Simultaneous alcohol and marijuana use among US high school seniors from 1976 to 2011: Trends, reasons, and situations

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Abstract

Background

Simultaneous alcohol and marijuana (SAM) use raises significant concern due to the potential for additive or interactive psychopharmacological effects. However, no nationally representative studies are available that document prevalence, trends, or related factors in US youth SAM use.

Methods

Nationally representative cross-sectional samples of 12th grade students surveyed in the Monitoring the Future project from 1976 to 2011 provided data on SAM use. Analyses were conducted in 2012.

Results

In 2011, 23% of all US high school seniors reported any SAM use. Among seniors reporting any past 12-month marijuana use, 62% reported any SAM use and 13% reported SAM use most or every time they used marijuana. SAM use consistently followed trends for past 30-day alcohol use over time. SAM use showed significant variation by psychosocial and demographic characteristics and was strongly associated with higher substance use levels, but occurred across the substance use spectrum. Certain reasons for alcohol or marijuana use (to increase effects of another drug; I’m hooked) and situations of alcohol or marijuana use (park/beach, car, party) were strongly associated with SAM use.

Conclusions

A sizable proportion of US high school seniors reported SAM use, and it appeared to occur frequently in social use situations that could impact both the public as well as youth drug users. SAM use appears to be a complex behavior that is incidental to general substance use patterns as well as associated with (a) specific simultaneous reasons (or expectancies), and (b) heavy substance use and perceived dependence, especially on alcohol.

Introduction

The use of alcohol together with one or more illegal substances at the same occasion (hereafter referred to as simultaneous drug use) raises significant concern due to the potential for additive or interactive psychopharmacological effects. Available studies indicate the most common form of simultaneous drug use involves alcohol and marijuana (Collins et al., 1998, Earleywine and Newcomb, 1997, Martin et al., 1996, Midanik et al., 2007, SAMHSA, 2009). Consequences of simultaneous alcohol and marijuana (SAM) use include additive effects on a variety of cognitive, perceptual and motor functions, with clearly increased risk for behaviors such as driving (Belgrave et al., 1979, Chesher et al., 1976, Chesher et al., 1977, Kelly et al., 2004, Lamers and Ramaekers, 2001, Ramaekers et al., 2000, Robbe, 1998). SAM use has been significantly and positively associated with social consequences, alcohol dependence and depression, binge drinking, and other health problems (Brière et al., 2011, Martin et al., 1996, Midanik et al., 2007, SAMHSA, 2009).

Little is known about why or where SAM use typically occurs. Findings are mixed as to whether SAM use is incidental to general substance use (i.e., use prevalence of alcohol and marijuana are both high enough that it may be common for both substances to be used together; Hoffman et al., 2000) or relates to specific simultaneous use expectancies over and above drug-specific expectancies (i.e., the desire for a unique high; Barnwell and Earleywine, 2006). If SAM use is a general “by-product” of heavy use of both substances, then reducing or preventing heavy use should reduce or prevent simultaneous use. However, if SAM use is not fully explained by independent levels of alcohol and marijuana use, there may be specific risk factors that could help identify individuals most at risk for SAM use and associated consequences.

Adult SAM use may be especially related to negative emotional states and social contexts (Pakula et al., 2009). SAM use has been shown to vary by gender (Collins et al., 1998, Hoffman et al., 2000, Martin et al., 1992, Midanik et al., 2007, Pakula et al., 2009, SAMHSA, 2009), sensation seeking (Martin et al., 1992) and low educational attainment (Midanik et al., 2007). Results have been mixed for differences by race/ethnicity (Collins et al., 1998, Hoffman et al., 2000, Midanik et al., 2007, Norton and Colliver, 1988, SAMHSA, 2009). Available studies on youth SAM use are limited. In the 1982 National Household Survey on Drug Abuse, 7% of youth aged 12–17 reported at least occasional past 30-day SAM use (Norton and Colliver, 1988). In the National Surveys on Drug Use and Health of 2006 and 2007, 14% of 12–17 year olds reported past-month simultaneous illicit drug or alcohol use (SAM use specifically was not reported, but marijuana was the illicit drug most frequently used with alcohol (SAMHSA, 2009)). Past 6-month SAM use prevalence rates among New York 7th–12th graders for the years 1983, 1990, and 1994 were reported to be 25%, 12% and 21%, respectively (Hoffman et al., 2000). SAM use among Quebec high school students from disadvantaged areas averaged 30% from 2004 to 2008 (Brière et al., 2011). An additional study used 1990 data from the RAND Adolescent Panel Study of West Coast youth to report past 12-month SAM use prevalence rates of 28% (Collins et al., 1998). To our knowledge, no studies using nationally representative data have been published presenting youth SAM use trends over time, or that provide detailed information on the reasons, locations, and situations for substance use reported by adolescents who also report SAM use.

The current study used nationally representative data from US high school seniors to examine the following questions: (1) What percentage report SAM use, and has this percentage remained stable from 1976 to 2011? (2) How does SAM use associate with use frequency of both marijuana and alcohol? (3) What psychosocial and demographic characteristics are associated with SAM use? (4) What reasons for and situations of alcohol and marijuana use are frequently reported by students who also report frequent SAM use? (5) Do the answers to the above research questions support the conceptualization of SAM use as being incidental to general substance use or indicate specific correlates (in particular, simultaneous use reasons/expectancies)?

Section snippets

Sample

The analyses utilized data from nationally representative cross-sectional samples of 12th grade students in the coterminous US collected through the Monitoring the Future (MTF) study (detailed information on design and procedures can be found in Bachman et al. (2011) and Johnston et al. (2012)). Yearly sample selection included approximately 15,000 high school seniors from about 130 schools. In order to reduce respondent burden but still obtain a wide variety of measures, six different

Results

A total of 103,129 unweighted cases were available from 1976 to 2011 from the questionnaire form with SAM use. Five percent of cases had missing data on past 12-month marijuana use; of the remaining 98,007 cases, 38% (37,566) reported any use of marijuana in the past year. SAM use was asked only of respondents indicating any past-year marijuana use; 36,107 respondents provided data (96% of past-year users). An additional 1257 cases with conflicting data on alcohol use and SAM use were removed

Discussion

In 2011, about three-fifths of US high school seniors who reported past 12-month marijuana use reported any SAM use (approximately one-fourth of all seniors) and more than 10% of past 12-month marijuana users reported SAM use most/every time (7% of all seniors). These rates are comparable to prior research (Brière et al., 2011, Hoffman et al., 2000, SAMHSA, 2009) and indicate SAM use affects a significant proportion of American youth. The similarity between SAM and alcohol use trends (a

Role of funding source

Support for the study was provided by the National Institute on Drug Abuse (DA01411). The study sponsor had no role in (a) study design; (b) the collection, analysis, and interpretation of data; (c) the writing of the report; or (4) the decision to submit the manuscript for publication.

Contributors

Johnston co-designed the study and wrote the protocol. O’Malley helped conduct the study and assisted with planning and guiding the statistical analysis. Terry-McElrath managed literature searches and summaries of previous work, conducted analyses, and drafted the first version of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare they have no conflicts of interest.

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      To answer the second research question, we selected several potentially salient correlates based on findings from past research. Specifically, we examined factors that have been found by past research to be correlated to SAM use among young adults/adolescents: gender (males might have higher risks than females; example OR from prior studies = 1.31–1.57), race/ethnicity (Black/AA and Hispanic Americans might have higher risks than White Americans; example ORBlack/AA = 0.42–0.44, ORHispanic = 0.59–0.66) (Patrick et al., 2019; Terry-McElrath et al., 2013), religiosity (lower religiosity might be associated with higher risks; example ORmedium religiosity = 1.56, ORlow religiosity = 1.58 compared to high religiosity) (Terry-McElrath et al., 2013), delinquency (higher delinquency-higher risk; example OR = 1.4) (Brière et al., 2011), other substance use (higher risk; example OR = 1.9–4.5) (Brière et al., 2011; Patrick et al., 2017), criminal justice involvement and substance use disorders (higher risk) (Green et al., 2016). We also explored other factors that have been commonly found to be associated with substance use among young adults/adolescents as potential correlates of SAM use, such as age, household income, psychological distress, risk propensity, substance accessibility, and risk perception (Cohn et al., 2018; Hai, 2018; Vaughn et al., 2016).

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