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Background: Prompted by the ongoing debate regarding whether cannabis serves as a complement to or substitute for alcohol, this study uses prospective data to examine daily associations between medicinal versus recreational cannabis and alcohol use in veterans. Methods: Three semi-annual waves of Timeline Followback Interview data were collected from a sample of veterans who reported co-using alcohol and cannabis on at least one day (N = 115; 56% medicinal users; 93% male; 62,100 observations). Linear mixed effects models were used to examine the association between daily cannabis use and number of drinks consumed across time for both medicinal and recreational users and to examine the frequency medicinal cannabis used to substitute for alcohol. Results: Compared to medicinal users, recreational users were more likely to drink more on cannabis use days relative to non-use days. Among medicinal users, those endorsing more frequent use of cannabis as a substitute for alcohol reported fewer number of drinks consumed on days when cannabis was used relative to non-use days. Conclusions: Among veterans, recreational users are at greater risk for increased drinking when co-using cannabis at the daily level, an association that is stable over time. Medicinal users may be at lower risk for increased drinking on days when cannabis is also used, especially those who endorse using cannabis to substitute for alcohol. Findings help clarify the debate on cannabis-alcohol substitution or complementary associations in a sample of veterans and suggests that alcohol interventions should address cannabis use as a risk factor, especially for recreational users.

Many youth experience alcohol-related problems; however, the majority report that they would not use a prevention program even if they perceived a need. Ninth through 12th grade students (N = 2883) completed surveys on alcohol use, willingness to use alcohol-related resources, and factors that might influence utilization. Adolescents were categorized into five groups: non-drinkers, recent abstainers, moderate drinkers, heavy drinkers, and problem drinkers. Level of alcohol use was inversely related to intention to use services. Heavy and problem drinkers also evaluated facilitators differently than abstaining and moderate drinking youth. Findings highlight the difficulty of engaging heavier drinking youth with strategies that may be more appealing to non-problematic drinkers. Results have important implications for the development of distinct alcohol prevention and intervention programs, and highlight the value of using multiple options to increase the likelihood of service utilization by non-drinking and drinking adolescents. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the majority of youth and adults resolve alcohol problems without formal treatment, we know little about the strategies used by youth in their efforts to decrease alcohol use. Recent studies have begun to address change efforts that adolescents report being helpful in cutting down or stopping alcohol use. The current study seeks to improve our understanding of adolescent change processes in alcohol use by examining the perceptions of high school students. METHODS: As part of a secondary alcohol intervention study of high school students (ages 12-18; 51% male), 1069 participants completed an anonymous supplemental questionnaire on change strategies for cutting down and stopping alcohol use. Based on content analysis of youth-generated responses, a classification system consisting of nine broad categories was developed (e.g., informal-interpersonal supports, formal aids, alternative activities). Participant responses were independently coded by two raters trained to criterion. Cases with full agreement (n = 934; 96%) were used for data analyses of methods for cutting down drinking, stopping drinking, and strategies recommended for a friend. RESULTS: The five most frequently youth-generated change strategies to alter drinking were environmental exposure management (e.g., avoid drinking situations, 19%); informal interpersonal supports (e.g., talk to a friend, 18%); formal aids (e.g., peer support group, counselor, 17%); behavioral self-management (e.g., limit consumption, 14%); and alternative activities (e.g., recreation, sports, 10%). Whereas informal interpersonal supports were consistently endorsed for all change situations, behavioral self-management strategies were viewed as more useful for reduction of drinking and formal aids more critical for cessation efforts. Some differences were observed in youth-generated strategies for changing their own drinking compared with efforts to help friends, with environmental changes (e.g., reducing exposure to risk situations and people, formal aids) more often considered when changing youth's own behavior, and strategies reflecting a need for personal change (e.g., education) recommended to others. CONCLUSIONS: Our findings support theoretical conceptualizations of alcohol and drug problem resolution that accommodates multiple pathways to recovery. The normative information about specific change strategies generated by youth may further aid in the design of interventions more acceptable for adolescents. [ABSTRACT FROM AUTHOR]

Background: Insomnia symptoms are pervasive and persistent in alcohol use disorder (AUD), though little is known about the mechanisms that underlie this association. We previously found that cognitive behavioral therapy for insomnia (CBT-I) reduced alcohol-related problems among veterans by improving insomnia severity (NCT03806491). In this planned secondary analysis of the same clinical trial data, we tested negative emotionality as one potential mechanism to explain this effect. Specifically, we tested the change in negative emotionality as a mediator of the association between change in insomnia symptoms and alcohol-related outcomes (craving, heavy drinking frequency, and alcohol-related problems)., Methods: Participants were 67 veterans in treatment for AUD who also met the criteria for insomnia disorder (91% male, 84% White, average age = 46.3 years). Participants were randomized to five sessions of CBT-I or a single-session sleep hygiene control. Assessments occurred at baseline, immediately posttreatment (~6 weeks after baseline), and at 6-week follow-up. Measures included the Insomnia Severity Index, Penn Alcohol Craving Scale, Timeline Followback, and Short Inventory of Problems. We created a latent negative emotionality indicator based on five validated and reliable measures of negative emotionality., Results: Contrary to hypotheses, CBT-I did not improve negative emotionality relative to sleep hygiene control. However, across both treatment conditions, decreases in insomnia symptoms from baseline to posttreatment were associated with concurrent decreases in negative emotionality, which in turn predicted reductions in alcohol craving and heavy drinking., Conclusion: Negative emotionality may help explain links between insomnia symptoms and alcohol-related outcomes., (© 2024 Research Society on Alcohol.)

Background: Simultaneous alcohol and cannabis use is associated with riskier daily drinking. However, little research has tested momentary mechanisms through which simultaneous use predicts continued drinking during acute drinking episodes. The current study tested whether simultaneous use moments predicted within-episode increases in subjective responses, craving, and continued drinking, and whether these relations were potentiated in social versus solitary settings., Methods: Emerging adults who co-use alcohol and cannabis (N = 85) completed 21 days of ecological momentary assessment with event-contingent reports during drinking episodes. Three-level multilevel models tested whether simultaneous (vs. alcohol-only) use moments indirectly predicted subsequent, continued drinking through subjective responses (i.e., high-arousal positive/stimulant, high-arousal negative/aggression, low-arousal positive/relaxation, low-arousal negative/impairment) and alcohol craving, and whether relations differed by social versus solitary contexts., Results: Within drinking episodes, simultaneous (vs. alcohol-only) use moments were associated with increased stimulation, which was indirectly associated with continued drinking through increased alcohol craving. Additionally, the relation between simultaneous (vs. alcohol-only) use and stimulating effects was potentiated during solitary drinking moments, whereas the relation between stimulating effects and craving was potentiated during social drinking moments. However, stimulating effects were higher in social contexts across all moments. Finally, simultaneous (vs. alcohol-only) use moments were associated with increased relaxation, which was indirectly associated with a lower likelihood of continued drinking through lesser craving., Conclusions: Simultaneous use predicted both continued within-episode drinking and cessation of drinking, with acute subjective effects and craving as mechanisms, dependent upon context. Just-in-time interventions should consider targeting affect, craving, and context in event-specific interventions., (© 2024 Research Society on Alcohol.)

Background: There is significant conflicting evidence as to how using cannabis while drinking alcohol (ie, simultaneous alcohol and cannabis use) impacts alcohol volume consumed, patterns of drinking, and alcohol-related consequences. The impact of simultaneous use on drinking outcomes may be influenced by several within-person (eg, contextual) and between-person (individual) factors., Objective: This study was designed to examine naturalistic patterns of alcohol and cannabis use to understand how simultaneous use may impact drinking outcomes. The primary aims were to understand the following: (1) if simultaneous use is associated with increased alcohol consumption and riskier patterns of drinking, (2) if simultaneous use leads to increased alcohol consequences, and (3) how contextual circumstances moderate the impact of simultaneous use on consumption and consequences., Methods: Data collection involves a 28-day ambulatory assessment protocol in which a sample of non-treatment-seeking young adults who report simultaneous use of alcohol and cannabis complete ecological momentary assessments (random, event-contingent, and time-contingent surveys) of alcohol and cannabis use, contexts, motives, and consequences on their personal smartphones while continuously wearing an alcohol biosensor bracelet. Participants also complete a baseline assessment, brief internet-based check-in on day 14, and a final session on day 28. Community-based recruitment strategies (eg, social media and flyers) were used to enroll 95 participants to obtain a target sample of 80, accounting for attrition., Results: Recruitment and data collection began in May 2021 and continued through June 2024. Initial results for primary aims are expected in October 2024. As of March 2024, the project had recruited 118 eligible participants, of whom 94 (79.7%) completed the study, exceeding initial projections for the study time frame. Remaining recruitment will provide the capacity to probe cross-level interactions that were not initially statistically powered. Strengths of the project include rigorous data collection, good retention and compliance rates, faster-than-expected enrollment procedures, use of a novel alcohol biosensor, and successful adaptation of recruitment and data collection procedures during the COVID-19 pandemic., Conclusions: This is the first investigation to assess the key momentary predictors and outcomes of simultaneous use as well as self-reported and objective (via alcohol biosensor) measures of alcohol consumption and patterns. The results of this study will inform prevention efforts and studies of individuals who use cannabis who are engaged in alcohol treatment., International Registered Report Identifier (irrid): DERR1-10.2196/58685., (©Rachel L Gunn, Jane Metrik, Nancy P Barnett, Kristina M Jackson, Sharon Lipperman-Kreda, Robert Miranda Jr, Timothy J Trull, Mary Ellen Fernandez. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.09.2024.)

Background: Alcohol and cannabis use rates are highest in college-aged young adults, and both alcohol and cannabis use are independently related to high-risk sexual behaviors (HRSBs). HRSBs (e.g., sex without protection against sexually transmitted infections) are a prevalent public health problem in college students, with little research examining simultaneous alcohol and cannabis use (i.e., using both alcohol and cannabis at the same time so the effects overlap) and HRSBs., Method: We examined simultaneous alcohol and cannabis-related HRSB frequency, gender differences in simultaneous alcohol and cannabis-related HRSBs, and differences in HRSBs between simultaneous and non-simultaneous users. Alcohol and cannabis using college students ( N = 534; Average Age = 19; 66.9% reported identifying as female) were recruited through a psychology department's human subjects research pool and completed a one-time, online, self-report survey., Results: One-third of participants engaged in simultaneous alcohol and cannabis use prior to sexual intercourse in the past 3 months. Additionally, over one-third of participants reported heavy drinking (4/5 or more drinks for women/men) simultaneously with cannabis use prior to sexual intercourse in the past 3 months. Simultaneous alcohol and cannabis use was significantly and positively related to sexual intercourse after simultaneous use and after heavy drinking simultaneously with cannabis use. Past year simultaneous alcohol and cannabis users, relative to non-simultaneous users, reported increased incidents of sex without protection against sexually transmitted infections. No gender differences in simultaneous alcohol and cannabis-related HRSBs were found., Conclusions: Future research should continue examining simultaneous alcohol and cannabis use and HRSBs., Competing Interests: The authors report no conflicts of interest., (© 2023 Authors et al.)

Objectives: Cannabinoid hyperemesis syndrome (CHS) is a clinical condition of cyclic vomiting, nausea, and abdominal pain associated with chronic cannabis use. Despite increased recognition of CHS, there are limited details on cannabis use practices and symptoms over time. Understanding what happens in the period surrounding the emergency department (ED) visit, including any changes in symptoms and cannabis use practices following the visit, can help inform the development of patient-centered interventions around cannabis use disorder for patients with CHS., Methods: A prospective observational cohort (n = 39) of patients with suspected CHS recruited from the ED at the time of a symptomatic cyclic vomiting episode was followed for 3 months. Disease progression, cannabis use practices, and health care utilization were monitored., Results: Participants reported high rates of persistent CHS symptoms (abdominal pain, nausea, or cyclic vomiting) in the 2-week period immediately following an ED visit with a median duration of 7 days. Cannabis use frequency and quantity were reduced immediately after the ED visit, but most participants returned to pre-ED visit cannabis use patterns within a few days. Recurrent ED visits for cyclic vomiting were reported by 25% of participants who completed follow-up during the 3-month follow-up period., Conclusions: Participants continued to have ongoing symptoms after the ED visit, but most managed symptoms on their own and did not return to the ED. Longitudinal studies beyond 3 months are needed to better understand the clinical course of patients with suspected CHS., (© 2023 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Background: Despite the prevalence and negative outcomes associated with simultaneous alcohol and cannabis use (i.e., marijuana [SAM] use; i.e., so that the effects of both alcohol and cannabis overlap) among college students, there is no comprehensive measure of SAM use, with past research relying on single items. The present studies aimed to develop the Alcohol and Cannabis Simultaneous Use Scale (ACSUS), a comprehensive self-report measure of SAM use frequency, quantity, and problems in college students., Methods: College students at two Midwestern universities who used alcohol and cannabis (Study 1: N =534; Mean age=19; 71% female; 88% White; Study 2: N =258; Mean age=21; 81% female; 85% White) completed the newly developed ACSUS., Results: Exploratory factor analysis (Study 1) revealed the ACSUS fit best with 9-items representing two factors: Factor 1 measures frequency and quantity of SAM use, and Factor 2 measures associated problems with SAM use. Confirmatory factor analysis (Study 2) supported the two-factor structure of the ACSUS which was positively associated with measures of alcohol use, cannabis use, simultaneous use motives, and impulsivity., Conclusions: These data provide initial support for the ACSUS, developed to investigate the frequency, quantity, and associated problems with SAM use in college students., Competing Interests: The authors report no conflicts of interest.

Objective: Cannabis demand (i.e., relative value), assessed cross-sectionally via a hypothetical marijuana purchase task (MPT), has been associated with use, problems, and dependence symptoms, among others. However, limited work exists on the prospective stability of the MPT. Furthermore, cannabis demand among veterans endorsing cannabis use, and the prospective cyclical relationship between demand and use over time, have yet to be investigated., Method: Two waves of data from a veteran sample ( N = 133) reporting current (past 6-month) cannabis use were analyzed to assess stability in cannabis demand over 6 months. Autoregressive cross-lagged panel models (CLPMs) assessed the longitudinal associations between demand indices (i.e., intensity, O max, P max , breakpoint) and cannabis use., Results: Baseline cannabis use predicted greater intensity (β = .32, p < .001), O max (β = .37, p < .001), breakpoint (β = .28, p < .001), and P max (β = .21, p = .017) at 6 months. Conversely, baseline intensity (β = .14, p = .028), breakpoint (β = .12, p = .038), and P max (β = .12, p = .043), but not O max , predicted greater use at 6 months. Only intensity demonstrated acceptable prospective reliability., Conclusions: Cannabis demand demonstrated stability over 6 months in CLPM models, varying along with natural changes in cannabis use. Importantly, intensity, P max , and breakpoint displayed bidirectional predictive associations with cannabis use, and the prospective pathway from use to demand was consistently stronger. Test-retest reliability ranged from good to poor across indices. Findings highlight the value of assessing cannabis demand longitudinally, particularly among clinical samples, to determine how demand fluctuates in response to experimental manipulation, intervention, and treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Importance: Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established., Objective: To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes., Design, Setting, and Participants: For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks., Interventions: Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment., Main Outcomes and Measures: Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up., Results: The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency., Conclusions and Relevance: In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence., Trial Registration: ClinicalTrials.gov Identifier: NCT03806491.

Study Objectives: The objectives of this study were to characterize the detailed cannabis use patterns (eg, frequency, mode, and product) and determine the differences in the whole-blood cannabinoid profiles during symptomatic versus asymptomatic periods of participants with suspected cannabinoid hyperemesis syndrome recruited from the emergency department (ED) during a symptomatic episode., Methods: This is a prospective observational cohort study of participants with symptomatic cyclic vomiting onset after chronic cannabis use. Standardized assessments were conducted to evaluate for lifetime and recent cannabis use, cannabis use disorder, and cannabis withdrawal symptoms. Quantitative whole-blood cannabinoid testing was performed at 2 times, first when symptomatic (ie, baseline) and at least 2 weeks after the ED visit when asymptomatic. The differences in cannabinoid concentrations were compared between symptomatic and asymptomatic testing. The study was conducted from September 2021 to August 2022., Results: There was a difference observed between delta-9-tetrahydrocannabinol metabolites, but not the parent compound during symptomatic episodes and asymptomatic periods. Most participants (84%) reported using cannabis > once per day (median 3 times per day on weekdays, 4 times per day on weekends). Hazardous cannabis use was universal among participants; the mean cannabis withdrawal discomfort score was 13, indicating clinically significant rates of cannabis withdrawal symptoms with cessation of use. Most participants (79%) previously tried to stop cannabis use, but a few (13%) of them had sought treatment., Conclusion: Patients presenting to the ED with cannabinoid hyperemesis syndrome have high cannabis use disorder scores. Further studies are needed to better understand the influence of THC metabolism and concentrations on symptomatic cyclic vomiting., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Simultaneous alcohol and cannabis use (SAM) is associated with riskier drinking. However, little is known regarding mechanisms of risk during drinking episodes. The current study tested whether subjective responses to simultaneous vs. alcohol-only use (i.e., high arousal positive/reward, high arousal negative/aggression, low arousal positive/relaxation, low arousal negative/impairment) were mechanisms through which SAM use was associated with daily drinking., Methods: Emerging adults who co-use alcohol and cannabis (N=85) completed 21 days of ecological momentary assessment with drink-contingent reports during drinking episodes. Participants reported on their simultaneous use and current subjective effects during drink reports and past-night total drinks consumed and negative consequences experienced the next morning. Three-level multilevel models (momentary, daily, person level) tested whether SAM use predicted subjective responses, and whether subjective responses mediated associations between SAM use, heavier drinking and negative consequences., Results: At the momentary and day-level, SAM (vs. alcohol-only) use predicted increased high arousal positive/rewarding, low arousal positive/relaxing, and low arousal negative/impairing subjective effects. SAM use indirectly predicted heavier day-level drinking and further negative consequences through high arousal positive/rewarding response. SAM use also indirectly predicted day-level negative consequences through low arousal negative/impairing response. At the person-level, more frequent SAM use predicted higher person-average high arousal positive/rewarding and low arousal positive/relaxing responses, and high arousal positive/rewarding response mediated relation between SAM frequency and heavier drinking., Conclusions: Simultaneous use was associated with reward, relief, and impairment, and reward and impairment were mechanisms of risk between SAM use and riskier drinking. Findings may inform theory and just-in-time interventions seeking to reduce alcohol misuse., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: The legal landscape surrounding purchasing cannabis without a medical cannabis card (i.e., without MCC) is changing rapidly, affecting consumer access and purchasing behaviors. Cannabis purchasing behaviors are related to subsequent use and experiencing greater cannabis-related negative consequences. However, purchasing behaviors of individuals who use cannabis without MCC are understudied., Methods: The current study analyzed qualitative data from focus groups with adults who use cannabis without MCC (n = 5 groups; 6-7 participants/group; n = 31 total participants). Focus groups followed a semi-structured agenda, and were audio recorded and transcribed. Two coders applied thematic analysis to summarize topics pertaining to cannabis purchasing attitudes and behaviors. Focus groups occurred in 2015 and 2016 in Rhode Island, when purchasing and use of cannabis without MCC was decriminalized but still considered illegal., Results: On average, participants (72% male) were 26 years old (SD = 7.2) and reported using cannabis 5 days per week (SD = 2.1). Thematic analysis revealed three key themes related to cannabis purchasing behaviors: (1) regular purchasing routines (i.e., frequency, schedule, amount of purchases), (2) economic factors (i.e., financial circumstances), and (3) contextual factors (i.e., quality of cannabis, convenience/availability) were perceived to influence purchasing decisions. Dealers' recommendations affected participants' purchases, who also reported minimal legal concerns. Participants reported saving money and using more cannabis when buying in bulk., Discussion: Purchasing behaviors were found to vary and were perceived to be affected by individual-level (e.g., routines) and contextual factors (e.g., availability) that, in turn, may impact use patterns. Future research should consider how factors (e.g., availability) that differ across contexts (e.g., location) and demographic groups interact to affect purchasing behaviors., Competing Interests: All authors list no conflicts of interest., (© 2023 Authors et al.)

Objective: There is substantial evidence linking anxiety sensitivity and distress intolerance to depressive symptoms, and further evidence linking depressive symptoms to alcohol and cannabis use. However, the prospective indirect associations of anxiety sensitivity and distress intolerance with alcohol and cannabis use through depressive symptoms remain uncertain. Thus, the current study examined whether depressive symptoms mediated the associations between anxiety sensitivity and distress intolerance with alcohol and cannabis use frequency, quantity, and problems in a longitudinal sample of veterans., Method: Participants ( N = 361; 93% male; 80% White) were military veterans with lifetime cannabis use recruited from a Veterans Health Administration in the Northeastern United States. Eligible veterans completed three semi-annual assessments. Prospective mediation models were used to test for the effects of baseline anxiety sensitivity and distress intolerance on alcohol and cannabis use quantity, frequency and problems at 12 months via depressive symptoms at 6 months., Results: Baseline anxiety sensitivity was positively associated with 12-month alcohol problems. Baseline distress intolerance was positively associated with 12-month cannabis use frequency and quantity. Baseline anxiety sensitivity and distress intolerance significantly predicted increased alcohol problems and cannabis use frequency at 12 months through depressive symptoms at 6 months. There were no significant indirect effects of anxiety sensitivity and distress intolerance on alcohol use frequency or quantity, cannabis use quantity, or cannabis problems., Conclusions: Anxiety sensitivity and distress intolerance share a common pathway to alcohol problems and cannabis use frequency through depressive symptoms. Interventions focused on modulating negative affectivity may reduce cannabis use frequency and alcohol problems.

Background: Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS., Methods: Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo., Findings: Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have., Conclusions: Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background and Aims: The Marijuana Purchase Task (MPT) is increasingly used to measure cannabis reinforcing value and has potential use for cannabis etiological and regulatory research. This meta-analysis sought to evaluate for the first time the MPT's concurrent validity in relation to cannabis involvement., Methods: Electronic databases and pre-print repositories were searched for MPT studies that examined the cross-sectional relationship between frequency and quantity of cannabis use, problems, dependence, and five MPT indicators: intensity (i.e. unrestricted consumption), O max (i.e. maximum consumption), P max (i.e. price at which demand becomes elastic), breakpoint (i.e. first price at which consumption ceases), and elasticity (i.e. sensitivity to rising costs). Random effects meta-analyses of cross-sectional effect sizes were conducted, with Q tests for examining differences by cannabis variables, meta-regression to test quantitative moderators, and publication bias assessment. Moderators included sex, number of MPT prices, variable transformations, and year of publication. Populations included community and clinical samples., Results: The searches yielded 14 studies (n = 4077, median % females: 44.8%: weighted average age = 29.08 [SD = 6.82]), published between 2015 and 2022. Intensity, O max , and elasticity showed the most robust concurrent validity (|r's| = 0.147-325, ps < 0.014) with the largest significant effect sizes for quantity (|r| intensity = 0.325) and cannabis dependence (|r| O max  = 0.320, |r| intensity = 0.305, |r| elasticity = 0.303). Higher proportion of males was associated with increased estimates for elasticity-quantity and P max -problems. Higher number of MPT prices significantly altered magnitude of effects sizes for P max and problems, suggesting biased estimations if excessively low prices are considered. Methodological quality was generally good, and minimal evidence of publication bias was observed., Conclusions: The marijuana purchase task presents adequate concurrent validity to measure cannabis demand, most robustly for intensity, O max , and elasticity. Moderating effects by sex suggest potentially meaningful sex differences in the reinforcing value of cannabis., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Cannabis demand (i.e., reinforcing value) can be assessed using a marijuana purchase task (MPT; assesses hypothetical purchasing of cannabis at escalating prices) and has been related to use frequency, problems, and cannabis use disorder symptoms in adults. Cannabis demand has yet to be studied in adolescents, which can inform prevention and intervention efforts to reduce cannabis-related risks. The present study sought to validate the MPT with a sample of late adolescent lifetime cannabis users. Participants aged 15-18 years old ( n = 115, M age = 16.9, SD = 0.9) residing in a state with legalized cannabis use completed online assessments at baseline and 6-month follow-up. Convergent and divergent validity was examined, while principal component analysis was conducted to determine the factor structure and assess predictive validity. Three indices, O max (i.e., maximum expenditure on cannabis), breakpoint (i.e., price suppressing consumption to zero), and alpha (i.e., degree to which consumption decreases with increasing price) were all significantly associated with cannabis use, consequences, craving, and expenditures and significantly differentiated low-risk users and high-risk users as measured by the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). A two-factor solution reflecting amplitude (intensity, alpha, O max ) and persistence (breakpoint, P max ) was observed. Both factors were associated with cannabis use and consequences in baseline regression models. At follow-up, persistence was associated with consequences; amplitude was not associated with either outcome. These findings provide initial evidence that the MPT is a valid measure for assessing cannabis demand among adolescents and can be used to understand mechanisms of adolescent cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Veterans often use cannabis for sleep despite limited evidence of its efficacy. Moreover, how sleep disturbances impact cannabis use longitudinally is unclear. We applied a behavioral economic framework to examine whether sleep disturbances and cannabis demand (i.e., relative value) were related risk-factors for future cannabis use and problems., Methods: Veterans deployed post-9/11/2001 who reported past 6-month cannabis use at baseline (n = 126) completed surveys on their sleep disturbances, demand via the Marijuana Purchase Task (MPT), and cannabis use. Mediation analyses using Hayes' PROCESS Macro and zero-inflated negative binomial models tested indirect effects of baseline sleep disturbances on 12-month cannabis use frequency, quantity, and problems via 6-month cannabis demand (i.e., intensity, O max , P max , and breakpoint)., Results: Only O max (i.e., maximum expenditure for cannabis) was a significant mediator for 12-month cannabis use quantity and problems when examined concurrently with other demand indices after controlling for covariates. Intensity (i.e., purchase at zero cost) was a significant mediator for 12-month cannabis use frequency when examined concurrently with other demand indices in models controlling for lifetime cannabis use, but not past 30-day use at baseline., Conclusion: Cannabis demand, specifically intensity and O max, may help to identify Veterans with sleep disturbances who are at increased risk for escalating their cannabis use. Subsequent research should assess the extent that sleep disturbances impact cannabis demand in the context of withdrawal, which will inform novel prevention and intervention strategies geared toward reducing negative cannabis-related outcomes among Veterans., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: Impulsivity is an established etiological risk factor for alcohol- and cannabis-related outcomes. However, limited work has focused on longitudinal associations between multiple trait impulsivity facets and indices of alcohol and cannabis use among military veterans-a contextually distinct population that evidence unique impulsive personality traits and substance use patterns., Method: A structural equation model (SEM) examined longitudinal associations between five UPPS-P impulsivity facets measured at baseline and six indices of alcohol and cannabis use (i.e., frequency, quantity, and problems) measured at 1-year follow-up among 361 returning Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans., Results: Findings indicated baseline sensation seeking was significantly positively associated with 1-year alcohol use frequency (β = .18); baseline negative urgency was positively associated with alcohol use problems (β = .31); and baseline lack of perseverance (β = .25) and sensation seeking (β = .21) were positively associated with 1-year cannabis use problems. None of the baseline impulsivity facets were associated with 1-year alcohol use quantity, cannabis use frequency, or cannabis use quantity., Conclusions: Results provide preliminary support that impulsivity may play a unique role in understanding alcohol- and cannabis-related problems over time among veterans. Further, results suggest that specific impulsivity facets are prospectively associated with cannabis problems (i.e., lack of perseverance and sensation seeking) and alcohol problems (i.e., negative urgency). Findings reinforce the importance of differentially evaluating impulsivity-substance use associations within contextually distinct populations (e.g., adolescent, veteran), and highlight potentially meaningful intervention targets among veterans. However, replication is needed with stronger temporal controls and more diverse veteran subsamples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social learning theories suggest that outcome expectancies are strong determinants of behavior, and studies find that alcohol and cannabis expectancies are associated with negative substance use outcomes. However, there are no measures to date that assess expectancies for simultaneous alcohol and cannabis use (SAM), often referred to as SAM, despite strong links with negative consequences and rising time trends. The present study sought to provide initial validation of test scores for the Anticipated Effects of Simultaneous Alcohol and Cannabis Use Scale (AE-SAM), using a sample of past month college student simultaneous users ( N = 434). Exploratory factor analysis and confirmatory factor analysis conducted in random half samples suggested five expectancy factors, representing high arousal positive, high arousal negative (alcohol driven), high arousal negative (cannabis driven), low arousal positive, and low arousal negative expectancies. The factor structure was invariant across sex, race/ethnicity, and simultaneous use frequency, and demonstrated convergent and discriminant validity with other alcohol/cannabis expectancy measures. AE-SAM high arousal positive expectancies were associated with simultaneous use frequency and heavier drinking/cannabis use, AE-SAM high arousal negative (cannabis driven) expectancies were associated with less frequent simultaneous use and more negative alcohol consequences, and AE-SAM low arousal negative expectancies were associated with less cannabis use. Effects of AE-SAM high arousal positive and high arousal negative (cannabis driven) expectancies remained, above and beyond other expectancy measures, suggesting that AE-SAM expectancies provide additional information beyond single substance expectancies. The results demonstrate the feasibility and utility of assessing simultaneous use expectancies, and lay groundwork for future research on simultaneous use expectancies in relation to alcohol and cannabis couse outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Given legislative initiatives in Rhode Island pertaining to consideration of cannabis legalization for recreational purpose, a qualitative inquiry was conducted regarding anticipated changes in use among recreational cannabis users in Rhode Island. Five focus groups were conducted with recreational cannabis users ( N = 31; 6-7 per group). Participants were queried about anticipated impact of legalization on their use patterns. Themes were identified using applied thematic analysis. Participants discussed (1) a desire to maintain the status quo due to satisfaction with local cannabis regulations and their current use behaviors, (2) how and why cannabis use may change, including pros and cons of legalization, and (3) anticipated changes in purchasing behavior given display and legitimacy of legal dispensaries. While participants anticipate use levels and prevalence may remain relatively stable following legislation changes, findings suggest possible changes related to mode of administration and location of use. Public health concerns exist related to high-risk potencies and use of cannabis in edible form; therefore, trialing of new cannabis products has important clinical implications should legalization occur in Rhode Island.

Competing Interests: Disclosures J.M. declares no competing financial or nonfinancial interests. S.P. is a scientific consultant for Psy Therapeutics and Jazz Pharmaceuticals.

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.

Background: Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis., Methods: Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms., Results: A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155-0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI -0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028-0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI -0.022 to 0.262)., Conclusions: Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.

Objective: Several studies suggest that alcohol and cannabis co-users are heavier drinkers and experience more alcohol-related consequences. However, day-level associations between co-use and drinking levels are mixed. One reason may be that individual characteristics moderate the daily impact of using alcohol alone or in conjunction with cannabis. The theory would suggest that highly impulsive individuals may drink more on co-use days, yet this assertion remains untested. Therefore, the current study tested whether impulsivity moderated the effect of co-use on same-day drinking quantity within veterans, a high-risk sample for substance use and impulsivity. Method: In a longitudinal observational study, co-using veterans ( N = 139) completed three semi-annual assessments reporting on their daily drinking quantity and cannabis use via Timeline Followback ( Observations = 19,245) and impulsivity via the UPPS-P. Mixed effect modeling was used to test hypotheses that co-use (compared to alcohol-only) days would be associated with heavier drinking for those high (but not low) in positive and negative urgency. Results: Significant interactions were found for positive urgency (PU) and lack of perseverance (LP), such that individuals at mean and low levels of PU and LP drank less on co-use (compared to alcohol-only) days. There were no significant interactions for other UPPS-P impulsivity facets. Conclusion: Findings are consistent with a substitution/compensatory effect for individuals at mean and low levels of both UPPS-P facets, and may be a byproduct of frequent cannabis use in veterans. In contrast, findings suggest that co-use and alcohol-only days may be characterized by similarly high levels of drinking for highly impulsive individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: As many as 74% of veterans with alcohol use disorders (AUDS) report symptoms of insomnia. Insomnia represents a barrier to alcohol treatment because insomnia symptoms (1) may lead to relapse among those who use alcohol to help them sleep and may negatively impact (2) executive functions and (3) emotion regulation skills. Cognitive-behavioural therapy for insomnia (CBT-I) is an efficacious first-line treatment for insomnia; however, no research has examined the impact of CBT-I on individuals' response to alcohol treatment. In the Sleep and Alcohol for Veterans (Project SAVE) randomised controlled trial, we hypothesise that CBT-I will enhance the efficacy of alcohol treatment among Veterans with insomnia by enhancing their abilities to attend to treatment, regulate emotions and initiate sleep without alcohol., Methods and Analysis: Eighty Veterans enrolled in alcohol treatment at the Veterans Administration (VA) hospital will be randomly assigned to receive either CBT-I or single-session sleep hygiene (SH) education. Individuals will be eligible to participate if they meet Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5) criteria for moderate to severe AUD and Insomnia Disorder of at least 1-month duration. Participants will complete assessments at baseline, post-treatment and 6-week follow-up. Preliminary process outcomes include retention/recruitment rates and treatment satisfaction (feasibility and acceptability, respectively). Primary outcomes are insomnia severity, percentage of heavy-drinking days and alcohol-related problems. We will assess a variety of secondary clinical and mechanistic outcomes (eg, post-traumatic stress disorder (PTSD) symptoms, attention and working memory)., Ethics and Dissemination: Ethics approval was obtained in October 2018. Data collection began in July 2019 and is planned for completion by July 2021. Trial results will be disseminated at local and national conferences, in peer-reviewed publications and through media outlets, as available. Results will also be shared with interested participants and clinical collaborators at the end of the trial., Trial Registration Number: clinicaltrials.gov identifier NCT03806491 (pre-results)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Alcohol-related motor vehicle crashes are a major preventable cause of death in the United States. One potential factor that may modulate the influence of alcohol on driving-related cognitions and decision-making is trauma-related stress. Indeed, in addition to compelling research indicating that both acute trauma-related stress and acute alcohol consumption may independently affect driving-related risky decision-making, there is reason to believe that the combination of these antecedents may have an exacerbating effect., Methods: The current study evaluated the influence of induction of acute trauma-related stress (via script-driven imagery) after alcohol consumption (0.06% Breath Alcohol Concentration [BrAC]) on driving-related cognitions - perceived likelihood of negative consequences and willingness to drive - among 25 trauma-exposed (currently symptomatic) adult drinkers from the community (M = 24.08; 36.0% female)., Results: Participants who were acutely exposed to trauma-related stress after alcohol consumption evidenced lower perceived likelihood of being pulled over by a police officer (ηp2 = 0.38, large effect size) and lower perceived likelihood of getting in an accident (ηp2 = 0.17, medium-to-large effect size) relative to participants exposed to a neutral cue; conversely, participants exposed to trauma-related stress after alcohol consumption evidenced greater willingness to drive (d = 1.16, large effect size) than participants exposed to a neutral cue., Conclusions: Generally, findings suggest that individuals with a trauma history that are acutely exposed to trauma-related stressors (e.g., reminders of their traumatic experience) may be particularly vulnerable to poorer driving-related decision-making after alcohol consumption. Results provide a meaningful target for the development of intoxicated driving prevention and intervention efforts geared specifically for individuals with trauma history., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked prospectively to cannabis; however, no study has examined mechanisms underlying this comorbidity. We examined 5 cannabis motives (i.e., coping with negative affect, sleep, social anxiety, perceived low risk of cannabis, and altered perception) as mediators of the prospective ADHD-cannabis relation. Method: Veterans reporting lifetime cannabis use ( N = 361; 93% male; 80% White) completed three semiannual assessments. Prospective mediation models using structural equation modeling analyzed the indirect effects of baseline ADHD symptoms on 12-month cannabis use and problems via each motive at 6 months. Zero-inflated negative binomial models were employed for both manifest outcomes and ADHD symptoms and motives were each modeled as 1-factor latent variables. Results: Sleep motives was a robust mediator for cannabis use frequency in single mediator models and was marginally significant when examined simultaneously with other motives after accounting for baseline cannabis use, demographics, other substance use, and other psychopathology. Coping with negative affect was the only significant mediator of ADHD symptoms and subsequent cannabis problem severity. Conclusion: Among veterans with ADHD symptoms, sleep disturbance is a salient motive for cannabis use, whereas coping with negative affect is a proximal predictor of cannabis problems. Findings support addressing sleep disturbance in adults with ADHD symptoms and converge with extant literature demonstrating robust associations between coping motives and substance use problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Behavioral economic demand for cannabis (i.e., relative reinforcing value) can be measured via marijuana purchase tasks (MPTs). However, commodity ambiguities pose challenges and design concerns exist regarding current MPTs. The aim of this 2-phase study was to modify and improve a MPT using qualitative methods. Phase I: Focus groups were conducted with regular (i.e., average use ≥ once/week) cannabis users ( n = 31; 6-7 per group M [ SD ] age = 26 [7]; 28% female). Focus groups followed a semistructured agenda, and executive summaries were made concerning key MPT themes. Feedback was used to refine the MPT. Phase II: Cognitive interviews using the refined MPT were conducted with regular cannabis users ( n = 20; M [ SD ] age = 28 [8]; 50% female). Phase I: Focus group analyses highlighted 4 critical areas for MPT improvement: (a) unit of purchase, (b) cannabis quality, (c) time duration specified for use episode, and (d) price. Participants suggested using grams as the unit of purchase, tailoring cannabis quality to the individual, and clarifying intended episode length. Phase II: Cognitive interviewing indicated additional areas for task refinement, resulting in a second iteration of the MPT based on the 2 phases. Qualitative research in both phases suggested a number of substantive modifications to the MPT format. MPT modifications are expected to improve comprehension, ecological validity, and general construct validity. Findings highlight the importance of careful instructional set development for drug purchase tasks for heterogeneous products that do not have standard units of consumption. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prior research suggests that cannabis expectancies are related to cannabis misuse and problems. Although there are established measures of cannabis expectancies, existing measures have psychometric limitations and/or are lengthy. Existing measures typically have a two-factor structure of positive and negative expectancies, but recent conceptualizations of alcohol expectancies support a valence- (positive vs. negative) and arousal-based (high vs. low arousal) structure. Thus, the present study sought to test a similar structure for cannabis. Cannabis expectancy items underwent 2 preliminary studies, assessing item valance/arousal ( n = 233) and relevance to cannabis ( n = 124). A final pool of 76 items underwent exploratory factor analysis ( n = 303), and remaining items underwent confirmatory factor analysis in a separate sample ( n = 469). Lastly, an additional sample ( n = 435) examined validity. Results suggested a 3-factor structure (general positive, high arousal negative, low arousal negative) for the 17-item Anticipated Effects of Cannabis Scale (AECS), which was invariant across cannabis use frequency, sex, and race/ethnicity. Positive expectancies were strongly associated with cannabis use, whereas low arousal negative expectancies were protective against cannabis frequency; high arousal negative expectancies were strongly associated with more negative consequences and dependence symptoms. In addition, the proposed interpretation of AECS test scores showed evidence of incremental validity relative to another abbreviated measure. The current study provides initial support for the AECS, a brief, psychometrically sound cannabis expectancies measure. The AECS captures the full range of cannabis effects and may be suited to test discrepancies between cannabis expectancies and subjective response. Additional research is needed to validate its structure and predictive utility. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Inpatient admissions are common for individuals with schizophrenia-spectrum disorders, and difficulty transitioning from the hospital to the community results in these individuals being at high risk for hospital readmissions. Thus, psychotic disorders account for high rates of rapid readmission within 30 days of discharge. Increasing evidence highlights the role of comorbid medical conditions, such as circulatory and metabolic problems, in contributing to early readmission rates for these patients. This study examined the specific role of circulatory and metabolic problems in predicting psychiatric rehospitalizations while accounting for other medical conditions, psychiatric comorbidities, and preadmission medications., Methods: The electronic medical records of 752 patients admitted to a psychiatric hospital were examined, with patients classified as having readmission within 30 days of their index hospitalization (n=79) or no readmission within 30 days (n=673). The 2 groups were compared on multiple variables in univariate and multivariate analyses., Results: Male sex [odds ratio (OR)=2.02, P=0.019)], disability status (OR=1.96, P=0.027), and presence of a circulatory (but not a metabolic) condition (OR=3.43, P=0.003) were associated with significantly increased odds of being rehospitalized within 30 days, even when accounting for additional predictors, including age, substance use disorder, race, and other medical conditions., Conclusions: These findings highlight the importance of considering circulatory, in addition to metabolic disorders, during inpatient stays. This comorbidity pattern may signify a subset of individuals with schizophrenia-spectrum disorders requiring more comprehensive discharge planning and support after an inpatient hospitalization to prevent rapid rehospitalization., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Co-use of alcohol and cannabis is highly prevalent among young adults and college students. Between-person reports suggest that co-use is associated with the experience of more frequent consumption and related consequences, compared to single substance use. However, recent studies have found conflicting evidence regarding the impact of co-use use on consumption and consequences in daily or event-level investigations. Conflicting evidence may be due to understudied factors, such as the order in which alcohol and cannabis are used. The current study aimed to examine the effect of substance use order on a) alcohol consumption; b) cannabis consumption; and c) negative alcohol and cannabis consequences., Methods: Data were collected from U.S. undergraduate college student alcohol and cannabis users (N = 258) who completed two 28-day longitudinal online assessment bursts examining alcohol and cannabis co-use patterns. Data were collected five times per day during both bursts (three months apart)., Results: Controlling for between-person alcohol and cannabis use, within-person mixed-effects models indicated that using cannabis first within a co-use day was associated with lower daily alcohol consumption, but greater daily cannabis consumption. Substance use ordering was not linked to consequences, whereas between-person levels of alcohol consumption and within-person number of drinks in a day were positive predictors of consequences., Conclusions: Overall, results highlighted that order of substance use is a robust predictor of consumption on co-use days. Therefore, future research on co-use use should consider patterns of use in addition to level of use., (Copyright © 2020 Elsevier B.V. All rights reserved.)

There is a high comorbidity between symptoms of depression and cannabis and alcohol use in civilian and veteran populations. Prospective studies attempting to clarify the directionality of these comorbidities have yielded mixed results. Further, the relations between these constructs and impulsive personality, particularly negative urgency (NU, the tendency to act rashly when experiencing emotional distress) warrants further attention, as NU relates to symptoms of depression and alcohol and cannabis use. Importantly, NU partially accounts for the association between symptoms of depression and cannabis and alcohol problems in cross-sectional studies. This study examined alternative theories of directionality in order to better understand the longitudinal associations between symptoms of depression, NU, and cannabis or alcohol use. Three semiannual waves of data (baseline, 6-month, and 12-month) were collected in parallel assessments from a sample of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans ( N = 361). Autoregressive cross-lagged panel models were used to test four alternative theory-driven models about the longitudinal associations between the interaction of symptoms of depression and NU and cannabis or alcohol use. Models revealed unique direction of effects specific to each substance, such that the interaction between symptoms of depression and NU at 6 months postbaseline predicted more alcohol use at 12 months postbaseline, whereas more cannabis use at 6 months postbaseline predicted more severe symptoms of depression at 12 months postbaseline. Results suggests alternate directions of effect for cannabis and alcohol use. Future research should examine these patterns over wider assessment periods in order to see more variability and change over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Prompted by the ongoing debate regarding whether cannabis serves as a complement to or substitute for alcohol, this study uses prospective data to examine daily associations between medicinal versus recreational cannabis and alcohol use in veterans., Methods: Three semi-annual waves of Timeline Followback Interview data were collected from a sample of veterans who reported co-using alcohol and cannabis on at least one day (N = 115; 56% medicinal users; 93% male; 62,100 observations). Linear mixed effects models were used to examine the association between daily cannabis use and number of drinks consumed across time for both medicinal and recreational users and to examine the frequency medicinal cannabis used to substitute for alcohol., Results: Compared to medicinal users, recreational users were more likely to drink more on cannabis use days relative to non-use days. Among medicinal users, those endorsing more frequent use of cannabis as a substitute for alcohol reported fewer number of drinks consumed on days when cannabis was used relative to non-use days., Conclusions: Among veterans, recreational users are at greater risk for increased drinking when co-using cannabis at the daily level, an association that is stable over time. Medicinal users may be at lower risk for increased drinking on days when cannabis is also used, especially those who endorse using cannabis to substitute for alcohol. Findings help clarify the debate on cannabis-alcohol substitution or complementary associations in a sample of veterans and suggests that alcohol interventions should address cannabis use as a risk factor, especially for recreational users., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Research suggests bidirectional associations between symptoms of posttraumatic stress disorder (PTSD) and sleep disturbance, both of which have been associated with alcohol problems. However, few studies have examined the interplay of these conditions in predicting alcohol problems over time. This study tested 2 competing models: (i) sleep disturbance as a mediator of the association between intrusive thoughts about trauma and alcohol problems and (ii) intrusion symptoms as the mediator of the sleep/alcohol problem association., Methods: Veterans (N = 325, 93% male, 81% White) completed assessments at baseline, 6 months, and 12 months as part of a larger observational study. Zero-inflated-negative binomial models were used to examine indirect effects of baseline predictors on (i) yes/no likelihood and (ii) number of 12-month alcohol problems through 6-month mediators. Models controlled for past-year cannabis use and drinks consumed per week at baseline., Results: The only significant predictor of alcohol problem likelihood was baseline drinking quantity. Baseline PTSD intrusions had a direct effect on number of alcohol problems at 12 months, with no indirect (mediated) effect through 6-month sleep disturbance. In the competing model, baseline sleep disturbance had a marginally significant direct effect on 12-month alcohol problems, with a significant indirect effect through 6-month PTSD intrusions., Conclusions: PTSD intrusions are associated with more alcohol problems and help explain the long-term association between sleep and alcohol problems among veterans. Because sleep disturbances are associated with more intrusive thoughts about trauma, we recommend that treatments targeting sleep in the context of PTSD and alcohol use include a cognitive component., (© 2019 by the Research Society on Alcoholism.)

Many studies have reported that heavy substance use is associated with impaired response inhibition. Studies typically focused on associations with a single substance, while polysubstance use is common. Further, most studies compared heavy users with light/non-users, though substance use occurs along a continuum. The current mega-analysis accounted for these issues by aggregating individual data from 43 studies (3610 adult participants) that used the Go/No-Go (GNG) or Stop-signal task (SST) to assess inhibition among mostly "recreational" substance users (i.e., the rate of substance use disorders was low). Main and interaction effects of substance use, demographics, and task-characteristics were entered in a linear mixed model. Contrary to many studies and reviews in the field, we found that only lifetime cannabis use was associated with impaired response inhibition in the SST. An interaction effect was also observed: the relationship between tobacco use and response inhibition (in the SST) differed between cannabis users and non-users, with a negative association between tobacco use and inhibition in the cannabis non-users. In addition, participants' age, education level, and some task characteristics influenced inhibition outcomes. Overall, we found limited support for impaired inhibition among substance users when controlling for demographics and task-characteristics., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Cannabis users with a dysregulatory risk factor may be particularly vulnerable to engaging in more frequent and problematic cannabis use. Contemporary models of dysregulated behavior suggest that dysregulation emerges due to distinct mechanisms. The current study seeks to examine the dysregulatory correlates of cannabis involvement, including working memory capacity, delay discounting, impulsivity, and reward sensitivity., Method: Participants were 104 non-treatment seeking frequent cannabis users (the average participant used cannabis 71% of the days/past 60 days [SD = 22%], with an average of two uses per day [SD = 1.2]). Mean age was 21.3 (SD = 4.3); 36.5% were female. Working memory was assessed via the Trail-Making Test-B and the Digit Span subtests of the WAIS-III, delay discounting was assessed via a computer-based task, trait impulsivity was self-reported via the Barratt Impulsiveness Scale, and reward sensitivity was self-reported via the Reward Dependence Scale and the Snaith-Hamilton Pleasure Scale., Results: Structural equation modeling estimated the associations between different facets of dysregulation and cannabis involvement. Results suggest that poor working memory capacity and high trait impulsivity were associated with both use and problem use. Greater delay discounting was associated with problem use, but not with frequency of use. Low reward sensitivity was associated with more frequent cannabis use, but not with problem use., Conclusions: Results confirm that the dysregulatory correlates of cannabis involvement consist of multiple dimensions of functioning. Prospective studies that assess the multidimensional structure of dysregulation and cannabis involvement are needed in order to disaggregate the dysregulatory antecedents and consequences of cannabis involvement., (Published by Elsevier Ltd.)

Frequency of cannabis use and cognitive vulnerabilities such as anxiety sensitivity (i.e., the fear of bodily sensations), have been independently linked with poor physical health, however the interplay between these health-mental health processes may compound poor physical health and functioning in cannabis users. Thus, the current study evaluated the direct and interactive effects of cannabis use frequency and anxiety sensitivity on physical health and functioning among cannabis-using veterans. Participants ( N = 138) were post-9/11 United States veterans recruited from a Veterans Affairs hospital who reported cannabis use in the past six months. Cannabis use frequency in the past month and anxiety sensitivity were significantly negatively correlated with perceived overall physical health. There was a significant interaction between cannabis use frequency and anxiety sensitivity, such that more frequent cannabis use was associated with poorer overall health and role functioning due to health problems among veterans with higher anxiety sensitivity (but not lower). Findings suggest that anxiety sensitivity is a cognitive vulnerability linked to poor perceived physical health and impairment among frequent cannabis users and could be targeted, along with cannabis use, for health-promotion in cannabis users., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare (None)

Objective: Vaporization of marijuana products, or "vaping," has become a prevalent mode of administration and is typically perceived to hold unique benefits compared to combustible administration methods. Such positive beliefs regarding marijuana vaporization may contribute to its abuse liability. This qualitative study examined cognitions pertaining to vaping among recreational marijuana users., Method: Focus groups were conducted with frequent marijuana users (N = 31; five groups; six to seven per group; M = 5.0 days/week marijuana use). Three topic areas were queried during discussions with the goal of revealing factors that may contribute to the abuse liability of vaporization. These comprised differences between smoking and vaporizing marijuana products, perceived advantages of vaporization, and perceived disadvantages of vaporization. Focus groups lasted approximately 60 minutes and followed a semistructured agenda; the sessions were audio recorded and transcribed for an applied thematic analysis. An executive summary of each group was made and key themes pertaining to vaporization were summarized., Results: Several themes emerged, including differences between smoking and vaporizing marijuana, convenience, discretion, and efficiency of vaping, perceived health benefits, the absence of traditional smoking rituals, and the high cost of vaporization devices., Conclusions: Several factors appear to promote marijuana vaporization, including device aspects (e.g., discreet, convenient), the subjective high, economical efficiency, and perceived harm-reducing and health-promoting effects. These qualitative data highlight unique cognitions about marijuana vaping that may substantially increase its abuse liability. Quantitative research is needed to examine the extent to which cognitions about marijuana vaporization contribute to actual use patterns and problematic behaviors.

Background and Aims: The evolving legal status of cannabis world-wide necessitates evidence-based regulatory policies to minimize risks associated with cannabis misuse. A prominent concern is the impact legalization may have on the illegal cannabis market, including whether illegal cannabis will serve as a substitute for legal cannabis. Empirical data on this issue are virtually non-existent. This study used behavioral economics to investigate substitutability of legal and illegal cannabis in legalized catchment areas in the United States., Design: A substitution-based marijuana purchase task assessed estimated cannabis consumption from concurrently available legal (a dispensary) and illegal (a dealer) sources. Prices of the two options were reciprocally either held constant ($10/gram) or escalated ($0-$60/gram)., Setting: US states with legalized recreational cannabis., Participants: Adult cannabis users who were at least 21 years old (n = 724; mean age = 34.13; 52% female; 74% Caucasian) were recruited using online crowdsourcing., Measurements: Mean consumption values were used in demand curve modeling to generate indices of price sensitivity and elasticity. Differences in demand indices were compared using extra sums-of-squares F-tests., Findings: Both legal and illegal fixed-price cannabis options had significant positive cross-price elasticities (Ps < 0.001), indicating that higher prices motivate substitution irrespective of legality. However, the presence of a legal alternative had a substantially greater effect on consumption and elasticity of illegal cannabis (∆ elasticity  = 0.0019; F (1,37)  = 160, P < 0.0001) than the presence of an illegal alternative on demand for legal cannabis (∆ elasticity  = 0.0002; F (1,37)  = 48, P < 0.0001), indicating asymmetric substitution. Demand for legal cannabis was significantly greater than for illegal cannabis (P < 0.0001)., Conclusions: Cannabis users treat legal cannabis as a superior commodity compared with illegal cannabis and exhibit asymmetric substitutability favoring legal product. Cannabis price policies that include somewhat higher consumer costs for legal cannabis relative to contraband (but not excessively higher costs) would not be expected to incentivize and expand the illegal market., (© 2018 Society for the Study of Addiction.)

Background: Prior research shows that cannabis use during treatment for Alcohol Use Disorders (AUD) is related to fewer abstinent days from alcohol, although only among those who use cannabis 1-2x/month. Here we extend prior research by assessing the relationship between the frequency of cannabis use during AUD treatment and post-treatment alcohol-related consequences., Methods: Data come from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a large US randomized control trial of treatments for AUD. The current analyses include 206 cannabis users and 999 cannabis abstainers and compare longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. The primary exposure was quartiles of cannabis use (Q1: less than 1x/month during treatment, Q2: 1-2x/month, Q3: 4-8x/month, Q4: 12x/month or more), with cannabis abstainers as the reference group. Outcomes were alcohol-related problems at the end of treatment and one-year post-treatment as measured by the Drinker Inventory Consequences., Results: Compared to cannabis abstinence, the most frequent use during treatment was related to 1.44 times as many physical consequences one-year post-treatment. Cannabis use was not related to physical consequences immediately after treatment, or to intrapersonal, interpersonal, social responsibility or impulse control problems at either post-treatment time point., Conclusions: In a sample of individuals in treatment for AUD, using cannabis 12x/month or more during treatment is associated with increased rates of physical consequences attributed to alcohol use. Individuals in treatment for AUD who also use cannabis might benefit from reducing or stopping cannabis use to avoid alcohol-related physical problems., (Copyright © 2018 Elsevier B.V. All rights reserved.)