Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 May 1.
Published in final edited form as: Drug Alcohol Depend. 2025 Feb 19;270:112612. doi: 10.1016/j.drugalcdep.2025.112612

Affective Reinforcement of Simultaneous Versus Single Use of Alcohol and Cannabis

Andrea M Wycoff a, Timothy J Trull b
PMCID: PMC11951136  NIHMSID: NIHMS2061748  PMID: 40020640

Abstract

Background:

Simultaneous alcohol and cannabis use is prevalent among adults who drink alcohol and is associated with more negative consequences than use of either substance alone. Understanding reinforcement processes that maintain simultaneous versus single-substance use will highlight intervention targets specific to this pattern of use. In individuals’ daily lives, we tested whether simultaneous use moments are associated with more affectively reinforcing outcomes compared to single use moments.

Methods:

We used ecological momentary assessment with 6+ daily reports for 14 days. Participants were 88 adults ages 18 to 44 who reported simultaneous use at least twice per week. Mean age was 25.22 years and participants were 60.2% female. At each momentary survey, participants reported alcohol and cannabis use, affect, momentary coping and enhancement motives, and subjective appraisals of use.

Results:

Simultaneously using cannabis during alcohol-use moments attenuated the increase in negative affect that accompanied coping-motivated drinking (anxious mood b = −0.11, 95% CI = [−0.19, −0.02], p = .016; depressed mood b = −0.14, 95% CI = [−0.23, −0.05], p = .003). Simultaneously using cannabis during alcohol-use moments attenuated the positive association between enhancement drinking motives and subjective drinking-contingent pleasure (b = −0.34, 95% CI = [−0.50, −0.18], p < .001).

Conclusions:

Simultaneously using cannabis during alcohol-use moments altered the subjective effects of alcohol, whereas simultaneously consuming alcohol during cannabis-use moments did not alter the subjective effects of cannabis. Individuals may perceive that simultaneous cannabis use mitigates undesirable effects of coping-motivated drinking, thereby driving simultaneous use of cannabis alongside alcohol.

Keywords: alcohol, cannabis, simultaneous use, motives, affect, ecological momentary assessment

1. Introduction

Cannabis is widely used among individuals who drink alcohol (SAMHSA, 2014; Yurasek et al., 2017). Most individuals who use both alcohol and cannabis use them simultaneously, such that their effects overlap, at least some of the time (Subbaraman & Kerr, 2015). Compared not only to individuals who only use alcohol but also to individuals who use both substances separately, those who use them simultaneously report more alcohol use, more alcohol-related harms and social consequences, more alcohol-impaired driving, higher risk of sexual assault, and more symptoms of alcohol use disorder (Davis et al., 2019; Jackson et al., 2020; Read et al., 2021; Subbaraman & Kerr, 2015). Given the prevalence of simultaneous use and associated consequences, we need to better understand its risk and maintenance factors. We used ecological momentary assessment (EMA) to examine the reinforcing effects of simultaneous alcohol and cannabis use in daily life.

Motivational models place motives as the most proximal predictor of use and posit that individuals use substances to experience positive and negative reinforcement (Cooper et al., 2016; Cox & Klinger, 1988; Kuntsche et al., 2005). Internally derived motives, coping (negative reinforcement) and enhancement (positive reinforcement), have received considerable attention because they are associated with alcohol-related negative consequences in cross-sectional and prospective longitudinal studies (Cooper et al., 2016; Merrill et al., 2014). Recent qualitative (Boyle et al., 2021) and daily diary (Arterberry et al., 2021; Jackson et al., 2021; Patrick et al., 2019; Stevens et al., 2022) studies found that coping and enhancement motives remain important predictors of simultaneous use.

Daily diary and EMA studies extended cross-sectional work to identify the proximal risks associated with simultaneous alcohol and cannabis use (reviewed by Lee et al.(2022)). Most studies compared simultaneous- to single-use days in terms of consumption quantities (e.g., (Gunn et al., 2021; Lee et al., 2020; Waddell, Corbin, et al., 2023)) or negative consequences (e.g., (Linden-Carmichael et al., 2020; Sokolovsky et al., 2020; Stevens et al., 2021), and no clear affect-use associations emerge in the few studies of affect predicting same-day simultaneous versus single use (Linden-Carmichael et al., 2022; Litt et al., 2023). Assessing motives alongside affective processes may clarify simultaneous use-affect associations and elucidate the next phase of reinforcement—whether individuals experience the affective outcomes they report wanting from use. Also, capturing momentary instead of daily associations may provide necessary granularity and temporal precedence to identify how reinforcement of simultaneous use unfolds.

EMA is uniquely positioned to elucidate momentary reinforcement processes. The proximity of motives to substance use as outlined by motivational models calls for measuring motives in-the-moment, during daily-life use (Votaw & Witkiewitz, 2021). Preliminary work suggests that coping-motivated alcohol use is associated with subjective drinking-contingent relief but no momentary improvement in negative affect (Wycoff et al., 2021) and that coping-motivated cannabis use is associated with increased negative affect (Ross et al., 2018; Wycoff et al., 2024). The discrepancy between subjective reinforcement versus no reductions in negative affect offers one possible explanation for how coping-motivated alcohol use is maintained over time despite not being an effective strategy. Collectively, coping-motivated alcohol and cannabis use do not appear to be negatively reinforcing, though work is preliminary, and no studies have examined cannabis-contingent relief. Further, extending this work to whether simultaneous use is more reinforcing than either substance alone will inform etiology and intervention targets.

We recruited adults who reported regular simultaneous alcohol and cannabis use for a 14-day EMA study to examine the reinforcing effects of coping- and enhancement-motivated use. We examined whether simultaneously using alcohol and cannabis enhanced the reinforcing effects of each substance. Results will add to emerging work on whether individuals achieve the affective outcomes they seek from alcohol and cannabis use separately and inform whether simultaneous use affords an advantage in terms of affective reinforcement. Aim 1 tested whether simultaneous cannabis use moderates the reinforcing effects of alcohol. Specifically, we tested whether simultaneous cannabis use moderates associations between a) alcohol coping motives and negative reinforcement outcomes: subjective drinking-contingent relief and change in negative affect, and b) alcohol enhancement motives and positive reinforcement outcomes: subjective drinking-contingent pleasure and change in positive affect. We hypothesized that simultaneous cannabis use (versus alcohol-only moments) would strengthen associations between momentary alcohol motives and reinforcing effects. Aim 2 tested whether simultaneous alcohol use moderates the reinforcing effects of cannabis. Specifically, we tested whether simultaneous alcohol use moderates associations between a) cannabis coping motives and negative reinforcement outcomes: subjective cannabis-contingent relief and change in negative affect, and b) cannabis enhancement motives and positive reinforcement outcome: subjective cannabis-contingent pleasure and change in positive affect. We hypothesized that simultaneous alcohol use (versus cannabis-only moments) would strengthen associations between momentary cannabis motives and reinforcing effects.

2. Method

2.1. Participants

The sample included 88 adults. Monte Carlo simulations prior to data collection for 80 participants with 80% compliance demonstrated >94% power to detect small (0.10) momentary effects. Inclusion criteria were age 18–45, owning a smartphone, reporting using cannabis at least 3x/week over the last 30 days, and reporting using cannabis and alcohol simultaneously, such that their effects overlap, at least 2x/week over the last 30 days. Exclusion criteria included using other illicit substances, being pregnant or planning to become pregnant, history of head trauma that resulted in changes to mood, concentration, or memory, endorsing past-year physiological withdrawal symptoms for alcohol or cannabis, being in/seeking treatment for alcohol or cannabis use, and past-year unsuccessful efforts to cut down/quit using alcohol or cannabis. Additional exclusion criteria included denying drinking at least 4 (women) or 5 drinks (men) at least once in the past six months, having medical contraindications for drinking alcohol, or having a history of flushing while drinking.1 Participants were 25.22 years old on average (SD=6.91, range=18—44). See Tables 1 and 2 for details.

Table 1.

Demographic information

Demographic categories n %
Gender identity
 Male 34 38.6
 Female 53 60.2
 Nonbinary 1 1.1
Race
 American Indian or Alaska native 3 3.4
 Asian or Asian American 4 4.6
 Black or African American 7 8.0
 Native Hawaiian or other Pacific Islander 1 1.1
 White 75 85.2
 Other (write in) 4 4.6
  Hispanic or Latino 2 2.3
  Mexican 1 1.1
  Sri Lankan 1 1.1
Ethnicity
 Hispanic or Latino 6 6.8
Marital status
 Single or never married 77 87.5
 Married 6 6.8
 Divorced 3 3.4
 Separated 1 1.1
 Living with someone as married 1 1.1
Highest level of education completed
 High school or equivalent 12 13.6
 Some post high school education (includes currently enrolled) 45 51.1
 Vocational or technical program 2 2.3
 Undergraduate degree 10 11.4
 Some post graduate education (includes currently enrolled) 10 11.4
 Graduate degree 9 10.2
Annual household income
 $0 to $25,000 44 50.0
 $25,001 to $50,000 23 26.1
 $50,001 to $75,000 5 5.7
 $75,001 to $100,000 5 5.7
 Above $100,000 11 12.5
Employed 68 77.3
Open in a new tab

Table 2.

Baseline sample characteristics

Sample characteristics Mean SD Range
AUDIT 10.45 4.91 3 to 26
CUDIT-R 10.92 5.67 3 to 25
Age at first alcohol use 14.59 2.62 6 to 22
Age at first cannabis use 16.27 3.47 8 to 31
Age at first simultaneous use 17.31 3.31 12 to 31
Past 30-day Timeline Follow-Back
 Alcohol use frequency (number of use days) 14.19 6.04 0 to 30
 Cannabis use frequency (number of use days) 23.49 7.21 10 to 30
Open in a new tab

Note. AUDIT = Alcohol Use Disorders Identification Test. CUDIT-R = Cannabis Use Disorder Identification Test—Revised.

2.2. Procedures

All procedures complied with relevant laws and institutional guidelines. The University of Missouri Institutional Review Board approved all procedures on 8/14/2019 (Protocol 2016077). Data collection occurred between 08/2020—06/2021. Participants were recruited from a previous study from our lab (Trull et al., 2022)2 and advertisements in a university-wide mailing list and on Facebook. After an eligibility phone screen, participants completed a one-hour orientation session remotely over Zoom. During orientation, participants completed questionnaires online, downloaded the EMA app (TigerAware) (Morrison et al., 2018), received EMA instructions, and were compensated $10 via Venmo or PayPal.

Starting the day after orientation, participants completed 14 days of EMA. Participants received morning surveys daily at 7am, which were available until noon and had reminders at 9:15am and 11:30am. Participants received five random surveys per day, one per two-hour block between noon and 10pm. Random surveys were available for 20 minutes with a 10-minute reminder. Participants were instructed to complete user-initiated substance use surveys just after using alcohol, cannabis, or both. After reporting substance use in any type of survey, participants received two follow-up surveys 60-and 120-minutes after the initial report. If additional use was reported in either follow-up, additional follow-ups arrived hourly until participants reported no use in two consecutive follow-ups. Random surveys were cancelled during follow-up timeframes. Participants could suspend surveys when it would be inappropriate or unsafe to respond.

Participants were compensated $80 for 80%+ overall compliance, with $10 reductions for 10% drops below 80% and no compensation for <50%. Compliance was monitored each weekday, and participants were contacted by phone if compliance fell below 80%. On average, compliance to morning reports was 87.19% (SD=17.50), random prompts 73.91% (SD=17.01), substance use follow-ups 75.45% (SD=19.50). Average compliance across survey types was 76.38% (SD=15.61%), just above the average compliance (75.01%) in a meta-analysis of substance use EMA studies (Jones et al., 2019). Participants completed on average 4.92 user-initiated substance use surveys (SD=4.22). Of the 88 participants, 82 finished all 14 days of EMA, and of those, 78 had >50% compliance.3

2.3. Measures

At orientation, participants completed the Alcohol Use Disorders Identification Test (Saunders et al., 1993), the Cannabis Use Disorders Identification Test—Revised (Adamson et al., 2010), age at first alcohol/cannabis/simultaneous use, and a 30-day alcohol and cannabis Timeline Follow-Back (Sobell & Sobell, 1992). Participants completed the Modified Drinking Motives Questionnaire—Revised (DMQ-R) (Grant et al., 2007) and the Comprehensive Marijuana Motives Questionnaire (CMMQ) (Lee et al., 2009) from which we used the coping and enhancement subscales as covariates.

Table 3 reports descriptive statistics for measures. During morning, random, and substance use follow-up surveys, participants were asked, “Have you used alcohol and/or cannabis since you woke up?” (for morning surveys) or “since the last survey you answered?” If yes (and when participants initiated a substance use survey), they selected alcohol only, cannabis only, or both. If both, participants indicated whether they used them at the same time so that effects overlapped. When participants selected one substance only, they were asked whether they had used the other substance prior to the last survey and, if yes, whether the effects overlapped. Instances of alcohol and cannabis use with overlapping effects were coded as simultaneous use moments. Moments with use of both substances but no overlapping effects were treated as single-use moments in analyses.

Table 3.

Descriptive statistics for analyzed measures

Measures M SD range
Momentary alcohol use motives
 1. Coping-anxiety 1.63 1.02 1 to 5
 2. Coping-depression 1.48 0.97 1 to 5
 3. Enhancement 3.69 1.14 1 to 5
Momentary cannabis use motives
 4. Coping-anxiety 1.98 1.19 1 to 5
 5. Coping-depression 1.72 1.13 1 to 5
 6. Enhancement 3.94 1.07 1 to 5
Momentary substance use (% of all moments)
 7. Alcohol use 14% 34% 0 to 100
 8. Cannabis use 24% 43% 0 to 100
 9. Simultaneous use 8% 27% 0 to 100
Momentary subjective appraisals
 10. Drinking-contingent relief 2.20 1.35 1 to 5
 11. Drinking-contingent pleasure 3.64 1.11 1 to 5
 12. Cannabis-contingent relief 2.75 1.36 1 to 5
 13. Cannabis-contingent pleasure 4.07 0.99 1 to 5
Momentary affective states
 14. Anxious mood 1.31 0.64 1 to 5
 15. Depressed mood 1.17 0.45 1 to 5
 16. Positive mood 2.33 0.81 1 to 5
Open in a new tab

When participants reported alcohol use, they rated how much they used alcohol for the following reasons: “to feel less anxious” (coping-anxiety), “to feel less depressed” (coping-depression), and “because I like the feeling” (enhancement). When participants reported cannabis use, they rated how much they used cannabis for the same reasons. When participants reported both alcohol and cannabis use, they rated motives for each substance separately. Items were rated from 1 (very slightly or not at all) to 5 (extremely). Items were adapted for EMA from the Modified DMQ-R (Grant et al., 2007) and the CMMQ (Lee et al., 2009) based on high factor loadings and wording consistency, and similar single-item motives were used in prior EMA studies (Jackson et al., 2021).

When participants reported alcohol use, they rated if the drinking was “pleasurable” and “relieved unpleasant feelings or symptoms.” When participants reported cannabis use, they answered the same questions for cannabis. When participants reported both alcohol and cannabis use, they appraised each substance separately. Items were rated from 1 (very slightly or not at all) to 5 (extremely) and were taken from previous EMA studies (Piasecki et al., 2014; Wycoff et al., 2021).

Affect was assessed at each survey using the Profile of Mood States (Cranford et al., 2006; McNair et al., 1992). Participants rated how much they felt each item in the past 15 minutes from 1 (very slightly or not at all) to 5 (extremely). Anxious mood items were, “on edge,” “anxious,” and “uneasy.” Depressed mood items were, “hopeless,” “discouraged,” and “sad.” Positive affect items were, “cheerful,” “lively,” “vigorous,” “relaxed,” “at ease,” and “calm.” We averaged item responses to create each subscale. Between- and within-person reliabilities were good–excellent: anxious mood within-person ω=.73, between-person ω=.90; depressed mood within-person ω=.79, between-person ω=.94; general positive affect within-person ω=.77, between-person ω=.93 (Geldhof et al., 2014).

2.4. Analytic method

Analyses were preregistered at https://osf.io/dmfcb. Unconditional multilevel models predicting momentary subjective appraisals demonstrated low within-person variability at the day level (ICCs ranged .07 [drinking-contingent relief] to .15 [drinking-contingent pleasure]). Thus, we deviated from our pre-registered three-level models and conducted two-level models (moments within person). Hypotheses were tested using multilevel models in SAS PROC MIXED.

To test whether simultaneous cannabis use strengthens associations between drinking motives and alcohol’s reinforcing effects (Aim 1), we restricted the dataset to observations with alcohol use. Models interacted momentary drinking motives (person-centered coping-anxiety, coping-depression,4 and enhancement motives) with simultaneous cannabis use to predict alcohol’s reinforcing effects (drinking-contingent relief and pleasure, and change in anxious, depressed, and positive mood). Models predicting change in affect (current-moment mood minus mood at the last survey) controlled for affect at the last survey. Change in affect was calculated using the most recent prior survey as long as the two ratings occurred on the same day. The average time between two assessments was 2h 21m (median=1h 40m, SD=1h 58m). Within-person reliabilities of momentary change (RC) were good–very good, supporting our use of change scores: anxious mood RC=.84, depressed mood RC=.85, positive affect RC=.73 (Shrout & Lane, 2012). Additional covariates included person-means of the momentary drinking motive (sample-mean-centered), person-means of cannabis use (representing the proportion of alcohol-use moments during which the participant also used cannabis simultaneously during the study) and the matching baseline motive (sample-centered) from the Modified DMQ-R (Grant et al., 2007) to determine whether any associations between person-level motive aggregates and outcomes are explainable by baseline motives (Piasecki et al., 2014), hour after wake, weekend (5pm Friday—5pm Sunday), study day, age (sample-centered), and gender (male versus female/nonbinary). Models included random intercepts for person and random slopes for momentary motives when significant.

To test whether simultaneous alcohol use strengthens associations between cannabis use motives and cannabis’s reinforcing effects (Aim 2), we restricted the dataset to moments with cannabis use and repeated all prior models with alcohol and cannabis variables flipped. Baseline motive covariates were from the CMMQ (Lee et al., 2009).5

3. Results

The dataset had 6,334 observations.6 On average, participants reported alcohol use on 5.20 days (SD=3.15), cannabis use on 8.56 days (SD=4.20), and simultaneous use on 3.40 days during the study (SD=2.95). Of observations with alcohol use (n=868), 54.3% had simultaneous cannabis use. Of observations with cannabis use (n=1,519), 29.9% had simultaneous alcohol use.

During alcohol-only moments, higher momentary coping-anxiety drinking motives predicted higher drinking-contingent relief. However, using cannabis simultaneously attenuated this association such that it was no longer significant during simultaneous use (Table 4; simple slope for coping-anxiety drinking motives during simultaneous use moments: b=0.14, 95% C I=[−0.00, 0.28], p=.055). During alcohol-only moments, higher momentary coping-depression drinking motives predicted higher drinking-contingent relief, and this association was not moderated by simultaneous cannabis use (Table 4). During alcohol-only moments, higher momentary enhancement drinking motives predicted greater drinking-contingent pleasure. Using cannabis simultaneously attenuated this association such that it was weaker during simultaneous use (Table 4; simple slope for enhancement drinking motives during simultaneous use: b=0.15, 95% CI=[0.02, 0.27], p=.022).

Table 4.

Aim 1 results examining whether momentary simultaneous cannabis use moderates the associations between drinking motives and subjective appraisals of alcohol use

Coping-anxiety predicting drinking-contingent relief Coping-depression predicting drinking-contingent relief Enhancement predicting drinking-contingent pleasure
Effect b 95% CI p b 95% CI p b 95% CI p
Intercept 2.35 [1.93, 2.76] <.001 2.49 [2.07, 2.90] <.001 3.87 [3.56, 4.19] <.001
Momentary motivea 0.39 [0.24, 0.55] <.001 0.42 [0.26, 0.57] <.001 0.49 [0.36, 0.61] <.001
Simultaneous cannabis use 0.07 [−0.07, 0.22] .319 0.07 [−0.08, 0.22] .365 −0.03 [−0.15, 0.10] .665
Momentary motivea × simultaneous use −0.26 [−0.45, −0.07] .007 −0.12 [−0.32, 0.08] .224 −0.34 [−0.50, −0.18] <.001
Covariates
 Person-level momentary motivea 0.97 [0.66, 1.28] <.001 0.84 [0.52, 1.17] <.001 0.63 [0.47, 0.78] <.001
 Person-level cannabis use −0.26 [−0.87, 0.35] .403 −0.43 [−1.05, 0.18] .166 −0.37 [−0.82, 0.09] .111
 Baseline motiveb 0.02 [−0.25, 0.29] .898 0.15 [−0.25, 0.54] .460 −0.05 [−0.21, 0.12] .577
 Hour after wake −0.00 [−0.02, 0.01] .761 −0.01 [−0.02, 0.01] .507 0.00 [−0.01, 0.01] .833
 Weekend −0.02 [−0.15, 0.10] .729 −0.03 [−0.16, 0.10] .664 −0.04 [−0.14, 0.07] .495
 Study day 0.00 [−0.02, 0.02] .975 −0.00 [−0.02, 0.01] .971 −0.01 [−0.03, −0.00] .026
 Age 0.01 [−0.02, 0.03] .676 0.00 [−0.03, 0.03] .928 −0.01 [−0.03, 0.01] .353
 Male (ref=female or nonbinary) −0.24 [−0.59, 0.12] .196 −0.27 [−0.64, 0.10] .158 0.07 [−0.20, 0.34] .610
Open in a new tab
a

The momentary motive is coping-anxiety, coping-depression, or enhancement, according to model/column.

b

The baseline motive is coping-anxiety, coping-depression, or enhancement from the Modified Drinking Motives Questionnaire-Revised(Grant et al., 2007), according to model/column.

Note. 95% CI = 95% confidence interval. Significant effects at p < .05 are bolded.

During alcohol-only moments, higher momentary coping-anxiety drinking motives predicted increased anxious mood from the last moment. Using cannabis simultaneously attenuated this association such that it was weaker during simultaneous use moments (Table 5; simple slope for coping-anxiety drinking motives during simultaneous use: b=0.10, 95% CI=[0.02, 0.17], p=.012). Similarly, during alcohol-only moments, higher momentary coping-depression drinking motives predicted increased depressed mood from the last moment. Using cannabis simultaneously also attenuated this association such that it was weaker during simultaneous use (Table 5; simple slope for coping-depression drinking motives during simultaneous use: b=0.13, 95% CI=[0.01, 0.24], p=.031). Finally, during alcohol-only moments, higher momentary enhancement drinking motives predicted increased positive affect from the last moment. Using cannabis simultaneously also predicted increased positive affect from the last moment but did not moderate the association between enhancement drinking motives and positive affect (Table 5).

Table 5.

Aim 1 results examining whether momentary simultaneous cannabis use moderates the associations between drinking motives and change in affect

Coping-anxiety predicting change in anxious mood Coping-depression predicting change in depressed mood Enhancement predicting change in positive affect
Effect b 95% CI p b 95% CI p b 95% CI p
Intercept 0.98 [0.81, 1.14] <.001 0.94 [0.79, 1.09] <.001 2.04 [1.75, 2.33] <.002
Momentary motivea 0.20 [0.12, 0.29] <.001 0.26 [−0.92, −0.79] <.001 0.08 [0.01, 0.15] .030
Simultaneous cannabis use 0.03 [−0.04, 0.09] .414 −0.02 [−0.08, 0.03] .411 0.11 [0.01, 0.20] .023
Momentary motivea × simultaneous use −0.11 [−0.19, −0.02] .016 −0.14 [−0.23, −0.05] .003 −0.00 [−0.10, 0.10] .953
Covariates
 Last-prompt moodb −0.83 [−0.89, −0.78] <.001 −0.85 [−0.92, −0.79] <.001 −0.69 [−0.75, −0.63] <.001
 Person-level momentary motivea 0.14 [0.05, 0.24] .005 0.15 [0.06, 0.24] .002 0.29 [0.17, 0.40] <.001
 Person-level cannabis use 0.03 [−0.17, 0.23] .793 0.03 [−0.14, 0.21] .702 −0.29 [−0.63, 0.04] .086
 Baseline motivec 0.04 [−0.04, 0.13] .320 0.06 [−0.05, 0.17] .289 −0.12 [−0.24, 0.00] .052
 Hour after wake 0.00 [−0.00, 0.01] .468 0.00 [−0.00, 0.01] .567 −0.00 [−0.01, 0.01] .759
 Weekend −0.02 [−0.08, 0.03] .340 0.02 [−0.04, 0.05] .987 0.01 [−0.06, 0.09] .739
 Study day 0.01 [0.00, 0.01] .041 0.00 [−0.00, 0.01] .050 −0.01 [−0.02, 0.00] .142
 Age −0.00 [−0.01, 0.01] .437 0.00 [−0.01, 0.01] .853 −0.00 [−0.02, 0.01] .704
 Male (ref=female or nonbinary) −0.04 [−0.16, 0.07] .447 0.05 [−0.13, 0.08] .671 −0.12 [−0.31, 0.08] .231
Open in a new tab
a

The momentary motive is coping-anxiety, coping-depression, or enhancement, according to model/column.

b

Last-prompt mood is anxious mood, depressed mood, or positive affect, according to model/column.

c

The baseline motive is coping-anxiety, coping-depression, or enhancement from the Modified Drinking Motives Questionnaire-Revised(Grant et al., 2007), according to model/column.

Note. 95% CI = 95% confidence interval. Significant effects at p < .05 are bolded.

During cannabis-only moments, higher momentary coping-anxiety cannabis-use motives predicted higher cannabis-contingent relief. Using alcohol simultaneously did not moderate this association (Table 6). Similarly, during cannabis-only moments, higher momentary coping-depression cannabis-use motives predicted higher cannabis-contingent relief, and using alcohol simultaneously did not moderate this association (Table 6). During cannabis-only moments, higher momentary enhancement motives for cannabis use predicted higher cannabis-contingent pleasure, and simultaneous alcohol use did not moderate this association (Table 6).

Table 6.

Aim 2 results examining whether momentary simultaneous alcohol use moderates the associations between cannabis motives and subjective appraisals of cannabis use

Coping-anxiety predicting cannabis-contingent relief Coping-depression predicting cannabis-contingent relief Enhancement predicting cannabis-contingent pleasure
Effect b 95% CI p b 95% CI p b 95% CI p
Intercept 2.90 [2.57, 3.24] <.001 3.06 [2.71, 3.40] <.001 4.19 [3.99, 4.39] <.001
Momentary motivea 0.32 [0.21, 0.42] <.001 0.31 [0.21, 0.41] <.001 0.37 [0.27, 0.46] <.001
Simultaneous alcohol use −0.03 [−0.15, 0.08] .602 −0.03 [−0.15, 0.09] .619 −0.02 [−0.10, 0.07] .688
Momentary motivea × simultaneous use −0.11 [−0.25, 0.04] .142 −0.14 [−0.31, 0.03] .108 −0.00 [−0.12, 0.12] .948
Covariates
 Person-level momentary motivea 0.70 [0.49, 0.91] <.001 0.64 [0.43, 0.86] <.001 0.72 [0.57, 0.87] <.001
 Person-level alcohol use −0.37 [−1.13, 0.39] .339 −0.67 [−1.45, 0.12] .096 −0.17 [−0.62, 0.28] .449
 Baseline motiveb 0.00 [−0.23, 0.24] .972 −0.01 [−0.26, 0.24] .954 −0.04 [−0.21, 0.14] .685
 Hour after wake −0.00 [−0.01, 0.01] .714 −0.00 [−0.02, 0.01] .409 0.00 [−0.00, 0.01] .370
 Weekend 0.04 [−0.05, 0.14] .382 0.00 [−0.10, 0.10] .932 −0.04 [−0.11, 0.04] .325
 Study day −0.00 [−0.01, 0.01] .730 −0.01 [−0.02, 0.01] .355 −0.02 [−0.02, −0.01] <.001
 Age 0.02 [−0.01, 0.05] .187 0.03 [−0.00, 0.05] .072 0.00 [−0.01, 0.02] .615
 Male (ref=female or nonbinary) −0.26 [−0.62, 0.11] .164 −0.29 [−0.67, 0.08] .126 −0.03 [−0.24, 0.18] .762
Open in a new tab
a

The momentary motive is coping-anxiety, coping-depression, or enhancement, according to model/column.

b

The baseline motive is coping or enhancement from the Comprehensive Marijuana Motives Questionnaire(Lee et al., 2009), according to model/column.

Note. 95% CI = 95% confidence interval. Significant effects at p < .05 are bolded.

During cannabis-only moments, higher momentary coping-anxiety cannabis-use motives predicted increased anxious mood from the last moment, and using alcohol simultaneously did not moderate this association (Table 7). Similarly, during cannabis-only moments, higher momentary coping-depression cannabis-use motives predicted increased depressed mood from the last moment, and using alcohol simultaneously did not moderate this association (Table 7). Finally, during cannabis-only moments, higher momentary enhancement motives for cannabis use predicted increased positive affect from the last moment. Using alcohol simultaneously also predicted increased positive affect but did not moderate the association between enhancement cannabis-use motives and positive affect (Table 7).

Table 7.

Aim 2 results examining whether momentary simultaneous alcohol use moderates the associations between cannabis motives and change in affect

Coping-anxiety predicting change in anxious mood Coping-depression predicting change in depressed mood Enhancement predicting change in positive affect
Effect b 95% CI p b 95% CI p b 95% CI p
Intercept 1.01 [0.88, 1.13] <.001 0.88 [0.77, 0.98] <.001 1.92 [1.72, 2.13] <.001
Momentary motivea 0.09 [0.03, 0.15] .004 0.10 [0.03, 0.17] .006 0.12 [0.08, 0.17] <.001
Simultaneous alcohol use −0.01 [−0.06, 0.05] .779 −0.03 [−0.06, 0.01] .193 0.08 [0.01, 0.16] .030
Momentary motivea × simultaneous use 0.04 [−0.03, 0.11] .292 −0.01 [−0.08, 0.06] .789 −0.02 [−0.12, 0.07] .600
Covariates
Last-prompt moodb −0.81 [−0.86, −0.76] <.001 −0.76 [−0.81, −0.71] <.001 −0.66 [−0.71, −0.61] <.001
Person-level momentary motivea 0.00 [−0.06, 0.06] .920 0.06 [0.01, 0.11] .023 0.23 [0.10, 0.36] <.001
Person-level alcohol use 0.12 [−0.10, 0.35] .284 0.02 [−0.16, 0.20] .833 0.06 [−0.31, 0.43] .740
Baseline motivec 0.13 [0.06, 0.19] <.001 0.08 [0.02, 0.14] .006 0.02 [−0.12, 0.17] .755
Hour after wake 0.00 [−0.01, 0.01] .830 −0.00 [−0.01, 0.00] .433 −0.00 [−0.01, 0.00] .231
Weekend 0.03 [−0.00, 0.08] .154 0.03 [−0.00, 0.06] .061 −0.03 [−0.10, 0.03] .281
Study day 0.00 [−0.00, 0.01] .481 0.00 [−0.00, 0.01] .260 −0.01 [−0.02, −0.00] .001
Age −0.01 [−0.01, 0.00] .106 −0.00 [−0.01, 0.01] .814 −0.00 [−0.01, 0.01] .842
Male (ref=female or nonbinary) −0.10 [−0.20, 0.00] .058 −0.03 [−0.12, 0.05] .413 −0.12 [−0.29, 0.06] .189
Open in a new tab
a

The momentary motive is coping-anxiety, coping-depression, or enhancement, according to model/column.

b

Last-prompt mood is anxious mood, depressed mood, or positive affect, according to model/column.

c

The baseline motive is coping or enhancement from the Comprehensive Marijuana Motives Questionnaire(Lee et al., 2009), according to model/column.

Note. 95% CI = 95% confidence interval. Significant effects at p < .05 are bolded.

4. Discussion

We examined the reinforcing effects of simultaneous alcohol and cannabis use in daily life. We tested whether individuals experienced the reinforcing effects they sought, based on self-reported motives in-the-moment, and whether simultaneous use enhanced those effects. Our findings suggest that simultaneous cannabis use alters several affect-related effects of alcohol, whereas simultaneous alcohol use does not alter affect-related effects of cannabis.

Specifically, in contrast to our hypothesis, the positive association between momentary coping-anxiety drinking motives and subjective drinking-contingent relief was only present when using alcohol by itself and not when using cannabis simultaneously. One interpretation could be that when participants reported drinking alcohol to feel less anxious, alcohol use by itself provided more relief than simultaneous use. However, coping-anxiety drinking predicted increased anxious mood during alcohol-only moments, and simultaneous cannabis attenuated that increase, introducing a discrepancy. Similarly, coping-depression drinking predicted increased depressed mood during alcohol-only moments, with simultaneous cannabis attenuating that increase.

The discrepancy between greater subjective relief from alcohol versus worsened anxious mood during drinking moments with higher coping-anxiety motives warrants further attention. Existing EMA work demonstrates a similar discrepancy with greater subjective relief from alcohol but no improvement in anxiety during moments with higher coping-anxiety motives (Wycoff et al., 2021). Present models parallel this, with greater perceived drinking-contingent relief versus increased depressed mood during drinking moments characterized by higher coping-depression motives. Collectively, coping-motivated drinking may be reinforced and maintained by perceived relief, whereas exacerbated negative affect may be one avenue through which coping motives contribute to alcohol-related problems (Cooper et al., 2016).

Second, the interpretation that alcohol use alone is more relieving than simultaneous use does not fit with the finding that simultaneous use predicted less of an increase in anxiety compared to coping-anxiety-motivated drinking alone. Given that we asked participants to attribute use-contingent-relief to alcohol and cannabis separately, participants may attribute perceived benefits to cannabis and not alcohol. This idea warrants further investigation using multivariate designs that are explicitly set up to test this hypothesis. This interpretation is also consistent with qualitative evidence that individuals use cannabis to offset the negative effects of alcohol (Waddell, Merrill, et al., 2023). Further, the positive association during alcohol-only moments between momentary enhancement drinking motives and drinking-contingent pleasure was attenuated by simultaneous cannabis use, which was inconsistent with our hypothesis. Together with evidence that simultaneous cannabis use did not alter the positive association between enhancement drinking motives and change in positive affect, this finding supports a similar attribution shift as that which may be present for substance-contingent relief. That is, it may not be that simultaneous use is less pleasurable than only using alcohol; rather, participants attribute more pleasure to cannabis than alcohol during simultaneous use.

Third, smaller increases in anxious and depressed mood during simultaneous compared to alcohol-only moments suggests that simultaneously using cannabis may improve the affective experience of drinking-to-cope relative to that when only drinking. Rather than interpreting this as support for our hypothesis that simultaneous use is more negatively reinforcing than single-use, it may be more appropriate to conclude that simultaneous use is associated with less worsening of negative affect than alcohol-only use. That is, both alcohol-only and simultaneous use moments were accompanied by increased negative affective, but simultaneous cannabis use may partially offset the increase in negative affect associated with coping-motivated drinking.

Finally, we found no support for our hypotheses that simultaneous alcohol use would moderate the reinforcing effects of cannabis. However, main effects during cannabis-only moments included a similar discrepancy between perceived relief versus worse negative affect such that momentary cannabis coping motives were positively associated with subjective cannabis-contingent relief despite also being associated with increased anxious and depressed mood.

The discrepancy between perceived relief and increased negative affect may be important in treatment. Validating that perceived relief during coping-motivated use feels reinforcing, alongside the possibility that anxiety and depression are exacerbated by use, could comprise a helpful balance in challenging the idea that substance use is an effective emotion-regulation strategy. Increased awareness of motives and reflection on emotional states surrounding use could help individuals feel more equipped to make changes. Future work should examine whether perceived relief versus changes in negative affect differentially predict future use of substances to cope to inform that leg of the reinforcement cycle. Similarly, whether perceived relief versus changes in negative affect differentially predict negative use-related consequences could highlight clinically relevant outcomes stemming from coping-motivated use. Future work should also examine predictors of continuing to use substances to cope after repeated experiences of increased negative affect following use, such as a perceived unavailability of other coping strategies.

The idea that perceived relief during simultaneous use could be attributed to cannabis rather than to alcohol could also be valuable in treatment. Combined with evidence that simultaneous cannabis use may mitigate the worsening of negative affect when drinking-to-cope, there could be some noticeable benefit of using cannabis simultaneously with alcohol when drinking to feel less anxious or depressed. This interpretation requires further research that captures the timing and ordering of cannabis and alcohol use within a simultaneous use event, especially considering possible differences in use patterns depending which substance was used first (Gunn et al., 2021). In addition, care is needed to avoid encouraging simultaneous use to attenuate negative effects of alcohol. Rather, acknowledging the potential benefit of cannabis in terms of negative affective experiences could promote client self-reflections and highlight possible avenues for change (e.g., finding other strategies to lessen the negative effects of alcohol).

4.1. Limitations

The present study had several limitations. We used single items to capture motives in EMA to reduce participant burden, consistent with similar studies (Jackson et al., 2021). Single-item measures may be appropriate (Allen et al., 2022), but assessment of the validity of singleversus multi-item motives in EMA is needed. Also, we assessed momentary motives whenever participants reported use since the last survey, but measuring motives right before use would more closely map onto motivational models (Cooper et al., 2016; Kuntsche et al., 2005). Further, assessing motives right after use could allow actual effects to influence endorsement. Assessing motives before use could clarify whether coping-motivated substance use is still associated with subjective relief if they are not assessed at the same time-point. Pre-use assessments would also capture affect immediately before use instead of relying on affect at the last survey, which could have been hours before use, especially in the case of missed surveys. Generalizability is limited because our participants were mostly White, lived in one U.S. state, and used cannabis frequently. Health inequities, differences in cultural acceptability of substance use based on race and ethnicity, geographic area, cannabis’s legal status, or less frequent use could influence the affective experience of simultaneous use and should be explored in future work (Bryant et al., 2022; Rhew et al., 2022). However, our eligibility criterion of frequent simultaneous use adds unique information to the literature. Whereas previous daily-life studies examined patterns and negative consequences among individuals with less frequent use (Lee et al., 2022), our study sheds light on reinforcement processes and potential treatment targets for heavier use. Similarly, although age was not a significant covariate in any of our models, future work might formally test differences based on age or substance use history. Finally, we excluded individuals who were in/seeking treatment for substance use, reported past-year unsuccessful attempts to stop/cut down, or reported severe past-year withdrawal symptoms. Future work should recruit individuals in or seeking treatment, as clinical implications of this work will be most useful to that population.

4.2. Conclusions

We used EMA to examine motivational and reinforcement processes surrounding simultaneous alcohol and cannabis use in daily life. We found that cannabis use may attenuate the increase in negative affect that accompanies drinking-to-cope, pointing to simultaneous cannabis use as a way that individuals might offset negative effects of alcohol. In addition, we found that using alcohol and cannabis to cope is associated with subjective use-contingent relief despite also being accompanied by a worsening of negative affect. Together, findings inform how simultaneous alcohol and cannabis use might be reinforced compared to use of alcohol or cannabis alone. Future work should continue characterizing these motivational and reinforcement processes, especially with samples of individuals in or seeking treatment for substance use, to create more targeted intervention strategies for reducing problematic patterns of use.

Highlights.

  • We examined simultaneous versus single use of alcohol and cannabis in daily life.

  • Cannabis use during drinking moments altered the affective experience of drinking.

  • Drinking during cannabis use moments did not alter cannabis’s affective effects.

  • Cannabis use attenuated alcohol’s undesirable effects during drinking-to-cope.

  • Simultaneous cannabis use attenuated subjective pleasure attributed to drinking.

Role of Funding Source

This work was supported by the National Institutes of Health F31 AA027958 (Wycoff). NIH had no role in the literature review, the interpretation of the findings, writing the manuscript, or the decision to submit the paper for publication.

This work was funded by NIH F31 AA027958 (Wycoff).

Footnotes

Declaration of Interest

Timothy J. Trull is a co-founder of TigerAware LLC which developed the software described in this study. He receives no compensation or royalties for the use of the software.

1

We used these exclusion criteria because we planned a laboratory alcohol administration component of the present study, which we were unable to execute due to covid-19.

2

Six participants in the present study were recruited from the previous EMA study in our lab, which had similar cannabis use frequency and age-related inclusion criteria.

3

Sensitivity analyses with the subset of individuals who finished the 14-day EMA study with >50% compliance showed the same pattern of results. Therefore, we retained all 88 participants in the analyses reported here.

4

We deviated from our pre-registration by separating coping-anxiety and coping-depression predictors into separate models due to their high correlation. Coping-anxiety and coping-depression motives were correlated .71 (p<.001) for alcohol and .69 (p<.001) for cannabis. However, the pattern of effects for coping-anxiety and coping-depression predictors that we report here remained the same in sensitivity analyses where we included the two motive types in the same model, suggesting that each motive has unique associations with our outcomes.

5

Correlations between person-level aggregates of momentary motives with their corresponding baseline motives ranged from 0.46 (p<.001) for cannabis enhancement to 0.61 (p<.001) for coping-depression. Sensitivity analyses removing baseline motives as covariates had the same pattern of effects reported here.

6

A data cleaning step related to two participants’ smartphone malfunctions during the study brought our total observations from 6371 (as stated in the preregistration) to 6334.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

  1. Adamson SJ, Kay-Lambkin FJ, Baker AL, Lewin TJ, Thornton L, Kelly BJ, & Sellman JD (2010). An improved brief measure of cannabis misuse: The Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Drug and Alcohol Dependence, 110(1–2), 137–143. 10.1016/j.drugalcdep.2010.02.017 [DOI] [PubMed] [Google Scholar]
  2. Allen MS, Iliescu D, & Greiff S (2022). Single item measures in psychological science: A call to action. European Journal of Psychological Assessment, 38(1), 1–5. 10.1027/1015-5759/a000699 [DOI] [Google Scholar]
  3. Arterberry BJ, Goldstick JE, Walton MA, Cunningham RM, Blow FC, & Bonar EE (2021). Alcohol and cannabis motives: Differences in daily motive endorsement on alcohol, cannabis, and alcohol/cannabis co-use days in a cannabis-using sample. Addiction Research & Theory, 29(2), 111–116. 10.1080/16066359.2020.1787390 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boyle HK, Gunn RL, Lopez G, Fox OS, & Merrill JE (2021). Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults. Psychology of Addictive Behaviors, 35(6), 638–649. 10.1037/adb0000746 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bryant BE, Jordan A, & Clark US (2022). Race as a social construct in psychiatry research and practice. JAMA Psychiatry, 79(2), 93–94. 10.1001/jamapsychiatry.2021.2877 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooper ML, Kuntsche E, Levitt A, Barber L, & Wolf S (2016). Motivational models of substance use: A review of theory and research on motives for using alcohol, marijuana, and tobacco. In Sher KJ (Ed.), Oxford Handbook of Substance Use Disorders (pp. 375–421). Oxford University Press. 10.1093/oxfordhb/9780199381678.013.017 [DOI] [Google Scholar]
  7. Cox M, & Klinger E (1988). A motivational model of alcohol use. Journal of Abnormal Psychology, 97, 168–180. 10.1037/0021-843X.97.2.168 [DOI] [PubMed] [Google Scholar]
  8. Cranford JA, Shrout PE, Iida M, Rafaeli E, Yip T, & Bolger N (2006). A procedure for evaluating sensitivity to within-person change: Can mood measures in diary studies detect change reliably? Personality and Social Psychology Bulletin, 32(7), 917–929. 10.1177/0146167206287721 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Davis CN, Slutske WS, Martin NG, Agrawal A, & Lynskey MT (2019). Identifying subtypes of cannabis users based on simultaneous polysubstance use. Drug and Alcohol Dependence, 205. 10.1016/j.drugalcdep.2019.107696 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Geldhof GJ, Preacher KJ, & Zyphur MJ (2014). Reliability estimation in a multilevel confirmatory factor analysis framework. Psychological Methods, 19(1), 72–91. 10.1037/a0032138 [DOI] [PubMed] [Google Scholar]
  11. Grant VV, Stewart SH, O’Connor RM, Blackwell E, & Conrod PJ (2007). Psychometric evaluation of the five-factor Modified Drinking Motives Questionnaire—Revised in undergraduates. Addictive Behaviors, 32(11), 2611–2632. 10.1016/j.addbeh.2007.07.004 [DOI] [PubMed] [Google Scholar]
  12. Gunn RL, Sokolovsky AW, Stevens AK, Metrik J, White HR, & Jackson KM (2021). Ordering in alcohol and cannabis co-use: Impact on daily consumption and consequences. Drug and Alcohol Dependence, 218(108339). 10.1016/j.drugalcdep.2020.108339 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jackson KM, Sokolovsky AW, Gunn RL, & White HR (2020). Consequences of alcohol and marijuana use among college students: Prevalence rates and attributions to substance-specific versus simultaneous use. Psychology of Addictive Behaviors, 34(2), 370–381. 10.1037/adb0000545 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jackson KM, Stevens AK, Sokolovsky AW, Hayes KL, & White HR (2021). Real-world simultaneous alcohol and cannabis use: An ecological study of situational motives and social and physical contexts. Psychology of Addictive Behaviors, 35(6), 698–711. 10.1037/adb0000765 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Jones A, Remmerswaal D, Verveer I, Robinson E, Franken IHA, Wen CKF, & Field M (2019). Compliance with ecological momentary assessment protocols in substance users: A meta-analysis. Addiction, 114(4), 609–619. 10.1111/add.14503 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kuntsche E, Knibbe R, Gmel G, & Engels R (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25(7), 841–861. 10.1016/j.cpr.2005.06.002 [DOI] [PubMed] [Google Scholar]
  17. Lee CM, Calhoun BH, Abdallah DA, Blayney JA, Schultz NR, Brunner M, & Patrick ME (2022). Simultaneous alcohol and marijuana use among young adults: A scoping review of prevalence, patterns, psychosocial correlates, and consequences. Alcohol Research: Current Reviews, 42(1). 10.35946/arcr.v42.1.08 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lee CM, Neighbors C, Hendershot CS, & Grossbard JR (2009). Development and preliminary validation of a comprehensive marijuana motives questionnaire. Journal of Studies on Alcohol and Drugs, 70(2), 279–287. 10.15288/jsad.2009.70.279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lee CM, Patrick ME, Fleming CB, Cadigan JM, Abdallah DA, Fairlie AM, & Larimer ME (2020). A daily study comparing alcohol-related positive and negative consequences for days with only alcohol use versus days with simultaneous alcohol and marijauana use in a community sample of young adults. Alcohol: Clinical and Experimental Research, 44(3), 689–696. 10.1111/acer.14279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Linden-Carmichael AN, Van Doren N, Bray BC, Jackson KM, & Lanza ST (2022). Stress and affect as daily risk factors for substance use patterns: An application of latent class analysis for daily diary data. Prevention science, 23, 598–607. 10.1007/s11121-021-01305-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Linden-Carmichael AN, Van Doren N, Masters LD, & Lanza ST (2020). Simultaneous alcohol and marijuana use in daily life: Implications for level of use, subjective intoxication, and positive and negative consequences. Psychology of Addictive Behaviors, 34(3), 447–453. 10.1037/adb0000556 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Litt DM, Zhou Z, Fairlie AM, King KM, Cross A, Kannard E, Geusens F, & Lewis MA (2023). Daily level examination indicates that positive affect, but not negative affect, is associated with alcohol and marijuana use among adolescents and young adults. Psychology of Addictive Behaviors, 37(8), 1030–1038. 10.1037/adb0000949 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. McNair DM, Lorr M, & Droppleman LF (1992). EdITS manual for the Profile of Mood States. Educational and Industrial Testing Service. [Google Scholar]
  24. Merrill JE, Wardell JD, & Read JP (2014). Drinking motives in the prospective prediction of unique alcohol-related consequences in college students. Journal of Studies on Alcohol and Drugs, 75(1), 93–102. 10.15288/jsad.2014.75.93 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Morrison W, Guerdan L, Kanugo J, Trull T, & Shang Y (2018). TigerAware: An innovative mobile survey and sensor data collection and analytics system. 2018 IEEE Third International Conference on Data Science in Cyberspace (DSC), Guangzhou, China. [Google Scholar]
  26. Patrick ME, Fairlie AM, Cadigan JM, Abdallah DA, Larimer ME, & Lee CM (2019). Daily motives for alcohol and marijuana use as predictors of simultaneous use among young adults. Journal of Studies on Alcohol and Drugs, 80(4), 454–461. 10.15288/jsad.2019.80.454 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Piasecki TM, Cooper ML, Wood PK, Sher KJ, Shiffman S, & Heath AC (2014). Dispositional drinking motives: Associations with appraised alcohol effects and alcohol consumption in an ecological momentary assessment investigation. Psychological Assessment, 26(2), 262–269. 10.1037/a0035153 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Read JP, Colder CR, Livingston JA, Maguin E, & Egerton G (2021). Alcohol and cannabis co-use and social context as risk pathways to sexual assault. Psychology of Addictive Behaviors, 35(6), 659–670. 10.1037/adb0000737 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rhew IC, Guttmannova K, Kilmer JR, Fleming CB, Hultgren BA, Hurvitz PM, Dilley JA, & Larimer ME (2022). Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State. Drug and Alcohol Dependence, 232. 10.1016/j.drugalcdep.2022.109332 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Ross CS, Brooks DR, Aschengrau A, Siegel MB, Weinberg J, & Shrier LA (2018). Positive and negative affect following marijuana use in naturalistic settings: An ecological momentary assessment study. Addictive Behaviors, 76, 61–67. 10.1016/j.addbeh.2017.07.020 [DOI] [PubMed] [Google Scholar]
  31. SAMHSA. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14–4863. Rockville, MD: Substance Abuse and Mental Health Services Administration [Google Scholar]
  32. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, & Grant M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. II. Addiction, 88, 791–804. 10.1111/j.1360-0443.1993.tb02093.x [DOI] [PubMed] [Google Scholar]
  33. Shrout PE, & Lane SP (2012). Psychometrics. In Mehl MR & Conner TS (Eds.), Handbook of research methods for studying daily life (pp. 302–320). Guilford Press. [Google Scholar]
  34. Sobell LC, & Sobell MB (1992). Timeline follow-back: A technique for assessing self-reported alcohol consumption. In Measuring alcohol consumption: Psychosocial and biochemical methods (pp. 41–72). Humana Press. [Google Scholar]
  35. Sokolovsky AW, Gunn RL, Micalizzi L, White HR, & Jackson KM (2020). Alcohol and marijuana co-use: Consequences, subjective intoxication, and the operationalization of simultaneous use. Drug and Alcohol Dependence, 212, 107986. 10.1016/j.drugalcdep.2020.107986 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Stevens AK, Aston ER, Gunn RL, Sokolovsky AW, Treloar Padovano H, White HR, & Jackson KM (2021). Does the combination matter? Examining the influence of alcohol and cannabis product combinations on simultaneous use and consequences in daily life. Alcohol: Clinical and Experimental Research, 45(1), 181–193. 10.1111/acer.14494 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Stevens AK, Gunn RL, Boyle HK, White HR, & Jackson KM (2022). Unplanned versus planned simultaneous alcohol and cannabis use in the daily lives of a predominantly white college student sample: What are the motives, contexts, and outcomes? Psychology of Addictive Behaviors, 36(3), 243–253. 10.1037/adb0000813 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Subbaraman MS, & Kerr WC (2015). Simultaneous versus concurrent use of alcohol and cannabis in the national alcohol survey. Alcoholism: Clinical & Experimental Research, 39(5), 872–879. 10.1111/acer.12698 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Trull TJ, Freeman LK, Fleming MN, Vebares TJ, & Wycoff AM (2022). Using ecological momentary assessment and a portable device to quantify standard tetrahydrocannabinol units for cannabis flower smoking. Addiction, 117(8), 2351–2358. 10.1111/add.15872 [DOI] [PubMed] [Google Scholar]
  40. Votaw VR, & Witkiewitz K (2021). Motives for substance use in daily life: A systematic review of studies using ecological momentary assessment. Clinical Psychological Science, 9(4), 535–562. 10.1177/2167702620978614 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Waddell JT, Corbin WR, Grimm KJ, Metrik J, Lee CM, & Trull TJ (2023). Dynamic relations among simultaneous alcohol and cannabis use, subjective responses, and problem drinking during naturally occurring drinking episodes. Drug and Alcohol Dependence, 249, 110837. 10.1016/j.drugalcdep.2023.110837 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Waddell JT, Merrill JE, Okey SA, Woods-Gonzalez R, & Corbin WR (2023). Subjective effects of simultaneous alcohol and cannabis versus alcohol-only use: A qualitative analysis. Psychology of Addictive Behaviors(Advance online publication.). 10.1037/adb0000908 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Wycoff AM, Carpenter RW, Hepp J, Piasecki TM, & Trull TJ (2021). Real-time reports of drinking to cope: Associations with subjective relief from alcohol and changes in negative affect. Journal of Abnormal Psychology, 130(6), 641–650. 10.1037/abn0000684 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Wycoff AM, Haney AM, Conger KB, & Trull TJ (2024). Momentary cannabis use motives and associated affective changes in daily life. Psychology of Addictive Behaviors, 38(7), 739–746. 10.1037/adb0001035 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Yurasek AM, Aston ER, & Metrik J (2017). Co-use of alcohol and cannabis: A review. Current Addiction Reports, 4(2), 184–193. 10.1007/s40429-017-0149-8 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES