Table 2.

Participants’ Reasons for Simultaneous Use, Evaluations of Simultaneous Use, and Patterns of Use

REASONS FOR SIMULTANEOUS USE
1. Cooper’s 4-Factor Model
Social (n=11)	“There are some drinking nights where like I would just sort of go to bed, but then other nights where people would be up until maybe three o’clock. If that was the case, then I would probably decide to smoke. I would say it’s definitely social for me.” -1043 (female) “Mixing it with drinking, like the right amount, to want to be social and want to go out and do stuff, but not to the extent to where I’m making bad decisions.” -1022 (male)
Enhancement (n=16)	“Uh probably to make the day/night more fun.” -1009 (female) “I usually drink and like if I smoke it’s with people that I’m close to so there is never peer pressure. I just do it cause I want to and cause it will be more fun and cause I want to because it seems like a thing that will make me feel good somehow.” -1021 (female)
Conformity (n=11)	“At that rush event that I described, it was just the social conformity scenario. I think because other people were drinking and smoking I was interested as well.” -1025 (male) “Um usually if it was friends who were mixing I’d just like join in. It was usually because friends were doing it” -1072 (female)
Coping (n=7)	“I would say that most of the time I would end up using marijuana after I was done drinking and the time period between my last drink and the marijuana was very short. My motivation for using marijuana was usually just to calm down from being just like upset.” -1043 (female) “If I was like really trying to get out of my head I guess I would say deciding to combine them is definitely more effective than using one or the other. It kind of feels like I’m, um more out of it or I guess I just feel the psychoactive properties. It’s like a lot more concentrated basically and I would say usually I am in a pretty good mood for the duration of the effects when I use both.” -1096 (male)
2. Harm Reduction Motives (n=15)	“I smoke so I don’t have to drink as much. It’s nice to have maybe three drinks over a couple of hours and then feel good for the night, instead of having like seven.” -1027 (female) “One of the reasons I’ve done that before is kind of like to reduce the possibility of having a hangover. I feel like I can usually drink less and kind of arrive to the same state of being or desired destination or whatever if I do smoke as well.” -1096 (male) “I use weed to mitigate the negative effects of alcohol. A lot of times when I just drink like I’m not as coordinated and I might get like a small headache in the morning or something like that and feel kinda lethargic the next day. I’ve found that all the times when I combine both I sleep better, I don’t wake up with a hangover, and I feel like a lot more in control in terms of my motor abilities.” -1048 (female)
3. Cross-faded Motives (n=6)	“Um, together I did it to bring my high to like the next level.” -1022 (male) “I would say the main reason is like marijuana is very helpful. When you mix it with alcohol it makes you feel more relaxed and at the same time you still get the positive like energetic effects of alcohol. It’s an interesting mix.” -1074 (trans female)
4. Reactive/Situational Reasons
Using Cannabis During a Drinking Event Because Intoxicated (n=11)	“Yeah it was just a matter of like “Oh why not!” I didn’t really like think it through, I think cause, I was already nine drinks in or something like that.” -1015 (male) “I made the decision to smoke marijuana, which isn’t a very good decision for me. A significant part of that was because I was drunk and making decisions less well.” -1080 (female) “Um, also sometimes people are smoking and if you’re drinking then I feel like you’re more likely to say “Oh yeah, I’ll smoke too.” -1111 (female)
Using Cannabis During a Drinking Event Because Available/Offered (n=17)	“Normally I smoke after drinking just because it’s there and I’m like “Oh I guess I wouldn’t mind doing that right now.” -1070 (female) “Yeah um I feel like I don’t ever seek out marijuana when I drink, it’s just I only use it when people will offer it.” -1102 (female) “Weed has a much more presence on this campus. It’s like very accessible and I think I wasn’t craving it; it was just there so I smoked and drank.” -1011 (male)
EVALUATION OF SIMULTANEOUS USE EVENTS
1. Depends on Patterns of Use (n=10)	“Usually when it’s dying down and once I’ve like stopped drinking, then they’ll pull it out and we smoke. I don’t evaluate this as different then a night I just drink.” -1102 (female) “Recreationally I would probably say alcohol only, marijuana only, and then both as last. But times when I smoke at the end of the night after drinking I would say that is similar to alcohol only times.” -1005 (male)
2. Depends on Positive and Negative Consequences Experienced (n=22)	“So I would say the nights where I have both are better. I feel better, I sleep better, I don’t wake up feeling like lethargic. I can get my schoolwork done without feeling tired, it’s a nicer feeling I feel more in control.” -1048 (female) “Well it’s an interesting and very different reality, cause your reality changes depending on what substance your using. I think I am pretty familiar with the feeling of the altered reality while drinking to some extent as the reality isn’t always so altered, but with marijuana it’s been changing for me recently. Like triggering fear and making me sick so cause of these times that really makes me not want to mix. I think the experience of being under both alcohol and marijuana can be more negative for me than just being under alcohol, but it depends.” -1080 (female)
3. Depends on Internal and External Context (n=20)	“If you’re going out like to gross parties that are like really packed, I usually don’t smoke because I don’t feel comfortable smoking around people I don’t know. I would evaluate that as negative. But I would drink.” -1111 (female) “So I would say when I just drink that would be more appropriate for if I’m going to like a frat party, or just some kind of larger on-campus party or socializing with a lot of people I don’t know. If I mixed for that scene that would be bad cause I might be out of control. I would mix the two most of the time with some friends and if it wasn’t like we had to do a lot afterward I would evaluate mixing there as positive.” -1096 (male)
PATTERNS OF SIMULTANEOUS USE
1. Order of Use (n=22)	“Given that I felt physically sick versus other nights when smoking after drinking, I avoid that order. I don’t typically, it’s not common for me to feel physically sick at the end of the night.” -1042 (male) “I would say that most of the time I would end up using marijuana after I was done drinking” -1043 (female)
2. Quantities of Substances Used (n=16)	“Um, I felt I didn’t have to drink as much to feel the effects because there were the effects of marijuana.” -1009 (female) “That night it was a little more blended, but like I drank the drink slower over time. I drank less and I didn’t smoke as much. So it was like I try to balance.” -1027 (female) “If I am having a lot of alcohol I’ll only smoke like a small one hit, maybe two hits that are like small, or if I’m pretty high I’ll have only one drink.” -1044 (male)
3. Timing of Substance Use (n=14)	“I usually like once I start smoking I stop drinking. There are only a couple of nights where I kept going because I wasn’t drinking a lot.” -1027 (female) “Well it was kinda more of just a chill night and so three shots doesn’t really hit me that hard so I did it an hour or so after I drank. Then we were all just chilling in the lounge and I was like yeah, and somebody asked so we all just smoked.” -1087 (male)