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Simultaneous alcohol and cannabis (SAM) use and alcohol mixed with energy drinks (AmED) days are associated with heavier drinking and negative consequences compared to alcohol-only days. However, it remains unclear if SAM and AmED days differ from one another in terms of consumption and negative consequences. It also remains unclear how often days characterized by both SAM + AmED occur and if these days are associated with incremental risk for heavier drinking and negative consequences. College students who engage in SAM use and AmED completed a 30-day timeline followback interview. Day-level data on drinking days were curated to test whether days characterized by alcohol only, SAM use only, AmED use only, or SAM + AmED were associated with increased drinking quantity, negative alcohol consequences, and positive alcohol consequences. Twenty-one percent of drinking days were AmED days, 19% were SAM days, and 15.4% were SAM + AmED days. SAM-only, AmED-only, and SAM + AmED days were associated with increased drinking and negative consequences compared to alcohol-only days. However, SAM-only and SAM + AmED (but not AmED-only) days were associated with more positive consequences than alcohol-only days. SAM-only and AmED-only days did not differ in drinking quantity or consequences, whereas SAM + AmED days were associated with increased drinking and negative (but not positive) consequences compared to both SAM-only and AmED-only days. Combined SAM + AmED days are common and associated with increased risk for negative outcomes. Prevention efforts should consider how to reduce the occurrence of SAM + AmED use and how to reduce risk on days when it does occur. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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: The COVID-19 pandemic highlighted the need for timely, evidence-based rapid risk assessments (RRA) of infectious disease events to inform public health action during rapidly evolving situations with high uncertainty. In 2022, the Public Health Agency of Canada established a coordinated approach to public health risk assessment, including a methodology for qualitative RRA of infectious disease threats., Objective: To describe the RRA methodology and illustrate its use with examples from different infectious hazards of public health concern., Methods: The RRA methodology employs the risk pathway to describe the sequence of events leading from a hazard's source to the adverse event of concern and subsequent impacts; define specific questions to be addressed; and identify relevant knowledge gaps, limitations and recommendations. Qualitative likelihood and impact estimates are derived through integration of evidence review and expert opinion and are communicated together with corresponding levels of uncertainty. The impacts of the event are based on an assessment of the most likely spread scenario within Canada, considering individual-level impact on affected individuals, the impact on the general population and, if relevant, sub-groups at higher risk., Results: This RRA approach aligns with well-established international methods and provides flexibility to accommodate a broad range of risk questions. It has been implemented to estimate the risk of various threats of concern to Canada, including mpox, avian influenza A(H5N1) and measles., Conclusion: Given the broad range and complexity of public health hazards, RRAs provide a timely, coordinated and systematic process for characterizing and communicating the risk to inform risk mitigation and decision-making and to guide appropriate public health response., Competing Interests: Competing interests None.

Objective: Decades of research has found support for the motivational model of alcohol use at the between-person level, yet research on event-level drinking motives is in its nascent stage. Similarly, drinking context has been largely ignored in studies of day-level motives. Therefore, the present study sought to test whether drinking context mediates the relation between affect and motivation on drinking outcomes at both day and person levels., Method: Emerging adults who drank in solitary and social settings (N = 107; 61.2% female) completed 21 days ecological momentary assessments. Affect was assessed during morning/afternoon reports; drinking motives were assessed during afternoon reports; and past-night drinking context, drinking quantity, and negative consequences were assessed during next morning reports. Two-level multilevel structural equation models tested whether within-person and between-person levels of predrinking affect were indirectly associated with negative consequences through predrinking motives, drinking context (social vs. solitary), and drinking quantity., Results: At the day and person levels, positive affect was associated with higher social and enhancement motives. At the day level, positive affect indirectly predicted consequences through social motives, social (vs. solitary) drinking, and drinking quantity, whereas positive affect indirectly predicted consequences through enhancement motives and drinking quantity above and beyond context. At the day and person levels, negative affect was associated with coping motives, but coping was not associated with context, drinking quantity, nor consequences., Conclusions: Findings suggest that positive affect was linked to drinking outcomes through motives (enhancement and social) and contexts (social), whereas negative affect was not. Findings suggest that positively valenced drinking motives may be an important just-in-time intervention target. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The theory of aversive transmission posits that children of parents who have an alcohol use disorder (AUD) may abstain or limit their own alcohol use because they believe themselves to be at risk of developing problems with alcohol. The present study examined relationships among parental AUD, perceived parental AUD, perceived risk for AUD, addiction avoidance reasons for limiting alcohol use, and alcohol use using a random intercept cross-lagged panel model., Method: Participants ( N = 805; 48% female; 28% Latinx) were from a longitudinal study investigating intergenerational transmission of AUD. Parental AUD, perceived parental AUD, perceived risk for AUD, addiction avoidance reasons for limiting alcohol use, and alcohol use (quantity, frequency, and frequency of heavy drinking) were measured every 5 years from late adolescence ( M age = 20) to adulthood ( M age = 32). Random intercept cross-lagged panel models tested whether there were stable between-person relations or time-varying within-person relations among these variables., Results: At the between-person level, perceived parental AUD predicted greater addiction avoidance reasons for limiting alcohol use and greater perceived risk. Those with greater addiction avoidance reasons for limiting alcohol use were less likely to use any alcohol and drank less frequently. Parental AUD was associated with higher levels of alcohol use as well as perceived risk. No consistent cross-lagged paths were found at the within-person level., Conclusions: Study findings were at the between-person level rather than the within-person level. Future work on aversive transmission is needed to better understand this subgroup of children of parents with AUD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Negative reinforcement models suggest that negative affect should predict event-level substance use, however, supporting daily-life evidence is lacking. One reason may be an emphasis in ecological momentary assessment (EMA) research on use behavior, which is subject to contextual and societal constraints that other substance outcomes, such as craving, may not be subject to. Therefore, the present study tested momentary, within-person reciprocal relations among negative affect and craving for alcohol and cannabis in daily life., Method: Adults ( N = 48) completed 60 days of EMA, consisting of four daily reports spanning 7 a.m.-11 p.m. assessing current negative affect and alcohol/cannabis craving. Preregistered analyses used dynamic structural equation modeling to test whether (a) within-person increases in negative affect co-occurred with within-person increases in alcohol and cannabis craving, and (b) within-person increases in negative affect predicted later within-person increases in craving (and vice versa), and (c) relations differed by substance use frequency., Results: Within-person increases in negative affect were contemporaneously associated with within-person increases in alcohol and cannabis craving. However, increases in negative affect did not prospectively predict increases in craving, and within-person increases in craving did not prospectively predict within-person increases in negative affect. Within-person relations were not moderated by substance use frequency., Conclusions: Negative affect and craving were associated in community adults. However, results advance a growing body of EMA work suggesting that the association of daily-life negative affect and substance use is, at best, not straightforward. Careful attention is needed to better translate existing negative reinforcement theory to the realities of daily life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Impulsive personality traits are strong, consistent risk factors for heavy drinking, and modern theories suggest that impulsive traits may also confer risk for internalizing symptoms. However, it remains unclear which specific impulsive traits are linked with heavy drinking versus internalizing symptoms, and whether heavy drinking and internalizing symptoms are mechanisms of risk for negative alcohol consequences in impulsive individuals., Method: Data are from a longitudinal study of young adults (N = 448, M age  = 22.27, 43.5 % female) assessed at baseline (T1), 6 months (T2), and one year later (T3). Longitudinal path models tested whether T1 impulsive traits (i.e., lack of premeditation, lack of perseverance, sensation seeking, positive urgency, negative urgency) were indirectly associated with T3 negative alcohol consequences through heavy T2 drinking and T2 internalizing symptoms (i.e., depression, anxiety, stress). Separate models were tested for positive and negative urgency given strong correlations between these measures., Results: Across models, T1 lack of premeditation indirectly predicted more T3 negative alcohol consequences through heavy T2 drinking. When tested separately, T1 negative urgency indirectly predicted more T3 negative consequences through higher T2 stress and depressive (but not anxiety) symptoms, and T1 positive urgency predicted higher T2 anxiety symptoms, but T2 anxiety was unrelated to T3 negative consequences. Across models, T1 sensation seeking indirectly predicted less T3 negative consequences through decreased T2 depression., Conclusions: Distinct impulsive traits prospectively predicted heavy drinking and internalizing symptoms, both of which conferred risk for negative alcohol consequences. Findings underscore the importance of targeted interventions based on personality and suggest that decreases in drinking may be more effective prevention for those who lack premeditation, whereas decreases in internalizing, particularly depression/stress, may be critical for those high in negative urgency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Pregaming represents a uniquely high-risk drinking event for young adults, and subfacets of impulsivity are robust predictors of alcohol use and related negative outcomes. Further, it is likely that pregame events contain social and physical stimuli that are particularly appealing for impulsive individuals, thus exacerbating risk for negative outcomes. However, no prior studies have investigated the extent to which impulsive personality traits interact with pregame events to confer alcohol-related risk. Thus, the present study examined the extent to which UPPS-P (urgency-perseverance-premeditation-sensation seeking-positive urgency) subfacets of impulsivity interact with the occurrence of pregaming to predict relations between pregaming, drinking quantity, and negative alcohol-related outcomes. College students ( N = 737) completed a modified, online version of the 30-day Timeline Followback in which they reported drinking quantity, negative consequences, and whether they engaged in pregaming on a given day. Results indicated that sensation seeking and a lack of premeditation moderated relations between pregaming and drinking quantity such that those who are higher in sensation seeking and lower in their ability to plan ahead drank more on pregaming days. Sensation seeking and positive urgency moderated relations between pregaming and negative consequences such that those who are higher in positive urgency experience more consequences on pregaming days whereas those who are higher in sensation seeking experience less consequences. Future studies may benefit from more granular assessments of pregame-related risk as subfacets of impulsivity may confer momentary risk. Prevention efforts targeting the reduction of pregaming frequency, particularly among impulsive individuals, may lower overall risk for heavy drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Research suggests that parental substance use disorder is associated with adolescent drinking indirectly through negative urgency, a form of impulsivity that is particularly associated with high-risk drinking. Moreover, childhood mechanisms of risk may play a role in this developmental chain such that childhood temperament and parenting may be mechanisms through which parental substance use disorder is associated with adolescent negative urgency and drinking behavior. Therefore, the current study tested whether parental substance use disorder was indirectly associated with adolescent drinking frequency through childhood temperament (i.e., "dysregulated irritability") and adolescent negative urgency, and whether relations differed by levels of maternal support and consistency of discipline. Data come from a multigenerational, longitudinal study of familial substance use disorder (N = 276, M age in childhood = 6.28 (SD = 1.16), M age in adolescence = 15.86 (SD = 1.56), 45.3% female). Findings indicated that parental substance use disorder indirectly predicted adolescent drinking through both childhood dysregulated irritability and adolescent negative urgency (mediated pathways). This indirect relation was stronger at higher vs. lower levels of maternal support but did not vary by maternal consistency of discipline. Parental substance use disorder also indirectly predicted adolescent drinking separately through childhood dysregulated irritability and negative urgency. Findings thus suggest that childhood dysregulated irritability may be an early marker of risk toward high-risk personality traits and behavior in adolescence that are associated with having a parental history of substance use disorder. Findings also suggest that increased maternal support may only be helpful in buffering risk for those with low levels of dysregulated irritability. Prevention efforts focused on childhood emotion regulation and emotion-based action may be useful in preventing adolescent risk behavior., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Heavier drinking and depression are common mental health concerns in the USA, yet few studies have sought to understand transdiagnostic risk factors for both. Two health-focused risk factors are impulsive personality traits and sleep duration, but research typically separates the two, precluding additive and interactive relations. The current study sought to test a theoretical model where risk conferred from impulsive traits is heightened when individuals have reduced sleep. Public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) were used to test study hypotheses. Participants reported on impulsive traits (i.e., lack of premeditation, sensation seeking), sleep duration, depression, and drinking across three waves spanning adolescence, emerging adulthood, and adulthood. Multilevel models distinguished risk processes at the between- vs. within-person level. At the between-person level, sensation seeking predicted drinking whereas premeditation predicted depression. Additionally, within-person deviations in both traits were associated with drinking, whereas within-person deviations in premeditation were associated with depression. Sleep duration was protective against outcomes at both levels. However, main effects were qualified by interactions at both levels, such that having below average sleep duration heightened the effects of premeditation at the between-person level, whereas within-person decreases in sleep heightened the effects of sensation seeking at the within-person level. Findings support a theoretical model where poor sleep exacerbates risk conferred from impulsive traits. Risk conferred from impulsive traits diverged based upon level of analysis, suggesting that global and just-in-time interventions may benefit from targeting specific impulsive traits as well as sleep., Competing Interests: Conflict of Interest The authors declare no competing interests.

Background: Simultaneous alcohol and cannabis use is associated with negative outcomes, yet little is known about what motivates the decision of simultaneous use. One possibility is that early-episode subjective effects motivate simultaneous use to complement or replace the first substance's effects. The current study used a hypothetical decision-making task to test this hypothesis. Objectives: College students ( N  = 486) were presented eight scenarios characterized by alcohol/cannabis subjective effects (i.e., high/low arousal positive [e.g., excited, relaxed], high/low arousal negative [e.g., aggressive, dizzy]) and asked their likelihood of simultaneously using the other substance per scenario. Multilevel modeling tested whether subjective effect scenarios predicted a higher likelihood of simultaneous use and whether ordering moderated this association. Results: Task-based simultaneous use likelihood was associated with self-reported simultaneous use, showing task validity. Scenarios characterized by high/low arousal positive effects were associated with higher likelihood of simultaneous use, whereas high/low arousal negative scenarios were associated with lower likelihood. Alcohol vs. cannabis-first scenarios were associated with higher likelihood of simultaneous use, and significant interactions were observed for high/low arousal positive and high arousal negative effects. High arousal positive scenarios were associated with higher likelihood of simultaneous use when cannabis was used first, low arousal positive scenarios with higher likelihood when alcohol was used first, and high arousal negative scenarios with lower likelihood when cannabis was used first. Conclusions: Beginning-of-episode subjective substance effects may be a promising event-level predictor of simultaneous use, and just-in-time interventions may benefit from targeting the ordering and subjective experiences of alcohol and cannabis use.

Introduction: Impulsive personality traits are associated with cannabis problems. Person-Environment Transactions Theory suggests that highly impulsive individuals behave differently in certain contexts, however little research has focused on the context in which cannabis is used. Therefore, the current study tested whether impulsive traits moderated relations between cannabis use contexts (social vs. solitary) and cannabis problems., Method: In this cross-sectional study, college student who use cannabis (N = 435; 60.7% female) reported on their impulsive traits (i.e., negative urgency, positive urgency, premeditation, perseverance, and sensation seeking), typical cannabis use context (i.e., alone, with friends), typical cannabis use frequency, and past 30-day cannabis problems., Results: Both solitary cannabis use and negative urgency were associated with more cannabis problems. There were significant interactions between negative urgency and solitary cannabis use and lack of perseverance and solitary cannabis use, such that high and mean (but not low) levels of both negative urgency and lack of perseverance were associated with more cannabis problems the more frequently an individual used cannabis alone. There was also a significant interaction between sensation seeking and social cannabis use, such that high and mean (but not low) levels of sensation seeking were associated with cannabis problems for individuals who used cannabis more socially., Conclusions: Findings suggest that impulsivity may potentiate risk for cannabis problems depending on the context in which cannabis is used. Prevention efforts may benefit from targeting protective strategy use in certain cannabis use contexts based upon an individual's personality traits., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This study was supported by grant F31-AA030167 (PI: Jack T. Waddell) from the National Institute on Alcohol Abuse and Alcoholism., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Concurrent and simultaneous cannabis and alcohol co-use confers risk for daily negative alcohol consequences. However, studies often treat co-use as a dichotomy, precluding examination of higher- and lower-risk co-use days. Additionally, little is known about specific alcohol consequences associated with daily co-use. Therefore, the current study 1) differentiated days based upon alcohol consumption, co-use, and simultaneous use, and 2) tested whether certain day-level use patterns conferred risk for daily alcohol consequences., Methods: College student co-users (N=489) completed an online Timeline Followback, reporting daily alcohol consumption, negative alcohol consequences, concurrent cannabis and alcohol co-use, and simultaneous co-use (SAM) on drinking days over the past month. Day-Level Latent Profile Analysis differentiated days based upon drinking quantity, co-use, and simultaneous use, and tested whether patterns of use conferred risk for overall and specific negative alcohol consequences., Results: Four day-level profiles emerged, including moderate consumption of alcohol-only days (57.5%), moderate consumption SAM use days (29.1%), higher consumption alcohol-only days (7.4%), and higher consumption SAM use days (6%). Higher consumption SAM use days were associated with more negative alcohol consequences than all other days; however, higher consumption SAM use days differed from higher consumption alcohol-only days in acute dependence symptoms. Higher consumption alcohol-only days were associated with more negative alcohol consequences than moderate consumption SAM days, particularly those that were action-oriented (i.e., dependence symptoms, blackout drinking, impaired control, risky behavior, social/interpersonal consequences)., Conclusions: Findings suggest that there are in fact lower-risk co-use days, and that links with unique negative alcohol consequences depend on levels of alcohol consumption and co-use., (© 2023 Authors et al.)

Objective: Theoretical models of addictive behavior suggest that subjective effects serve as a mechanism through which substance use disorders develop. However, little is known about the subjective effects of simultaneous alcohol and cannabis use, particularly whether simultaneous use (a) heightens specific subjective effects or (b) is related to unique subjective effects relative to single-substance effects. The present study used formative, qualitative data analysis to examine patterns of responses within open-answer text response data on subjective effects of simultaneous use., Method: College students who simultaneously use alcohol and cannabis ( N = 443; 68.2% female) were asked to describe how alcohol effects differ on simultaneous alcohol and cannabis use versus alcohol-only use days., Results: Conventional content analysis revealed nine concepts related to simultaneous (vs. alcohol-only) use subjective effects including as follows: (a) increased/decreased impairment, (b) low arousal/relaxation, (c) balancing/replacement effects, (d) "cross-faded" effects, (e) little-to-no differences, (f) altered sensation and perception, (g) increased negative affective states, (h) increased appetite, and (i) increased/decreased negative consequences. Increased impairment ( N = 191) and increased relaxation ( N = 110) were the most often endorsed subjective effects, followed by decreased impairment (N = 55), balancing/replacement effects ( N = 50) and cross-faded/enhancement effects ( N = 44)., Conclusions: Subjective effects from simultaneous use largely map onto domains of single-substance alcohol and cannabis effects (e.g., relaxation, sociability, cognitive/behavioral impairment), but also include distinct domains related to simultaneous use (e.g., balancing/replacement effects, altered sensation and perception). Future quantitative research is needed to validate measures of subjective effects from simultaneous use and their relations with use behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: The legal cannabis landscape has greatly outpaced scientific knowledge. Many popular cannabis claims, such as cultivar (colloquially referred to as strain) classification and terpene content producing different subjective effects, are unsubstantiated. This study examined, for the first time, whether cultivar classification (sativa/indica) and terpene content (caryophyllene, limonene, myrcene, pinene, and terpinolene) were associated with subjective cannabis effects (i.e., pain levels, low-arousal ["indica-like"] effects, high-arousal ["sativa-like"] effects, and negative effects). Methods: Regular cannabis users ( n =101) took part in a 2-week long ecological momentary assessment study in which they responded to questions about their cannabis use, stated their preference for sativa versus indica, and reported their in-the-moment subjective effects within 30 min of smoking cannabis. Cultivars were coded for sativa versus indica classification and primary terpene content using Leafly, a popular search engine. Linear mixed-effect models then examined subjective response by sativa/indica and primary terpene. Covariates included demographics (age, sex, race, income), cannabis use (medical use, cannabis use frequency, stated preference for sativa/indica, global expected cannabis effects), morning pain ratings, and specific smoked cannabis occasions (hour of day, minutes since use, context, number of hits, and tetrahydrocannabinol). Results: The majority of participants (78.3%) had a preference for either sativa or indica and reported reasons for their preference that aligned with industry claims. After controlling for covariates, findings revealed that cultivars classified as indica dominant were associated with greater low-arousal (e.g., sluggish, slow) effects relative to the unweighted mean of all cannabis cultivars ( b =  0.44, SE=0.16, p =0.01). Cultivars with primary caryophyllene were associated with greater pain ratings ( b =  0.53, SE=0.24, p =0.03) and negative effects ( b =  0.22, SE=0.08, p =0.01) relative to the mean of all other terpene types. Cultivars with primary pinene were associated with less negative effects ( b =  -0.35, SE=0.18, p =0.04). Conclusions: Cultivars classified as indica dominant were associated with greater low-arousal effects in models that accounted for both within- and between-person variation, despite the scientific challenges distinguishing between sativa and indica. Preliminary findings also suggest terpenes may play a role in subjective effects. These results emphasize the need for further research, particularly controlled lab studies.

Alcohol misuse represents a universal public health concern that spans multiple demographics. As such, understanding shared, biological indicators of alcohol-related risk is vital to implementing targeted prevention and intervention efforts. Self-report measures of subjective response to alcohol (SR) capture both psychological and pharmacological effects of alcohol and robustly predict patterns of alcohol use, negative consequences, and the development of alcohol use disorders. Importantly, several biological markers of alcohol's sedating effects, including cortisol, have been identified and complement subjective response assessments. However, biological markers of alcohol's stimulating effects are less understood. Studies have implicated alcohol-induced changes in heart rate as a viable marker, but heart rate measurements are susceptible to measurement error. Salivary α-amylase, a reliable indicator of sympathetic nervous system activation, represents a promising alternative biomarker of alcohol-induced stimulation. Using data from a large, placebo-controlled alcohol administration study ( N = 448), the present study examined the extent to which α-amylase is a viable marker of alcohol-induced stimulation. To test this, a measurement model was estimated in which baseline and ascending limb subjective stimulation latent variables were created using two validated measures of subjective response. Ascending self-reports of stimulation and levels of α-amylase were then regressed onto beverage conditions and allowed to correlate with each other. Findings indicated that α-amylase is sensitive to acute alcohol consumption and is positively, but not statistically reliably, related to the ascending limb stimulant SR. Future studies should consider including salivary α-amylase as a noninvasive physiological indicator of alcohol's stimulating effects. (PsycInfo Database Record (c) 2023 APA, 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.)

Emerging adult alcohol and cannabis co-use is on the rise and enacts risk for alcohol misuse/alcohol use disorder (AUD). However, few studies have differentiated whether levels of cannabis use (rather than any cannabis use) moderate between-person risk. Considering low-frequency co-users may use both substances via substitution, low-risk/frequency co-use may not enact the same risk for AUD as higher risk co-use. The present study sought to test this assertion. Public access data on emerging adults from the National Study on Drug Use and Health were used (2002-2019; N = 231,681). Participants reported on their past year alcohol use, cannabis use, as well as AUD symptoms. Regression models tested whether levels of cannabis use frequency moderated the association between alcohol use frequency and AUD symptom counts. A significant interaction of cannabis use frequency by alcohol use frequency predicting AUD symptoms was detected. Individuals who co-used alcohol and cannabis reported more AUD symptoms than those who only used alcohol at the same frequency or less. However, co-use was associated with lower AUD symptom counts than alcohol-only use at higher frequency. Findings suggest that all co-users (and alcohol-only users) are not necessarily created equal, and that relations among co-use and risk for AUD symptoms are complex. Rather than a dichotomy of co-users versus alcohol-only users, between-group risk may depend on frequency of both alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction: Military Veterans have an increased risk of suicide compared to the general population, but less is known about changes in risk with the onset of the COVID-19 pandemic, or whether any changes have been moderated by psychiatric or demographic factors. The primary objective was to test the hypothesis that the likelihood of suicide attempt or death by suicide was stable during the first year of the pandemic versus the preceding year for the full sample. A second objective was to test the hypothesis that, in contrast, risk increased for Veteran subgroups characterized by traditional risk factors (e.g., psychiatric diagnosis)., Materials and Methods: We extracted electronic health record data for 771,570 Veterans who received one or more health care visits between March 13, 2019, and March 12, 2021, at eight VA hospitals across the southwestern United States. Primary outcome measures were suicide attempts and deaths by suicide. Predictor variables included psychiatric diagnoses and demographic factors., Results: Multivariable models indicated that the odds of death by suicide did not change during the first year of the COVID-19 pandemic, while the odds of making a suicide attempt declined. Veterans treated for major depression were at heightened risk for attempting suicide in both years, but the association was smaller during the pandemic than the year prior. In contrast, the relative risk of attempt for Veterans who were never married and Veterans treated for a non-alcohol, non-opioid substance-use disorder increased during the pandemic., Conclusions and Relevance: The findings suggest that the pandemic has not led to an increase in suicidal behavior, which is consistent with other studies, although the degree of decline varied across diagnostic and demographic groups. Further longitudinal research is needed to evaluate whether the prolonged nature of COVID-19 may lead to changes in risk over time., (© The Association of Military Surgeons of the United States 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Models of personality suggest that adolescent substance use may be associated with adolescent impulsive traits as well as changes in impulsive traits from adolescence into emerging adulthood. However, little research has focused on how adolescent alcohol and cannabis co-use, an increasingly popular and risky substance use pattern, may relate to adolescent impulsive traits as well as changes in impulsive traits from adolescence to emerging adulthood. Therefore, the current study tested patterns of adolescent co-use and their links with adolescent impulsive traits and changes in impulsive traits into emerging adulthood. Data come from the Add Health study and encompassed two timepoints spanning adolescence (age 13-18) and emerging adulthood (age 19-25). A combination of latent profile analysis, mean comparisons, and latent difference scores were estimated. Results suggested that four profiles of co-users and alcohol-only users emerged, and profiles differed in levels of adolescent personality and prospective personality change. Importantly, frequent adolescent co-users had higher levels of adolescent sensation seeking and impulsivity, but also reported the steepest decline in both traits into emerging adulthood. Findings are discussed in terms of personality theory and public health implications., (© 2023 Authors et al.)

Objective: Alcohol craving is a predictor of continued drinking and a diagnostic criterion for alcohol use disorder. Rewarding subjective effects potentiate craving, but it remains unclear if relations are expectancy-driven vs. alcohol-induced. In addition, it remains unclear if relations operate solely at the person level, or if there is also within-person dynamic change., Methods: Participants (N = 448) come from a placebo-controlled alcohol administration study. Participants in the alcohol condition reported subjective effects and alcohol craving on ascending (BAC = .068), peak (BAC = .079), and descending (BAC = .066) BAC limbs. Participants in the placebo condition were yoked to alcohol condition participants. Multilevel models tested whether (1) within-person deviations in subjective effects predicted within-person deviations in craving, (2) between-person levels of subjective effects predicted between-person levels of craving, and (3) effects were dependent upon experimental condition., Results: At the within-person level, increases in high arousal positive/stimulant effects were associated with within-person increases in alcohol craving, regardless of experimental condition. At the between-person level, interactions were observed between high arousal positive/stimulant (and low arousal positive/relaxing) effects and condition. Probing suggested that the association between person-level high arousal positive/stimulant effects and craving was statistically significant in the alcohol but not the placebo condition. Conversely, the association between person-level low arousal positive/relaxing effects and craving was positive and statistically significant in the placebo but negative in the alcohol condition., Conclusions: Findings suggest expectancy-like relations among high arousal positive/stimulant effects and craving within-person. However, alcohol-induced positive reinforcement (i.e., stimulation) facilitated heightened person-level craving, whereas expectancy-like negative reinforcement (i.e., relaxation) attenuated person-level craving., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Day-level drinking motives are associated with intensity of drinking and occurrence of negative consequences. However, little is known about how day-level drinking motives relate to alcohol craving, an approach-oriented motivational state proximal to continued drinking. This study tested whether day-level (and between-person) drinking motives were associated with craving during drinking episodes and whether this effect varied by drinking-induced changes in negative/positive affect (PA). Emerging adults ( N = 114) took part in up to two waves of 21-day ecological momentary assessments. Participants reported positive/negative affect (NA) prior to and during drinking episodes, drinking motives at beginning of episodes, and craving during all drink reports. Analyses tested whether day-level and between-person (aggregated) drinking motives were associated with heightened craving and whether any effects on craving were moderated by drinking-induced changes in affect. A significant interaction emerged for day-level coping by negative affect, such that higher-than-average coping was associated with less drinking-induced craving when negative affect decreased relative to predrinking levels. However, interactions of between-person coping by negative and positive affect also emerged, such that higher person-level coping was associated with more drinking-induced craving when negative affect and positive affect increased. Day-level and between-person conformity motives by negative affect interactions were also detected, such that higher day-level and between-person conformity motives were associated with more drinking-induced craving when negative affect decreased. Relations between day-level motivation and craving may be sensitive to changes in negative/positive affect while drinking. Future research is needed to differentiate mechanisms through which person-level versus day-level motives relate to craving. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: The Acquired Preparedness Model (APM) posits that highly impulsive individuals develop stronger positive alcohol expectancies, which in turn predicts heavier drinking. However, most acquired preparedness studies have focused solely on between-person relations, despite the theory suggesting that there are potential developmental-specific within-person relations. Thus, the current study tested the APM from late adolescence into adulthood, while disaggregating within- from between-person relations., Methods: Data come from a multigenerational study of familial alcohol use disorder (N=653) spanning three waves 5 years apart. Participants reported their lack of conscientiousness, sensation seeking, positive alcohol expectancies, and binge drinking at each wave. First, missing data techniques were used to create a "ghost timepoint," allowing the specification of four developmental-specific timepoints representing late adolescence (age 18 to 20), emerging adulthood (age 21 to 25), young adulthood (age 26 to 29), and adulthood (age 30 to 39). Second, a Random-Intercept Cross-Lagged Panel Model tested between-person and within-person relations among variables., Results: At the between-person level, lower conscientiousness and sensation seeking were correlated with higher positive expectancies, and positive expectancies were correlated with more binge drinking. There were no within-person prospective relations among conscientiousness, sensation seeking, and positive expectancies. However, within-person increases in lack of conscientiousness during late adolescence predicted within-person increases in emerging adult binge drinking, and within-person increases in late adolescent and emerging adult binge drinking predicted within-person increases in lack of conscientiousness during emerging and young adulthood, respectively. Similarly, within-person increases in late adolescent and young adult sensation seeking predicted within-person increases in binge drinking during emerging adulthood and adulthood, respectively. Binge drinking did not reciprocally predict sensation seeking., Conclusions: Findings suggest that acquired preparedness effects may be between persons rather than within persons. However, several within-person developmental-specific relations among conscientiousness, sensation seeking, and binge drinking were observed, outside of expectancies. Findings are discussed in terms of theory and prevention., (© 2023 Research Society on Alcohol.)

Background: This study examined whether the 4/20 cannabis holiday was associated with increases in medical cannabis sales from licensed dispensaries in Arizona from 2018-2021, and whether adult-use cannabis legalization (the vote in November 2020 and retail sales in January 2021) was associated with declines in medical cannabis sales and in the number of registered medical patients., Methods: Data came from the Arizona Medical Marijuana Program monthly reports from January 2018-December 2021. The reports show daily sales from licensed medical cannabis dispensaries (i.e., the number of medical cannabis dispensary transactions and the amount of cannabis sold in pounds), which we averaged by week, and show the number of registered medical cannabis patients each month. Autoregressive integrated moving average models were used to test changes in these outcomes associated with the 4/20 cannabis holiday and with legalization of adult-use cannabis., Results: During the week of the 4/20 cannabis holiday, medical cannabis dispensary transactions abruptly increased by an average of 2,319.4 transactions each day (95% CI: 1636.1, 3002.7), and the amount of medical cannabis sold increased by an average of 120.3 pounds each day (95% CI: 99.3-141.3). During the first week of adult-use cannabis sales in late January 2021, medical cannabis dispensary transactions abruptly decreased by an average of 5,073 transactions each day (95% CI: -5,929.5, -4216.7), and the amount of medical cannabis sold decreased by an average of 119.1 pounds each day (95% CI: -144.2, -94.0). Moreover, medical cannabis sales continued to gradually decline each week after the start of adult-use retail sales, with declines in sales preceding declines in registered patients. By December 2021, slightly over a year after the vote to legalize adult-use cannabis, the actual number of registered medical cannabis patients fell short of the forecasted number, had adult-use not been legalized, by 36.5%. Moreover, the number of medical dispensary transactions and the amount of medical cannabis sold fell short of expectations, had adult-use cannabis not been legalized, by 58% and 53%, respectively., Conclusions: Findings document the blurred boundary between medical and non-medical cannabis use and are consistent with the possibility that medical cannabis legalization contributes to increases in adult cannabis use and dependence., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Latino/a adolescents are increasingly represented in higher education. Whereas previous work suggests that positive aspects of the family can promote adjustment during the college transition, less is known regarding the longitudinal, reciprocal nature of these associations. The current study examined changes in parenting, family dynamics, and adjustment across the transition from high school to college among 207 Latino/a young adults ( M age = 18.10; 65.0% female identifying) in the Southwestern United States and investigated within- and between-person reciprocal relations using standard and random-intercept cross-lagged panel models. Participants self-reported on parental support, parental monitoring, family communication, depressive symptoms, and alcohol use during their senior year of high school (Time 1; spring/summer 2017), first semester of college (Time 2; fall 2017), and second semester of college (Time 3; spring/summer 2018). Parental support, family communication, depressive symptoms, and alcohol use increased across the initial transition from high school to college, whereas parental monitoring decreased across time. Reciprocal effects were largely between-person driven. Family communication in high school was concurrently and prospectively related to fewer depressive symptoms. Higher parental monitoring during the first semester of college was related to less alcohol use within and across semesters. In addition, students who experienced within-person increases in depressive symptoms during the first semester of college perceived less parental support than usual the next semester. Study findings point to the importance of developmental timing and further highlight the role that family plays during Latino/a students' transition to college. Implications for family-based prevention efforts are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Planned and unplanned substance use have been examined as predictors of heavier alcohol and cannabis use and problems at the between-person level. However, it remains unclear whether planned versus unplanned use is riskiest at the day-level, and for whom. The present study tested whether day-level planned versus unplanned alcohol and cannabis use were associated with higher alcohol and cannabis consumption and negative consequences that day and whether two impulsive traits, lack of premeditation and positive urgency, moderated associations., Method: Young adults ( N = 409; 50.9% female) completed five bursts of daily surveys, each consisting of a morning and afternoon report across 14 consecutive days. During a baseline session, participants reported their impulsivity (UPPS-P). During afternoon surveys, participants reported their plans to use alcohol/cannabis that night. During morning surveys, participants reported number of drinks consumed/hours spent high yesterday and negative consequences experienced., Results: Planned drinking days were associated with a greater number of drinks and negative consequences, whereas planned cannabis use days were associated with more hours spent high but not negative consequences. In the drinking quantity model, there was a significant interaction for planned versus unplanned drinking by positive urgency. Planned drinking was associated with heavier alcohol consumption across levels of positive urgency; however, unplanned drinking was associated with heavier consumption for individuals with higher (vs. lower) levels of positive urgency., Conclusions: Day-level planned drinking and cannabis use are important factors to target in just-in-time interventions. However, interventions focused on planned and unplanned drinking may be particularly effective for individuals with higher levels of positive urgency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Recent studies have extended the acquired preparedness model to experimental data, finding that impulsivity predicts subjective alcohol response, a related yet distinct construct from expectancies. However, studies have not tested whether specific facets of impulsivity predict subjective response, or whether impulsivity indirectly predicts alcohol craving through subjective response. Young adults who reported past-month binge drinking ( N = 448) participated in a placebo-controlled alcohol administration study. Mediation models tested whether UPPS-P impulsivity facets indirectly predicted alcohol craving through subjective response on the ascending and descending limbs of the blood alcohol content (BAC). High arousal positive (e.g., sociable), low arousal positive (e.g., relaxed), high arousal negative (e.g., rude), and low arousal negative (e.g., dizzy) subjective effects were measured across limbs. Moderation by beverage condition was not detected, so models were collapsed across beverage condition. Sensation seeking indirectly predicted craving through high arousal positive subjective response on both limbs, whereas positive and negative urgency directly predicted craving. When controlling for baseline subjective response and craving, effects of sensation seeking and negative urgency on subjective response and craving became nonsignificant. The effects of positive urgency on craving remained, and an effect of positive urgency on high arousal positive effects emerged on the ascending limb. Findings suggest that relations among impulsivity, subjective response, and craving are contingent upon the specific facet of impulsivity. Interventions targeting predrink cue exposure and/or positive emotionality may be most effective for sensation seekers, whereas targeting subjective response and/or expectancies may be most efficacious for individuals high in positive urgency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The aim of the present study was to conduct a preliminary investigation of the associations between facets of impulsivity and alcohol outcomes through motives for drinking responsibly described by self-determination theory among college students. Participants (N=2,808) were part of a multisite investigation of college student drinking across 10 universities in 8 states in the U.S. who reported past-month drinking. Results of a structural equation model testing all possible indirect associations simultaneously indicated that one-third (20 out of 60) of the indirect associations were statistically significant ( p <.01). Facets with higher scores representing higher impulsivity (negative/positive urgency) were negatively associated with more internalized motives (autonomous motivation and introjected regulation) and positively associated with less internalized motives (external regulation and amotivation) for drinking responsibly. Facets with higher scores representing lower impulsivity (perseverance and premeditation) demonstrated opposite patterns of associations with motives for drinking responsibly. In turn, more internalized motives were related to higher frequency of protective behavioral strategies use, lower alcohol use severity, and fewer negative alcohol-related consequences; less internalized motives demonstrated an opposite pattern of associations with these alcohol outcomes. The present findings should be replicated using experimental and longitudinal studies for appropriately testing mediation but offer support for a novel hypothesis for motivational pathways from impulsivity to alcohol outcomes that may provide insight into intervention targets., Competing Interests: The authors report there are no competing interests to declare.

Aims: Alcohol expectancies are directly linked to alcohol misuse and indirectly linked to negative consequences via use. Likewise, willingness to experience negative consequences imparts direct risk for negative consequences and may represent an important individual difference when predicting risky alcohol use. To date, no studies have examined how willingness to experience consequences may moderate relations between expectancies and alcohol use in the prediction of negative consequences. It is possible that those who expect appetitive effects and are high in willingness may discount the severity of negative consequences and drink more to realize positive expectations. Alternatively, those who expect aversive alcohol-related effects and are high in willingness may drink more to overcome negative experiences., Methods: The current study tested these hypotheses in a sample of undergraduate students (N = 657) from a larger study focused on alcohol and cannabis co-use., Results: Findings suggested that high-arousal positive expectancies (e.g. sociable, lively, talkative) function as a risk factor for negative consequences indirectly through heavier drinking, whereas low-arousal positive (e.g. mellow, relaxed) expectancies served as an indirect protective factor against negative consequences through lighter drinking. Willingness to experience negative consequences had direct and indirect effects on negative consequences through drinking but did not interact with alcohol expectancies., Conclusions: The present study demonstrates the utility of assessing the full range of alcohol expectancies and behavioral willingness in continued research into the dynamic nature of antecedents to alcohol misuse and negative consequences., (This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Simultaneous use of alcohol and cannabis (i.e., using both on same occasion) is a risk factor for heavier drinking and negative alcohol consequences; however, little research has investigated risk conferred for specific negative consequences. One theoretically relevant negative consequence may be alcohol hangovers; however, no studies have tested cross-sectional or prospective relations between simultaneous use and experiencing alcohol hangovers., Method: The current study (N = 2,964) used public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) to test whether simultaneous alcohol and cannabis use conferred risk for hangover frequency directly or indirectly through heavier drinking. The current study also tested moderated mediation by depressive symptoms, considering simultaneous users have higher levels of depressive symptoms, and depressive symptoms largely mirror those of a hangover., Results: In a cross-sectional model, simultaneous use was associated with more frequent hangovers both directly and indirectly through heavier drinking. In a prospective model, simultaneous use indirectly predicted more frequent hangovers through heavier drinking; however, the direct path was not significant. None of the paths from simultaneous use to drinking or hangovers were moderated by depressive symptoms in either model., Conclusions: The current study suggests that, both concurrently and prospectively, heavier drinking explained significant variance in the relation between simultaneous use and hangover frequency. The significant direct effect of simultaneous use in the cross-sectional model suggests that simultaneous users may have individual characteristics, outside of depressive symptoms, that confer risk for more frequent hangovers above and beyond heavier drinking., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Military veterans are a high-risk group for health risk behaviors, including alcohol and cannabis use. However, research on veteran vs. non-veteran rates of alcohol/cannabis use are inconsistent across studies. Further, no research has investigated veteran vs. non-veteran rates of alcohol and cannabis co-use, and few studies have tested whether demographic variables, particularly race/ethnicity, moderate group differences. Therefore, the current study tested whether 1) veteran vs. non-veterans differed in rates of alcohol use, cannabis use, and alcohol and cannabis co-use, and 2) whether demographic covariates (age, sex, race/ethnicity) moderated associations., Methods: Data on adults (N = 706,897; 53.4% female) were derived from the 2002-2019 National Study on Drug Use and Health. Participant demographics, alcohol use frequency, drinking quantity, and cannabis use frequency were self-reported., Results: Non-veterans reported higher drinking quantity, cannabis frequency, and co-use. However, being a veteran was a risk factor for heavier drinking for women, ethnic/racial minoritized participants, and adults under the age of 50. Additionally, veteran status was a risk factor for cannabis use frequency in racial/ethnic minoritized participants and women. Similarly, being a veteran was a risk factor for alcohol and cannabis co-use for racial/ethnic minoritized participants, and the buffering effect of being a Veteran on co-use was reduced for older participants and women., Conclusions: Results suggest that, at the population level, non-veterans may be heavier alcohol/cannabis users. However, moderating analyses suggested that being a veteran is a risk factor for women, racial/ethnic minoritized individuals, and younger individuals. Findings are discussed in terms of public health implications., (Copyright © 2022 Elsevier Ltd. 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).

Objective: Using cannabis in solitary contexts is associated with greater cannabis use problems than using cannabis in social contexts. However, it remains unclear why solitary use predicts greater problems. Consistent with a social learning perspective, the current study examined whether cannabis use motives mediated the association between context of cannabis use and negative consequences. We also examined whether cannabis type (concentrates vs. flower) moderated the relation between context of use and motives., Method: Recreational college cannabis users ( n = 387) reported their frequency of using cannabis alone or with others, motives for cannabis use, negative cannabis consequences, and type of cannabis typically used., Results: Solitary cannabis use was associated with greater global negative consequences through coping motives (β = 0.26, SE = 0.10, 95% CI [0.10, 0.43]). Cannabis type did not moderate relations between context and motives, despite concentrate users reporting more frequent cannabis use, more frequent solitary use, and greater consequences than flower users., Conclusions: Frequent cannabis use in solitary contexts was associated with greater negative cannabis consequences, both directly and indirectly via coping motives. Efforts to reduce frequent use of cannabis in solitary contexts, particularly for the purpose of coping, may be beneficial in reducing negative consequences.

Introduction: Solitary drinking (i.e., drinking alone) and coping drinking motives are risk factors for alcohol problems. Theoretical models suggest that solitary drinking and coping motives are highly related. However, the direction of effects between solitary drinking and coping motives is unclear. It also remains unclear if relations are present solely at the between-person level, or if there are also dynamic, within-person relations. Therefore, the current study tested dynamic, reciprocal relations among solitary drinking, coping motives, and alcohol problems using Random Intercept Cross Lagged Panel Modeling (RI-CLPM)., Methods: Data came from a large alcohol administration study with longitudinal follow-ups over 2 years (N = 448). Participants completed a baseline session and then were followed up 6, 12, 18, and 24 months later. Participants reported their solitary drinking frequency, coping motives, drinking behavior, and alcohol problems at all assessments., Results: Person-level solitary drinking was related to person-level coping motives and alcohol problems, and person-level coping motives were related to person-level alcohol problems. There were also contemporaneous within-person effects, such that a within-person increase in solitary drinking was associated with a concurrent within-person increase in coping motives, and a within-person increase in coping motives was associated with a concurrent within-person increase in alcohol problems. There were no within-person prospective relations among any variables., Conclusions: Findings suggest strong between-person associations among solitary drinking, coping motives, and alcohol problems. Within-person associations were concurrent but not prospective. Targeting solitary and coping-motivated drinkers, as well within-person increases in both, may be effective at reducing risk for alcohol problems., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Reductions in substance involvement into adulthood are thought to represent a normative maturing out of substance use. However, patterns and predictors of maturing out of alcohol and cannabis co-use remain largely unstudied. Therefore, the current study tested developmental trajectories of alcohol and cannabis use from late adolescence into adulthood and whether late adolescent personality traits predicted trajectory class membership., Methods: Data come from a longitudinal study of family history of alcohol disorder (N = 458). Age bands were created to model trajectories of drinking quantity, negative alcohol consequences, and cannabis use frequency from late adolescence (age 18-22) to young adulthood (age 23-28) and adulthood (age 29-36). Participants reported on their sensation seeking, conscientiousness, and neuroticism during late adolescence and their typical drinking quantity, negative alcohol consequences, and cannabis use frequency at each age band., Results: Three trajectory classes were derived from an initial Parallel Process Growth Mixture Model: (1) low-risk maturing out of alcohol-only use, (2) high-risk maturing out of co-use, and (3) high-risk switchers who increased their cannabis use into adulthood. Late adolescent sensation seeking was associated with higher odds of being in both co-use trajectories, whereas a lack of conscientiousness was associated with higher odds of being a co-use switcher., Conclusions: We identified heterogeneity in trajectories of co-use, which suggests that a lack of maturing out of alcohol involvement may be accompanied by increased cannabis use. Moreover, late adolescent personality traits may predispose individuals toward riskier developmental trajectories of substance use into adulthood., (© 2022 Research Society on Alcoholism.)

Although alcohol expectancies and subjective response are independent predictors of drinking, social-cognitive theory suggests that expectancies may distort one's subjective response, creating discrepancies between expected and actual alcohol effects. A recent cross-sectional study found that unmet expectancies (using difference scores) were associated with heavier drinking. However, cross-sectional data cannot establish temporal precedence, and using difference scores ignores important conditional main effects. As such, the current study sought to evaluate how expectancy-subjective response discrepancies predict future drinking using prospective data and an interaction approach. Participants ( N = 258) were randomly assigned to consume alcohol (target BAC = .08%) within a placebo-controlled alcohol administration session. Alcohol expectancies and subjective response were assessed across the full valence by arousal affective space using parallel measures. Results indicated a significant high arousal positive (HIGH+) interaction, such that, as HIGH+ expectancies increased, individuals at low and mean levels of HIGH+ subjective response drank more heavily 12 months later. There was also a significant high arousal negative (HIGH-) interaction with a similar pattern of moderated effects. No interactions were found for low arousal effects. These results indicate that individuals with unmet HIGH+ and HIGH- expectancies drink more heavily 12 months later, controlling for prior drinking. This suggests that clinicians may consider recommending specific interventions (e.g., expectancy challenges vs. pharmacotherapy) based upon an individual's levels of expectancies and subjective response to optimize intervention efficacy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Naltrexone is an effective treatment for heavy drinking among young adults. Laboratory-based studies have shown that naltrexone dampens the subjective response to alcohol and craving. However, few studies have tested naltrexone's dynamic, within-person effects on subjective response and craving among young adults in natural drinking environments., Methods: Using daily diary data from a randomized, placebo-controlled study of naltrexone's efficacy in young adults, we examined the between-person effects of treatment condition (i.e., naltrexone vs. placebo) and medication dosage (i.e., daily, targeted, and daily + targeted) on the subjective response to alcohol and craving on drinking days. Multilevel mediation models predicted subjective response and craving from treatment condition (between-person) and medication dosage (within-person), accounting for drinking levels. All effects were disaggregated within and between persons., Results: At the between-person level, naltrexone directly blunted intense subjective effects (i.e., "impaired", "drunk") and indirectly blunted subjective effects through reduced drinking. Naltrexone was not associated with craving. Between-person effects were not significant after alpha correction, but their effect sizes (bs = 0.14 to 0.17) exceeded the smallest effect size of interest. At the within-person level, taking two (vs. 1) pills was associated with heavier drinking, and taking one (vs. 0) pill was associated with lighter drinking, and lighter drinking was associated with a lower subjective response and craving. Treatment condition did not moderate the within-person effects of dosing on outcomes., Conclusions: Our findings suggest that the direct between-person effect of naltrexone was largest on intense subjective responses, blunting feelings of being "drunk" and "impaired". Future research using momentary (rather than daily) assessments could confirm and extend these findings., (© 2022 by the Research Society on Alcoholism.)

Objective: Research suggests that impulsivity is a risk factor for problem drinking, but prior studies have yet to examine typical drinking context as a potential moderator of relations between impulsivity and drinking outcomes. Guided by Person-Environment Transactions Theory, the current study tested whether five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking) interacted with typical drinking context to prospectively predict drinking quantity., Method: Young adult participants ( N = 448; mean age = 22.27) were recruited from a southwestern university and the surrounding community. Data from a baseline survey (Time [T] 1) and a 1-year follow-up (T2) were used for the current analyses. Impulsivity (UPPS-P Impulsive Behavior Scale), typical drinking context, and typical drinking quantity were assessed at T1, and typical drinking quantity at T2., Results: Context items were loaded onto latent factors comprising high-arousal (e.g., at a tailgate, large house party) and low-arousal (e.g., at a restaurant, on a date) drinking contexts. In univariate (separated by UPPS-P facet) and multivariate (UPPS-P facets together) models, lack of premeditation and positive urgency interacted with high-arousal drinking contexts to predict T2 drinking, such that individuals at high/mean levels of impulsivity drank more heavily the more frequently they drank in high-arousal contexts. Only interactions in univariate models remained significant after a false discovery correction, although effect sizes were very similar across univariate and multivariate models., Conclusions: Individuals high in positive urgency and lack of premeditation may be particularly vulnerable to riskier drinking behavior in high-arousal environments. Findings advance the literature on context-specific cues that may be important intervention targets, particularly for individuals high in positive urgency and lack of premeditation., Competing Interests: Authors report no conflicts of interest.

Background: There is speculation that enrollment in U.S. state medical cannabis programs differs depending on whether adult recreational cannabis use is legal. If true, this could have implications for public health and policy., Methods: Using medical cannabis registry data from U.S. states with a mandatory registry between 2013 and 2020 (N = 23 states), this study examined time-trends in medical cannabis cardholder enrollment and tested whether enrollment trends differed depending on adult recreational cannabis legalization., Results: Multilevel models showed that time-trends for registered active medical cardholders differed during years when adult recreational cannabis use was legal versus not legal (time*recreational cannabis law interaction: b = -0.004, p < 0.01, 95% CI = -0.005, -0.003). The population prevalence of registered active medical cardholders increased over time in years when recreational cannabis was not legal (i.e., medical-only years; b = 0.004, p < 0.001, 95% CI = 0.003, 0.004, corresponding to an increase of 380 cardholders per 100,000 people per year), and decreased in years when recreational cannabis was legal (i.e., recreational years; b = -0.001, p < 0.001, 95% CI = -0.002, -0.001, corresponding to a decrease of 100 cardholders per 100,000 people per year). Time-trends were similar for each sex (male, female) and age group (18-30/35, 30/35+), with each cardholder group showing increases in medical-only years and decreases in recreational years. In medical-only years, there were no differences in enrollment time-trends across sex, but older cardholder (30/35+) enrollment increased at a faster rate than younger cardholder enrollment (18-30/35) (F = 16.199, p < 0.001). In recreational years, male cardholder enrollment decreased at a faster rate than female cardholder enrollment (F = 7.347, p < 0.01), but there was no difference in trends across age. Three states, all with medical-only years, provided data on ethnicity/race. Results showed significant increases from 2016 to 2020 in enrollment of White, African-American, and Hispanic individuals., Conclusions: Findings suggest that recreational cannabis legalization is associated with decreasing enrollment in medical cannabis programs, particularly for males., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Theory suggests that behavioral undercontrol mediates the effect of parental substance disorder on offspring substance use, but no studies have tested multidimensional impulsive personality traits as mechanisms of risk. Adolescents (N = 392; 48% female) from a multigenerational study of familial alcohol disorder self-reported impulsive personality traits via the UPPS-P (M age  = 16.09; Range = 13-19) and alcohol/cannabis frequency one year later. The UPPS-P assesses negative and positive urgency (i.e., rash action in a negative or positive mood state), lack of premeditation (i.e., lack of planning/forethought), lack of perseverance (i.e., inability to finish tedious/boring tasks), and sensation seeking (i.e., thrill seeking/risk taking). Parent substance disorder was assessed via diagnostic interviews. Two-part hurdle models tested predictors of any substance use (i.e., binary part) and frequency of use (i.e., continuous part). Parent substance disorder was indirectly associated with any alcohol/cannabis use (binary part) and higher cannabis frequency (continuous part) through negative urgency. Parental substance disorder was associated with higher alcohol frequency through a lack of premeditation. Sensation seeking was associated with any alcohol/cannabis use but unrelated to parental substance disorder. Despite indirect effects, strong effects of parental substance disorder on substance use remained. The findings are discussed in terms of theory and public health implications., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Alcohol- and cannabis-related risk perceptions are strong predictors of use behavior. Studies suggest that attitudes toward cannabis are becoming increasingly permissive, however studies have yet to comprehensively a) compare time trends in cannabis-related attitudes to those of other commonly used substances, such as alcohol, and b) test whether trends significantly differ by age., Method: Public access data from the National Study on Drug Use and Health from 2002 to 2019 were used (N = 1,005,421). Structural Equation Models tested whether study year (linear trend), was associated with alcohol- and cannabis-related risk perceptions (correlated outcomes), and whether age (adolescence [12-17], emerging adulthood [18-25], adulthood [26-35], middle adulthood [36-49], and older adulthood [50+]) moderated time trends. Sex, race/ethnicity, and use frequency were covaried., Results: The linear trend of study year was associated with decreased cannabis-related risk perceptions (p < .001). There was also a significant interaction of age by study year for cannabis-related risk perceptions, such that adults, emerging adults, and middle adults had the largest decrease in attitudes over time. For alcohol-related risk perceptions, the linear trend of study year was significantly associated with increased risk perceptions (p = .001), but the interaction of time by age was non-significant; alcohol-related effects were extremely small (b < 0.01)., Conclusions: Findings suggest that cannabis-related risk perceptions are becoming more permissive with time across ages, but particularly in adults, emerging adults, and middle adults. In contrast, alcohol-related risk perceptions have stayed relatively stable over time, with only negligible increases. Findings underscore the importance of targeting permissive cannabis-related attitudes via prevention efforts., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Several studies find between-person reciprocal relations between adolescent/college drinking and positive expectancies. However, drinking and expectancies from college into adulthood are largely unstudied, as are within-person associations. During these age periods, negative alcohol consequences may represent "teachable moments" via expectancy change. The current study tested the reciprocal effects of drinking, negative consequences, and expectancies from college age to adulthood., Method: Using data from a longitudinal study focused on familial alcohol disorder, age bands were created to model effects from college age (18-22) to young adulthood (23-28) and adulthood (29-34). Participants ( N = 420) reported on their drinking, negative consequences, and expectancies across three waves (1995-2010)., Results: Negative consequences did not predict negative expectancies, but the random intercepts of the two were highly related. Young adult negative consequences predicted a within-person increase in adult heavy drinking. A within-person increase in college age negative expectancies indirectly predicted a within-person decrease in adult negative consequences through reduced young adult drinking, whereas within-person increases in college age positive expectancies indirectly predicted a within-person increase in adult negative consequences through heavier young adult drinking., Conclusions: Findings suggest that negative consequences were related to trait-level negative expectancies, even though prospective effects were not observed. Findings also suggest that college age negative expectancies were protective against future use and consequences, and this effect was unique to college age.

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).

Background: Alcohol and cannabis co-use is a between-group risk factor for heavier drinking and negative consequences, but only one study has tested links between co-use and AUD. In addition, few studies focus on risk profiles within co-users, despite heterogeneity in levels of co-use. The current study tested between-group (co-users vs. alcohol-/cannabis-only users) and within-group (patterns of co-use) risk profiles for AUD and CUD in a large, nationally representative sample., Methods: Data from the 2002-2019 National Study on Drug Use and Health (NSDUH) were used for analyses (N = 1,005,421). Analyses tested 1) whether co-users had greater odds of AUD/CUD than alcohol- and cannabis-only users, respectively, 2) whether there were latent profiles of co-use patterns within co-users, and 3) whether profile membership conferred within-group risk for AUD/CUD., Results: Co-users were at 3.38 greater odds of having an AUD, but co-use did not confer risk for CUD. Within co-users, five latent profiles emerged: weekly alcohol/cannabis use, weekly alcohol/monthly cannabis, weekly cannabis/occasional alcohol, weekly alcohol/occasional cannabis, and occasional use of both. Multiple comparisons suggested that, generally as frequency of each substance use increased, odds of both AUD and CUD became greater., Conclusions: Primary alcohol users who also use cannabis are at risk for AUD, but the opposite effect was not observed in primary cannabis users. Higher frequency of each substance also conferred risk within co-users for both AUD and CUD. Findings add novel contributions that should be considered within both alcohol and cannabis use interventions. Future studies using prospective data are needed., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Alcohol and cannabis co-users experience more negative alcohol consequences, but distal and mediating mechanisms of this association remain largely unstudied. Considering research suggests that individuals high in impulsivity and sensation seeking are more likely to be co-users, it is possible that co-users have more positive expectancies and become heavier drinkers, which confer risk for future negative consequences. Therefore, the current study tested prospective mediation models in which impulsive personality traits indirectly predicted negative consequences through co-use, heavier drinking, and expectancies., Methods: The current study used data from a study of familial AUD spanning 3 waves (1995-2010). Participants (N = 567) reported on impulsivity (via the Eysenck Personality Inventory and Sensation Seeking Scale) alcohol and cannabis use, alcohol expectancies, and negative consequences. Models tested the factor structure of impulsive personality traits and whether these traits predicted future negative consequences through past-year co-use and drinking/expectancies., Results: Factor analysis suggested two factors, sensation seeking and lack of premeditation. Sensation seeking was associated with future negative consequences indirectly through co-use and both drinking quantity and positive expectancies. Lack of premeditation was not associated with co-use, but indirectly predicted negative consequences through positive expectancies, above and beyond co-use. Sensation seeking directly predicted negative expectancies, but negative expectancies did not predict negative consequences., Conclusions: Impulsive personality traits in co-users, particularly sensation seeking, explained variance in future negative alcohol consequences via heavier drinking (behavior) and positive expectancies (cognition). Personalized interventions targeting a lack of premeditation, and sensation seeking in co-users, may interrupt a developmental trajectory toward problem drinking., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Negative affect (NA) is presumed to be an important trigger for drinking, particularly among coping-motivated drinkers. However, diary studies attempting to predict alcohol use from interactions between state NA and coping motives have proved inconsistent. Craving or momentary desire for alcohol may be a more proximal and robust consequence of NA in coping-motivated drinkers., Method: Data were drawn from an ecological momentary assessment investigation. Frequent drinkers ( N = 403) carried electronic diaries for 21 consecutive days, recording their drinking behavior, and rating cravings for alcohol and NA., Results: Outside of active drinking episodes, within-person elevations of momentary NA were associated with increased craving intensity, and this effect was more prominent among drinkers with higher dispositional coping motives. There was no significant interaction between coping motives and momentary NA in predicting the occurrence and amount of same-day alcohol use. Significant conditional indirect effects indicated that NA promoted drinking through increases in craving. These indirect effects were stronger among drinkers reporting higher coping motives., Conclusions: Coping motives and within-person fluctuations in NA interactively predict alcohol craving. NA promotes drinking indirectly via increased craving, particularly among coping-motivated drinkers. Alcohol craving may be a proximal and sensitive response channel for investigating interactions between affective distress and coping motives. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Recent studies suggest that solitary (but not social) drinking may confer risk for negative alcohol consequences via beliefs about alcohol's ability to reduce tension, and explicit motivations to drink to cope with negative mood states. However, because prior studies are largely cross-sectional, it is unclear if tension reduction expectancies and drinking to cope are antecedents or consequences of solitary drinking. The current study aimed to address this gap in the literature using prospective data (3 waves across 12 months) from a sample of moderate to heavy drinking young adults. Data were drawn from a larger investigation of contextual influences on subjective alcohol response. Participants (N = 448) reported on alcohol use in multiple drinking contexts and tension reduction expectancies at baseline (T1), drinking motives at a 6-month follow-up (T2), and past-month negative alcohol consequences at a 12-month follow-up (T3). We examined potential indirect effects of drinking contexts on negative consequences operating through alcohol expectancies and drinking motives. Solitary drinking was indirectly associated with later negative consequences through stronger coping motives, although tension reduction expectancies did not serve as a significant mediator. Social drinking was not directly or indirectly related to later alcohol consequences. Results suggest that solitary drinking contexts confer risk for negative consequences through coping motives, and that these effects are invariant across sex, race, and ethnicity. These findings have important clinical implications as they suggest that targeting solitary drinkers for skills-based coping interventions may reduce risk for a developmental trajectory toward negative alcohol consequences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Negative urgency, rash action during negative mood states, is a strong predictor of risky behavior. However, its developmental antecedents remain largely unstudied. The current study tested whether childhood temperament served as a developmental antecedent to adolescent negative urgency. Participants ( N =239) were from a longitudinal study oversampled for a family history of alcohol use disorder (AUD). Negative emotionality (anger and sadness reactivity) and effortful control were measured in childhood (5-8) and negative urgency in adolescence (13-18). Childhood anger reactivity was uniquely related to later negative urgency above and beyond sadness reactivity. Effortful control was not related to later negative urgency; however, a latent variable capturing the shared variance between childhood effortful control and anger reactivity was related to later negative urgency.

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).