Background: Bisexual individuals consistently report higher levels of alcohol use and are at greater risk for developing alcohol use disorder compared to heterosexual, gay, or lesbian individuals. Acc...

Objective: As the legalization of adult-use cannabis has expanded to include almost half of the states in the United States, substance use–related enforcement responsibilities for state and local law enforcement agencies may have changed. We assessed the use of cannabis and alcohol enforcement strategies at local and state levels and in legal and nonlegal cannabis states. Method: We conducted surveys of 1,024 local law enforcement agencies, 53 state alcohol beverage control agencies, and 48 state patrol agencies. We calculated the prevalence of cannabis enforcement strategies and their analogous alcohol strategies and analyzed differences across legal and nonlegal cannabis states. We assessed associations between cannabis enforcement strategies, cannabis legalization status, and agency and jurisdiction characteristics. Results: Cannabis enforcement strategies were less common than their analogous alcohol strategies. The percentage of agencies conducting enforcement of cannabis-impaired driving and public use of cannabis did not differ significantly across agencies in legal and nonlegal states. Agencies in cannabis-legal states (compared with nonlegal states) were more likely to train officers in identifying cannabis impairment among drivers (risk ratio [RR] = 1.23, 95% CI [1.08, 1.42]). Several local agency and jurisdiction characteristics were associated with a higher likelihood of conducting cannabis enforcement, but results were inconsistent across strategies. Conclusions: Our study shows that cannabis enforcement strategies were used less than analogous alcohol strategies in legal and nonlegal jurisdictions, suggesting that increased cannabis enforcement could lead to reductions in public health harms. This study provides a foundation for much-needed research on cannabis and alcohol enforcement during a changing cannabis legalization landscape.

Objective: In 2015, 193 nations adopted the United Nations’ Sustainable Development Goals (SDGs). Alcohol was included as a specific focus in target 3.5 (substance abuse), highlighting its relevance i...

Objective: Despite an abundance of public discourse about the opioid crisis in the media, there is little research characterizing opioid-related content on TikTok, a popular video-based social media platform. This study sought to examine how opioids are portrayed on TikTok. Method: This study used mixed methods to analyze top opioid-related posts marked with the hashtag “#opioids” collected in May 2023. “Holistic coding” was used to topically categorize multimedia content in posts and to quantify the frequency of mentioning opioid-related content areas (e.g., overdose, pain, fentanyl). Template analysis methods were then used to develop themes. Results: A total of 115 posts were analyzed. The most frequently used opioid-related topic codes include prescription opioids (58.3% of posts), pain (47.0%), overdose (35.7%), and fentanyl (34.8%). Posts were most commonly about challenges to accessing prescription opioids for pain management (37.4%), opioid policy (36.5%), and negative consequences of using opioids (32.2%). Qualitative analysis yielded themes about the potential dangers associated with using opioids, treatment and recovery from opioid use disorder, and barriers to obtaining prescription opioids for pain management. Conclusions: This study revealed polarizing opinions within opioid-related content on TikTok. The two main stances, dangers of nonmedical opioid use and advocacy for the availability of prescription opioids for pain management, represent nationwide tensions between the opioid and chronic pain crises. The vast audience TikTok garners presents an opportunity for disseminating opioid education, harm-reduction strategies, and treatment options for opioid use disorder that were largely absent among the posts analyzed.

Objective: To identify which topics for alcohol warnings most motivate people to reduce their drinking and best inform them of alcohol’s harms. Methods: A nationally representative sample US adults (n...

Objective: Prenatal alcohol and tobacco exposure continue to have an impact on a significant portion of the U.S. population every year. Differences in neighborhood environment may be a contributing factor. The current study examines whether prenatal alcohol and tobacco exposure differ by neighborhood environment. Method: We used neighborhood environment data linked to a U.S.-based, nationally representative cohort of adolescents (N = 8,731; 47.2% female; age: M = 118.6 months, SD = 7.4 months). Results: Lower neighborhood deprivation, less air pollution, higher lead risk, and higher perceived neighborhood safety were associated with prenatal alcohol exposure, whereas higher neighborhood deprivation and lower perceived neighborhood safety were associated with prenatal tobacco exposure. Conclusions: Neighborhood environments differ between prenatal alcohol–exposed children and unexposed children, as well as between prenatal tobacco–exposed children and unexposed children. Future research should consider the cumulative and interactive effects of prenatal exposure to alcohol and tobacco and the neighborhood environment.

Background: High-level commitments to engage the private sector in governance and limited attention to managing conflict of interest (COI) have enabled alcohol industry actors to engage with policy de...

Objective: One in five college women experiences sexual assault. Feminist scholars have called for the use of programming that empowers women by increasing their ability to recognize and resist sexual assault. One such program, the Enhanced Assess, Acknowledge, Act Sexual Assault Resistance Education Program (EAAA), has demonstrated lower rates of sexual assault up to 24 months. EAAA could be further enhanced by directly targeting women's risky alcohol and cannabis use, two known risk factors for sexual assault, within an integrated framework. This study evaluated the acceptability and preliminary efficacy of an integrated version of EAAA with enhanced alcohol and new cannabis content. Method: College women (n = 14) ages 18–24 who reported engaging in past-month heavy alcohol use, cannabis use, and simultaneous alcohol and cannabis use participated in the adapted program. Women completed a baseline assessment, measures of acceptability at strategic points during the program, and a post-program assessment. Results: Women rated the program very high in likability, quality, organization, relevance, and usefulness and were likely to recommend it to other women. Overall, acceptability and usability ratings for EAAA+ were high. Content analysis of open-ended questions indicated that some women wanted more cannabis and/or alcohol content included. Conclusions: Results indicate that the adapted content is acceptable for the target population and has promising pre–post changes on alcohol, cannabis, and sexual assault–related outcomes.

Objective: For thousands of years, people have used alcohol to reduce their sensitivity to physical and emotional pain. Previous research has shown that alcohol increases the pain threshold. Previous research has also shown that the pain threshold is positively associated with aggression. This research tests the novel hypothesis that the relationship between alcohol and aggression is mediated by an increased pain threshold. Method: To replicate findings, two independent laboratory experiments were conducted (Experiment 1: N = 543; Experiment 2: N = 327). In both experiments, heavy social drinkers were randomly assigned to consume either an alcohol or placebo beverage. Next, they reported their pain level to electric shocks that increased in a stepwise manner until the level was described as “painful,” which was defined as the pain threshold level. Finally, they delivered painful electric shocks to an ostensible opponent each time they won a competitive reaction time task. Participants won half of the 34 trials (randomly determined). Shock intensity and duration levels were standardized and summed across the 34 trials to create a more comprehensive measure of aggression. Results: Participants who consumed an alcoholic beverage had a higher pain threshold level than those who consumed a placebo beverage. The less pain participants felt themselves, the more pain they inflicted on their ostensible partner via electric shock. Results were nearly identical across both experiments. Conclusions: These findings provide novel evidence regarding one possible reason why intoxicated people behave more aggressively than sober people do. Alcohol intoxication increases aggression partially through its effect on increasing the pain threshold.

Objective. Motivational models argue that people use alcohol and cannabis to regulate emotions (Cooper et al., 2016; Cox & Klinger, 1988). Descriptions of global self-reports of coping motives have em...

Objective: A low level of response (LR) to alcohol is a known risk factor for alcohol use disorder (AUD). Although higher total body water (TBW) is associated with lower blood alcohol concentrations and reduced responses following alcohol consumption, the relationship between morphometric measures such as body mass index (BMI) and LR is less clear. This study aimed to examine the relationship between BMI and LR to alcohol and the contribution of TBW to this relationship. Method: Participants (n = 1,086) enrolled in the National Institute on Alcohol Abuse and Alcoholism Natural History Protocol were assessed for LR to alcohol using the Self-Rating of the Effects of Alcohol (SRE) Questionnaire. BMI was estimated using height and weight, and TBW was based on height, weight, age, and sex. Participants were categorized based on BMI into three groups: normal weight (18.5–25.0 kg/m2; n = 430), overweight (25.0–30.0 kg/m2; n = 403), and obese (≥30.0 kg/m2; n = 253). Associations between the BMI group and SRE scores for the most recent 3-month period (SRE-Recent) and the effect of TBW were analyzed using analysis of variance. Linear regression analysis was conducted to estimate the proportion of variation in SRE-Recent, as explained by BMI and TBW. Results: BMI category was associated with LR, with the normal weight group showing higher responses (lower SRE-Recent scores) to alcohol than the overweight or obese groups. After controlling for TBW, the relationship became nonsignificant. Linear regression models confirmed these findings. Conclusions: Higher BMI is associated with lower LR to alcohol. However, TBW seems to account for this relationship, suggesting that concentrations achieved following alcohol consumption may be the primary determinant of BMI-related differences in LR. Future work should replicate these findings and examine these relationships throughout the life span and in individuals with AUD.

Objective: An inability to correctly perceive chemosensory stimuli can lead to a poor quality of life. Such defects can be concomitant with excess alcohol consumption, but a large-scale cohort study linking these effects is lacking. This study aimed to investigate the impact of chronic alcohol consumption on chemosensory function by analyzing data from the 2013–2014 U.S. National Health and Nutrition Examination Survey (NHANES), involving 395 participants categorized by alcohol intake behavior: 219 no-intake, 136 light-intake, and 40 risky-intake groups. Method: Chemosensory function was assessed using a self-reported Chemosensory Questionnaire along with objective tests for taste (quinine solution) and smell (appetitive and hazardous odors). Adjusted regression analyses were conducted, controlling for age, gender, smoking status, and multiple pairwise comparisons. Weighted regression analyses were also performed. Results: Risky drinkers had significantly lower odds of identifying quinine (bitter taste) compared with light drinkers (odds ratio [OR] = 0.37, p-adjusted = .04). Risky drinkers also had higher odds of identifying appetitive odors such as strawberry (OR = 5.44, p-adjusted = .03) but lower odds for detecting hazardous odors such as natural gas (OR = 0.11, p-adjusted = .001) compared with light drinkers. In addition, light drinkers identified the leather scent more effectively than nondrinkers (OR = 2.54, p = .02). Conclusions: Chronic alcohol consumption, particularly at risky levels, is associated with altered chemosensory function. These findings emphasize the importance of assessing chemosensory symptoms in individuals with alcohol-related behaviors.

Objective: There is a robust body of work demonstrating that certain drinking practices, such as pregaming or playing drinking games, are linked to heavier, riskier patterns of drinking among college students. However, less attention has been paid to other drinking practices that are relatively common among undergraduates, such as daytime drinking (i.e., drinking before 4:00 p.m.). Method: Using data from an intensive longitudinal study (bursts of daily data over 12 months; 6,842 total days of data) collected from a high-risk sample of college students (N = 403), the present study tested daytime drinking as both a proximal (daily-level drinking outcomes) and distal (alcohol use disorder symptoms) risk factor for hazardous drinking. Results: Daytime drinking was reported by more than 70% of the sample and on approximately 15% of drinking days. Daily-level findings indicated that compared with non–daytime drinking days, daytime drinking days were significantly associated with more drinks consumed, more high-risk drinking practices (i.e., heavy episodic or high-intensity drinking), and greater subjective intoxication. Longitudinal analyses identified frequent daytime drinking as a risk factor for increased hazardous drinking behavior, particularly among individuals who were younger or reported lower hazardous drinking at baseline. Conclusions: Findings add to a sparse literature supporting daytime drinking as a risky drinking practice among college students. Future work should aim to further characterize contextual and psychosocial factors associated with daytime drinking practices.

Objective: Risk perceptions for alcohol-impaired driving (AID) are reliably associated with AID behavior. Extant research relies on samples comprised predominantly of White individuals, despite racial inequities in alcohol-related harms. This study is one of the first to compare AID risk cognitions in Black and White young adults. We assessed AID cognitions following a moderate dose of alcohol and examined their associations with AID behavior. Method: Participants (N=137, M age=24.57, 67% female, 43% Black) received a moderate dose of alcohol (target BrAC = .08%). Subjective intoxication and perceived danger of driving were assessed five times following alcohol consumption. Perceived safe driving limit and AID behavior were assessed at baseline, and AID behavior was assessed at 6-month follow-up. Multilevel models tested differences between groups in subjective intoxication and perceived danger, while generalized estimating equations tested risk perceptions as predictors of AID behavior both cross-sectionally and prospectively. Results: Black participants reported lower perceived driving danger than White participants (b = -0.27; p < .05), but no group differences were observed for subjective intoxication or perceived safe limit. Higher subjective intoxication in the lab was prospectively associated with less AID for Black participants (b = -0.43; p < .001). Perceived safe limit was associated with AID, but this association did not differ for Black and White young adults. Conclusions: Results suggest commonalities and differences in AID risk for Black and White young adults. Future AID research among individuals with minoritized identities is needed to explore how experiences of discrimination influence risk perceptions and AID decision making.

Objective: A handful of studies have examined differences in the subjective effects and consequences of using different modes of cannabis (e.g., smoking vs. vaping) at the daily level. However, results have been mixed, and recent research suggests that there may be individual-level differences in these effects based on how often individuals use each mode. We aimed to determine whether within-person associations between mode of cannabis use (i.e., smoking, vaping plant material, vaping concentrates, dabbing, edibles, multiple modes) and quantity, subjective intoxication, consequences, contexts of cannabis use, and co-use with alcohol or tobacco varied based on how often individuals used each mode. Method: We used data from a 30-day ecological momentary assessment study of cannabis use with 338 sexual minority women and gender diverse young adults assigned female at birth, populations at high risk for cannabis use disorder. Results: Several associations between mode of cannabis use and outcomes differed based on how frequently individuals used each mode. People who used edibles less frequently experienced more consequences when using edibles compared with smoking cannabis, whereas people who used edibles more frequently did not. People who used multiple modes more frequently took fewer hits when using multiple modes, whereas those who used multiple modes less frequently did not. Conclusions: Analyses suggest that frequency, quantity, and consequences of some modes of use differed based on how frequently individuals used each mode. Further research is needed to identify protective behavioral strategies that may be utilized by individuals who use particular modes more often.

Background Historically, cannabis use and cannabis use disorder (CUD) have been more prevalent among males. However, emerging evidence suggests cannabis use may be increasing faster among females in younger age groups. This study characterized changes in female versus male differences in cannabis use and CUD across age groups and time. Methods Annual data from the 2014-2023 National Surveys on Drug Use and Health (NSDUH) were analyzed by age groups (12-17 [adolescents], 18-25 years, and 26 years or older) for past-month cannabis use, past-year daily/near-daily cannabis use (300 or more days) and past-year CUD. Prevalence differences (PDs) in percentage points between females and males were evaluated using generalized linear models. Results From 2014 to 2023, the prevalence of cannabis use (past-month and daily/near daily) and CUD increased among adults, with shifts in PDs across age groups. In 2022, adolescent females surpassed males in past-month cannabis use (PD = 2.3; 95% confidence interval [CI]: 1.0, 3.6). By 2023, both daily/near daily use and CUD prevalence were higher among adolescent females (e.g., CUD PD = 2.4; 95% CI: 1.4, 3.4). Among adults aged 18-25, all outcomes remained lower among females, but PDs narrowed over the study period. In adults aged 26 years or older, females consistently had lower prevalence across all outcomes. Conclusion Results showed reversals in female versus male differences among adolescents and narrowing gaps among younger adults. Tailored interventions considering sex and age may prevent and reduce CUD. Further research is needed to understand reasons behind these shifts.

Objective: Despite a decline in cigarette use, the dual use of cigarettes and electronic vaping products (EVPs) is a concerning pattern of nicotine consumption in the United States. Anxiety, a risk factor for tobacco use, may contribute to dual-use patterns; however, the association between daily anxiety symptoms and dual use of cigarettes and EVPs is not known. This study investigated associations between daily anxiety symptoms and dual cigarette and EVP use overall and by sex, race, and ethnicity. Method: Data are from the 2020–2022 National Health Interview Survey (n = 83,544). Multinomial logistic regression models, adjusted for sociodemographic factors, tobacco use, mental health services, and medication characteristics, examined the relationship between daily anxiety and current exclusive/dual cigarette and EVP use. Stratified analyses explored effect modification by sex, race, and ethnicity. Results: Among the sample, 13.0% reported daily anxiety symptoms, and 1.3% reported dual cigarette and EVP use. Daily anxiety was associated with increased odds of exclusive cigarette (odds ratio [OR] = 1.54, 95% CI [1.42, 1.68]), exclusive EVP (OR = 1.44, 95% CI [1.23, 1.68]), and dual use (OR = 2.16, 95% CI [1.77, 2.63]). Stratified analyses showed significant associations between dual use and daily anxiety among Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian adults. Of note, Hispanic males and females, non-Hispanic White males and females, Black females, non-Hispanic Asian males, and females of another race/ethnicity had higher odds of dual use, whereas Asian females had lower odds. Conclusions: This study highlights heterogeneous relationships between daily anxiety and dual cigarette and EVP use at the intersection of sex, race, and ethnicity. Tailored interventions addressing persistent mental health symptoms are crucial for reducing tobacco use and associated disparities.

Objective: Substance use patterns vary considerably in the general population, yet little is known about patterns before and during pregnancy. The purpose of this study was to describe single substance and polysubstance use (PSU) before and during pregnancy among recent births in the United States and compare exposure patterns. Method: We used data from the Pregnancy and Risk Assessment Monitoring System (PRAMS) postpartum survey for 2016–2018 to estimate the prevalence and identify patterns of substance use by participants 1 to 3 months before and during pregnancy. Data on use of cigarettes, cannabis, opioids, amphetamines, heroin, and cocaine were available for seven states. We used latent class analysis to identify patterns of substance use and tested whether participants with those patterns differed by age, income, race/ethnicity, and pre-pregnancy alcohol use. Analyses were weighted using PRAMS' state-level weights. Results: We studied 15,429 participants representing 384,918 live, singleton births. Approximately half (51.3%) were 20–29 years old, 42.3% were above 200% of the Federal Poverty Level, and 73.3% were non-Hispanic White. We identified seven latent classes of maternal substance use: minimal users (70.7%), pre-pregnancy cigarette users (10.5%), persistent cigarette users (6.8%), pre-pregnancy cannabis users (5.5%), broad PSU (3.6%), opioid-only users (1.9%), and persistent cigarette/opioid co-users (1.0%). Participants in these groups differed significantly by age, income, race/ethnicity, and pre-pregnancy alcohol use (p < .001). Conclusions: This novel empirical classification of single substance and PSU could help to further our understanding of the impact of PSU on perinatal health and to design interventions for maternal substance use.

Objective: The primary aim of this study was to assess and adjust for measurement non-equivalence (bias) by sex, race/ethnicity, and co-occurring social identities (Sex × Race/Ethnicity) for the Marijuana Effect Expectancies Questionnaire–Brief (MEEQ-B) among Black, Latinx, and non-Latinx White youth. The second aim was to determine how group comparisons change after accounting for possible measurement bias. Method: Black, Latinx, and non-Latinx White youth from the Adolescent Brain and Cognitive Development Study Follow-up 3 (n = 8,982; mean age = 12.91, SD = 0.65; 47.28% female; 15.03% Black, 22.93% Latinx, 62.04% non-Latinx White) completed the MEEQ-B. Moderated nonlinear factor analysis (MNLFA) generated positive and negative expectancies factor scores accounting for non-equivalence. Analyses contrasted group differences by sex, race/ethnicity, and these co-occurring social identities using original (unadjusted) versus MNLFA-generated scores adjusted for measurement non-equivalence. Results: Measurement non-equivalence was observed for positive and negative expectancies across sex, race/ethnicity, and their co-occurring social identities. MNLFA revealed between-group differences at the factor and item level. Further, comparisons of original (unadjusted) and MNLFA-generated adjusted scores revealed that unadjusted scores underestimated or did not detect some group differences in positive expectancies identified using adjusted scores, and unadjusted scores underestimated how much lower negative expectancies were in Black and Latinx relative to non-Latinx White youth. Conclusions: Results highlight the need for caution when interpreting scores of a measure like the MEEQ-B that has not undergone measurement equivalence testing and demonstrate how failing to adjust for non-equivalence can result in biased estimates of positive and negative expectancies, particularly when used with diverse populations.

Objective: Racial and ethnic discrimination is a risk factor for substance use among U.S. adults. However, whether discrimination is associated with substance use disorders (SUDs) overall and by race and ethnicity is less understood. Method: We used data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions–III (n = 35,355) and defined past-year discrimination as a summary scale (range: 0–4). Past-year SUDs included alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and illicit drug use disorder (IDUD) based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; number of SUDs included one, two, or three or more SUDs. We estimated associations between discrimination and each SUD outcome using logistic and multinomial logistic regression and examined effect modification by race and ethnicity. Results: Discrimination was associated with each substance-specific SUD (odds ratio [OR] range: 1.36–1.78) and with one, two, and three or more SUDs (OR range: 1.34–2.19). Models stratified by race and ethnicity revealed that discrimination was associated with AUD among all groups (OR range: 1.42–1.52), with TUD only among adults who were non-Hispanic White, non-Hispanic Black, and another non-Hispanic race; with CUD only among non-Hispanic White and non-Hispanic Black adults; and with IDUD only among Hispanic, non-Hispanic White, and non-Hispanic Black adults. In addition, discrimination was associated with three or more SUDs among all groups. Conclusions: Discrimination was associated with all SUD outcomes, with variation in these relationships by race and ethnicity. Understanding this heterogeneity can guide efforts to prevent problematic substance use and reduce health disparities.