Cannabis craving in response to alcohol cues in the laboratory and in daily life

Abstract

Background: Cannabis use is prevalent among adolescents and young adults who drink alcohol. Compared to individuals who only drink alcohol, those who (co-)use both alcohol and cannabis are at greater risk of experiencing substance-related problems. One factor that could maintain patterns of co-use is the potential for one substance to elicit craving for another. This idea has been studied extensively in the alcohol and tobacco co-use literature but has yet to be applied to alcohol and cannabis co-use. Thus, the present study examined whether alcohol cues elicit cannabis craving in the lab and in daily life. Method: Participants were 54 adolescents and young adults ages 15 to 24 (M age = 19.69, SD = 2.04) who were enrolled in one of two medication trials targeting alcohol use and endorsed lifetime cannabis use. Participants were 51.9% female, 75.9% white, and 87.0% not Hispanic or Latino. Average age at first alcohol use was 15.28 (SD = 2.07), and average age at first cannabis use was 15.91 (SD = 2.37). Participants reported cannabis use on an average of 22.4% of the last 90 days via timeline follow-back. Participants also completed a lab cue-reactivity task where they rated cannabis craving when presented with alcohol and control cues. Finally, participants completed one week of ecological momentary assessment in their daily lives, reporting multiple times per day on their cannabis craving and the presence of alcohol cues in their surroundings. The data used in the present analyses were collected prior to randomization into medication condition and prior to taking any medications for the larger pharmacotherapy trials. Results: Results from mixed models demonstrated that baseline cannabis use frequency was positively related to lab cannabis craving, regardless of cue type, although this association was larger for control cues than for alcohol cues (b = -0.01, SE = 0.00, p = .004). In daily life, the presence of alcohol cues was associated with greater momentary cannabis craving (b = 0.57, SE = 0.25, p = .029). Finally, greater lab cannabis craving in response to alcohol cues predicted greater momentary cannabis craving across all moments in daily life (not solely when alcohol cues were present; b = 0.61, SE = 0.11, p < .001). Discussion: Results suggest that cannabis craving in the lab translates to daily-life cannabis craving across contexts, and that daily-life cannabis craving may be heightened in the presence of alcohol cues in individuals’ natural environments. Collectively, these findings support the idea that alcohol cues may elicit cannabis craving among adolescents and young adults who report a history of alcohol-cannabis co-use. Our findings may inform future work seeking to tailor cannabis use interventions among individuals who co-use cannabis with alcohol.