In a 21-day diary study of 237 college students, co-using alcohol and cannabis was associated with more frequent and higher pleasure than cannabis alone, but not more than alcohol alone, suggesting alcohol drives the pleasure of co-use.
College substance use prevention specialists, addiction researchers, and harm reduction professionals
2,086 daily substance use surveys from 237 students
What the researchers found
On co-use days, odds of substance-related pleasure were higher than on single-substance days. However, level of pleasure was higher on co-use days only compared to cannabis-only days, not alcohol-only days. This suggests the perceived pleasure of co-use is largely driven by alcohol.
Why it matters
Understanding why people co-use alcohol and cannabis together is important for prevention. If pleasure drives co-use but is mainly attributable to alcohol, interventions targeting alcohol-related pleasure expectations may reduce co-use.
The numbers in context
237 college students; 21-day diary; 2,086 daily surveys with substance use; higher odds of any pleasure on co-use days; level of pleasure higher on co-use vs cannabis-only but not vs alcohol-only days
How the study worked
Twenty-one-day daily diary study of 237 college students (65% female, ages 18-24) who reported at least one alcohol-cannabis co-use occasion. Daily surveys assessed substance use and pleasure experiences, yielding 2,086 use-day surveys analyzed with multilevel models.
What this study cannot tell us
Self-selected co-using students; subjective pleasure reports; 21-day window may not capture variation over longer periods; cannot determine if pleasure causes continued co-use or if other factors drive both; no biological measures of intoxication
How to read the evidence
Daily diary design with multilevel modeling captures real-time experiences, though limited to self-selected co-users and subjective pleasure reports.
When this study was published
2024 study
The bigger picture
Co-use of alcohol and cannabis is associated with greater risks than either substance alone. If the pleasure incentive is mainly alcohol-driven, breaking the co-use pattern may be achievable through alcohol-focused interventions.
Questions still open
- Would reducing alcohol-related pleasure expectations (through expectancy challenges) reduce co-use? Is the relationship between co-use and pleasure different for daily versus occasional users?
Common questions
Is co-using alcohol and cannabis more pleasurable?
Why does this matter for prevention?
Read the original research
Alcohol and cannabis use in daily lives of college-attending young adults: Does co-use correspond to greater reported pleasure?
Addictive behaviors, 159, 108130
Citation
Linden-Carmichael, Ashley N; Stull, Samuel W; Lanza, Stephanie T. (2024). Alcohol and cannabis use in daily lives of college-attending young adults: Does co-use correspond to greater reported pleasure?. Addictive behaviors, 159, 108130. https://doi.org/10.1016/j.addbeh.2024.108130
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