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. Author manuscript; available in PMC: 2025 Feb 25.
Published in final edited form as: Subst Use Misuse. 2024 Feb 25;59(7):1059–1066. doi: 10.1080/10826084.2024.2320374

Daily Stress, Drinking Motives and Alcohol Co-Use with Other Drugs

Stephen Armeli 1, Richard Feinn 2, Mark D Litt 3, Howard Tennen 4
PMCID: PMC11014761  NIHMSID: NIHMS1978166  PMID: 38403591

Abstract

Recent evidence indicates that alcohol and other substance co-use, compared to alcohol-only use, might be more closely associated with negative reinforcement processes, and thus more likely during periods of increased stress. The present study examined this possibility by using data from an intensive longitudinal (daily) study of college student drinkers (N = 1461, 54% women). We also examined individual differences in coping and enhancement drinking motives as predictors of alcohol and other substance co-use. We used multilevel multinomial logistic regression to predict, relative to alcohol-only days, the likelihood of alcohol co-use with either cigarettes or marijuana, along with alcohol use with multiple substances and other substance-only use from daily interpersonal and academic stress, day-of-the-week, sex, and individual differences in coping and enhancement drinking motives. We found that, relative to alcohol-only, alcohol and marijuana co-use was more likely, and non-alcohol related substance use was less likely, on weekends. Alcohol and marijuana co-use was less likely, and other substance-only use was more likely, on days characterized by greater academic stress, whereas alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress. Individuals with higher levels of drinking to cope motivation were more likely to engage in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple substances, relative to alcohol-only. Individuals with higher levels of enhancement motives were more likely to engage in all types of alcohol and other substance co-use and other substance-only use relative to alcohol-only.

Substance use in college students, particularly alcohol consumption, continues to constitute a serious health threat (SAMHSA, 2016). National survey data indicate that college students drink more than non-college students in the same age cohort (Linden-Carmichael & Lanza, 2018). Additional risks arise when these young adults use other substances in addition to alcohol, or “co-use.” These other substances are typically marijuana and tobacco, though other substances may also be used. Indeed, compared to alcohol-only users, individuals who report co-use of alcohol and other substances report more negative consequences such as blackouts (Haas & Smith, 2012) and legal consequences (Shillington & Clapp, 2006), and evidence from intensive longitudinal studies indicates that negative consequences are more likely after alcohol and other substance co-use compared to instances when only alcohol is consumed (Linden-Carmichael et al. 2020; Mallett et al., 2017, cf. Mallett et al., 2019).

Despite the recent focus on alcohol and other substance co-use, factors that help to discriminate such use from alcohol-only use are not well-understood. This is unfortunate given that such information could help us better design prevention and intervention strategies. One line of research posits that, compared to alcohol-only, co-use might be more closely linked to negative reinforcement processes, i.e., co-use might be more often used as a method for coping with the effects of stress and negative affect. Research examining alcohol use as a coping strategy provides a framework for understanding how co-use might arise in the stress and coping process. Specifically, findings from intensive longitudinal studies show that coping-motivated drinking in some instances might have a paradoxical effect of exacerbating distress (Armeli et al., 2014; Piasecki et al., 2014; Wycoff et al., 2021). Under these circumstances individuals may supplement their alcohol use with other substances.

Some evidence for the posited negative reinforcement mechanisms underlying alcohol and other substance co-use also comes from studies examining motives for substance use. For example, Patrick et al.’s (2019) intensive longitudinal study of young adults showed that among individuals who reported drinking, higher average levels of coping motivation were related to greater alcohol and marijuana co-use. Day level analyses also indicated that alcohol and marijuana co-use, relative to alcohol-only, was more likely on days characterized by higher coping motivation. In contrast, findings from Arterberry et al.’s (2021) intensive longitudinal study of young adults recruited from an urban emergency department found that day-level reports of coping motivation were unrelated to alcohol and marijuana co-use relative to use of either substance alone.

Linden-Carmichael et al.’s (2021) intensive longitudinal study of young adult alcohol and marijuana co-users provided a more direct test of the posited link between daily stress and co-use. Specifically, they examined how daily stress levels were related to naturally occurring profiles of a variety of substances including alcohol, marijuana, vaping, cigarettes, and stimulants. Results from their multilevel latent class analyses indicated that co-use – i.e., days in which substances such as marijuana, vaping, and stimulant use occurred often with alcohol – was more likely than alcohol-only on days characterized by higher stress levels. One drawback of this study was that many of the co-use classes identified included days during which alcohol use did not occur, thus making it unclear whether daily stress was related to alcohol and other substance co-use or the use of other substances.

The present study extended research examining daily correlates of alcohol co-use with other substances in several ways. First, as in the Linden-Carmichael et al. (2021) study, we examined the effects of daily stress on alcohol co-use with multiple substances (marijuana, cigarettes, etc.). However, the approach taken by Linden-Carmichael et al. contrasted alcohol-only days with co-use categories that often did not include alcohol use, making it unclear whether higher stress on such days was truly related to alcohol and other substance co-use or simply to use of the other substances. In the present study we contrasted alcohol-only with days that were explicit alcohol and other substance co-use days.

Second, we assessed stress in the afternoon/early evening prior to nighttime substance use, which was reported the next day. Linden-Carmichael et al. assessed both stress and substance use retrospectively for the previous day. Our approach allowed us to partially establish temporal precedence regarding the stress-substance use association. Third we examined academic and social stress, two relevant life domains for college students (Crocker et al., 2003; Vrshek-Schallhorn et al., 2015), thus providing more specificity to inform prevention and intervention efforts with respect to the correlates of the identified substance use classes.

Fourth, we also examined how co-use varied across weekdays and weekends. This is important for several reasons. Previous studies show robust weekly cycles among college students such that daily drinking is low Sundays through Wednesdays, increases on Thursdays, and peaks on Fridays and Saturdays (Lau-Barraco et al., 2016; Park et al., 2004; Richton et al., 2017). In contrast, academic stress would be expected to be higher during weekdays compared to weekends. In addition, O’Hara et al. (2014) found that two commonly reported reasons for not drinking – “too much schoolwork” and “usually do not drink on this day” – were most often endorsed on Sundays through Wednesdays and least likely endorsed on Fridays and Saturdays. Thus, not only is the weekday-weekend cycle indicative of normative alcohol use for college students, but it is also related to, or possibly a more global indicator of, the weekly stress cycle.

At the person level of analysis, we examined affect regulation drinking motives (i.e., coping and enhancement) given their relevance to the stress and coping process (Armeli et al., 2020) and their stronger associations with drinking-related problems (Cooper et al., 2016). We expected that drinking to cope motivation would be more closely related to days characterized by co-use of alcohol with other substances relative to days characterized by alcohol-only use (e.g., Patrick et al., 2019; cf., Arterberry et al., 2021). Finally, we included sex in our models, given evidence of greater co-use of alcohol with other substances among men compared to women (Linden-Carmichael et al., 2019).

METHODS

Participants and procedure

Procedures were approved by the university institutional review board. Undergraduates at a large eastern state university were recruited over 9 semesters from the psychology department research pool and through campus-wide email advertisements to participate in a study of daily life and alcohol use. Prospective participants needed to be at least 18 years of age, to have drunk alcohol at least twice in the past 30 days, and to have no past treatment for alcohol problems.

Participants provided informed consent and completed an online baseline survey assessing demographics and drinking motives. Then, approximately two weeks later, participants completed the daily diary portion of the study in which they logged on to a secure website each day for 30 days to complete a brief survey between the hours of 2:30 – 7:00 PM. – a period for many undergraduate students that coincides with the end of the school day but before typical evening activities begin. Relevant to our study, participants were asked each day to report their general stress perceptions, and stress in the academic and interpersonal domains. Participants also reported on their previous night’s substance use (i.e., after completing the prior day’s survey); marijuana use was not legal during the data collection period. Participants received $25 for completing the baseline survey and up to $120 for completing the daily diaries, including bonuses as diary adherence increased.

We recruited 1818 students, 178 of whom either had missing data on their baseline survey or failed to adhere to minimum daily reporting of 15 days. The remaining 1640 had a daily diary adherence rate of 87.7%. Of these, 126 participants did not report alcohol or other substance use and were not included in the analyses. In addition, 53 participants who did report some alcohol or other substance use were missing matching daily stressor data from the previous day’s daily report and were therefore excluded from analysis. This resulted in a final sample of 1,461, 53.9% women, with an average age of 19.2 years (SD = 1.53), and most (82.2%) were Caucasian.

Measures

Drinking motives.

In the baseline survey, participants completed a modified version of the Motivations for Alcohol Use scale (Cooper, 1994). Specifically, two of the five original coping items (e.g., “drinking helps you when depressed or nervous,” “because you feel more self-confident and sure of yourself”) were divided into two separate items (“drinking helps you when depressed,” “drinking helps you when nervous,” “to feel more sure of yourself,” and “to feel more self-confident”) for goals unrelated to the present study. The five enhancement items (e.g., “because it’s exciting,” “because you like the feeling”) were unaltered. Responses were made using a 5-point scale (1 = “almost never/never” to 5 = “almost always/always”) regarding how often they drink for these reasons. We averaged together relevant coping and enhancement items, respectively, to create scale scores; alphas were .90 for both scales.

Daily academic and interpersonal stress.

Each day participants rated their academic and interpersonal stress up to reporting time. Academic stress was assessed with six items (“worked on project/paper/assignment,” “completed project/paper/assignment,” “studied for test/quiz,” “took a test/quiz,” “received negative feedback on schoolwork, progress in class,” “did poorly on test/paper”), and interpersonal stress was assessed with 3 items (i.e., “conflict/argument with friends,” “conflict/argument with boy/girlfriend, romantic other,” “conflict/argument with others”). Participants were asked if the events occurred, and if they did, to rate its stressfulness on a 7-point scale (0 = not stressful at all; 6 = extremely stressful). Events that did not occur were coded zero. Total scores were created by summing the values across all the items. See Hamilton et al. (2021) for more detail regarding the creation of these items.

Daily substance use.

Each day participants reported the previous night’s substance use (i.e., after the completion of the previous day’s daily survey). Participants were asked how many drinks of alcohol (responses: 0 to >15) they had in social (interacting with others) and non-social (alone; not interacting with others) contexts separately for the previous evening. One drink was listed as “one 12-oz. can or bottle of beer, one 5-oz. glass of wine, one 12-oz. wine cooler or 1-oz. of liquor straight or in a mixed drink.” We recoded alcohol use into a binary indicator with 0 corresponding to no drinking and 1 corresponding to any drinking (social or non-social). Participants were also asked how many cigarettes they smoked (responses: 0 to >30); this was recoded into a binary variable (0 = did not smoke vs. 1 = smoked). Finally, participants were asked if they used any marijuana, ecstasy, amphetamines, cocaine, opiates (painkillers), or “other” and responded in either “yes” (coded 1) or “no” (coded 0). Given low base rates of use across substance use days – ecstasy (0.4%), amphetamines (1.8%), cocaine (0.6%), opiates/pain killers (1.6%), and other (3.0%) – we collapsed all drugs except marijuana into an “other drugs” category (coded 0 = none, 1 = at least one drug used).

Data Analysis

We addressed our aims with generalized linear mixed model with multinomial logistic regression link using SPSS v28. The dependent variable was a 6-level categorical variable with the following categories: alcohol-only, alcohol and cigarette co-use, alcohol and marijuana co-use, alcohol and “other drugs” co-use, alcohol and more than one other substance, and non-alcohol-related substance-only use. We chose to focus on alcohol use and each of the other substances individually given that the majority (79.9%) of alcohol co-use days were characterized by alcohol and one other substance. We treated alcohol use and two or more other substances as a separate category, as was substance-only use. Supplemental analyses examined a more parsimonious 3-level version of this outcome variable in which all alcohol and other substance co-use types were collapsed into one category. For all analyses, the alcohol-only group was the reference group. Similar to previous studies (Linden-Carmichael et al., 2019; Patrick et al., 2019), we focused only on substance use days and did not contrast co-use to non-use days. Indeed, evidence from past findings from intensive longitudinal studies (e.g., Armeli et al., 2010) indicates that days characterized by higher levels of distress are more likely to be non-use days. However, there are a variety of factors that contribute to non-use, including substance availability, social opportunity, school and work responsibilities, etc. (O’Hara et al., 2014; Stevens et al., 2021). Thus, we believe that focusing only on substance use days provides a more precise test of which patterns of substance use are more closely related to negative reinforcement processes.

To match up daytime stress with later day substance use, substance use for the previous evening (reported on day t+1) was matched to the previous record (day t). Predictors at the within-person level of analysis included daily interpersonal and academic stress and a weekday-weekend dummy code (Sunday through Wednesday [weekdays] coded 0, Thursday through Saturdays [weekends] coded 1). We included Thursdays as weekend days and Sundays as weekdays given past findings for college students show greater drinking levels (Park et al., 2004; Richton et al., 2017) and fewer reasons for not drinking on the former versus the latter (O’Hara et al., 2014). Predictors at the between-person level of analysis included sex (coded 0 = men, 1 = women) and coping and enhancement motivation. The daily stress measures were group mean-centered, and the means were included as predictors in the person level of the model (this allows for the evaluation of the within- and between-person effects of the stressors). The mixed effects multinomial logistic regressions specified fixed effects for the predictors described above and a person-level random intercept to account for the correlation among the daily level observations. A robust covariance matrix was used to estimate parameter standard errors and statistical significance was set at an alpha level of 0.05.

Results

Descriptive statistics

Evening substance use was reported on 25% of the total reporting days. Only those records were selected in which some substance use occurred and in which stress ratings were available from the previous day. This resulted in 8890 substance use person-days for analysis, a mean of 6.05 per person (SD = 5.14). For these substance use days, alcohol use was the most often reported substance (72.3% of the days), followed by marijuana (25.0%), cigarettes (22.1%), and “other drugs” (5.6%). Table 1 shows the descriptive statistics and correlations for the person level measures and the aggregated daily stress and the substance use variables. The substance use variables were each coded 0 for no use and 1 for any use at the daily level. Thus, the mean levels shown in Table 1 correspond to the unweighted proportion of days used (i.e., frequency of use) across all individuals. As seen in Table 1, coping motivation was positively related to the average levels of both types of daily stress and cigarette and marijuana use, and negatively related to alcohol use. Enhancement motivation was positively related to cigarette and marijuana use, and negatively related to alcohol use.1 Mean levels of daily interpersonal stress were unrelated to use of all substances, whereas mean levels of academic stress were positively associated with “other drug” use and negatively associated with alcohol use. The frequency of using alcohol was negatively associated with the frequency of use for the other substances.

Table 1.

Descriptives statistics and correlations

M SD 1 2 3 4 5 6 7 8
1. Coping motives 1.84 0.83 --
2. Enhancement motives 2.93 1.06 .50* --
3. Sex 0.54 -- .01 −.07* --
4. Mean Interpersonal stress 0.42 1.17 .10* .00 −.02 --
5. Mean academic stress 3.09 3.38 .11* −.05 .06* .33* --
6. Other drugs use 0.04 -- .02 −.01 .00 .05 .09* --
7. Cigarette use 0.12 -- .16* .12* −.08* .02 .01 .04 --
8. Marijuana use 0.15 -- .08* .18* −.21* .03 .01 .09* .13* --
9. Alcohol use 0.83 -- −.11* −.10* .13* −.03 −.07* −.42* −.50* −.59
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Note. Sex: 0 = men, 1 = women. Other drug use, cigarette use, marijuana use, alcohol use: unweighted proportion of days used.

*

p <.05

The percentages for our substance use categories over all substance use days were as follows: alcohol-only (54.9%), alcohol and cigarette co-use (6.8%), alcohol and marijuana co-use (6.4%), alcohol and “other drugs” co-use (0.7%), alcohol and more than one other substance (3.5%), and other substance-only use (27.7%). Alcohol and more than one other substance days were commonly days on which both marijuana and cigarette use occurred, with cigarette use occurring on 91.6% of the days and marijuana use occurring on 92.9% of the days. Less often “other drugs” were reported with either marijuana or cigarette use (23.2% of the days). The most common substance reported on other substance-only use days was marijuana (55.4% of the days), followed by cigarette use (43.6%) and “other drugs” (14.5%). Most individuals (58.5%) reported only one type of substance use (out of our six categories). Among individuals reporting one type of substance use, alcohol-only was the most common (93.7%). Inspection of substance use categories that included alcohol use indicated that the number of drinks consumed was higher on alcohol and other substance co-use days – alcohol and cigarette co-use (M = 7.05, SD = 4.68), alcohol and marijuana co-use (M = 6.80, SD = 5.00), and alcohol and more than one other substance (M = 7.89, SD = 5.21) – compared to alcohol-only days (M = 5.37, SD = 4.15).2

Predicting daily substance use categories

We initially estimated a model predicting the 6-level substance use categorical outcome, however, this model did not converge, possibly due to the small number of days for alcohol and “other drug” co-use. We omitted this group from the analysis and the model converged. Table 2 shows the results from this model. Relative to alcohol-only, alcohol and marijuana co-use was more likely on weekends versus weekdays, whereas other substance-only use was less likely on weekends versus weekdays. Men, compared to women, were more likely to engage in all types of alcohol and other substance co-use and non-alcohol related substance use, relative to alcohol-only.

Table 2.

Results from multilevel multinomial regression predicting substance use type.

95% CI for OR
Outcome variablea Predictors B SE p OR Lower Upper
Alcohol and cigarette co-use Weekend 0.15 0.13 .25 1.17 0.90 1.52
Coping motives 0.32 0.10 <.01 1.38 1.12 1.69
Enhancement motives 0.23 0.09 .01 1.26 1.05 1.50
Sex −0.39 0.16 .01 0.67 0.49 0.92
Mean interpersonal stress 0.00 0.06 .94 1.00 0.88 1.12
Mean academic stress −0.02 0.03 .55 0.98 0.94 1.04
Daily interpersonal stress 0.08 0.03 .03 1.08 1.01 1.16
Daily academic stress −0.01 0.01 .54 0.99 0.97 1.02
Alcohol and marijuana co-use Weekend 0.31 0.15 .03 1.37 1.03 1.82
Coping motives −0.11 0.10 .27 0.89 0.73 1.09
Enhancement motives 0.52 0.08 <.01 1.67 1.43 1.97
Sex −0.68 0.14 <.01 0.50 0.38 0.67
Mean interpersonal stress 0.08 0.06 .15 1.09 0.97 1.22
Mean academic stress 0.00 0.03 .99 1.00 0.95 1.05
Daily interpersonal stress −0.01 0.04 .68 0.99 0.92 1.06
Daily academic stress −0.03 0.01 .04 0.97 0.94 1.00
Non-alcohol substance use Weekend −2.01 0.08 <.01 0.13 0.12 0.15
Coping motives 0.23 0.10 .02 1.25 1.03 1.52
Enhancement motives 0.22 0.08 .01 1.24 1.06 1.46
Sex −0.70 0.14 <.01 0.50 0.37 0.66
Mean interpersonal stress −0.02 0.05 .73 0.98 0.88 1.09
Mean academic stress 0.04 0.02 .09 1.04 0.99 1.09
Daily interpersonal stress −0.03 0.03 .25 0.97 0.92 1.02
Daily academic stress 0.02 0.01 .02 1.02 1.00 1.03
Alcohol and two or more other substances Weekend 0.07 0.15 .65 1.07 0.80 1.42
Coping motives 0.25 0.12 .04 1.28 1.01 1.63
Enhancement motives 0.37 0.11 <.01 1.44 1.16 1.80
Sex −1.19 0.21 <.01 0.30 0.20 0.46
Mean interpersonal stress 0.03 0.07 .70 1.03 0.89 1.19
Mean academic stress 0.05 0.03 .15 1.05 0.98 1.12
Daily interpersonal stress 0.02 0.04 .64 1.02 0.94 1.11
Daily academic stress −0.01 0.02 .53 0.99 0.96 1.02
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Note.

a

Alcohol-only is reference group.

Sex: 0 = men, 1=women. OR: Odds ratio

Individuals with higher levels of coping motivation showed a greater likelihood of engaging in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple other substances, relative to alcohol-only. Individuals with higher levels of enhancement motivation were more likely to engage in all types of alcohol and other substance co-use and non-alcohol substance use, relative to alcohol-only. Individual differences (mean levels) for both types of stress did not differentiate alcohol-only from the other types of substance use. Regarding daily deviations in stress levels, alcohol and cigarette co-use, relative to alcohol-only, was more likely on days characterized by higher levels of interpersonal stress. Daily deviations in academic stress were negatively associated with alcohol and marijuana co-use, and positively associated with other substance-only use.

Table 3 shows the results of a similar model with a more parsimonious 3-level categorical outcome variable. Specifically, we collapsed all alcohol and other substance co-use categories into one category (alcohol and all other substances), and we retained the alcohol-only and non-alcohol substance use categories. We do not show the results for the non-drinking substance use category because it was substantively identical to what is shown in Table 2. Key results from this model showed that alcohol and other substance co-use, relative to alcohol-only, was more likely on weekends and was positively associated with enhancement motivation and being male.

Table 3.

Results from multilevel multinomial predicting combined alcohol and substance co-use category.

95% CI for OR
Outcome variablea Predictors B SE p OR Lower Upper
Alcohol and other substances Weekend 0.31 0.10 <.01 1.36 1.13 1.64
Coping motives 0.16 0.09 .07 1.17 0.99 1.39
Enhancement motives 0.43 0.07 <.01 1.53 1.33 1.76
Sex −0.75 0.13 <.01 0.47 0.37 0.61
Mean Interpersonal stress 0.04 0.05 .40 1.04 0.95 1.14
Mean academic stress 0.01 0.02 .78 1.01 0.96 1.05
Daily interpersonal stress 0.03 0.02 .21 1.03 0.98 1.08
Daily academic stress −0.01 0.01 .12 0.99 0.97 1.00
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Note.

a

Alcohol-only is reference group.

Sex: 0 = men, 1=women. OR: Odds ratio

Discussion

We found some evidence that alcohol co-use with other substances, compared to alcohol use alone, might be more closely linked to negative reinforcement processes. Specifically, relative to alcohol-only, alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress and among individuals with higher levels of drinking to cope motivation. Drinking to cope motivation was also positively related to alcohol use with two or more other substances. In contrast, alcohol and marijuana co-use, relative to alcohol-only, was unrelated to person-level differences in coping motivation and less likely on days characterized by higher levels of academic stress. We also found some support for positive reinforcement mechanisms underlying alcohol and other substance co-use with individuals higher in enhancement motivation being more likely to engage in all alcohol co-use types relative to alcohol-only. Weekend effects were mixed, with alcohol co-use with marijuana, but not cigarettes, being more likely on weekends. Finally, men compared to women were more likely to report all types of alcohol and other substance co-use, and other substance-only use, relative to alcohol-only.

Evidence for negative reinforcement processes was strongest for alcohol and cigarette co-use. Relative to alcohol-only use, this form of co-use was more likely on evenings following days characterized by higher levels of interpersonal conflict. This is somewhat consistent with Linden-Carmichael et al.’s (2021) finding showing that relative to alcohol-only days, general stress levels were higher on days characterized by vaping or cigarette use that also included some degree of alcohol use. The possibility that alcohol and cigarette co-use might be more closely linked to negative reinforcement processes is also consistent with findings showing that coping is the most common reason reported for tobacco use (Cooper et al., 2016).

It should be noted that alcohol and cigarette co-use, relative to alcohol-only use, was also more likely among individuals higher in enhancement motivation, thus suggesting both positive and negative reinforcement pathways underlying such co-use. The link with enhancement motivation is consistent with our finding that, compared to alcohol-only days, alcohol and cigarette co-use days were characterized by higher drinking levels, which is commonly found to be associated with this form of motivation (Cooper et al, 2016). The possibility that this co-use pattern is driven by positive and negative motivational processes is also consistent with our lack of weekday-weekend patterns. Past research indicates that individuals report less negative affect (Larsen & Kasimatis, 1990; Stone et al., 2012; Stone et al., 1985) and greater vitality and physical health symptoms (Ryan et al., 2010) on weekends compared to weekdays. Thus, if alcohol and cigarette co-use was predominately driven by negative reinforcement processes, we might expect it to be less likely on weekends.

These findings raise the possibility that, at least among college student drinkers, alcohol and cigarette co-use days are heterogenous in nature. For example, co-use episodes characterized by lower drinking levels might be more closely linked to negative reinforcement processes whereas episodes characterized by heavier drinking might be more closely linked to positive reinforcement processes. Given the few instances of this form of co-use, and our lack of a priori predictions concerning this possibility, we opted not to further subdivide these co-use episodes by drinking level. Future studies utilizing longer daily observations periods, thus allowing for more observations of these patterns, are needed to begin to identify these more nuanced substance use types.

Our results did not provide evidence of negative reinforcement processes underlying alcohol and marijuana co-use. Like Arterberry et al. (2021), we did not find coping motivation related to this form of co-use, unlike other previous studies (Patrick et al., 2019; Linden-Carmichael et al., 2021). These inconsistencies might be due to sample differences in that studies showing evidence of negative reinforcement were limited to individuals who reported alcohol and marijuana co-use, whereas the samples in our study and that of Arterberry et al. (2021) tended to show more diverse substance use patterns. One possibility is that individuals who habitually co-use alcohol and marijuana show distinct motivational profiles, with coping playing a more prominent role. Future research that oversamples co-users of each substance to compare them with non-co-users is needed to test this possibility.

Further underscoring the idea that alcohol and marijuana co-use in our sample was not driven by negative reinforcement processes was our finding that compared to alcohol-only use, this type of co-use was less likely on days characterized by higher levels of academic stress. However, it should be noted that overall marijuana use frequency was related to individual differences in coping motivation. In addition, other substance-only use days (a large portion of which included marijuana use), relative to alcohol-only, was positively associated with coping motivation, and these days were more likely to be characterized by higher levels of academic stress. One possibility is that marijuana use alone might be used to cope with certain forms of increased stress, but days characterized by co-use with alcohol – which in our study tended to be heavier drinking days – are more closely linked to positive reinforcement processes. Again, future research is needed to examine if marijuana and alcohol use show differential links with positive and negative- reinforcement-related correlates depending on the level of alcohol consumption. For example, marijuana use alone, or with lower levels of alcohol use, might be used as a form of coping with increased anxiety during periods of high academic stress. Marijuana use accompanied by higher drinking levels might be avoided on such days given the need to deal with academic pressures that require persistent effort and focused attention (e.g., assignment deadlines, studying).

Finally, we found evidence that positive and negative reinforcement processes might underly alcohol co-use with multiple other substances, relative to alcohol-only use. Specifically, individual differences in coping and enhancement motivation uniquely predicted this type of substance use. Our lack of findings for daily stressors might be due to the heterogenous nature of this category – including cigarette, marijuana, and other drug use. Again, future studies with even larger samples – that recruit co-user subgroups – and longer daily sampling timeframes are needed to better understand the person- and day-level correlates of these various forms of co-use. Although we had a sizeable person-level sample size, instances of certain types of co-use were relatively rare. Indeed, our models would not converge when trying to example alcohol use plus “other drugs” given the low frequency of such use patterns.

Our study had several other limitations that merit mention. First, the correlational design precludes us from making causal conclusions. Second, our sample was drawn from one university and was mostly Caucasian, thus limiting our generalizability. Third, we only examined two forms of daily stress; moreover, our operationalizations of these forms of stress were somewhat narrow. For example, our measure of interpersonal stress focused mainly on conflict. Other forms of interpersonal stress, such as social scenarios that elicit anxiety, might be more relevant to substance use behavior among emerging adults. Fourth, it is unclear to what degree reports of the substances used on our co-use days represent simultaneous use. Here, methods such as ecological momentary assessment would provide more precise information on such behavior. Fifth, we only asked about cigarette use and did not evaluate related behavior such as vaping. Our inability to identify this form of nicotine use, to the degree that it was present on co-use days involving other drugs, might have increased error variance in our models. Sixth, non-alcohol substance use days might have included various co-use patterns (e.g., marijuana and nicotine co-use versus nicotine-only); failing to account for these patterns also could have increased error in prediction. Finally, it is unknown whether missing reporting days were characterized by certain patterns of alcohol or substance use. Exclusion of these days could bias the results.

In addition to these limitations, we should also note that our observed significant effects were small – attesting to the high power of the study. To the degree that these represent real effects in the population, multiple factors might have contributed to these small signals. For example, our narrow conceptualization of our daily stressors might have attenuated our observed effects. In addition, our analytic framework only captures one possible temporal window for detecting links between daily stressors and substance use (afternoon to evening). Although we specified this model by design – to establish temporal precedence – our approach was insensitive to stress in these domains that occurred previous to, or simultaneous with, evening substance use.

These limitations notwithstanding, our findings add to a growing literature highlighting the person- and day-level correlates of alcohol co-use patterns that could help to better inform prevention and intervention efforts. Indeed, college students represent an unusually vulnerable population. In recent decades substance use has become one of the most widespread health problems on college campuses in the United States. There is an increasingly recognized need to develop preventive services to help students avoid the most severe consequences of alcohol and other substance use. Our understanding of the phenomenology of use in this population is limited, however. The present study sheds light on the some of the circumstances in which students engage in the more harmful practices, i.e., polysubstance use, especially co-use of alcohol and other drugs. In particular, prevention programs on college campuses may use results like those presented here to highlight for students those circumstances that will pose the highest risk, and focus on preemptive measures to help students cope with the stresses of college life.

Funding.

Funding for this study was provided by NIAAA Grant 5P50-AA027055.

Footnotes

Conflict of Interest. The authors have no competing interests to declare that are relevant to the content of this article.

Ethics Approval. Procedures were approved by the university’s institutional review board.

Consent to Participate. Informed consent was obtained from all individual participants included in the study.

1.

Enhancement motivation showed positive associations with the total number of substance use days (r = .22, p <.001) and average daily drinks consumed (r = .20, p < .001). In contrast, coping motivation showed weaker relationships with the number of substance use days (r = .12, p <.001) and average daily drinks consumed (r = .06, p = .017).

2.

Significance tests regarding these mean differences were estimated with linear multilevel regression models with 4 dummy codes contrasting each alcohol and other substance co-use type with alcohol-only occasions. Alcohol-only occasions had significantly fewer drinks consumed compared to alcohol and cigarette co-use (p < .001), alcohol and marijuana co-use (p < .001), and alcohol and more than one other substance (p < .001, but not alcohol and “other drug” use (p = .067).

Contributor Information

Stephen Armeli, School of Psychology and Counseling, Fairleigh Dickinson University, 1000 River Road, Teaneck, NJ, 07666, USA.

Richard Feinn, Department of Medical Sciences, Quinnipiac University, 275 Mt Carmel Avenue, Hamden, CT 06518, USA.

Mark D. Litt, Division of Behavioral Sciences & Community Health, UConn School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA

Howard Tennen, Department of Public Health Sciences, UConn School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.

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