Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults.

Abstract

Use of alcohol and cannabis together so their effects overlap (simultaneous use) is common among college students and associated with numerous negative consequences. The aim of this study was to gain insight into college students' recent simultaneous use events in order to inform future studies (i.e., generate hypotheses, inform measures/assessments of simultaneous use, and identify factors influencing simultaneous use). Qualitative interviews of simultaneous use experiences among heavy drinking college students (n = 38) were conducted to better understand reasons for simultaneous use, evaluations of simultaneous use events, and patterns of substance use during simultaneous use events. Findings indicated that students' reasons for simultaneous use included traditional four-factor motive types (i.e., social, conformity, enhancement, and coping), cross-fading motives, harm reduction motives (e.g., to drink less), and reactive/situational reasons (e.g., because it was offered/available). There was variability in participants' subjective evaluations of how positive versus negative simultaneous use events were and how this compared to single-substance events. Evaluation of simultaneous use events depended on patterns of use, external and internal context, and consequences experienced. Additionally, patterns of simultaneous use including order of substances, timing of using each substance, and quantities of substances used were highly variable across participants. Notably, participants endorsed patterns of use they perceived to reduce negative consequences during simultaneous use events. Further research on reasons for simultaneous use and patterns of use may help identify simultaneous use occasions that result in greater risk; identification of high-risk simultaneous use occasions and evaluation of these occasions can then help inform targeted interventions. Public Health Significance StatementThis study highlights variations in reasons for simultaneous alcohol and cannabis use, evaluations for simultaneous use, and patterns of use. Understanding reasons and corresponding patterns of simultaneous use may help to identify risky simultaneous use occasions. Understanding evaluations of these occasions may help to predict future substance use behavior and inform prevention and intervention efforts aimed at reducing simultaneous use and associated harms.

Unplanned versus planned simultaneous alcohol and cannabis use in the daily lives of a predominantly white college student sample: What are the motives, contexts, and outcomes?

“…Corroborating prior research on unplanned drinking (Boyle et al, 2021;Stevens, Haikalis, & Merrill, 2021), plans for any substance use (whether it be planned simultaneous or planned single-substance) were motivated by social and enhancement reasons. These findings are especially relevant for unplanned simultaneous use occasions when only alcohol was planned versus occasions when only cannabis was planned.…”

“…Stevens, Boyle, White, & Jackson (2021) corroborated these relations in a multisite sample of college students and found that drinking to cope or because alcohol was offered was related to unplanned drinking. Boyle et al (2021) expanded upon this finding in a qualitative study of young adult heavy drinkers, showing that many participants did not plan to use cannabis during a drinking event, but did so simply because it was available and offered to them. Other than this qualitative study, motives have not been investigated as predictors of unplanned or planned simultaneous use.…”

Insights into the context of simultaneous alcohol and cannabis use among young adults.

“…This suggests that simultaneous use in these situations may have been unplanned. Previous qualitative (Boyle et al, 2021) and quantitative (Stevens et al, 2022) research have found availability and offers to be reasons for unplanned simultaneous use. Identifying these situations of unplanned simultaneous use may inform prevention efforts aimed at intervening on unplanned substance use and highlight the importance of providing young adults with refusal skills and/or education about the risks of simultaneous use.…”

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

“…Although this is an important limitation, theories of simultaneous use suggest that using alcohol and cannabis simultaneously enhances single substance effects (i.e., complementarity) or substitutes one substance’s effects with the other (i.e., substitution; Risso et al, 2020; Subbaraman, 2016). This theory has been affirmed both in quantitative work suggesting that alcohol effects are enhanced by simultaneous use (e.g., Lee et al, 2017; Sokolovsky et al, 2020), as well as qualitative work where participants report phrases such as “When you mix [cannabis] with alcohol it makes you feel more relaxed and at the same time you still get the positive like energetic effects of alcohol” and “I [simultaneously used] to bring my high to like the next level” (Boyle et al, 2021). Thus, simultaneous use may have a greater impact on the magnitude of effects than the specific types of effects experienced.…”