Motives for and impairment associated with alcohol and marijuana use among college students

IntroductionAlcohol and marijuana use are prevalent on college campuses. As recreational marijuana use is legalized, more undergraduate students may use marijuana in combination with alcohol. The motives for, frequency of, and impairment associated with dual use (alcohol and marijuana) compared to alcohol-only use may differ. We examined motives for, frequency of, and impairment associated with alcohol use and dual use at a university in a state where recreational marijuana has been legalized.MethodUndergraduate college students completed an anonymous online survey (N = 430) concerning alcohol and marijuana frequency, motives, and impairment. Students were classified as either alcohol-only users (n = 279) or dual users (n = 151).ResultsAnalyses indicated that among alcohol-only users, social motives predicted more alcohol use, while among dual users, enhancement motives predicted more alcohol and marijuana use and impairment. Coping motives predicted more marijuana use among dual users, but not more alcohol use. Frequency of alcohol and marijuana use predicted more impairment across both the alcohol-only and dual users.ConclusionsFuture research should examine the influence of marijuana use over time to understand how motives may change for previous alcohol-only users.     

LETTERS TO THE EDITORS

ABSTRACT

Alcohol and marijuana are the most commonly used substances for college-attending young adults. This study evaluated differences in substance-specific consequence attribution by alcohol-marijuana use patterns (concurrent alcohol and marijuana [CAM; use of both substances, not at same time] and simultaneous [SAM; use of both, at same time]) as well as alcohol-only (AO). First-year college students with prior alcohol use (N = 610, 50.9% women, 71% White, M_age = 18) completed an online assessment of past-three-month substance use, including SAM, and related consequences. Results indicated that polydrug (SAM and CAM) users reported greater alcohol involvement and earlier alcohol initiation than AO, and polydrug use was associated with more alcohol-related problems, including sexual risk taking and alcohol-related blackouts. When restricted to SAM/CAM users, logistic regressions indicated that SAM users reported an increased incidence in two marijuana-related problems relative to CAM (driving after using and academic difficulties), but lower rates of social problems. SAM users were also less likely to attribute substance-related social problems to alcohol. Overall, findings highlight variations that exist within alcohol-marijuana polydrug users and show areas to consider for intervention development and future research.     

Simultaneous Use of Alcohol and Marijuana: Patterns and Individual Differences

Background: Simultaneous alcohol and marijuana (SAM) use, or using alcohol and marijuana in such a way that their effects overlap, is associated with negative health and behavioral outcomes. Objectives: Our study sought to fill gaps in our knowledge on this emerging public health concern by comparing SAM users and alcohol-only users on individual-level factors and substance use outcomes as well as examining associations of SAM use frequency, within users. Methods: Participants were recruited through online postings. Our analytic sample consisted of 1017 young adults (18–25?years) who reported past-month alcohol use. Most were male (67.8%), Caucasian (71.5%), and had attended at least some college (74.8%). Results: Past-year SAM users reported higher levels of sensation seeking and greater perceptions of their close friends’ drinking behavior in comparison to alcohol-only users. SAM users reported heavier and more frequent alcohol use than alcohol-only users. Within past-year SAM users, 70% reported SAM use at least weekly. More frequent SAM use was associated with all alcohol use outcomes (e.g., weekly quantity, frequency, alcohol-related problems) and marijuana use outcomes (e.g., quantity, frequency, peak use) and higher drinking norms. Conclusions/Importance: It is clear that SAM users are a vulnerable sub-population of young adult drinkers. SAM users are differentiated from alcohol-only users in terms of their personality characteristics and perceptions of peer groups’ drinking. SAM users and more frequent users are also at heightened risk for substance use outcomes. Prevention and intervention efforts targeting high-risk drinking may benefit from also assessing whether they simultaneously use alcohol and marijuana.     

Social anxiety and marijuana-related problems: The role of social avoidance

BackgroundPeople with elevated social anxiety seem vulnerable to marijuana-related impairment. Yet little work has examined core facets of social anxiety that may be especially related to marijuana-related problems.MethodThe present study examined the relationships between current (past three months) marijuana-related problems and two aspects of social anxiety (fear in social situations and social avoidance) among current (N = 102) marijuana users.ResultsAlthough both social fear and social avoidance were significantly correlated with marijuana-related problems, only social avoidance was uniquely related to marijuana problems (after controlling for social fear, sex, negative affect, alcohol problems, and marijuana use frequency). Sex moderated the relationship between social avoidance and marijuana-related problems such that men with greater social avoidance exhibited the greatest severity of marijuana-related problems.ConclusionsAvoidance of social situations appears robustly related to marijuana-related problems. This finding has important implications for theoretical models that can inform treatment of co-occurring social anxiety and marijuana problems.     

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies

Abstract

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (M_age = 20.26, SD?=?3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30?days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.     

Personal strivings and marijuana use initiation,frequency, and problems

This study examined relations between perceived conflict/utility of marijuana use in achieving valued personal goals and marijuana use initiation, marijuana use frequency, and marijuana-related problems. Personal strivings are higher order goals that may influence marijuana use to the extent that they are congruent or incongruent with use. Participants were 592 young adults who generated lists of personal strivings independent of the substance use assessment. They then evaluated their 10 most important strivings with regard to the perceived conflict/utility of several levels of marijuana use in achieving their most important strivings. Less marijuana use-striving conflict was positively associated with use initiation and frequency. A significant gender interaction emerged in the prediction of use frequency; marijuana use-striving conflict was more strongly associated with use frequency for men than women. The relationship between use-striving conflict and marijuana-related problems was mediated fully by use frequency.     

Characteristics of clinically anxious versus non-anxious regular, heavy marijuana users

Both the key mechanism of action for marijuana (the endocannabinoid system) and the symptoms associated with marijuana withdrawal suggest an important link to anxiety. Despite this link, there is a dearth of research on the characteristics of heavy marijuana users with clinical-level anxiety compared to those with heavy marijuana use alone. Over 10,000 participants (friends or affiliates of the National Organization for the Reform of Marijuana Laws) provided data via online survey. After careful, conservative screening, anxiety, other psychopathology, other drug use, and marijuana-related problems were examined in 2567 heavy marijuana users. Subsequently, 275 heavy users with clinical-level anxiety were compared to demographically-equivalent non-anxious heavy users on psychopathology, drug use, and cannabis-related problems. Among several psychological variables (including anxiety, depression, schizotypy, and impulsivity), anxiety was most strongly predictive of amount of marijuana used and marijuana-related problems. Group comparison (n=550 total) revealed that clinically anxious heavy users exhibited more use, more non-anxiety psychopathological symptoms, and a greater number and severity of marijuana-related problems than their non-anxious peers. The findings reveal that anxiety shows an important relation to marijuana use and related problems among regular, heavy users. Further examinations of common and unique factors predisposing individuals for anxiety and marijuana abuse appear warranted.     

Mental health problems and interest in marijuana treatment among marijuana-using college students

Background

There is growing recognition that marijuana use among college students is associated with marijuana-related problems. Yet little work has examined whether use is associated with mental health problems and whether there is a dose effect such that individuals engaging in more frequent use evince relatively greater psychiatric impairments. Further, little is known about factors related to interest in marijuana treatment among students experiencing marijuana-related problems.

Method

The current study examined academic and psychiatric functioning as well as interest in marijuana treatment among undergraduates (N = 1,689). Approximately 29% acknowledged marijuana use, with 9.8% using weekly or more.

Results

More frequent marijuana use was related to more academic difficulties. Marijuana use (among both weekly and less frequent users) was related to greater psychiatric impairment. Interest in marijuana treatment was examined among students with 2+ marijuana-related problems (n = 251). Of those, 22.7% expressed interest in marijuana treatment. Factors positively related to treatment interest included: marijuana use frequency, use-related problems, friends' marijuana use, age, employment status, and some types of mental health problems.

Conclusions

Marijuana use among college students is associated with academic, psychiatric, and marijuana-related impairments. However, there is some interest in treatment to manage marijuana use among undergraduates, particularly among those with more frequent and more problematic marijuana use.     

Expectancy mediated effects of marijuana on menopause symptoms

Background Medical marijuana alleviates a variety of symptoms, including those associated with menopause, such as insomnia, irritability, depression and joint pain. However, little work has addressed the use of marijuana in a population of menopausal women, or the role of menopausal women’s marijuana treatment expectancies in regard to consumption. We hypothesized that menopausal women who used marijuana would expect it to alleviate symptoms that have responded well to the plant in previous research. Based on the marijuana expectancy literature, we also hypothesized that links from menopause symptoms to marijuana use would arise via indirect paths through expectancies. Methods Menopausal and post-menopausal women (N = 115) who endorsed lifetime marijuana use completed an online survey assessing their frequency of use, average intoxication – a proxy for quantity, menopause symptoms, and expectancies of relief from menopause symptoms. Results Women expected marijuana to improve joint/muscle discomfort, irritability, sleep problems, depression, anxiety and hot flashes, but not sex problems, heart discomfort, exhaustion, vaginal dryness and bladder problems. Expectancies mediated the links between menopause symptoms and frequency of use. Average intoxication did not correlate with symptoms or expectations of relief. Symptoms, expectancies, and frequency of marijuana use were all independent of marijuana-related problems. Conclusions Particularly as the population ages, increased research on how medical marijuana might help menopause symptoms without increasing marijuana-related problems could prove heuristic.     

Marijuana Motivations Across Adolescence: Impacts on Use and Consequences

Background. Motivational models for marijuana use have focused on reasons to use marijuana, but rarely consider motives to abstain. Objectives: We examined how both adolescent marijuana abstinence motives and use motives contribute to marijuana use and problems at the end of emerging adulthood. Methods. 434 community recruited youth who had not initiated marijuana use at baseline were followed from adolescence (at ages 12, 15, and 18 years) into emerging adulthood (age 25 years). Motives to abstain and to use marijuana, marijuana consumption, and marijuana-related problems were assessed across time. Results. Endorsing more motives to abstain from marijuana across adolescence predicted less marijuana use in emerging adulthood and fewer marijuana-related problems when controlling for past motives to abstain and marijuana-related behavior. Positive reinforcement use motives related to increased marijuana consumption and problems, and negative reinforcement motives predicted problems when controlling for past marijuana use motives and behaviors. Expansion motives during adolescence related to lower marijuana use in emerging adulthood. When considered together, motives to abstain buffered the effect of negative reinforcement motives on outcomes at age 25 for youth endorsing a greater number of abstinence motives. Conclusions/ Implications. Given these findings, inclusion of both motives to use and abstain is warranted within comprehensive models of marijuana use decision making and may provide important markers for prevention and intervention specialists.     

Marijuana and self-regulation: Examining likelihood and intensity of use and problems

It is important to understand the individual differences that contribute to greater frequency or intensity of marijuana use, or greater frequency of experiencing marijuana-related problems. The current study examined several elements of behavioral and emotional self-regulation as predictors of the likelihood and intensity of both marijuana use and marijuana-related problems. As predicted, indices of behavioral self-regulation (self-control, sensation seeking) were better predictors of marijuana use, while indices of emotional self-regulation (affect, distress tolerance, and emotional instability) better predicted marijuana-related problems. Surprisingly, urgency was not related to use but was predictive of problems, and there were no significant interactions between behavioral and emotional self-regulation in predicting either use or problems. From these findings we conclude that while behavioral dysregulation may put individuals at risk for using marijuana, or using it more frequently, it is those individuals with difficulty in emotional self-regulation that are at risk for experiencing negative consequences as a result of their marijuana use. Clinically, these data are relevant; clinicians might focus more on addressing emotional regulation in order to lessen or eliminate the consequences of marijuana use.     

Psychometric evaluation of the Marijuana Reduction Strategies Self-Efficacy Scale with young recreational marijuana users

Introduction

This study evaluated the cue-reactivity and several psychometric properties of a questionnaire designed to assess marijuana users' self-efficacy to employ 21 specific cognitive-behavioral strategies to reduce their marijuana use.

Method

Using a web-based recruitment and data-collection procedure, 513 regular marijuana users completed dependent measures following marijuana-related or control cue exposure.

Results

Although exposure to marijuana-related stimuli significantly increased reported craving, mean reduction-strategy self-efficacy scores did not differ as a function of cue exposure. Reliability analyses supported retaining all 21 items as a single scale. Reduction-strategy self-efficacy was positively associated with marijuana-refusal self-efficacy and with recent past use of reduction strategies, was negatively associated with quantity and frequency of marijuana use and marijuana-related problems, and was positively but weakly associated with general self-efficacy. The most frequently reported strategies that were employed reflected restricting marijuana use to once per day, not keeping a large stash available, turning down unwanted hits, and not obtaining more marijuana right away if one's supply runs out.

Conclusions

These findings further support the reliability and validity of the questionnaire when administered to a diverse sample of regular marijuana users.     

Marijuana use motives and social anxiety among marijuana-using young adults

Given the high rates of co-occurring marijuana use and social anxiety, the present investigation examined the relations among marijuana use motives, marijuana use and problems, and social anxiety in 159 (54.7% female) young adults (M(age)=18.74, SD=1.20). As expected, after covarying for a number of variables related to both marijuana use and social anxiety (e.g. gender, alcohol use problems, anxiety sensitivity), social anxiety predicted greater numbers of marijuana use problems. Interestingly, social anxiety was not related to marijuana use frequency. Also consistent with prediction, social anxiety was a significant predictor of coping and conformity motives for marijuana use above and beyond relevant variables. Finally, coping motives for marijuana use mediated the relation between social anxiety and marijuana use problems. These data provide novel evidence for the unique effects of coping-motivated marijuana use in the link between marijuana-related impairment and social anxiety.     

Attitudes toward marijuana use and drug-free experience: relationships with behavior

Attitude toward drug-free experience is conceptualized as a psychological context for drug use that influences the evaluation of perceived consequences of marijuana use. Two studies examined the moderating effect of attitude toward drug-free experience on relationships between attitudes toward marijuana and drug use. In Study 1 (N = 316), attitude toward drug-free experience emerged as a significant moderator. Participants with positive attitudes toward marijuana use and relatively low attitudes toward drug-free experience used marijuana at the highest rates. Study 2 (N = 308) provided a partial replication and extension. In a second sample, a quadratic relationship emerged between drug-free experience and marijuana use. The interaction between the two attitudes approached significance. Among the 47 participants who had used marijuana more than 100 times in their lifetime, attitude toward drug-free experience moderated the relationship between attitude toward marijuana and marijuana-related problems.     

Marijuana use motives mediate the association between experiences of childhood abuse and marijuana use outcomes among emerging adults

IntroductionExperiences of childhood sexual abuse (CSA) and childhood physical abuse (CPA) are associated with poor mental health outcomes including substance use in subsequent years. Marijuana use motives (i.e., coping with negative affect, enhancing positive affect, or improving social interactions) may influence problematic substance use among young adults. Specifically, motives may be associated with severity of marijuana use outcomes among individuals who have experienced CSA or CPA. This study investigated the indirect effect of marijuana use motives between experiences of CSA or CPA and marijuana use and problems among emerging adults.MethodParticipants were 397 young adults (50.1% male, 66.2% White) between ages 18–25 years, who reported 15.85 (SD = 11.66) days of marijuana use in the past month. Participants reported on history of childhood abuse, marijuana use days, problems, and motives for use.ResultsFindings suggest a significant indirect effect of coping motives in the association between CPA and marijuana use days and marijuana problems. Further, both coping motives and marijuana use days indicated a significant indirect effect between CPA and problems. Motives of socializing or enhancement did not have a significant indirect effect between CPA and marijuana use or problems. There were no significant findings with CSA and marijuana use outcomes.DiscussionCoping motives might be an important potential target for future marijuana interventions in persons with childhood physical abuse.     

PTSD,alcohol dependence,and conduct problems: Distinct pathways via lability and disinhibition

This study tested the role of affect lability and disinhibition in mediating associations between PTSD symptoms and two forms of alcohol-related problems, dependence syndrome symptoms (e.g., impaired control over consumption) and conduct problems (e.g., assault, risk behaviors). Genotype at the serotonin transporter linked polymorphic region (5-HTTLPR) was hypothesized to moderate associations between traumatic stress and PTSD symptoms. In addition, the study tested whether childhood traumatic stress moderated associations between combat trauma and PTSD symptoms. Participants were 270 OIF/OEF/OND veterans. The hypothesized model was largely supported. Participants with the low expression alleles of 5-HTTLPR (S or L_G) exhibited stronger associations between childhood (but not combat) traumatic stress and PTSD symptoms. Affect lability mediated the associations between PTSD symptoms and alcohol dependence symptoms. Behavioral disinhibition mediated associations between PTSD symptoms and conduct related problems. Conditional indirect effects indicated stronger associations between childhood traumatic stress and lability, behavioral disinhibition, alcohol consumption, AUD symptoms, and associated conduct problems via PTSD symptoms among those with the low expression 5-HTTLPR alleles. However, interactions between combat trauma and either childhood trauma or genotype were not significant. The results support the hypothesis that affect lability and behavioral disinhibition are potential intermediate traits with distinct associations with AUD and associated externalizing problems.     

Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: an application of the acquired preparedness model

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.     

Marijuana and alcohol use in pregnancy

The literature is sparse on the adverse effects of moderate alcohol consumption and marijuana use during pregnancy. Recent studies have evaluated the association of these drugs of abuse with pregnancy outcome, each using interview and medical record data of over 12 000 women. Children of marijuana users were more likely to have one or more major malformations, lower birthweight, and shorter gestation than children of nonusers. However, when logistic regression was used to control for other variables, these relationships were not statistically significant. The odds ratio for major malformations does, however, remain suggestive for marijuana. The use of similar logistic regression techniques revealed that the only statistical association between alcohol intake of 14 or more drinks per week was placenta abruptio. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks weekly was not associated with an increased risk of any adverse outcome. There was no association between alcohol use at any level and the rate of congenital malformations. Recommendations based on these data are presented.     

Adolescent ecstasy and other drug use in the National Survey of Parents and Youth: the role of sensation-seeking, parental monitoring and peer's drug use

The association between high sensation-seeking, close friends' drug use and low parental monitoring with ecstasy (MDMA) use in adolescence was examined in a sample of US household-dwelling adolescents aged 12-18 years (N=5049). We also tested whether associations were of stronger magnitude than associations between these correlates and marijuana or alcohol/tobacco use in adolescence. Data from Round 2 of the National Survey of Parents and Youth (NSPY) Restricted Use Files (RUF) was analyzed via Jackknife weighted multinomial logistic regression models. High sensation-seekers were more likely to be ecstasy, marijuana, and alcohol/tobacco users, respectively, as compared to low sensation-seekers. High sensation-seeking and close friends' drug use were more strongly associated with ecstasy as compared to marijuana and alcohol/tobacco use. Low parental monitoring was associated with marijuana use and alcohol/tobacco use and there was a trend for it to be associated with ecstasy use. Ecstasy use is strongly associated with peer drug use and more modestly associated with high sensation-seeking. School prevention programs should target high-sensation-seeking adolescents and also encourage them to affiliate with non-drug using peers.