Alcohol use and cannabis craving in daily life: Sex differences and associations among young adults

Abstract

Background: Alcohol and cannabis are commonly used together by young adults. With frequent pairings, use of one substance may become a conditioned cue for use of a second, commonly co-used substance. Although this has been examined for alcohol and cannabis in laboratory conditions and with remote monitoring, no research has examined whether pharmacologically induced cross-substance craving occurs in naturalistic conditions.

Methods: In a sample of 63 frequent cannabis-using young adults (54% female) who completed 2 weeks of ecological momentary assessment, we tested whether alcohol use was associated with stronger in-the-moment cannabis craving. We also examined whether sex moderated this association and whether cannabis craving was stronger at higher levels of alcohol consumption.

Results: Although alcohol use and cannabis craving were not significantly associated at the momentary level, there was evidence that this relation significantly differed by sex. Among female participants, there was a negative association between alcohol use since the last prompt and momentary cannabis craving (b = -0.33, SE = 0.14, p = 0.02), while the association among male participants was positive (b = 0.32, SE = 0.13, p = 0.01). Similarly, alcohol quantity was negatively associated with cannabis craving at the momentary level for female participants (b = -0.10, SE = 0.04, p = 0.009) but was not significantly associated for male participants (b = 0.05, SE = 0.04, p = 0.18).

Conclusions: Alcohol may enhance cannabis craving among male individuals but reduce desire for cannabis among female individuals. This may point to differing functions of co-use by sex, highlighting a need for research to elucidate the mechanisms underlying this increasingly common pattern of substance use.

Keywords: alcohol; cannabis; craving; ecological momentary assessment; sex differences.

FIGURE 1

Simple slopes of alcohol use × sex interaction predicting momentary cannabis craving. Simple slopes of the interactions between any alcohol use and sex (Panel A) and number of drinks and sex (Panel B) predicting momentary cannabis craving. For the number of drinks interaction, simple slopes were plotted at the 10th (low drinks) and 90th (high drinks) percentiles for number of drinks. Error bars depict standard errors for each slope (SE = 0.13 for Panel A and 0.04 for Panel B).