@article{ref1,
title="Alcohol first, cannabis last: identification of an especially risky use pattern among individuals who co-use alcohol and cannabis",
journal="Substance use and misuse",
year="2023",
author="Karoly, Hollis C. and Prince, Mark A. and Conner, Bradley T.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Alcohol and cannabis co-use is common and confers increased risk for potential harms, such as negative consequences and substance dependence. The existing evidence suggests that factors such as dose of delta-9-tetrahydrocannabinol (THC) consumed and order of use of each substance (i.e., using alcohol or cannabis first or last when co-using) may impact co-use outcomes. Existing co-use research has focused primarily on college-samples or young adults, and few studies have explored these nuanced relations among community samples. <br><br>METHODS: We examined survey data from 87 community members (mean age 32.9 years, 49.4% female) recruited from legal market cannabis dispensaries. Using a combination of regression techniques (i.e., OLS, negative binomial, censor-inflated) we modeled relations among co-use ordering patterns, THC dose and cannabis outcomes as well as interactions with sex assigned at birth and age. <br><br>RESULTS: Individuals who endorsed co-use reported significantly higher CUDIT scores than those who had never co-used (p < 0.01). Using alcohol first and cannabis last (a pattern we refer to as &quot;AFCL&quot;) was more common among females than males (p < 0.01). In the context of typical substance use weeks, more frequently engaging in the AFCL pattern was associated with significantly higher CUDIT scores (p < 0.001) and negatively predicted positive consequences (p < 0.001). Other patterns predicted higher CUDIT scores during heavy use weeks. <br><br>CONCLUSIONS: Results indicate that co-use ordering patterns are related to substance use outcomes. Further research leveraging within-subjects, longitudinal designs is needed to test causal relations between these variables.<p /> <p>Language: en</p>",
language="en",
issn="1082-6084",
doi="10.1080/10826084.2023.2270674",
url="http://dx.doi.org/10.1080/10826084.2023.2270674"
}