Alcohol and cannabis dual use among Black adults: Associations with alcohol use, use-related problems, and race-based discrimination.

BACKGROUND AND OBJECTIVES: Black adults who drink alcohol appear at risk for poor alcohol-related outcomes, yet little research has examined whether cannabis use among those who consume alcohol (alcohol-cannabis dual use) is related to worse alcohol-related consequences, as observed in predominantly White samples. Further, it may be that experiencing more race-based discrimination may be related to using multiple substances to cope with such experiences; however, no known studies have examined the impact of race-based discrimination on alcohol-cannabis dual use. METHODS: Participants were 270 Black undergraduates who endorsed past-month drinking, 112 of whom endorsed alcohol-cannabis dual use. RESULTS: The dual use group reported heavier drinking, more drinking-related problems, and more race-based microaggressions (but not overt racism) than the alcohol-only group. CONCLUSIONS: The use of cannabis among Black young adults who drink alcohol was related to heavier drinking and more alcohol-related problems. Further, experiencing more microaggressions may place these individuals at risk for using multiple substances, presumably to cope with these experiences. SCIENTIFIC SIGNIFICANCE: Considering models suggesting that the dual use of cannabis may result in less alcohol use, the current study highlights that for Black adults who consume alcohol, cannabis dual use is related to heavier drinking and more alcohol-related problems, which can inform intervention and treatment efforts.

Sexism and alcohol-related problems among women: The role of social anxiety and coping motivated drinking.

BACKGROUND AND OBJECTIVES: Experiencing sexism is related to more alcohol-related problems, presumably via drinking to cope with negative affect associated with experiencing sexism. Yet no known studies have directly tested whether the relation of sexism to alcohol problems occurs via relevant negative emotions and drinking to cope with negative emotions. Given that sexism is a type of negative evaluation, social anxiety may be one type of negative affect that plays a role in sexism's relation with drinking behaviors. METHOD: This study tested whether sexism was related to alcohol-related problems via the serial effects of social anxiety and coping-motivated alcohol use among 836 cis-female undergraduates who endorsed past-month alcohol use. RESULTS: Past-year experiences with sexism were positively correlated with coping and conformity-motivated alcohol use, alcohol problems (but not peak estimated blood alcohol content, eBAC), social anxiety, and depression. After statistically controlling for depression and peak eBAC, sexism was indirectly related to alcohol problems via the serial effects of social anxiety and drinking motives (coping, conformity). DISCUSSION AND CONCLUSIONS: Results highlight the important role of social anxiety and drinking to cope with negative emotions and to fit in with peers who drink in relation of sexism with alcohol-related problems. SCIENTIFIC SIGNIFICANCE: This is the first known study to find that experiences of sexism are related to alcohol problems via the serial effects of social anxiety and coping and conformity-motivated drinking. This is also the first known study to find that sexism is related to more conformity-motivated drinking.

Social Anxiety and Cannabis-Related Problems: The Serial Roles of Distress Tolerance and Cannabis Use Motives.

Background: Individuals with elevated social anxiety are vulnerable to experiencing negative consequences related to cannabis use. One transdiagnostic vulnerability factor that has received little attention in the social anxiety-cannabis problem relation is distress tolerance, which is associated with more cannabis use to manage negative affect broadly (i.e., coping motives) and cannabis-related problems. However, it is unknown whether distress tolerance is related to greater cannabis use to manage social anxiety specifically (i.e., social anxiety motives). Objectives: This study tested whether the relation between social anxiety and cannabis problems occurred via perceived distress tolerance among 309 (77.3% female) undergraduates who endorsed current (past three-month) cannabis use. Results: Social anxiety was negatively associated with distress tolerance and positively associated with cannabis problems, coping, and social anxiety motives. Social anxiety was indirectly (via distress tolerance) related to more cannabis problems and motives to cope with negative affect generally and to cope with social anxiety specifically. Social anxiety was indirectly related to more cannabis problems via the serial effects of distress tolerance and coping and social anxiety motives. Conclusions: Findings suggest that individuals with elevated social anxiety may be vulnerable to using cannabis to manage negative affect (generally and social anxiety specifically) due to low perceived ability to tolerate psychological distress, which may lead to more cannabis problems. Keywords: cannabis; marijuana; distress tolerance; social anxiety; motives; coping motives.

Dual Electronic and Combustible Cigarette Use: Understanding the Relation of Cannabis Use with E-Cigarette Outcomes.

Background: E-cigarette use is on the rise and many who use e-cigarettes also smoke combustible cigarettes. Dual use (i.e., use of both electronic and combustible cigarettes) is associated with greater rates of cannabis use and cannabis use among individuals who engage in dual use is related to more severe ecigarette-related problems. Yet, no known studies have tested whether cannabis use is related to more severe e-cigarette problems via negative affect and the expectation that e-cigarettes can help manage negative affect. Objectives: The current study tested this hypothesis among 400 adults who endorsed dual use, 33% of whom endorsed current (past three month) cannabis use. Results: Results indicated that participants with cannabis use reported more anxiety, depression, e-cigarette problems, and the following e-cigarette use expectancies: negative consequences, negative reinforcement, and weight concerns. Multiple mediator models found that the relation between cannabis use status and e-cigarette problem severity was mediated by anxiety (but not depression) and by negative reinforcement and weight concerns (but not negative consequences) expectancies. Serial mediator models indicated that the relation between cannabis use and e-cigarette problems occurred via the serial effects of anxiety and negative reinforcement (but not weight concerns) expectancies. Conclusions: These results highlight several clinical correlates of cannabis use among adults who smoke combustible and e-cigarettes, and suggest that anxiety and the expectation that e-cigarettes may help manage such negative emotions play important roles in e-cigarette-related problems among these individuals.

Cannabis and Nicotine Dual Use among Sexual Minority Individuals: Relations to Cannabis Use and Negative Affect.

Background: Sexual minority individuals report significantly more cannabis use and use-related problems than their heterosexual peers, and emerging data indicate sexual minority individuals who use cannabis are at greater risk for dual use of nicotine products (combustible smoking, e-cigarette use) than heterosexual individuals. Although cannabis-nicotine dual use is related to worse cannabis outcomes and negative affect, little work has identified factors related to dual use among sexual minority individuals or tested if sexual orientation-based discrimination (microaggressions, overt discrimination) is related to dual use. Objectives: The current study tested if cannabis-nicotine dual use is related to more frequent cannabis use, more cannabis-related problems, negative affect, and discrimination among sexual minority undergraduate students who endorsed current (past three-month) cannabis use (N = 328), 43.6% of whom endorsed dual nicotine use. Cannabis-nicotine dual use was related to more frequent cannabis use, more cannabis-related problems, more anxiety (but not depression), and more sexual orientation-based microaggressions and microaggressions-related negative affect (but not overt discrimination or non-sexual orientation-based daily stressors). Conclusions/Importance: Overall, this is the first known study to identify that sexual orientation-based discrimination is related to cannabis-nicotine dual use and that dual use is related to more frequent cannabis use, use-related problems, and negative affect (especially anxiety) among this underrepresented group.

Social Anxiety and Alcohol Use and Related Problems among Black Adults: Differential Roles of Motives by Sex.

Background: Black individuals who consume alcohol are at risk of experiencing alcohol-related problems. Psycho-sociocultural models of substance use posit that these individuals may continue to drink despite alcohol-related problems to cope with psychological distress. Emerging data indicate that social anxiety is one type of distress that may play an important role in drinking behavior among Black adults. Objectives: Yet despite evidence that drinking to cope varies as a function of sex among predominantly White samples, this is the first known study to test whether socially anxious Black women are similarly at risk for coping motivated drinking and its negative sequelae. Participants were 257 (75% female) Black undergraduates endorsing current alcohol use. Results: Among women and men, social anxiety was significantly related to more alcoholrelated problems and coping-depression and conformity motives. Among women (but not men), social anxiety was also significantly related to more coping-anxiety and greater typical drinking. Serial mediation analyses among women indicated that social anxiety was indirectly related to more alcohol problems via the serial effect of each of the relevant drinking motives (copinganxiety, coping-depression, conformity) and drinking frequency. Among men, social anxiety was indirectly related to alcohol problems via coping-depression and conformity motives. Conclusions/Importance: Findings highlight the importance of considering sex in research on psychosocial vulnerability factors associated with alcohol-related problems among Black adults.

False safety behavior use among Black adults.

Anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to anxiety in predominantly White samples are related to anxiety among Black individuals. Yet, given less mental health service utilization and greater experience of some life stressors, Black persons may be especially at risk for using false safety behaviors (FSB; designed to decrease anxiety in the short term, but are associated with more longer-term mental health problems). We tested whether non-Hispanic/Latin Black persons (n = 133) reported greater FSB use than non-Hispanic/Latin White participants (n = 844) as well as whether FSB use was related to more mental health problems among Black participants. Data were collected online among undergraduates. Black participants did endorse more frequent FSB use, especially FSB-Avoidance and FSB-Body Sensations. Results indicate that among Black participants, FSB use was related to more anxiety, depression, and suicidal thoughts and behaviors. FSB may be an important behavioral vulnerability factor related to anxiety and associated mental health problems among Black young adults.

Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Alcohol and marijuana co-use among adults with chronic low back pain: Associations with substance misuse, mental health, and pain experience.

BACKGROUND AND OBJECTIVES: Individuals with chronic lower back pain (CLBP) report using alcohol and marijuana to cope with pain. Little research has tested whether co-use is associated with worse psychological outcomes. METHODS: Participants had CLBP and past-month alcohol/marijuana co-use (n = 192), alcohol use (n = 148), marijuana use (n = 78), or no use (n = 101). RESULTS: Co-use was associated with more drinking-related problems, anxiety, and pain anxiety compared to alcohol-(but not marijuana-) only, whereas marijuana-only use was associated with worse psychological outcomes than alcohol use-only; effect sizes were small to medium. DISCUSSION AND CONCLUSIONS: Co-use and marijuana-only were associated with worse outcomes than alcohol-only. SCIENTIFIC SIGNIFICANCE: The present findings extend current understanding of co-use by finding that marijuana use among people with CLBP (a group with especially high rates of use of these substances) is associated with worse alcohol-related problems and psychological outcomes.

Racial Discrimination and Hazardous Drinking among Black Drinkers: The Role of Social Anxiety in the Minority Stress Model.

Objective: Black Americans who consume alcohol experience worse alcohol-related outcomes. Thus, identifying psycho-sociocultural factors that play a role in hazardous drinking among Black individuals is vital to informing prevention and treatment efforts to reduce these disparities. Racial discrimination is related to hazardous drinking among Black adults, suggesting that some may drink (and continue to drink despite drinking-related problems) to alleviate negative affect (e.g., depression, anxiety) associated with discrimination. Yet, despite the social nature of both racial discrimination and drinking, no known research has examined the role of social anxiety in the relations among racial discrimination experiences and hazardous drinking. Method: Participants were 164 Black current drinking undergraduates. Results: Racial discrimination was significantly, positively correlated with hazardous drinking, depression, and social anxiety. Discrimination was indirectly related to hazardous drinking via social anxiety, but not depression. Further, discrimination was indirectly related to hazardous drinking via social anxiety alone and via the sequential effects of social anxiety and drinking to cope, but not via coping motives alone. It was also related to hazardous drinking via the sequential effects of depression and drinking to cope but not depression alone. Alternative model testing indicated that social anxiety was not related to hazardous drinking via discrimination, strengthening confidence in directionality of proposed relations. Conclusions: Negative affect (social anxiety, depression) appears to be related to hazardous drinking among those who experience more discrimination due in part to drinking to cope. Social anxiety plays an important role in the relation between discrimination and hazardous drinking among Black adults.

Financial strain among adult African American/Black cannabis users.

African American/Black persons belong to the second largest racial/ethnic minority group in the United States. This group evinces significant disparities related to cannabis use problems. Social determinants of health may be potentially relevant to better understand cannabis use problems among African American/Black adults. As such, the current study sought to provide an initial test of the role of financial strain, a prominent social determinant of health, in cannabis use problems and perceived barriers for cannabis cessation among African American/Black adults. Participants were 76 (32.9% female, Mage = 38.64, SD = 10.82) African American/Black adult, current cannabis users. Hierarchical regression results indicated that greater financial strain was associated with more cannabis use problems and greater perceived barriers for cannabis cessation; such effects were evident above and beyond the variance explained by a range of relevant covariates, including age, sex, income, education, and depressive symptoms. These findings suggest addressing financial strain (e.g., financial planning, psychoeducation about the handling financial stress) may be a useful therapeutic tactic in the larger landscape of treatment programming when targeting cannabis use behaviors and beliefs among African American/Black adult cannabis users.

Biopsychosocial Model Social Anxiety and Substance Use Revised.

PURPOSE OF REVIEW: To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it. RECENT FINDINGS: Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

Anxiety, depression, and opioid misuse among adults with chronic pain: the role of emotion dysregulation.

The opioid epidemic is a significant public health concern in the United States, particularly among adults with chronic pain. Considerable research suggests that people with mental health problems, including anxiety and depression, may experience more opioid-related problems in the context of chronic pain. Yet, little work has examined potential mechanisms underyling these relations. Emotion dysregulation is one mechanistic factor that may link anxiety and depression and opioid-related problems among persons with chronic pain. Therefore, the current study examined the explanatory role of emotion dysregulation in the cross-sectional relationship between anxiety and depression problems and current opioid misuse and severity of opioid dependence among 431 adults with chronic pain who reported currently using opioid medications (74% female, Mage=38.32 years, SD = 11.11). Results indicated that emotion dysregulation explained, in part, the relationship between anxiety and depression symptoms and opioid-related problems. These findings highlight the need to further consider the role of emotion dysregulation among adults with chronic pain who use prescription opioids and experience symptoms of anxiety or depression. Future prospective research will be needed to further establish emotion dysregulation as a mechanism in anxiety/depression-opioid misuse/dependence processes.

Functional Impairment in Response to the COVID-19 Pandemic among Cannabis Users.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 2 million deaths and hospitalization of many individuals worldwide. Although preliminary evidence suggests that cannabis use has increased during the pandemic, there has been little research on the impact of cannabis use on COVID-related psychological outcomes. Cannabis use among college students is associated with problematic psychosocial outcomes; thus, it follows that cannabis users during the pandemic may experience more functional impairment problems with daily living as a result of increased psychological distress from the pandemic and difficulty with regulating that distress. METHODS: The current study tested whether cannabis use status was related to functional impairment in daily activities and whether this was due to difficulty with emotion regulation and COVID-related distress. The sample comprised of 727 (184 current cannabis users) young adults in Louisiana, a state that had some of the highest rates of COVID-19 deaths and infections in the U.S. RESULTS: Cannabis use was related to greater functional impairment in daily activities and this relation was mediated by the sequential effects of difficulty with emotion regulation and COVID-related distress. CONCLUSIONS: Results indicated that cannabis users during the COVID-19 pandemic are experiencing problematic psychosocial outcomes further highlighting the need for the development of interventions to help target COVID-related distress and improve psychosocial functioning during the pandemic.

The Role of Anxiety Sensitivity and Fatigue Severity in Predicting E-Cigarette Dependence, Barriers to Cessation, and Cravings among Young Adults.

Background: Electronic cigarette (e-cigarette) use has risen dramatically in the United States among young adults; however, little is understood about potential factors that are related to e-cigarette use and maintenance among this population. Fatigue severity is one promising individual difference factor, as past work indicates that it is related to greater withdrawal symptoms and greater dependence on e-cigarettes, and more barriers to quitting. In addition, anxiety sensitivity and severe fatigue are both uniquely related to poor e-cigarette use outcomes; yet, no known studies have examined whether these individual difference factors are related to e-cigarette outcomes among young adults. Method: The current study sought to examine the unique and interactive effects of anxiety sensitivity and fatigue severity in predicting a variety of e-cigarette outcomes among 685 (69.1% female; Mage = 19.61 years, SD = 1.44) young adult e-cigarette users. Results: Results indicated that anxiety sensitivity was significantly associated with greater barriers for cessation (ß = .63, p <.001) and e-cigarette cravings (ß = .67, p =.001), but not dependence. Fatigue severity was significantly associated with greater e-cigarette dependence (ß = .58, p <.001), barriers to cessation (ß = 1.56, p <.001), and e-cigarette cravings (ß = 3.34, p <.001). The interactive effects of anxiety sensitivity and fatigue severity did not significantly predict the outcomes. Discussion: Results suggest that anxiety sensitivity and fatigue severity independently predict greater e-cigarette maintenance factors among young adults. The current investigation highlights the importance of targeting anxiety sensitivity and fatigue severity among young adult e-cigarette users.

Difficulties with emotion regulation and drinking during the COVID-19 pandemic among undergraduates: the serial mediation of COVID-related distress and drinking to cope with the pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has contributed to thousands of hospitalizations and deaths worldwide. Although alcohol use has increased in response to the pandemic, no known studies have identified transdiagnostic risk factors for greater drinking in response to COVID-related distress. Individuals with more difficulty with emotion regulation may drink more during the pandemic to manage pandemic-related distress. The current study tested whether difficulty with emotion regulation was related to greater estimated blood alcohol content (eBAC) during a typical week in the past month and if this was due to COVID-related distress and drinking to cope with the pandemic. The sample consisted of 347 past-month drinking undergraduates in Louisiana, a state with some of the U.S. highest rates of COVID-19 infections and related deaths. Difficulty with engaging in goal-directed behaviors was related to greater past-month eBAC and this relation was mediated by the sequential effects of COVID-related worry and drinking to cope with the pandemic. Results indicate that individuals with difficulty engaging in goal-directed behaviors are especially vulnerable to greater eBAC during the COVID-19 pandemic which may be due in part to their vulnerability to more COVID-related worry which may lead to more drinking to cope with the pandemic.

The Acute Impact of Hatha Yoga on Craving Among Smokers Attempting to Reduce or Quit.

INTRODUCTION: Despite negative effects of smoking, smokers have difficulty quitting, suggesting a need for additional strategies to help them quit. A single-session hatha yoga intervention acutely reduced craving among nicotine-deprived smokers not attempting to reduce or quit, yet it is unknown if it reduces craving among those attempting to change their smoking. Thus, this study tested the efficacy of a single-session hatha yoga intervention for acutely reducing craving among smokers attempting to reduce or quit smoking. METHODS: Data presented are part of a larger dissertation project. Participants were 55 community-recruited smokers (62% male) motivated to reduce or quit smoking randomized to one session of hatha yoga (n = 25) or wellness control (ie, reading educational materials about healthy lifestyle; n = 30) on their intervention day (ie, the day on which they began to reduce or quit smoking). Participants rated, "I have a desire for a cigarette right now," on a 7-point Likert scale immediately before and after the intervention. RESULTS: After statistically controlling for CO in breath, participant type, age, gender, race, and ethnicity, a significant Time × Condition interaction was found, F(1, 47) = 4.72, p = .035, ηp2 = .09, suggesting craving decreased at a greater rate in the hatha yoga condition relative to the wellness condition. CONCLUSIONS: Results from this study add to a growing body of research demonstrating the potential clinical utility of hatha yoga as an adjunctive intervention tool for smoking cessation. IMPLICATIONS: This is the first known study to test the impact of a single-session hatha yoga intervention on craving among adult smokers attempting to reduce or quit smoking. We found that 30 minutes of hatha yoga produced a greater reduction in craving compared to a 30-minute wellness control condition. This relationship was evident even after statistically accounting for other important variables (eg, gender). Results of this study add to a growing body of literature demonstrating the potential clinical utility of hatha yoga as an adjunctive intervention strategy for smoking cessation.

The Effects of Cannabis Use: A Test Among Dual Electronic and Combustible Cigarette Users.

BACKGROUND AND OBJECTIVES: Despite greater rates of cannabis use among those that smoke combustible cigarettes, it is currently unknown whether cannabis use is related to e-cigarette dependence or maladaptive beliefs about combustible cigarettes. Therefore, the current study sought to identify whether adult dual users of combustible and e-cigarettes (ie, dual users) who also used cannabis differed from dual users who did not use cannabis on e-cigarette dependence severity, perceived barriers to quitting, and perception of risks and of benefits of e-cigarettes. METHODS: Participants were 414 current dual users (48.3% female, Mage = 35.1 years, SD = 10.0), 51% of whom were current cannabis users. RESULTS: Dual users who reported current cannabis use evidenced more severe dependence on e-cigarettes (ηp 2 = 0.12), higher perceived barriers for quitting e-cigarettes (ηp 2 = 0.06), and greater perceived benefits (ηp 2 = 0.03) as well as higher perception of risks (ηp 2 = 0.03) for using e-cigarettes. The results were evident after controlling for the variance associated with sex, age, education, income, and frequency of e-cigarette use. DISCUSSION AND CONCLUSIONS: Overall, the current findings suggest cannabis may be an important type of substance use behavior that is relevant to e-cigarette dependence and beliefs about use and quitting among adult dual users. SCIENTIFIC SIGNIFICANCE: The present data extend current understanding of dual users by contextualizing cannabis use within e-cigarette and combustible cigarette use behaviors and highlight a potential substance use behavior that may be targetable in the framework of nicotine cessation. (Am J Addict 2020;00:00-00).

Cannabis-Related Impairment and Social Anxiety: The Role of Use to Manage Negative and Positive Affect in Social Situations.

Background and Objectives: Individuals with elevated social anxiety are thought to be at high risk for developing cannabis-related problems because they use cannabis to cope with anxiety-provoking social situations. Social anxiety is unique among the anxiety conditions in that it is characterized by both elevated negative affect (NA) and lower positive affect (PA). Yet it is unclear whether persons with elevated social anxiety use cannabis to decrease their NA or to increase their PA. Methods: This study examined the role of PA and NA (including cannabis use to increase PA and to decrease NA in social situations) on cannabis use frequency and related problems among current (past three-month) cannabis users (N = 278). Results: Social anxiety was significantly correlated with NA, PA, cannabis use to decrease NA, and use to increase PA. Serial mediation analyses tested the paths between social anxiety, affect, use to manage affect, typical cannabis use frequency, and cannabis use-related problems. Contrary to prediction, social anxiety was not indirectly related to use frequency or related problems via NA or PA generally. Rather, social anxiety was indirectly related to cannabis problems via the serial effect of use to cope with NA and typical use frequency and via the serial effect of use to increase PA and typical use frequency. Conclusions/Importance: Social anxiety may be associated with using cannabis to decrease NA and increase PA specifically in social situations, which increases cannabis use frequency and thus, problem risk.

Cannabis Use among Dual Electronic and Combustible Cigarette Smokers: Relations with Pain and Hazardous Drinking.

Background: E-cigarette use is on the rise and many adult e-cigarette users also smoke combustible cigarettes. Past work suggests that dual use (i.e. use of both electronic and combustible cigarettes) is associated with greater rates of cannabis use, yet little is known about the nature of cannabis use among dual users. Objectives: The current study examined 414 adult dual users (48.3% female, Mage = 35.1 years), half of whom endorsed current (past month) cannabis use. Results: Results indicated that cannabis users reported more severe pain, greater pain interference, and more hazardous drinking. In addition, cannabis use was robustly related to hazardous drinking after statistically controlling for demographic and pain-related variables. Cannabis use was also associated with hazardous drinking indirectly via pain interference at greater levels of pain severity. Conclusions/Importance: These results highlight several clinical correlates of cannabis use among adult dual users, and also suggest that pain may play an important role in hazardous drinking among these individuals.