Perceived risk of harm for different methods of cannabis consumption: A brief report.

BACKGROUND: Emerging adults' (EAs; ages 18-25) perceived risk of cannabis-related harms has decreased in recent decades, potentially contributing to their high prevalence of cannabis consumption. With the changing cannabis policy and product landscape, it is critical to understand perceived risk related to different consumption methods (e.g., smoking, dabbing). We examined differences in cannabis risk perceptions by method and consumption patterns. METHODS: EAs recruited from an emergency department (N=359, 71.3% female, 53.5% Black) completed assessments on individual characteristics, cannabis/other substance use, and perceived risk of cannabis-related harm for four different methods (smoking, vaping, dabbing, ingestion) and two use frequencies (occasional, regular). Analyses examined associations between variables of interest and three mutually exclusive groups: no cannabis use, smoking-only, and multiple/other methods. RESULTS: Forty-two percent of EAs reported no past 3-month cannabis use, 22.8% reported smoking only, and 35.1% reported consumption via multiple/other methods. Among all participants, the methods and frequency with the largest number of EAs endorsing any perceived risk from cannabis were dabbing and vaping cannabis regularly; smoking occasionally had the smallest number of EAs endorsing perceived risk. A greater proportion of EAs in the no use group viewed vaping cannabis regularly as having the most risk (63.6%), whereas the largest proportion of EAs in the smoking-only (64.6%) and multiple/other methods (47.2%) groups perceived dabbing regularly as having the most risk. CONCLUSIONS: This work shows that EAs vary in perceptions of risk across methods of cannabis use and can inform potential directions for public health and policy efforts.

Development and Pilot Testing of an Experimental Cannabis Marketplace: Toward Evaluating the Impact of Cannabis Policy on Consumer Choices.

Introduction: The legal landscape of recreational cannabis production and consumption is rapidly expanding, driving a need to inform empirically supported cannabis regulatory policy. A behavioral economic framework integrating economic constructs (e.g., price, substitutability) with psychology and decision-making sciences, has previously been applied to tobacco regulatory sciences through the use of experimental marketplaces. However, experimental marketplaces have not yet been applied to understand cannabis choice behaviors or study ways to minimize risks from use. Herein, we describe the development and initial feasibility testing of an Experimental Cannabis Marketplace (ECM). The ECM can serve as an experimental platform relevant to evaluating the impact of regulatory policies on cannabis choices and use behavior. Methods: The ECM was designed to resemble an online cannabis dispensary. Adults aged 21 and older with past month cannabis use and past month purchase from a recreational dispensary were recruited online. To test the feasibility and acceptability of the ECM, 62 people completed the ECM shopping task and provided feedback on the ECM prototype. Participants also reported about their typical purchases from real-world dispensaries. Results: Nearly all participants rated the ECM as very (80.65%) or somewhat (16.13%) easy to navigate, and rated task instructions as at least mostly clear (100%). The majority (75.81%) said cannabis products available in the ECM were mostly the same or exactly the same as at their typical dispensary. Participant purchase choices in actual dispensary purchases closely matched ECM purchases, with 88% of product choices in typical real-world cannabis dispensaries matching the ECM products purchased. Discussion: Initial testing of the ECM indicates it is an acceptable and feasible tool for understanding cannabis purchasing and choice behavior. These preliminary findings suggest that the ECM mimics cannabis dispensary settings with people making similar choices to those made in the real world.

A systematic review of remotely delivered contingency management treatment for substance use.

BACKGROUND: Substance use and related consequences (e.g., impaired driving, injuries, disease transmission) continue to be major public health concerns. Contingency management (CM) is a highly effective treatment for substance use disorders. Yet CM remains vastly underutilized, in large part due to implementation barriers to in-person delivery. If feasible and effective, remote delivery of CM may reduce barriers at both the clinic- and patient-level, thus increasing reach and access to effective care. Here, we summarize data from a systematic review of studies reporting remote delivery of CM for substance use treatment. METHODS: We conducted a systematic review, reported according to PRISMA guidelines. The study team identified a total of 4358 articles after deduplication. Following title and abstract screening, full-text screening, and reference tracking, 39 studies met the eligibility criteria. We evaluated the methodological quality of the included studies using the Effective Public Health Practice Project Quality tool. RESULTS: Of 39 articles included in the review, most (n = 26) targeted cigarette smoking, with others focusing on alcohol (n = 9) or other substance use or targeting multiple substances (n = 4). Most remotely delivered CM studies focused on abstinence (n = 29), with others targeting substance use reduction (n = 2), intervention engagement (n = 5), and both abstinence and intervention engagement (n = 3). CM was associated with better outcomes (either abstinence, use reduction, or engagement), with increasingly more remotely delivered CM studies published in more recent years. Studies ranged from moderate to strong quality, with the majority (57.5 %) of studies being strong quality. CONCLUSIONS: Consistent with in-person CM, remotely delivered CM focusing on abstinence or use reduction from substances or engagement in substance use treatment services improves outcomes at the end of treatment compared to control conditions. Moreover, remotely delivered CM is feasible across a variety of digital delivery platforms (e.g., web, mobile, and wearable), with acceptability and reduced clinic and patient burden as technological advancements streamline monitoring and reinforcer delivery.

Patterns and predictors of high-intensity drinking and implications for intervention.

Efforts to intervene with subgroups at particularly high risk for alcohol use require information on factors that differentiate drinking intensity levels. This article summarizes existing research and provides new findings on sociodemographics and risk factors that differentiate high-intensity drinking (HID) to provide context for developing and delivering interventions for the highest-risk drinkers. Cross-sectional data were obtained in 2019 from participants who reported past 30-day alcohol use in 2018 as part of the nationally representative 12th grade Monitoring the Future study. Among past 2-week drinkers in 2019 (N = 601; modal age 19; 57.0% male; 67.4% non-Hispanic White), bivariate associations between drinking intensity (moderate drinking [1-4 drinks for women/1-5 drinks for men], binge-only drinking [4-7/5-9 drinks], and HID [8+/10+ drinks]) and a range of sociodemographic characteristics, risk factors, and alcohol-related consequences were examined. Results showed binge-drinking norms, social and enhancement drinking motives, nicotine vaping, and use of limiting/stopping drinking and manner of drinking protective behavioral strategies differentiated all drinking intensity levels, lending support to HID and binge-only drinking having an overlapping risk profile. However, there were also risk factors uniquely associated with HID, including sex, college attendance, employment, HID norms, use of serious harm reduction protective behavioral strategies, family history of drinking problems, any cigarette or drug use other than marijuana, and depression symptoms. Therefore, risk factors differentiate young adult drinking intensity. These results can inform efforts to adapt interventions for young adults who report HID. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

New Directions for Motivational Incentive Interventions for Smoking Cessation.

Background: Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs. Purpose: Technological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions. Conclusions: Technological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.

Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol.

Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.

Perceived impacts of the COVID-19 pandemic on cannabis-using emerging adults.

Cannabis-using youth are a large epidemiologic subgroup whose age and smoking-related risks underscore the importance of examining the impact of the COVID-19 pandemic in this population. Within a clinical trial (n = 36 received an intervention prior to data collection reported herein), we surveyed cannabis-using emerging adults (ages 18-25) about perceived COVID-19 impacts. Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the past 30) were enrolled and completed online surveys as part of either their baseline or 3 month assessment. COVID-19-related measures included symptoms, substance use, mood, etc. Participants were 57% female (mean age = 21, standard deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African American, and 10% of other races. Most participants (86%) reported quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), but none reported testing COVID-19 positive. Many respondents felt their cannabis use (35%-50%, across consumption methods) and negative emotions (e.g., loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) increased. They reported decreased in-person socialization (90.8%) and job losses (23.4%). Reports of increased cannabis smoking were associated with increased negative emotions. On an open-response item, employment/finances and social isolation were frequently named negative impacts (33.3% and 29.4%, respectively). Although cannabis-using emerging adults' reports of increases in cannabis use, coupled with mental health symptoms and social isolation, are concerning, the full impact of the pandemic on their health and well-being remains unknown. Future studies examining the relationship between social isolation, mental health, and cannabis use among young people are needed.

Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes.

BACKGROUND: Despite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users. METHODS: This prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes. RESULTS: Overall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88). CONCLUSIONS: Cannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.

Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms.

BACKGROUND AND AIMS: Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN: Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment. SETTING: Hurley Medical Center Emergency Department (ED) in Flint, MI, USA. PARTICIPANTS: The sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR: ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS: Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up. FINDINGS: TBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant. CONCLUSIONS: Emergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.

Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States.

INTRODUCTION: Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. METHODS: Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007-2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. RESULTS: Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. CONCLUSIONS: Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.

Predictors of empirically derived substance use patterns among sexual minority groups presenting at an emergency department.

AIM: Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems. Findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgroups. To inform models of substance use risk, we identified empirical patterns of substance use and related risk behaviors among LGB individuals. METHOD: LGB participants (N = 343; Mage = 35.5, SD = 11.8; 71.4% = Female; 80.5% = White) were screened in an Emergency Department as part of a randomized controlled trial of an alcohol brief intervention. We conducted latent class analyses using the AUDIT-C (12 month; frequency, quantity, & binge) and ASSIST (12 month; illicit or misused prescription substance). Multinomial regression was performed to test predictors of class membership including depression symptoms, driving after alcohol or marijuana, and sexually transmitted infection (STI) history. RESULTS: A 3-class model fit best and included "low use alcohol, marijuana, and tobacco users," (Low use; n = 244) "hazardous alcohol, tobacco and marijuana users," (Hazardous; n = 74) and "high-risk polysubstance users" (HPU; n = 25). The Low use class comprised the largest proportion of the sample across age, race/ethnicity, and sexual orientation. Compared to the Low use class, higher likelihood of depression symptoms, driving after alcohol or marijuana use, and STI was found for both Hazardous and HPU classes. CONCLUSION: Researchers and clinicians should consider substance use patterns within the LGB population to inform interventions that address a variety of complex needs such as allocating more support for LGB individuals endorsing high-risk polysubstance use.

Acceptability of nonabstinent treatment outcome goals among addiction treatment providers in Ukraine.

We examined whether acceptability of nonabstinence treatment outcome goals varied as a function of a patient's severity of diagnosis (ICD-10 harmful use vs. dependence syndrome; World Health Organization, 1992), finality of outcome goal (intermediate vs. final), and type of substance (e.g., tobacco, alcohol, cannabis), among addiction treatment providers in Ukraine. We surveyed 44% of Ukrainian treatment providers (n = 446/1023; Mage = 40.4, SD = 8.6; Male = 67%; MYears Of Experience = 10.2, SD = 7.2). For tobacco use, most respondents (78%-93%) rated nonabstinence as acceptable, regardless of diagnostic severity or finality of outcome goal (i.e., intermediate, final). Most respondents also rated nonabstinence as acceptable as an intermediate or final goal for patients with harmful use of alcohol (70% to 86%) or cannabis (71% to 93%); however, nonabstinence was less commonly indicated by respondents as an intermediate goal for patients with a dependence syndrome (alcohol = 52%; cannabis = 68%). Regarding other drug use, although most rated nonabstinence acceptable as an intermediate goal for patients with harmful use of opioids (68%) or sedatives (64%), fewer rated nonabstinence acceptable as a final goal (26% to 33%), particularly for patients with a dependence syndrome (10% to 27%). Very few providers (5% to 15%) rated nonabstinence acceptable for other substances. Patients in Ukraine who wish to moderate cannabis or tobacco use will find that their provider is typically accepting of this goal; however, providers are mixed regarding whether alcohol and opioid moderation is appropriate, particularly for those with dependence. Findings support education and research efforts to better understand how provider and patient alignment regarding goals impact patient outcomes following substance use treatment in Ukraine. (PsycINFO Database Record

Utility of the comprehensive marijuana motives questionnaire among medical cannabis patients.

BACKGROUND: Little is known about motives for cannabis use among the population of adults using cannabis medically. Therefore, we evaluated the performance of the 12 factor, 36-item Comprehensive Marijuana Motives Questionnaire (CMMQ) among a sample of medical cannabis patients. METHODS: Study participants were adults ages 21years or older with scheduled appointments to obtain new or renewed medical cannabis certification from clinics in one Midwestern state (n=1116). Confirmatory factor analysis was used to evaluate properties of the CMMQ. Multiple regressions were used to estimate associations between motives and cannabis use, physical health functioning, and mental health functioning. RESULTS: Fit indices were acceptable, and factor loadings ranged from 0.57 to 0.94. Based on regression analyses, motives accounted for 7% of the variance in recent cannabis use, and independent of cannabis use, accounted for 5% and 19% of physical and mental health functioning, respectively. Regression analyses also revealed that distinct motives were associated with cannabis use and physical and mental health functioning. CONCLUSIONS: Among adults seeking medical cannabis certification, the factor structure of the CMMQ was supported, and consistent with prior studies of adolescents and young adults using cannabis recreationally. Thus, individuals who use cannabis medically may have diverse reasons for use that extend beyond the management of medical symptoms. In addition, coping and sleep-related motives may be particularly salient for this population. Findings support the utility of the CMMQ in future research on medical cannabis use; however, expansion of the scale may be needed to address medical motives for use.

Daily associations between cannabis motives and consumption in emerging adults.

BACKGROUND: Increasing rates of cannabis use among emerging adults is a growing public health problem. Intensive longitudinal data can provide information on proximal motives for cannabis use, which can inform interventions to reduce use among emerging adults. METHOD: As part of a larger longitudinal study, patients aged 18-25 years (N=95) recruited from an urban Emergency Department completed daily text message assessments of risk behaviors for 28days, including daily cannabis quantity and motives. Using a mixed effects linear regression model, we examined the relationships between daily quantity of cannabis consumed and motives (i.e., enhancement, social, conformity, coping, and expansion). RESULTS: Participants were, on average, 22.0 years old (SD=2.2); 48.4% were male, 45.3% were African American, and 56.8% received public assistance. Results from the multi-level analysis (clustering day within individual), controlling for gender, race, and receipt of public assistance, indicated daily use of cannabis use for enhancement (ß=0.27), coping (ß=0.15), and/or social motives (ß=0.34) was significantly associated with higher quantities of daily cannabis use; whereas expansion and conformity motives were not. CONCLUSIONS: Daily data show that emerging adults who use cannabis for enhancement, social, and coping motives reported using greater quantities of cannabis. Future research should examine more comprehensive cannabis motives (e.g., boredom, social anxiety, sleep) and test tailored interventions focusing on alternative cognitive/behavioral strategies to address cannabis motives.

Marijuana and other substance use among male and female underage drinkers who drive after drinking and ride with those who drive after drinking.

The study sought to describe the occurrence of adolescent driving after drinking (DD) and riding with a driver who had been drinking (RWDD) and associations with substance use for both males and females. As part of screening for a randomized controlled trial, we surveyed 16-20year olds (N=3418) recruited from an emergency department (ED) and analyzed data from those reporting past-year alcohol consumption (n=2150, 58% females). DD was reported by 22% of females and 28% of males and RWDD was reported by 39% of females and 38% of males, also in the past year. In regression models, risky alcohol use and past-year marijuana use were associated with increased odds of DD and RWDD for females and males. Marijuana use was a strong predictor, with odds increased by 2.3 and 1.7 times for DD among females and males respectively and 1.4 times for RWDD for females and males. Prescription drug misuse was also associated with RWDD for females and for both males' and females' reported DD. The findings highlight the alarming rate of DD and RWDD among both males and females and suggest ED-based injury prevention efforts consider such risky road behavior as well as consider their substance use. Future research might also further examine the effects of driving under influence of substances, particularly marijuana, and the negative synergistic effects of co-ingestion prior to driving.

Characteristics of university students who mix alcohol and energy drinks.

OBJECTIVE: Research has identified correlates (eg, drug use, risky sex, smoking) of using alcohol mixed with energy drinks (AMEDs). Few studies have investigated common mental health-related concerns (eg, depression, sleep). PARTICIPANTS: Alcohol-using college students (n = 380 never used AMEDs, n = 180 used AMEDs) were recruited in the study during the fall 2011 semester. METHODS: The study examined demographics, substance use, depressive symptoms, and sleep problems in association with AMED use. RESULTS: Multivariable logistic regression indicated that alcohol use severity (AOR = 1.24; 95% CI = 1.14+1.34), drug use severity (AOR = 1.20; 95% CI = 1.04-1.39), depressive symptoms (AOR = 1.06; 95% CI = 1.01-1.12), and smoking (AOR = 2.12; 95% CI = 1.22-3.68) were independently associated with AMED use; sleep problems were non-significant. CONCLUSIONS: Administrators may consider policies regarding energy drink availability on campus, and campus health personnel may increase screening and education surrounding AMED use to reduce risks among students.

Synthetic cannabinoid use among patients in residential substance use disorder treatment: prevalence, motives, and correlates.

BACKGROUND: The abuse of synthetic cannabinoids has emerged as a public health concern over the past few years, yet little data exist characterizing the use of synthetic cannabinoids, particularly among patients seeking substance use disorder (SUD) treatment. In a sample of patients entering residential SUD treatment, we examined the prevalence of and motivations for synthetic cannabinoid use, and examined relationships of synthetic cannabinoid use with other substance use and demographic characteristics. METHODS: Patients (N=396; 67% male, 75% White, Mage=34.8) completed self-report screening surveys about lifetime prevalence of synthetic cannabinoid use, route of administration, and motives for use. RESULTS: A total of 150 patients (38%) reported using synthetic cannabinoids in their lifetimes, primarily by smoking (91%). Participants chose multiple motives for use and the most commonly endorsed included curiosity (91%), feeling good/getting high (89%), relaxation (71%), and getting high without having a positive drug test (71%). Demographically, those who used synthetic cannabinoids were younger and more were White. They had higher rates of other substance use and higher scores on measures of depression and psychiatric distress. CONCLUSIONS: Lifetime synthetic cannabinoid use was relatively common in SUD patients and many of those who used it reported doing so because they believed it would not result in a positive drug test. Further research is needed to characterize the extent of synthetic cannabinoid use among SUD treatment samples, and to establish understanding of the longitudinal trajectories of synthetic cannabinoid use in combination with other substance use, psychiatric distress, and treatment outcomes.

Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse.

BACKGROUND: Little research has investigated the correlates of problematic tanning and tanning dependence. OBJECTIVE: We sought to identify characteristics associated with problematic tanning and tanning dependence, and to evaluate simultaneously the associations of variables as correlates of problematic tanning and tanning dependence. METHOD: To assess tanning-related characteristics, psychopathology, and demographics, we administered questionnaires to 533 tanning university students; 31% met criteria for tanning dependence, 12% for problematic tanning. RESULTS: Both problematic tanning and tanning dependence were significantly associated with being female (P < .001 and P < .001, respectively) and with screening positive on measures of obsessive-compulsive (P < .001 and P = .005, respectively) and body dysmorphic (P = .019 and P < .001, respectively) disorders. Frequency of tanning in the past month was the strongest correlate of problematic tanning (P < .001) and tanning dependence (P < .001) when included in a model that controlled for shared variance among demographics and psychopathology. LIMITATIONS: The sample was recruited from 1 university and contained only self-report measures. CONCLUSION: Results suggest that many who engage in excessive tanning may also have significant psychiatric distress. Additional research is needed to characterize compulsive, problematic tanning and its rates, correlates, and risk factors among diverse samples.