Project lifeline: implementing SBIRT in rural pharmacies to address opioid overdoses and substance use disorder.

Background: There is emerging recognition of the unique benefits of implementing screening, brief intervention, and referral to treatment (SBIRT) in pharmacy settings to identify patients who can benefit from services and connecting them to those services.Objectives: This study describes Project Lifeline - a multipronged public health initiative to provide educational and technical support to rural community pharmacies implementing SBIRT for substance use disorder (SUD) and providing harm reduction support.Methods: Eight community pharmacies were recruited. Patients receiving a Schedule II prescription were invited to engage in SBIRT and offered naloxone. Patient screening data and key informant interviews with pharmacy staff on implementation strategy were analyzed.Results: Between 2018-2020, 4,601 adult patients were offered screens and 3,407 screens were completed on 2,881 unique adult patients (51.3% female; <0.01% nonbinary; 95.7% White). Of these unique screens, 107 patients were indicated for brief intervention, 31 accepted the brief intervention; and 12 were given a referral to SUD treatment. Patients who declined SBIRT or who did not want to reduce their use were offered access to naloxone (n = 372). Key informant interviews highlighted the importance of person-centered staff education, role-playing, anti-stigma training, and integrating activities into existing patient-care processes.Conclusion: While ongoing research is needed to characterize the full impact of Project Lifeline on patient outcomes, the reported findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the SUD crisis.

Flexibly modeling age trends in the prevalence of co-occurring patterns of substance use and mental health disorders using time-varying effects and latent class analysis.

Background: Substance use disorders (SUDs) and mental health disorders may change and co-occur in complex patterns across adult ages, but these processes can be difficult to capture with traditional statistical approaches.Objective: To elucidate disorder prevalence and comorbidities across adult ages by using time-varying effect models (TVEMs), latent class analysis (LCA), and modeling latent class prevalences as complex functions of age.Methods: Data were drawn from participants who are 18-65 years old in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women) and a subsample who reported a past-year post-traumatic stress disorder (PTSD), mood, anxiety, or SUD based on DSM-5 diagnoses (n = 11,279). TVEM and LCA were used to examine age trends and comorbidity patterns across ages.Results: SUD prevalence peaked at age 23 (31%) and decreased thereafter, while mental health disorder prevalence was stable (20%-26% across all ages). The prevalence of five classes of individuals based on specific combinations of mental health and SUDs varied by age: the Alcohol Use Disorder class had the highest prevalence at age 26, whereas the Mood and Anxiety Disorder classes peaked around age 63. Interestingly, the Poly-Disorder class prevalence was greatest at age 18 but decreased sharply across young adulthood; however, the prevalence of the other high comorbidity class, PTSD with Mood or Anxiety Disorder, remained fairly constant across age, peaking at age 44.Conclusions: Multimorbid mental health disorders (excluding SUDs) persist in prevalence across adult ages. LCA, TVEM, and their integration together hold substantial potential to advance addiction research.

Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives.

Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.

Greater adolescent tiredness is related to more emotional arousal during a hyperventilation task: An area under the curve approach.

INTRODUCTION: Approximately 36% of adolescents report sleep problems (Crowley et al., 2018). Understanding the relation between sleep and emotional experience is crucial in understanding the high incidence of mental health concerns during adolescence. The current study sought to expand understanding in the area by testing the hypothesis that baseline tiredness ratings would predict greater emotional arousal and negative valence across the course of emotional response elicited by a voluntary hyperventilation procedure. METHODS: A community sample of 110 youth (10-18 years; 47.8% girls) provided baseline tiredness ratings and ratings of emotional valence and arousal, 2 min before, immediately after, and 3 min after a hyperventilation task. The area under the curve (AUC) was calculated using the repeated measures of valence and arousal, and correlations between the response curves and baseline tiredness were examined. RESULTS AND CONCLUSIONS: Findings indicated baseline tiredness was positively associated with AUC arousal (r = 0.23), but not valence. This suggests daytime tiredness is associated with the degree of emotional arousal elicited by a psychobiological stressor. By extension, adolescents may experience more arousing emotional reactions when tired, and thus the common sleep deprivation observed during this developmental period may increase risk for mental health problems associated with elevated emotional reactivity.

Indirect Associations of Anxiety Sensitivity with Tobacco, Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents.

Theoretically, anxiety sensitivity-fear of anxiety symptoms-enhances perception of and emotional reactivity to autonomic arousal and mental distress, thereby increasing negative affect and motivation to use substances for negative reinforcement. Because no prior study of adolescents has tested if anxiety sensitivity is indirectly associated with substance use problems through symptoms of emotional disorders (i.e., disorders involving high levels of negative affect), the current cross-sectional study examined this theoretical pathway. Participants included ninth-grade students from 10 different high schools in the Los Angeles metropolitan area (N = 3005; 54.3% female). Self-report measures of anxiety sensitivity, emotional disorder symptoms, tobacco dependence, and alcohol and other drug problems were administered. Controlling for sex, race/ethnicity, parental education, school, and impulsiveness, we tested the associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems as well as the indirect effects of anxiety sensitivity on each domain of substance use problems through emotional disorder symptoms. Anxiety sensitivity was associated with more severe tobacco dependence and greater alcohol problems and other drug problems, and anxiety sensitivity further was indirectly associated with all three domains of substance use problems through emotional disorder symptoms. Current findings suggest that adolescents high in anxiety sensitivity tend to experience emotional disorder symptoms, which may increase risk for substance use problems. Interventions that target anxiety sensitivity and enhance negative-affect coping skills may assist in preventing and reducing adolescent substance use problems.

Relations Between Parental Distress Intolerance, Adolescent Motives for Cigarette Use, and Adolescent Cigarette Smoking Levels.

Background: A relatively large body of evidence indicates that coping motives for cigarette smoking are associated with a number of problematic outcomes (e.g., greater smoking frequency) among adolescents. Evidence also indicates that lower distress tolerance (or higher distress intolerance) is related to higher levels of coping motives for cigarette smoking among adults and adolescents. Therefore, it is critical to improve our understanding of factors that may increase the likelihood of smoking to cope among adolescents. In addition, evidence suggests that a number of parenting behaviors may affect adolescent smoking behavior. No work to date, however, has examined the relation between parental distress intolerance and adolescent smoking motives, or adolescent smoking behavior. Objective/methods: The current study involving adolescents (n = 46) and one of their parents aimed to address this gap in the literature by examining the association between parent-reported parental distress intolerance, self-reported adolescent motives for cigarette use, and self-reported adolescent cigarette smoking levels. Results: Results indicated that parental distress intolerance was related to greater adolescent coping motives for cigarette smoking, but not to other motives for adolescent cigarette use. Furthermore, results indicated that parental distress intolerance was indirectly associated with higher adolescent cigarette smoking levels through adolescent coping motives for cigarette smoking. Conclusions: Parental distress intolerance is associated with coping motives for adolescent cigarette smoking. This suggests parental emotional factors may be associated with adolescent cigarette use.

Heterogeneous Patterns of Marijuana Use Motives Using Latent Profile Analysis.

Background: Given that marijuana use is often associated with detrimental physical and mental health problems, research examining motives for its use is critical for effective remedial and preventive treatment. To date, the majority of research on marijuana use motives has used variable-centered analyses, which overlooks potentially meaningful heterogeneous response patterns and the associations of those patterns with other risk/protective factors. Methods: To address this gap, in the current study, we conducted a person-centered analysis (latent profile analysis) to identify subgroups of participants based on endorsed marijuana use motives, and examined the construct validity of the optimal class solution (covariates included sociodemographic (e.g., age), psychiatric (e.g., depression), and marijuana-use indices (e.g., use-frequency, use-related problems). Participants were 898 college students (Mage = 20.93, SDage = 3.10; 68.9% female) who completed an anonymous online survey examining substance use and psychological well-being, were 18 years or older, and endorsed lifetime marijuana use. Data were collected November 2016 through February 2018. Results: Results identified four unique classes of coping, conformity, social, and enhancement marijuana use motives: (a) "Low Motives" (37.6%), (b) "High Conformity" (4.9%), (c) "Low Conformity" (45.8%), and (d) "High Motives" (11.7%). In terms of covariates, higher motive classes tended to report more frequent and problematic use. The two classes uniquely characterized by conformity motives only differed on past-month marijuana use frequency. Conclusions/Importance: The current findings provide evidence that specific classes of motives were not only associated with marijuana use frequency and problems but other risk and protective factors, such as anxiety sensitivity and social support.

Violent interpersonal trauma predicts aggressive thoughts and behaviors towards self and others: findings from the National Comorbidity Survey-Adolescent Supplement.

PURPOSE: The purpose of the current study is to examine the relation between adolescent traumatic event exposure and aggression directed towards the self and others. Theoretical perspectives underscore the particularly pernicious effects of violent traumas intentionally perpetrated by others in terms of negative posttraumatic outcomes. However, a careful comparison of trauma type in relation to aggression has not been done with youth. The current project, therefore, examined differences between youth with a history of violent interpersonal trauma (VIT) compared to those with a non-violent trauma type history in terms of aggressive behavior directed towards others as well as aggressive self-directed thoughts (suicidal ideation). METHOD: The sample was drawn from the National Comorbidity Survey-Replication and consisted of 1928 adolescents (M = 15.4; SD = 1.47 years), each assigned to one of four age- and gender-matched trauma history groups. RESULTS: Consistent with hypotheses, among trauma-exposed youth, those who had experienced or witnessed a VIT (compared to those reporting a non-VIT only) evidenced elevated aggression, even after controlling for a number of theoretically relevant covariates (e.g., gender, age, household income, demographic factors). CONCLUSION: Results indicate that youth with a history of VIT may be at unique risk for experiencing aggression directed towards others and the self compared to those without this specific trauma history. This is important because trauma type is an easily assessed indicator of potentially elevated risk for these types of deleterious outcomes. Findings are situated in a research agenda aimed at continuing to refine our understanding of the link between interpersonal trauma and aggression.

Perceived control of anxiety as a moderator in the relationship between anxiety sensitivity and problematic alcohol use among adolescents.

The current study examined perceived control over anxiety as a moderator in the relationship between AS and (1) alcohol use frequency and (2) binge drinking frequency among 80 community-recruited adolescents (Mage = 15.40; 40% female). Eighty-five percent of adolescents reported consuming an alcohol beverage, while 39.5% reported binge drinking. Results indicated significant interactions between AS and perceived control. More specifically, when perceived control was low, higher anxiety sensitivity was related to increased frequency of alcohol use days, but not with binge drinking days. Alternatively, when perceived control over anxiety was high, elevated anxiety sensitivity was associated with a decreased in binge drinking days, but not with alcohol use days. Findings suggest that influence of perceived control over anxiety may be another important, malleable factor that should be considered in future etiological and intervention-oriented work targeting anxiety sensitivity and alcohol misuse among adolescence.

Dimensions of parenting among mothers and fathers in relation to social anxiety among female adolescents.

Social anxiety is the most common anxiety disorder among youth; theoretical and empirical work suggest specific parenting behaviors may be relevant. However, findings are inconsistent, particularly in terms of maternal as compared to paternal effects. In the current study, we evaluated the indirect effects of perceived psychological control on the relation between anxious rearing behaviors and child social anxiety among 112 community-recruited girls (ages 12-15 years). In addition to self-report, adolescent participants completed a laboratory-based social stress task. In line with hypotheses, results indicated indirect effects of psychological control on the relation between anxious rearing behaviors and child social anxiety in maternal but not paternal models. Findings are discussed in terms of their theoretical and empirical implications for clarifying the role of parental relations in adolescent social anxiety.

An Examination of Social Anxiety in Marijuana and Cigarette Use Motives Among Adolescents.

Marijuana and nicotine are two of the most widely used substances among adolescents in the United States. Symptoms of social anxiety (SA) typically emerge during early adolescence, and elevated levels are associated with increased substance-related problems despite inconsistent links to frequency of use. Substance use motives, and in particular coping motives, have been found to play an important role in understanding the heightened risk for use problems among those with elevated SA. Importantly, work to date has been conducted almost exclusively with adult samples; thus the current study examined whether similar patterns would emerge among adolescents. The current project included 56 community-recruited adolescents (ages 12-17 years; 41% girls) with a positive history of lifetime marijuana and cigarette use. Consistent with the adult literature, SA was not positively associated with frequency of use across either substance. Further, SA was positively associated with conformity use motives and unrelated to social or enhancement motives for both substances. Unexpectedly, SA was unrelated to coping use motives for either marijuana or cigarettes. These preliminary data highlight the need for future research designed to forward developmentally sensitive models of substance use behaviors and etiology.

Why Substance Use Screening Frequency Matters in Adult Primary Care.

BACKGROUND: Evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time. METHODS: Quantitative data were obtained from seven primary care sites implementing SBIRT, with patients who were screened twice using the Drug Abuse Screening Test, US Alcohol Use Disorders Identification Test, or the Alcohol, Smoking, and Substance Involvement Screening Test and experienced any risk category change (n = 1,364). Patients were 49% male, 51% female, 81% White, and 14% Black. An intercept-only generalized estimating equation model tested whether category changes between screen one and screen two were statistically significant. RESULTS: The average number of months between screenings for those experiencing a risk category change was 9.01 with a range of 0 to 46 months. There was a statistically significant change between screening one and screening two (P > 0.001), with 44% undergoing a decrease in risk category and 56% undergoing an increase in risk category. Of those undergoing an increase in risk category, 91% moved from a negative/low risk category to a positive/higher risk category. CONCLUSIONS: Results suggest that frequent screening policies may improve identification of substance use risk category changes. The results act as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection.

Examination of college student health behaviors and self-reported executive functions.

Objective: Emerging adulthood is characterized by maturation of executive functions (EF) and changes in health behaviors (HB). Interestingly, EF are bi-directionally related to many specific HB; yet how EF performs in relation to overall patterns of HB engagement is unclear. Groupings of HB and the relationship between these HB groupings and EF were examined. PARTICIPANTS: Full-time college students were recruited from three large Mid- and Southwest universities (N = 1,387). METHODS: Online self-report questionnaires assessing demographics, HB, and EF were completed. RESULTS: Latent class analysis of HB revealed three classes: (1) High Substance Use, (2) Moderately Healthy, (3) Healthy. In general, the Healthy class had significantly greater EF compared to no significant differences between the other two classes. CONCLUSIONS: Collective engagement in HB is associated with EF. Interventions targeting both HB and EF simultaneously may be most efficacious.

Pennsylvania's Community Coordination Strategy to Reduce Opioid Overdose Deaths.

OBJECTIVE: The Pennsylvania Opioid Overdose Reduction Technical Assistance Center (ORTAC) was developed to provide community-level support across Pennsylvania with the goal of reducing the opioid-related overdose death (ODD) rate via coalition building/coordination and tailored technical assistance. This study evaluates the initial effects of ORTAC engagement on county-level opioid ODD reductions. METHOD: Using quasi-experimental difference-in-difference models, we compared ODD per 100,000 population per quarter between 2016 and 2019 in the 29 ORTAC-implementing counties against the 19 nonengaged counties while controlling for county-level time-varying confounders (e.g., naloxone administration by law enforcement). RESULTS: Before ORTAC implementation, the average ODD/100,000 was 8.92 per 100,000 (SD = 3.62) in ORTAC counties and 5.62 per 100,000 (SD = 2.17) for the 19 comparison counties. Relative to the pre-study rate, there was an estimated 30% decrease in the ODD/100,000 within implementing counties after the first two quarters of ORTAC implementation. In the second year after ORTAC implementation, the estimated difference between ORTAC and non-ORTAC counties reached a high of 3.80 fewer deaths per 100,000. Overall, analyses indicated that ORTAC's service was associated with avoiding 1,818 opioid ODD in the 29 implementing counties in the 2 years following implementation. CONCLUSIONS: Findings reinforce the impact of coordinating communities around addressing the ODD crisis. Future policy efforts should provide a suite of overdose reduction strategies and intuitive data structures that can be tailored to individual communities' needs.

Medications for opioid use disorder in rural primary care practices: Patient and provider experiences.

INTRODUCTION: The opioid epidemic has exacted a significant toll in rural areas, yet adoption of medications for opioid use disorder (MOUD) lags. The Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project facilitated adoption of MOUD in rural primary care clinics. The purpose of this study was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide MOUD in rural Pennsylvania. METHODS: In total, the study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. Qualitative analysis incorporated both deductive and inductive approaches. The study team coded interviews and performed thematic analysis. Using a modified social-ecological framework, themes from the qualitative interviews are organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. RESULTS: Patients and providers agreed on many barriers (e.g., lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health, as they highlighted their lives outside of the therapeutic encounter in the clinic. Providers focused on their professional roles, responsibilities, and operations within the primary care setting. CONCLUSIONS: Providers may want to discuss barriers to treatment related to social determinants of health with patients, and pursue partnerships with organizations that seek to address those barriers. The findings from these interviews point to potential opportunities to enhance patient experience, increase access to and optimize processes for MOUD in rural areas, and reduce stigma against people with opioid use disorder (OUD) in the wider community.

Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model.

Background: Access to providers and programs that provide medications for opioid use disorder (MOUD) remains a systemic barrier for patients with opioid use disorder (OUD), particularly if they live in rural areas. The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) addressed this problem with a multisystem partnership that recruited, trained, and supported rural primary care providers to provide MOUD and implement an integrated care model (ICM) for patients with OUD. Given the demonstrated efficacy of Project RAMP, this article summarizes our recruitment strategies, including feasibility concerns for further expansion into other regions. Methods: The approach for recruiting implementation sites included two phases: partner outreach and site identification. Once recruited, the Systems Transformation Framework guided planning and implementation activities. Recruitment and implementation activities were assessed with implementation trackers and evaluated by providers via key informant interviews (KIIs). Results: Project RAMP recruited 26 primary care practices from 13 counties, including nine health systems and two private practice groups-exceeding the original target of 24 sites. There was a median of 49 days from first contact to project onboarding. A total of 108 primary care practices spanning 22 health systems declined participation. Findings from the KIIs highlighted the value of engaging PCPs by connecting to a shared vision (i.e., improving the quality of patient care) as well as addressing perceived participation barriers (e.g., offering concierge technical assistance to address lack of training or resources). Conclusion: Findings highlight how successful recruitment activities should leverage the support of health system leadership. Findings also emphasize that aiding recruitment and engagement efforts successfully addressed prescribers' perceived barriers to providing MOUD as well as facilitating better communication among administrators, PCPs, behavioral health professionals, care managers, and patients.Plain Language Summary: Opioid use disorder (OUD) is one of the leading causes of preventable illness and death. The standard of care for OUD is the provision of medications for opioid use disorder (MOUD) and the application of an integrative integrated care model (ICM) where behavioral health is blended with specialized medical services. Unfortunately, access to providers and healthcare facilities that provide MOUD or apply an ICM remains a systemic barrier for patients with OUD, particularly if they live in rural areas. Although there is no one-size-fits-all approach to implementing MOUD in primary care, findings from Project The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) highlight strategies that may improve future MOUD and ICM implementation efforts in similar rural contexts. Specifically, future efforts to increase MOUD capacity by recruiting new providers should be prepared to leverage health system leadership, address provider barriers via training and expert consultation, and facilitate connections to local behavioral health providers. This approach may be helpful to others recruiting health systems and primary care practices to implement new care models to use MOUD in treating patients with OUD.

Associations of mode of administration on cannabis consumption and subjective intoxication in daily life.

OBJECTIVE: As cannabis products are becoming increasingly available and young adults are increasingly using vaporizers to consume cannabis, there is a need to understand how this population is using different modes of administration and the extent to which specific modes are associated with differential cannabis use outcomes. Toward this end, the current study characterized predictors of cannabis mode of administration and examined how consumption levels and subjective intoxication vary as a function of mode of administration in daily life. METHOD: Participants were 106 young adult cannabis and heavy alcohol users (51% female) who completed up to 14 daily diaries (n = 1,405 person days). Each day, participants reported whether they used any cannabis and, if any, which mode(s) were used, number of hits used per mode, overall subjective intoxication, and the socio-environmental context in which they used cannabis. RESULTS: Across all cannabis use days, Bong-Only and Vape-Only days were the most common, followed by Multimode, Joint-, Pipe-, and Blunt-Only days. Participants reporting a greater proportion of cannabis use days were more likely to report Bong-Only and Multimode days than Vape-Only days. Compared to Vape-Only days, participants reported fewer hits on Bong-Only days and more hits on Blunt-Only, Pipe-Only, and Multimode days. Participants felt more intoxicated on Bong-Only days than Vape-Only days. CONCLUSIONS: Mode-specific associations with cannabis consumption and subjective intoxication levels suggest assessing modes of administration may be a meaningful way to guide individual and public health intervention efforts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A psychometric evaluation of the Marijuana Problems Index among college students: Confirmatory factor analysis and measurement invariance by gender.

Although the Marijuana Problems Index (MPI) is widely used in studies with college student samples to reflect a unidimensional measure of cannabis-related problems, no studies have assessed the psychometric properties of the MPI in a college student population. The present study sought to resolve this gap in a sample of 879 college students reporting past-year cannabis use. Confirmatory factor analyses were used to test the factor structure of the unidimensional 23- and 18-item MPI and measurement invariance across gender. Bivariate correlations between the final factors, cannabis use history/frequency, and other substance use outcomes were used to examine concurrent and discriminant validities (i.e., vs. noncannabis outcomes). The 18-item (but not the 23-item) MPI demonstrated good model fit, measurement invariance across gender, adequate internal reliability, as well as concurrent and discriminant validities. Results support the use of the 18-item MPI over the 23-item MPI for conceptualizing problematic cannabis use, including the testing of gender-specific differences, among college students. Findings also reinforce the importance of evaluating the psychometric properties of widely used measures across samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing subjective cannabis effects in daily life with contemporary young adult language.

INTRODUCTION: Subjective ratings of cannabis effects are important predictors of use-related consequences. However, psychometric research is fairly limited, particularly for measures to capture variability in daily life when diverse modes of cannabis administration and co-substance use are common. METHODS: This study evaluated the predictive utility of a revised item to assess perceived cannabis effects and examined modes of cannabis administration and alcohol and nicotine co-use as moderators. Participants were 106 young adults (18-25 years; 51% female) who completed up to 14 consecutive daily reports of substance use (n = 1405 person-days). Two measures of subjective effects were examined: a standard item (0-100 rating of "how high do you feel?") and a revised item that uses four crowd-sourced anchor points ranging from relaxed (0), calm/chill (33), high (67), and stoned/baked (100). The items shared substantial variance (Pseudo-R2 = 59.5%), however, the revised item showed greater within-person variability (77.0% vs. 68.8%) and stronger day-level associations with consumption levels (Pseudo-R2 = 25.0% vs. 16.7%). RESULTS: The cannabis consumption-subjective effects link was weaker on blunt-only days compared to vape-only days. Subjective cannabis effects were higher on nicotine co-use days after controlling for cannabis consumption; neither alcohol nor nicotine co-use moderated the cannabis consumption-subjective effects link. DISCUSSION: The revised subjective cannabis effects item is a viable alternative to the standard item among young adults who engage in simultaneous alcohol and cannabis use. CONCLUSIONS: Future research focused on characterizing the variability in cannabis effects is needed.

An experimental investigation of peer rejection and social anxiety on alcohol and cannabis use willingness: Accounting for social contexts and use cues in the laboratory.

OBJECTIVE: Evidence suggests that social anxiety (SA) is a risk factor for problematic alcohol and cannabis use, particularly during states of social stress. Unfortunately, laboratory studies to date have overlooked decision-making mechanisms (e.g., use willingness) and contextual features of commonly used social stress tasks that may clarify what is driving these links. The current study begins to address this gap by testing the effects of SA and laboratory-induced peer rejection on acute alcohol and cannabis use willingness within a simulated party setting. METHOD: 80 emerging adults (18-25 years; 70% women) endorsing lifetime alcohol and cannabis use were randomly assigned to experience rejection or neutral social cues. They rated their willingness to use alcohol and cannabis before and after cue exposure within the simulated party. A hierarchical regression tested the main and interaction effects of SA symptoms and experimental condition (Rejection vs. Neutral) on alcohol and cannabis use willingness, controlling for past-year use frequency and willingness to accept any offers (e.g., food and nonalcoholic drinks). RESULTS: There were statistically significant main (but not interaction) effects of SA and experimental condition on cannabis use willingness. Higher SA and Rejection exposure were each associated with greater cannabis use willingness. There were neither main nor interaction effects on alcohol willingness. CONCLUSIONS: Results suggest that elevated SA increases cannabis use willingness across social contexts, regardless of Rejection exposure, while Rejection exposure increases use willingness similarly across levels of SA. Together, findings reinforce the need to consider social-contextual factors and polysubstance use in laboratory settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).