1 Department of Psychology, York University, Toronto, Ontario, Canada.
2 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
4 Department of Addictions, Kings College London, London, UK.
5 Department of Psychology, Concordia University, Montreal, Quebec, Canada.
6 Bowles Center for Alcohol Studies, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
7 Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.

Background: Simultaneous alcohol and cannabis use is common, but observational studies examining negative consequences of simultaneous use have rarely considered dose-related interactions between alcohol and cannabis. This study examined interactions between quantities of cannabis and alcohol consumed in predicting negative consequences on simultaneous use days.

Methods: Young adults (N = 151; 64% female; 62% White) reporting recent simultaneous use and at least weekly alcohol and cannabis use completed 21 daily, smartphone-based surveys assessing previous day quantities of cannabis and alcohol used, types of cannabis used (flower, concentrates, edibles), and negative substance-related consequences. Multilevel models examined: (1) whether negative consequences differed within-person across simultaneous use days and single-substance use days; and (2) whether quantities of alcohol and cannabis consumed on simultaneous use days interacted, within-person, to predict negative consequences. We focused on quantities of cannabis flower (grams) in primary analyses and explored quantities of other forms of cannabis (concentrates, edibles) in supplementary analyses.

Results: Participants reported fewer negative consequences on alcohol-only (243 observations) and cannabis-only (713 observations) days than they did on simultaneous use days (429 observations). On simultaneous use days involving cannabis flower use (313 observations across 81 participants), the within-person association between number of standard drinks and negative consequences was weaker on days during which larger (vs. smaller) amounts of cannabis flower were consumed. Inspection of simple slopes revealed that decreased alcohol use was associated with less of a decline in negative consequences when combined with relatively greater amounts of cannabis flower.

Conclusions: Although simultaneous use was associated with more negative consequences than alcohol-only and cannabis-only use, negative consequences on simultaneous use days varied as a function of the interaction between alcohol and cannabis quantities. As findings suggest that using larger amounts of cannabis may attenuate declines in negative consequences associated with lighter drinking, interventions for higher-risk simultaneous use patterns may benefit from a focus on quantities of both alcohol and cannabis.