster, Randi M.; Potter, Kevin; Lamberth, Erin; Rychik, Natali; Hareli, Maya; Allen, Sophia; Broos, Hannah C.; Mustoe, Audrey; Gilman, Jodi M.; Pachas, Gladys; Evins, A. Eden

doi:10.1016/j.pnpbp.2020.110205

Cited by 7 publications

(5 citation statements)

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“… 25 Conversely, among adolescents undergoing a contingency management intervention for cannabis, an increase in drinking was observed when participants were not using cannabis, whereas a reduction in drinking was observed after cannabis use was reinitiated. 26 This inverse association between cannabis use and alcohol use while in treatment suggests that cannabis in fact may function effectively for some individuals as a substitute for alcohol, but may serve as a complement for others, and thus increasing drinking or exacerbating other alcohol treatment outcomes. Individual differences may be important factors in whether alcohol acts as a substitute for or a complement to cannabis use.…”

Section: Resultsmentioning

confidence: 99%

“… 16 – 20 However, when those who make heavy use of cannabis abstain from using it, there is consistent evidence for substitution with alcohol. 8 , 26 , 41 – 43 Additionally, participants with CUD, compared to those with AUD, report daily patterns of co-use more consistent with substitution. 27 Motivations for use may be another mechanism by which co-use or cannabis use may impact drinking outcomes.…”

Section: Conclusion and Recommendations For Future Workmentioning

confidence: 99%

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Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Gunn

2122

ARCR

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PURPOSE The purpose of this review is to discuss the literature regarding the concurrent use (co-use) of alcohol and cannabis and competing hypotheses as to whether cannabis acts as a substitute for (i.e., replacing the effects of alcohol, resulting in decreased use) or a complement to (i.e., used to enhance the effects of alcohol, resulting in increased use) alcohol. The impact of cannabis use on alcohol-related outcomes has received increased attention in the wake of ongoing legalization of cannabis for both medical and recreational purposes. Evidence for both hypotheses exists in the literature across a broad range of data collection methods and samples and is carefully reviewed here. In addition, various mechanisms by which cannabis may act as an alcohol substitute or complement are explored in depth with the goal of better understanding equivocal findings. SEARCH METHODS This review includes articles that were identified from a search for studies on alcohol and cannabis co-use, with a specific focus on studies exploring complementary versus substitution aspects of co-use. Search terms were included in Google Scholar, PsycINFO, MEDLINE, and Web of Science. Eligible studies were those that measured alcohol and cannabis co-use in human samples in laboratory, survey, or ecological momentary assessment studies, or that directly referenced substitution or complementary patterns of use. SEARCH RESULTS Search results returned 650 articles, with 95 meeting inclusion criteria. DISCUSSION AND CONCLUSIONS Results of this review reveal compelling evidence for both substitution and complementary effects, suggesting nuanced yet significant distinctions across different populations examined in these studies. Several mechanisms for the impact of cannabis use on alcohol-related outcomes are identified, including patterns and context of co-use, timing and order of use, cannabinoid formulation, pharmacokinetic interactions, and user characteristics (including diagnostic status), all of which may influence substitution versus complementary effects. This review will inform future research studies examining this topic in both clinical and community samples and aid in the development of treatment and prevention efforts targeting those populations most vulnerable to negative consequences of co-use. Finally, this review highlights the need for additional research in more diverse samples and the use of mixed-methods designs to examine both pharmacological and contextual influences on co-use.

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Section: Resultsmentioning

confidence: 99%

Section: Conclusion and Recommendations For Future Workmentioning

confidence: 99%

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Gunn

2122

ARCR

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“…Our data also suggest that use of the Guide and abstinence from cannabis did not lead to increased alcohol use in our sample, which has been raised as a concern in prior investigations with young adults who discontinue cannabis use. 23 Treatments for cannabis use disorders, even brief interventions, can be resource intensive.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Utility of a Structured Guide for Cannabis Tolerance Breaks in Young Adults

Fontana

Schulz

Budney

et al. 2022

Preprint

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Objective: To explore the feasibility and utility of a tolerance break (T-Break) guide on young adults' cannabis use. Participants: Young adults aged 18-29 (n=125) who were current cannabis users. Methods: Participants recruited through posters and listservs at various universities were offered the T-Break Guide (daily activities, advice, and encouragement) to help complete a 21-day cannabis break. Bivariate analyses examined associations between Guide use and follow-up measures. Results: Compared to non-Guide users, participants who used the Guide "a lot" were more likely to complete the 21-day abstinence break (84% vs. 57%), revise their personal definition of balance to mean less cannabis (84% vs. 62%), and plan a future break (32% vs. 11%). Conclusion: Use of this self-directed Guide may help young adults take a break from cannabis use and reduce future use. Further research using more rigorous designs to test the Guide's efficacy and assess longer-term maintenance of effects is needed.

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“…All study procedures were approved by the Partners Healthcare Human Subjects Committee. A detailed description of study procedures has been documented elsewhere (40)(41)(42)(43). Briefly, at the baseline visit participants were randomized to 4 weeks of cannabis abstinence using an escalating financial incentive structure (contingency management; CB-Abst) or 4 weeks of monitoring with no abstinence requirement (CB-Mon).…”

Section: Methodsmentioning

confidence: 99%

Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents

et al. 2021

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Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression.Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms.Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ).Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = −0.08, p = 0.01, MASQ-GDA: stnd beta = −0.11, p = 0.003, MASQ-GDD: stnd beta = −0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use.Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.

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Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth

Cited by 7 publications

References 77 publications

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Patterns of Cannabis and Alcohol Co-Use: Substitution Versus Complementary Effects

Feasibility and Utility of a Structured Guide for Cannabis Tolerance Breaks in Young Adults

Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents

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