Associations between Alcohol-Free Sources of Reinforcement and the Frequency of Alcohol and Cannabis Co-Use among College Freshmen

Daiil Jun, Tera L Fazzino, Daiil Jun, Tera L Fazzino

Abstract

Co-use of alcohol and cannabis is common among young adults in the United States. A behavioral economics framework indicates that greater engagement in substance-free sources of reinforcement may be protective against co-use frequency. The current study tested the association between proportionate alcohol-free reinforcement and the frequency of co-use among college freshmen. Participants (N = 86) were freshmen who enrolled in a freshman orientation course and completed surveys at the beginning of the semester. Past month alcohol use, cannabis use, and reinforcement from alcohol-free and alcohol-involved activities were assessed. A zero-inflated Poisson regression was used to test the association between proportionate alcohol-free reinforcement and days of co-use. The results indicated that proportionate alcohol-free reinforcement was negatively associated with co-use days in the count model when controlling for alcohol use days and gender as covariates (β: -3.28, p = 0.016). Proportionate alcohol-free reinforcement did not significantly differentiate individuals who did not engage in co-use in the zero-inflated model (β: -1.68, p = 0.497). The study suggested that greater proportionate alcohol-free reinforcement may be associated with lower engagement in the co-use of alcohol and cannabis among young adults. Increasing engagement in alcohol-free sources of reinforcement may be considered a target for co-use prevention or harm reduction efforts.

Keywords: alcohol; behavioral economics; co-use; heavy drinking; marijuana; young adults.

Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

References

    1. Schulenberg J., Johnston L., O’Malley P., Bachman J., Miech R., Patrick M. Monitoring the Future National Survey Results on Drug Use, 1975-2019: Volume II, College Students and Adults Ages 19–60. 2020. [(accessed on 8 January 2023)]. Available online: .
    1. Looby A., Prince M.A., Villarosa-Hurlocker M.C., Conner B.T., Schepis T.S., Bravo A.J. Young adult use, dual use, and simultaneous use of alcohol and marijuana: An examination of differences across use status on marijuana use context, rates, and consequences. Psychol. Addict. Behav. 2021;35:682–690. doi: 10.1037/adb0000742.
    1. White H.R., Kilmer J.R., Fossos-Wong N., Hayes K., Sokolovsky A.W., Jackson K.M. Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences. Alcohol. Clin. Exp. Res. 2019;43:1545–1555. doi: 10.1111/acer.14072.
    1. Sokolovsky A.W., Gunn R.L., Micalizzi L., White H.R., Jackson K.M. Alcohol and marijuana co-use: Consequences, subjective intoxication, and the operationalization of simultaneous use. Drug Alcohol Depend. 2020;212:107986. doi: 10.1016/j.drugalcdep.2020.107986.
    1. Karoly H.C., Ross J.M., Ellingson J.M., Feldstein Ewing S.W. Exploring Cannabis and Alcohol Co-Use in Adolescents: A Narrative Review of the Evidence. J. Dual Diagn. 2020;16:58–74. doi: 10.1080/15504263.2019.1660020.
    1. Mechoulam R., Parker L. Cannabis and alcohol—A close friendship. Trends Pharmacol. Sci. 2003;24:266–268. doi: 10.1016/S0165-6147(03)00107-X.
    1. McCabe S.E., Arterberry B.J., Dickinson K., Evans-Polce R.J., Ford J.A., Ryan J.E., Schepis T.S. Assessment of changes in alcohol and marijuana abstinence, co-use, and use disorders among US young adults from 2002 to 2018. JAMA Pediatr. 2021;175:64–72. doi: 10.1001/jamapediatrics.2020.3352.
    1. Schlienz N.J., Lee D.C. Co-use of cannabis, tobacco, and alcohol during adolescence: Policy and regulatory implications. Int. Rev. Psychiatry. 2018;30:226–237. doi: 10.1080/09540261.2018.1465399.
    1. Yurasek A.M., Aston E.R., Metrik J. Co-use of Alcohol and Cannabis: A Review. Curr. Addict. Rep. 2017;4:184–193. doi: 10.1007/s40429-017-0149-8.
    1. Linden-Carmichael A.N., Wardell J.D. Combined use of alcohol and cannabis: Introduction to the special issue. Psychol. Addict. Behav. 2021;35:621–627. doi: 10.1037/adb0000772.
    1. Jackson K.M., Sokolovsky A.W., Gunn R.L., White H.R. Consequences of alcohol and marijuana use among college students: Prevalence rates and attributions to substance-specific versus simultaneous use. Psychol. Addict. Behav. 2020;34:370–381. doi: 10.1037/adb0000545.
    1. Subbaraman M.S., Kerr W.C. Simultaneous Versus Concurrent Use of Alcohol and Cannabis in the National Alcohol Survey. Alcohol. Clin. Exp. Res. 2015;39:872–879. doi: 10.1111/acer.12698.
    1. Bickel W.K., Johnson M.W., Koffarnus M.N., MacKillop J., Murphy J.G. The behavioral economics of substance use disorders: Reinforcement pathologies and their repair. Annu. Rev. Clin. Psychol. 2014;10:641–677. doi: 10.1146/annurev-clinpsy-032813-153724.
    1. Murphy J.G., Dennhardt A.A. The behavioral economics of young adult substance abuse. Prev. Med. 2016;92:24–30. doi: 10.1016/j.ypmed.2016.04.022.
    1. Hallgren K.A., Greenfield B.L., Ladd B.O. Psychometric properties of the adolescent reinforcement survey schedule-alcohol use version with college student drinkers. Subst. Use Misuse. 2016;51:812–822. doi: 10.3109/10826084.2016.1155609.
    1. Morris V., Amlung M., Kaplan B.A., Reed D.D., Petker T., MacKillop J. Using crowdsourcing to examine behavioral economic measures of alcohol value and proportionate alcohol reinforcement. Exp. Clin. Psychopharmacol. 2017;25:314–321. doi: 10.1037/pha0000130.
    1. Strickland J.C., Alcorn J.L., Stoops W.W. Using behavioral economic variables to predict future alcohol use in a crowdsourced sample. J. Psychopharmacol. 2019;33:779–790. doi: 10.1177/0269881119827800.
    1. Tucker J.A., Lindstrom K., Chandler S.D., Bacon J.P., Cheong J. Behavioral economic indicators of risky drinking among community-dwelling emerging adults. Psychol. Addict. Behav. 2021;35:415–423. doi: 10.1037/adb0000686.
    1. Patel H., Reed D.D., MacKillop J., Amlung M. Clarifying the Relation Between Alcohol Demand and Alcohol-related Relative Reinforcement and Driving After Drinking in a Canadian Community Sample. Can. J. Addict. 2019;10:16–23. doi: 10.1097/CXA.0000000000000048.
    1. MacPhillamy D.J., Lewinsohn P.M. The pleasant events schedule: Studies on reliability, validity, and scale intercorrelation. J. Consult. Clin. Psychol. 1982;50:363. doi: 10.1037/0022-006X.50.3.363.
    1. Yurasek A.M., Acuff S.F., Berry M.S. Measuring Substance Use Contexts and Substance-Free Reinforcement. In: Tucker J.A., Witkiewitz K., editors. Dynamic Pathways to Recovery from Alcohol Use Disorder: Meaning and Methods. Cambridge University Press; Cambridge, UK: 2022. pp. 280–300.
    1. Correia C.J., Simons J., Carey K.B., Borsari B.E. Predicting drug use: Application of behavioral theories of choice. Addict. Behav. 1998;23:705–709. doi: 10.1016/S0306-4603(98)00027-6.
    1. Acuff S.F., Dennhardt A.A., Correia C.J., Murphy J.G. Measurement of substance-free reinforcement in addiction: A systematic review. Clin. Psychol. Rev. 2019;70:79–90. doi: 10.1016/j.cpr.2019.04.003.
    1. Morris V., Patel H., Vedelago L., Reed D.D., Metrik J., Aston E., MacKillop J., Amlung M. Elevated Behavioral Economic Demand for Alcohol in Co-Users of Alcohol and Cannabis. J. Stud. Alcohol Drugs. 2018;79:929–934. doi: 10.15288/jsad.2018.79.929.
    1. Naudé G.P., Reed D.D., Thornton T.J., Amlung M. Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach. Exp. Clin. Psychopharmacol. 2021;29:407. doi: 10.1037/pha0000369.
    1. Ramirez J.J., Cadigan J.M., Lee C.M. Behavioral economic demand for alcohol among young adults who engage in simultaneous alcohol and marijuana use. Subst. Abus. 2020;41:203–207. doi: 10.1080/08897077.2019.1671939.
    1. Meshesha L.Z., Dennhardt A.A., Murphy J.G. Polysubstance Use Is Associated With Deficits in Substance-Free Reinforcement in College Students. J. Stud. Alcohol Drugs. 2015;76:106–116. doi: 10.15288/jsad.2015.76.106.
    1. Meshesha L.Z., Utzelmann B., Dennhardt A.A., Murphy J.G. A Behavioral Economic Analysis of Marijuana and Other Drug Use Among Heavy Drinking Young Adults. Transl. Issues Psychol. Sci. 2018;4:65–75. doi: 10.1037/tps0000144.
    1. Fazzino T.L., Kunkel A., Bellitti J., Romine R.S., Yi R., McDaniel C., Lejuez C.W. Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences. Behav. Chang. 2022:1–14. doi: 10.1017/bec.2022.7.
    1. Murphy J.G., Correia C.J., Colby S.M., Vuchinich R.E. Using behavioral theories of choice to predict drinking outcomes following a brief intervention. Exp. Clin. Psychopharmacol. 2005;13:93. doi: 10.1037/1064-1297.13.2.93.
    1. Sobell L.C., Brown J., Leo G.I., Sobell M.B. The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug Alcohol Depend. 1996;42:49–54. doi: 10.1016/0376-8716(96)01263-X.
    1. Sobell L.C., Sobell M.B. Timeline Follow-Back. In: Litten R.Z., Allen J.P., editors. Measuring Alcohol Consumption: Psychosocial and Biochemical Methods. Humana Press; Totowa, NJ, USA: 1992. pp. 41–72.
    1. Levy S., Sherritt L., Harris S.K., Gates E.C., Holder D.W., Kulig J.W., Knight J.R. Test-Retest Reliability of Adolescents’ Self-Report of Substance Use. Alcohol. Clin. Exp. Res. 2004;28:1236–1241. doi: 10.1097/01.ALC.0000134216.22162.A5.
    1. Pedersen E.R., Grow J., Duncan S., Neighbors C., Larimer M.E. Concurrent validity of an online version of the Timeline Followback assessment. Psychol. Addict. Behav. 2012;26:672. doi: 10.1037/a0027945.
    1. Donohue B., Azrin N.H., Strada M.J., Silver N.C., Teichner G., Murphy H. Psychometric Evaluation of Self- and Collateral Timeline Follow-Back Reports of Drug and Alcohol Use in a Sample of Drug-Abusing and Conduct-Disordered Adolescents and Their Parents. Psychol. Addict. Behav. 2004;18:184–189. doi: 10.1037/0893-164X.18.2.184.
    1. The R Development Core Team . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; Vienna, Austria: 2022.
    1. Zeileis A., Kleiber C., Jackman S. Regression Models for Count Data in R. J. Stat. Softw. 2008;27:1–25. doi: 10.18637/jss.v027.i08.
    1. Atkins D.C., Baldwin S.A., Zheng C., Gallop R.J., Neighbors C. A tutorial on count regression and zero-altered count models for longitudinal substance use data: Correction to Atkins et al.(2012) Psychol. Addict. Behav. 2013;27:379. doi: 10.1037/a0033147.
    1. Daughters S.B., Magidson J.F., Lejuez C.W., Chen Y. LETS Act: A behavioral activation treatment for substance use and depression. Adv. Dual Diagn. 2016;9 doi: 10.1108/ADD-02-2016-0006.
    1. Fazzino T.L., Bjorlie K., Lejuez C.W. A systematic review of reinforcement-based interventions for substance use: Efficacy, mechanisms of action, and moderators of treatment effects. J. Subst. Abus. Treat. 2019;104:83–96. doi: 10.1016/j.jsat.2019.06.016.
    1. Murphy J.G., Dennhardt A.A., Skidmore J.R., Martens M.P., McDevitt-Murphy M.E. Computerized versus motivational interviewing alcohol interventions: Impact on discrepancy, motivation, and drinking. Psychol. Addict. Behav. 2010;24:628–639. doi: 10.1037/a0021347.
    1. Murphy J.G., Dennhardt A.A., Skidmore J.R., Borsari B., Barnett N.P., Colby S.M., Martens M.P. A randomized controlled trial of a behavioral economic supplement to brief motivational interventions for college drinking. J. Consult. Clin. Psychol. 2012;80:876. doi: 10.1037/a0028763.
    1. Murphy J.G., Dennhardt A.A., Martens M.P., Borsari B., Witkiewitz K., Meshesha L.Z. A randomized clinical trial evaluating the efficacy of a brief alcohol intervention supplemented with a substance-free activity session or relaxation training. J. Consult. Clin. Psychol. 2019;87:657. doi: 10.1037/ccp0000412.
    1. Thompson K., Holley M., Sturgess C., Leadbeater B. Co-use of alcohol and cannabis: Longitudinal associations with mental health outcomes in young adulthood. Int. J. Environ. Res. Public Health. 2021;18:3652. doi: 10.3390/ijerph18073652.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa