Elsevier

Addictive Behaviors

Volume 119, August 2021, 106946
Addictive Behaviors

Alcohol-related cognitions: Implications for concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse among young adults

https://doi.org/10.1016/j.addbeh.2021.106946Get rights and content

Highlights

  • A large number of young adults age 18–20 engage in concurrent substance use.

  • Certain alcohol-related cognitions are associated with concurrent substance use.

  • Reducing alcohol-related cognitions may help reduce concurrent substance use.

Abstract

Introduction

This study examined the associations between alcohol-related cognitions within the social reaction pathway of the Prototype Willingness Model and concurrent (use of two or more substances within a specified time period) use of 1) alcohol and marijuana and 2) alcohol and prescription stimulant misuse.

Methods

A convenience sample of 1,062 emerging adults in the U.S. (18–20 years old; 54.5% female) who reported past 3-month alcohol use completed a baseline survey as part of a larger randomized controlled trial.

Results

Results indicate that controlling for age, biological sex, race, ethnicity, and college enrollment, perceived descriptive norms and willingness to drink were associated with past 3-month concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse. However, alcohol prototype similarity and alcohol-related perceived vulnerability were not associated with either concurrent use outcome examined.

Discussion

These findings suggest that alcohol-related perceived descriptive norms and willingness to drink are associated with concurrent substance use among young adults. Thus, it is possible that existing efficacious alcohol interventions that target descriptive norms and willingness to drink may have the added benefit of also reducing concurrent substance cognitions and ultimately use.

Introduction

Substance use among young adults in the United States is a major public health concern (Birnbaum et al., 2011, Florence et al., 2016, Rehm et al., 2009). Despite possible consequences, young adults continue to use and/or misuse substances, including alcohol, marijuana, and prescription stimulants (National Institute on Drug Abuse, 2015, Substance Abuse and Mental Health Services Administration., 2020). Alcohol is often the first substance that adolescents and young adults experiment with prior to initiating use of other substances, including marijuana and prescription stimulants (Aiken et al., 2018, Richmond-Rakerd et al., 2017, Substance Abuse and Mental Health Services Administration., 2019a). Moreover, early alcohol initiation is associated with later occurrences of abuse and dependence (DeWit et al., 2000, Grant et al., 2001, King and Chassin, 2007, Warner and White, 2003, York et al., 2004).

Despite alcohol being the most commonly used substance among young adults (SAMHSA, 2020), research indicates that many young adults who use alcohol also report using other substances including marijuana and nonmedical prescription drugs such as stimulants (Barrett et al., 2006, Derefinko et al., 2016, Pape et al., 2009, Substance Abuse and Mental Health Services Administration., 2020, Schulenberg and Maggs, 2002, Wiesner and Windle, 2004). Marijuana is the second most used substance within the U.S. (SAMHSA, 2020). Rates of marijuana use peak in young adulthood (SAMHSA, 2020) and are higher among males, racial and ethnic minorities, and those in college (Miech et al., 2016). The use of marijuana has been linked to acute effects such as impaired cognitive and motor functioning, as well as longer-term effects such as impaired memory and respiratory infections (Meier et al., 2012, Volkow et al., 2014).

Although used less frequently than alcohol or marijuana, the misuse of prescription stimulants is also problematic among young adults. Prescription stimulant misuse is typically defined as taking stimulants without a valid prescription or use of stimulants other than as prescribed, and occurs regularly in young adults (Austic, 2015, Benson et al., 2015, McCabe et al., 2014, Weyandt et al., 2013). In 2019, nearly 2% of all adults in the U.S. reported having ever misused prescription medications, with rates of use being significantly higher (nearly 6%) among young adults (SAMHSA, 2020) and those enrolled in college (between 6 and 17%; Benson et al., 2015), and lower among racial and ethnic minorities (Compton et al., 2018). Risks associated with excessive prescription stimulant use can include cardiovascular failure, irregular heartbeat, high blood pressure, and paranoia (Volkow, 2005).

Notably, research indicates that a significant portion of young adults engage in concurrent substance use, which is commonly defined as the use of two or more substances within a specified time. Concurrent substance use is particularly important to understand among young adults as this is the time when alcohol, marijuana, and prescription stimulant misuse peak (Substance Abuse and Mental Health Services Administration., 2020, Schulenberg and Maggs, 2002). Estimates indicate that concurrent alcohol and marijuana use among young adults ranges between 34 and 75% (Haas et al., 2015, Moss et al., 2014) and that 48.7% of young adults who use alcohol use also report misusing prescription stimulants (McCabe et al., 2015). Examining concurrent substance use during young adulthood is critical, as individuals who engage in concurrent substance use, including using alcohol with marijuana or stimulants, have an increased risk of experiencing negative health and social consequences, such as substance use disorders and negative alcohol-related consequences compared to those who are single-substance users (Conway et al., 2013, Green et al., 2016, Kelly et al., 2015, Lewis et al., submitted for publication, Moss et al., 2014, Yurasek et al., 2017). As such, it is important to identify social cognitive factors that may place one at risk for such use.

The Prototype Willingness Model (PWM) posits that risk behavior among young adults operates through two pathways: a more planful and reasoned pathway and a social reaction pathway wherein risk behaviors are conceptualized as behaviors that are not planned but instead are reactions to risk-conducive environments (Gerrard et al., 2008, Gibbons et al., 2003). Although both the reasoned and social reaction pathways have utility in predicting risk behavior, the social reaction pathway is more predictive of behavior among adolescents and young adults (Gerrard et al., 2008, Pomery et al., 2009) and as such is the primary focus of the present paper. The PWM social reaction pathway is comprised of descriptive norms, prototypes, perceived vulnerability, and behavioral willingness (Gerrard et al., 2008). Descriptive norms, or perceptions of the quantity and frequency of a behavior among others (Cialdini et al., 1991, Reno et al., 1993), are a key part of the PWM social reaction pathway. In addition, prototypes are images of the type of person who engages in specific behaviors (e.g., typical drinker their age) and are often conceptualized as being two constructs, prototype favorability (i.e., perception that the prototype is associated with positive and/or negative attributes) and prototype similarity (i.e., perception of oneself as similar to the prototype)(Gerrard et al., 2008). However, recent research indicates that prototype similarity, but not favorability, is a stronger predictor of adolescent and young adult alcohol use when examining heavy-episodic drinking (Litt et al., 2020, Teunissen et al., 2017). Perceived vulnerability is the perceived chance an individual has of experiencing negative consequences if they were to engage in a risky behavior (Gerrard et al., 2008). Finally, behavioral willingness is an openness to engage in a risk behavior under certain circumstances (Gerrard et al., 2008).

PWM social reaction pathway risk cognitions such as descriptive norms, prototype similarity, perceived vulnerability, and willingness are often established well before a behavior occurs (Ajzen, 1985, Fishbein and Ajzen, 1975, Gerrard et al., 2008). Therefore, cognitions related to a specific health behavior may also be described as having a predisposition to engage in that behavior. For example, endorsing riskier alcohol-related cognitions has consistently been found to be significantly associated with greater alcohol use (Andrews et al., 2008, Gerrard et al., 2002, Pomery et al., 2009, Rivis et al., 2006). Although less studied than alcohol use, research indicates that the PWM social reaction pathway is an appropriate model to apply to young adult marijuana use (Hampson et al., 2008, Lewis et al., 2018) and prescription stimulant misuse (Molloy et al., 2019, Stock et al., 2013).

Despite clear associations between PWM social reaction pathway alcohol-related cognitions and alcohol use, no research to date has examined whether these same cognitions are associated with engagement in other substance use, such as marijuana and prescription stimulant misuse. Given that alcohol is often the first substance initiated among adolescents and young adults (Grant et al., 2001, King and Chassin, 2007, York et al., 2004), determining what specific PWM social reaction pathway alcohol-related cognitions may be associated with concurrent use of other substances is important when determining when and on what factors to intervene. For example, alcohol is the most common prevention target for substance use among colleges and medical providers (Blevins and Khanna, 2016, Substance Abuse and Mental Health Services Administration., 2019b). Therefore, knowing whether certain PWM social reaction pathway alcohol-related cognitions are associated with concurrent use of other substances among current drinkers is one way to reduce screening burden as one may be able to determine whether current drinkers may also be at risk for concurrent substance use based on known associations between alcohol-related risk cognitions and the use of other substances. Thus, the present study aimed to determine whether alcohol-related PWM social reaction pathway cognitions are associated with concurrent substance use.

Based on the extant literature, we hypothesized that when controlling for important covariates (i.e., age, biological sex, race, ethnicity, and college enrollment), alcohol-related PWM social reaction pathway cognitions (descriptive norms, prototype similarity, perceived vulnerability, and willingness) would be associated with 1) concurrent use of alcohol and marijuana and 2) concurrent use of alcohol and prescription stimulant misuse over the past 3 months among young adult drinkers age 18–20.

Section snippets

Participants and procedures

Participants for the present study included 1,065 18–20-year-old young adults who were participating in a larger study evaluating an intervention for alcohol-related risky sexual behavior. Data for the present analyses come from the baseline assessment. Demographics for the baseline sample include a mean age of 19.17 years old (SD = 0.79) and 54.5% were female. Ethnic and racial representation of the baseline sample was as follows: 15.1% Hispanic/Latino; 70.5% White, 10.3% Other/More than one

Descriptive statistics and correlations

Participants reported drinking, on average, nearly twice per week (M = 5.82, SD = 1.72). On average, participants reported using marijuana a little more than twice per month (M = 4.34, SD = 3.76) and prescription stimulants were misused on an average of 1.19 (SD = 5.38) occasions in the past 90 days. Over the past 3 months, 14.5% of participants only used alcohol, 85% of the sample reported concurrent alcohol and marijuana use, 24% reported concurrent alcohol and prescription stimulant misuse,

Discussion

The current findings suggest that, beyond being associated with cognitions about other substances (Andrews et al., 2008, Gibbons et al., 2003), several alcohol-related PWM social reaction pathway cognitions are also associated with the actual concurrent use of alcohol with marijuana and prescription stimulant misuse. Results of the study indicate that in particular, perceived descriptive norms and willingness to drink are associated with both concurrent alcohol and marijuana use and concurrent

Role of funding source

Data collection and manuscript preparation were supported by National Institute on Alcohol Abuse and Alcoholism Grant R01AA021379 awarded to Melissa A. Lewis.

Data collection and manuscript preparation were supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R01AA021379) awarded to Dr. Melissa A. Lewis. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol

Author CRediT Statement

Dana Litt was a Co-Investigator on the grant from which the study data was drawn and was in charge of study conceptualization, data analyses, paper writing, and coordination of authors. Ashley Lowery and Cassidy LoParco assisted with manuscript preparation. Melissa Lewis was the PI of the grant from which the study data was drawn and assisted the first author with manuscript preparation. All authors conducted multiple rounds of edits and revisions prior to submission.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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