OBJECTIVE:Systemic inequities are associated with stressor experiences of racial and ethnic minoritized individuals and disparities in health and substance use. Recently, young adults (YAs) have experienced pandemic-related stressors, but the differences in exposure and their long-term implications for substance use are not well understood. We examined associations of pandemic-related stressors with alcohol, cannabis, and nicotine use among non-Latinx (NL) Asian, Latinx, and NL White YAs in the context where the use of these substances is legal for those 21 and older. METHOD:We used data from a statewide longitudinal (2019-2022) sample of YAs in Washington State (N = 3,646; 13.8% NL Asian, 16.6% Latinx, and 69.6% NL White; 74.9%, 75.1%, and 74.2% female, respectively). Stressors in 2020 were regressed on race, ethnicity, and 2019 background covariates. Substance use outcomes (modeled as latent variables of use in 2020-2022) were regressed on race and ethnicity, 2020 stressors, and background covariates. RESULTS:Latinx YAs experienced more pandemic-related stressors than NL White YAs. Across 2020-2022 and adjusting for use in 2019, Latinx YAs reported more cannabis use days, and NL Asian YAs reported fewer cannabis and alcohol use days, than NL White YAs. Stressors were positively and significantly associated with cannabis, cigarette, and e-cigarette use in 2020-2022 but were not strongly associated with alcohol use. Associations between substance use and stressors were similar across groups. CONCLUSIONS:Pandemic-related stressors may have long-term implications for YAs' substance use, and these stressors are an area of emphasis for preventive interventions.

Cue-induced craving-the desire to use a drug triggered by exposure to cues associated with prior use-is a central mechanism in the development and maintenance of problematic substance use behaviours. Drug cues have the power to induce craving even in long-term abstinent individuals, which has led clinicians to advise patients to avoid the people, places and objects that are associated with their use. This preliminary study builds on prior behavioural research that demonstrates that exposure to multimodal drug cues can increase craving even after the drug cues are removed from the environment.We used a novel fMRI paradigm that combined multimodal cannabis cue-exposure with resting-state functional connectivity to examine positive and negative functional connectivity (i.e., correlations and anticorrelations) between the ventral tegmental area (VTA) and the striatum, a circuit critically involved in reward processing and addiction. Intrinsic VTA-striatal connectivity was measured in 28 individuals who use cannabis regularly (CU group) and 26 age- and sex-matched controls who had never used cannabis before and after multimodal (visual and olfactory) cannabis cue exposure. Craving was assessed at baseline using the Marijuana Craving Questionnaire-Short Form to test whether VTA-striatal connectivity was correlated with self-reported craving measured prior to the fMRI scan. There were no significant group differences in VTA-striatal connectivity during the baseline resting-state scan. However, following cue exposure, CU participants showed significantly greater VTA-caudate connectivity compared to controls. Further, within the CU group, baseline craving was positively correlated with VTA-striatal connectivity at both time points.Our preliminary findings support prior investigations demonstrating that alterations of mesostriatal connectivity are associated with cannabis use and craving in individuals with problematic cannabis use. In addition, the observation of altered connectivity during the post-cue resting-state scan-after multimodal cannabis cues were removed-suggests a potential neural mechanism by which cue exposure may contribute to relapse vulnerability in individuals with problematic cannabis use.

BACKGROUND:Undergraduates with higher social anxiety symptoms are at risk for co-occurring substance misuse, heavier drinking in certain contexts, and experiencing more negative alcohol-related consequences. Among undergraduates broadly, online norms-based interventions provide consistent and cost-effective reductions in alcohol use and related risks. However, research on norms-based interventions for undergraduates with higher social anxiety symptoms is limited, and less is known about the longitudinal impacts of social anxiety symptoms on the efficacy of online, norms-based alcohol interventions. METHODS:Secondary analyses were conducted on data from a large randomized controlled trial (RCT) with undergraduates who reported past-month heavy episodic drinking and were randomized to an attention control or a norms-based intervention. Generalized linear models tested whether baseline social anxiety symptoms moderated the efficacy of receiving a norms-based intervention versus a nonalcohol-focused attention control condition at 3-, 6-, and 12-month follow-up. RESULTS:Social anxiety symptoms moderated intervention efficacy on the number of typical drinks consumed and descriptive norms at 3 months, as well as injunctive norms at 3 and 12 months. However, these effects appeared to be primarily driven by the individuals with higher social anxiety symptoms in the attention control group. Overall, norms-based interventions demonstrated efficacy in reducing the number of typical drinks consumed, descriptive and injunctive norms, and negative consequences up to 12 months later, regardless of social anxiety symptoms. CONCLUSIONS:Results demonstrated that online norms-based interventions were similarly efficacious for reducing drinking, negative consequences, and normative beliefs for undergraduates, regardless of social anxiety symptoms. Further, effects were maintained up to 12 months. Thus, existing alcohol-focused brief interventions are efficacious for those with higher social anxiety symptoms, even without adaptation for social anxiety-specific concerns. Individuals with higher social anxiety symptoms who did not receive an active intervention reduced drinking beliefs and behaviors, although reductions were not maintained over time.

The current study examined age-varying patterns of cannabis use, cannabis-specific risk factors, and their associations across young adulthood. We used repeated cross-sectional data from young adults (N = 15,251; Mage = 22.02 years, SDage = 2.22; 68

Depression and substance use are often comorbid, but less is known about these associations in non-clinical community samples. Moreover, existing research is primarily cross-sectional or focuses on long-term trajectories of depressive symptoms and substance use. The present study examines within-person associations to estimate the extent to which monthly fluctuations in depressive symptoms relate to alcohol and cannabis use. A community sample of 778 young adults (Mage = 21.1 at baseline, 56

Purpose Heavy drinking is common on college campuses, and personalized normative feedback interventions (PFI) are commonly implemented to reduce heavy drinking behaviors. The current study tested the preliminary efficacy of a web-based PFI intervention, Web-BASICS (Brief Alcohol Screening and Intervention for College Students), tailored for participant selection of their normative peer group to reduce descriptive drinking norms and alcohol use compared to a control condition. Methods College students (N = 248) were recruited to participate in a study on alcohol use. Participants were randomized to receive Tailored Web-BASICS or a control condition and were asked to complete a survey at baseline and three months post-intervention. Results Most participants (77 %; n = 97) assigned to receive Tailored Web-BASICS chose to have normative feedback tailored by race, ethnicity, gender, sexual orientation, and university. Descriptive drinking norms mediated the effect of Tailored Web-BASICS on alcohol use. Those assigned to Tailored Web-BASICS had reductions in descriptive drinking norms, thereby reducing alcohol use at three months post-intervention relative to control. Conclusion Tailored Web-BASICS may be a useful strategy to reduce alcohol use for all college students, irrespective of identity. Future research is needed to assess the efficacy of this approach in a large randomized controlled trial. Clinical trial.gov registration NCT06776796

Objective:The I3 model outlines how factors interact to predict intimate partner violence (IPV) perpetration such as relationship tension, emotion regulation (ER) and distress tolerance difficulties, and alcohol use. Despite the model's emphasis on these factors' synergistic nature (i.e., "perfect storm"), they are typically examined disparately and use retrospective self-report over an aggregate timeframe, preventing a nuanced examination of IPV. The current event-level study aimed to (a) examine the confluence of event-level instigating (e.g., relationship tension), impelling (e.g., ER difficulties, distress intolerance), and disinhibiting (e.g., alcohol use) I3 factors predicting IPV perpetration; and (b) investigate how between- and within-person deviations in these I3 factors impact likelihood of same-day IPV perpetration. Method:A community sample of 150 young adults with IPV histories completed 25 online daily diaries examining I3 factors and IPV perpetration. Results:Using generalized estimating equations examining the interactive effects of relationship tension, ER difficulties, distress intolerance, and alcohol use on IPV likelihood, results showed a significant three-way interaction between average levels of relationship tension, ER difficulties, and alcohol use predicting IPV perpetration likelihood. At high average levels of relationship tension and alcohol use, ER difficulties had a significant positive effect on IPV perpetration likelihood. When examining within-person deviations in I3 factors, only deviations in relationship tension above one's average level significantly predicted IPV perpetration likelihood. Conclusion:Findings support the synergistic nature of relationship tension, ER difficulties and alcohol use on increased likelihood of IPV perpetration, particularly for one's typical level of each factor.

Young adults who engage in problematic cannabis use report lower work and interpersonal functioning yet are less likely to seek treatment, necessitating alternative methods for assessing and intervening on problematic cannabis use (e.g., mobile health applications to self-monitor drivers of cannabis use in daily life). However, previous work examining maintenance models of problematic cannabis use has primarily focused on modeling predictors of cannabis use as measured using static retrospective report rather than examining cannabis use as a series of interactions that unfold in everyday life. In this study, we analyzed ecological momentary assessment data (T = 3,230 observations) from 65 young adults who reported problematic cannabis use (Cannabis Use Disorders Identification Test-Revised: M = 10.38, SD = 4.35) and an interest in reducing their use. We used multilevel network analyses to model associations among biopsychosocial factors that aligned with social learning, self-medication, and experiential avoidance theories of substance use. Network models demonstrated consistent associations between socioenvironmental triggers and cannabis cravings, use, and intoxication that were nearly all clinically meaningful in size (bs > 0.10). Results indicated a statistically significant association between negative and positive affect with cannabis use and intoxication, respectively; however, these associations were not clinically meaningful in size. There were no clinically meaningful associations between coping strategies and cannabis use variables. Findings advance our understanding of cannabis use in everyday life, which is critical for refining more dynamic conceptualization of substance use and improving the precision of clinical assessments. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Personalized feedback-based interventions for reducing high-risk alcohol use among college students vary in length and intensity. Comprehensive multicomponent personalized feedback interventions (PFIs) include more material and have greater intensity compared to briefer, single-component interventions such as personalized normative feedback (PNF). However, while PFIs may offer more comprehensive support, their lengthiness can potentially reduce attention and engagement with the intervention content, impacting their overall efficacy. This study examines how attentiveness-the degree to which participants engage with and process the intervention material-differs between single- and multicomponent interventions and how this variation moderates the efficacy of PFIs. METHODS:A secondary analysis of a longitudinal randomized clinical trial was conducted, involving 1137 undergraduates reporting past-month heavy episodic drinking (63% female; mean age = 20.1 years). Assessments occurred at baseline and 3, 6, and 12 months postintervention, with primary outcomes including drinks per week and negative alcohol-related consequences. Intervention conditions included (a) assessment-only control (AOC), (b) multicomponent PFI, and (c) single-component PNFs. Generalized linear mixed models were used to evaluate attentiveness as a moderator of treatment efficacy across multicomponent PFI, single-component PNFs, and AOC conditions. RESULTS:Analysis detected significantly higher attentiveness levels in single-component PNFs compared to the multicomponent PFI (b = 0.35, p < 0.001). A three-way interaction (Time × Condition × Attentiveness) indicated that the efficacy of multicomponent PFI versus AOC on drinks per week was only significant for those reporting moderate-to-high attentiveness levels, not for those with low attentiveness. When comparing multicomponent PFI to single-component PNF, multicomponent PFI outperformed single-component PNF only when attentiveness was high; conversely, when attentiveness was low, single-component PNF outperformed multicomponent PFI. CONCLUSIONS:While the simplicity of PNF allows for easy implementation with minimal cognitive effort, multicomponent PFI demonstrates greater efficacy potential, particularly when comprehended thoroughly. Future research could explore strategies to enhance attentiveness with multicomponent PFI, such as sequential delivery across multiple sessions to optimize its benefits.

Alcohol and cannabis are the two most commonly used substances in young adulthood. Prior evidence shows that while risky alcohol use peaks in the mid-20 s and decreases by the end of young adulthood (i.e., “maturing out”), cannabis use prevalence decreases gradually across young adulthood. As the landscape of cannabis legalization in the USA evolves, it is critical to assess changes in young adult patterns of use. This study examined developmental patterns of young adult cannabis and alcohol use in Washington State (WA). Annual repeated cross-sectional survey data from 2015 to 2022 were collected from 15,371 young adults 18–25 living in WA. Logistic regression models examined changes in alcohol (any past month use, frequent use, heavy episodic drinking [HED]) and cannabis (any past month use, frequent use) by developmental age and birth cohort. Cannabis use prevalence was higher at age 21–22 compared to age 18–20, a departure from prior studies. In more recent birth cohorts, prevalence among 23–25-year-olds was lower than among 21–22-year-olds, suggesting an emerging pattern of maturing out. Additionally, there was a significant moderation of developmental patterns of risky (HED and frequent) alcohol use by birth cohort. As cannabis legalization continues to evolve, it is critical for programs to prioritize early prevention prior to and at age 21 to mitigate and prevent associated adverse health outcomes of cannabis use. Continued surveillance including older age groups is needed to characterize changing developmental patterns of young adult cannabis use.

BACKGROUND AND AIMS:Efficacy of brief alcohol interventions for young adults with internalizing distress (i.e. symptoms of depression, anxiety and stress) is unclear. We tested the moderating effect of internalizing distress on the efficacy of alcohol single- and multicomponent personalized feedback interventions (PFIs). DESIGN:Secondary data were analyzed from a randomized controlled trial (RCT) testing the efficacy of single and multicomponent PFIs, compared with an attention-only control condition. SETTING:Participants were sampled from two West Coast universities in the United States. All study protocols were completed online. PARTICIPANTS:Participants (n = 1137) were college students (63% female; Mage = 20.1 years; 62.6% non-Hispanic white) who reported on internalizing distress at baseline. Some individuals reported clinically significant symptoms (depression: mild/moderate = 24.0%, severe/extremely severe = 10.5%; anxiety: mild/moderate = 19.6%, severe/extremely severe = 11.4%; and stress: mild/moderate = 37.5%, severe/extremely severe = 6.0%). INTERVENTIONS:There were four different alcohol single-component PFIs administered and an attention-only PFI control. Alcohol PFIs varied in their complexity and single-component PFIs (i.e. personalized normative feedback) were compared with multicomponent PFI (i.e. containing additional alcohol-focused psychoeducation). MEASUREMENTS:Baseline levels of internalizing distress were measured using the summed total of the Depression, Anxiety and Stress Scales (DASS). Drinking outcomes (alcohol consumption, peak eBAC, alcohol-related consequences) were measured at baseline, 3, 6 and 12 months post-intervention. FINDINGS:Alcohol PFI (compared with attention-only control) reduced alcohol consumption and related consequences at 6-month [rate ratio (RR)Consumption = 0.85, P = 0.004] or 12-month follow-ups (RRConsumption = 0.76, P < 0.001; RRConsequences = 0.85, P = 0.020), regardless of baseline DASS score. Participants with higher DASS scores (compared with those with lower DASS scores) reported lower 6-month alcohol consumption after receiving a single-component intervention (RR = 0.80, P < 0.001). However, individuals with higher DASS scores (compared to those with lower DASS scores) reported more 6-month alcohol-related consequences after receiving a multicomponent intervention (RR = 0.78, P = 0.004). CONCLUSIONS:Personalized feedback interventions may demonstrate efficacy towards reducing drinking in young adults and appear similarly beneficial across levels of internalizing distress, although lower-complexity interventions may be more efficacious.

BACKGROUND:High-risk drinking among college students is common, and alcohol expectancies and experienced consequences are proximal predictors of use. This study tested short- and long-term efficacy of a personalized just-in-time adaptive intervention with daily messages about alcohol use, alcohol expectancies, and consequences delivered via mobile app. METHODS:Participants were 408 students enrolled at a 2- or 4-year college (75% 4-year; 64% female) who completed twice-daily assessments for 21 days and follow-up surveys at 1-, 6-, and 12-months. Data collection spanned January 2020 through April 2022. Participants were randomized to either an intervention condition receiving daily intervention messages and other related alcohol and expectancy-focused content via the app or an assessment-only control condition. Both conditions were administered daily surveys through the app. RESULTS:Poisson multilevel models were conducted to examine intervention effects on alcohol outcomes (i.e., drinks per week, heavy episodic drinking frequency, peak estimated blood alcohol concentration, and alcohol-related consequences, as well as positive and negative alcohol expectancies) at each follow-up assessment. On average, participants in both conditions reported decreased alcohol use outcomes, consequences, and expectancies at 1-, 6-, and 12-month follow-up compared to baseline. A single statistically significant difference between participants in the intervention and control conditions was observed at 1-month follow-up. Specifically, participants in the intervention condition reported a 17% greater decrease in heavy episodic drinking frequency than participants in the control condition, on average. CONCLUSIONS:Findings highlight the complexities of developing, implementing, and testing adaptive interventions, particularly within the context of the COVID-19 pandemic.

Post-traumatic stress disorder (PTSD) symptoms and hazardous drinking have been linked to lower relationship satisfaction; however, few studies have evaluated these associations over time in a college sample. The current study aimed to examine within-person and between-person longitudinal main and interactive effects of self-reported PTSD symptoms and hazardous drinking on relationship satisfaction in a college sample. We further examined whether individual PTSD symptom clusters (i.e., re-experiencing, avoidance, hyperarousal, and emotional numbing) uniquely predicted relationship satisfaction. College students in current dating relationships ( N = 307; 71% cisgender women) completed online self-report measures assessing relationship satisfaction, PTSD symptoms, and hazardous alcohol use on four occasions across 12 months. Multilevel models revealed that students with more severe PTSD symptoms than average had lower relationship satisfaction (i.e., at the between-person level). Additionally, higher hazardous drinking at the between-person and within-person levels was associated with lower relationship satisfaction. When examining specific PTSD symptom clusters, results indicated only emotional numbing symptoms were negatively associated with relationship satisfaction at the between-person and within-person levels after controlling for other PTSD symptom clusters. Collectively, these results underscore the impact of within- and between-person individual differences in PTSD symptoms and hazardous drinking on romantic relationships in college student populations.

BACKGROUND:Despite intervention efforts, negative alcohol-related consequences continue to impact young adults. Most alcohol interventions focus on reducing alcohol consumption; however, previous research indicates that focusing solely on alcohol use may not decrease consequences. Additionally, many alcohol interventions have diminishing engagement, and few are designed with young adults involved in the development process. Drawing on user-centered design, this study sought to understand young adult perceptions, preferences, and needs for electronic interventions specifically aimed at reducing alcohol consequences. METHODS:Using semi-structured qualitative interviews, 21 young adult drinkers (ages 18-24; 57.1% female) shared their opinions regarding the need for electronic interventions (i.e., mobile or web-delivered) to reduce alcohol consequences as well as their preferences for content, features, and ways to increase engagement. Interviews were coded and analyzed using a multi-step thematic analysis approach. RESULTS:As part of our discovery phase of intervention development, content coding revealed four main themes. Participants perceived several benefits of interventions focused on alcohol consequences, such as promoting mindful alcohol use and reducing alcohol-related harms. Participants also discussed perceived limitations of such programs, including believing consequences from drinking are unavoidable, necessary for learning, and associated with peer pressure. Preferences for features included real-time tracking, personalized feedback, and psychoeducation along with preferences for design including non-judgmental framing, interactive content, and a user-friendly platform. CONCLUSIONS:Engaging end users early in the development process is a valuable approach to increase intervention relevancy with the target population. This can also inform intervention content and design to maximize engagement and satisfaction (e.g., framing, features, and interactivity) while also reducing barriers identified early on (e.g., peer pressure).

Background/Objectives: Pregnant women have limited information on the impact of prenatal cannabis exposure (PCE) alone. Our aim was to determine if PCE, without alcohol, tobacco, or illicit drug use, is associated with altered birth outcome measures in obstetrically low-risk women. Methods: In this observational cohort study, pregnant women were recruited between 2019 and 2022 from communities in Washington and Oregon, USA, and enrolled following their first trimester. PCE eligibility required a minimum of three days/week of cannabis use during the first trimester with no required minimum use thereafter. For all participants, illicit drug, nicotine, or alcohol use was exclusionary throughout pregnancy and monitored via urine toxicology at multiple time points. Cannabis use was quantified into delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) mg/day using product weight and potency. Outcome measures included gestational age, weight, length, head circumference, and Apgar scores. Results: Study participants included 37 people in the PCE cohort and 35 controls. Average cannabis use for the PCE cohort was 198.0 mg of THC (SD = 221.2 mg)/day and 3.5 mg of CBD (SD = 4.3)/day. PCE newborns weighed less (38th vs. 52nd percentile, p = 0.04) and were shorter (40th vs. 55th percentile, p = 0.03) for their gestational age than controls. Female PCE newborns had smaller head circumference for gestational age (28th percentile; SD = 23), compared to male PCE newborns (55th percentile; SD = 32; p = 0.02). Conclusions: PCE is associated with reduced birth weight and shorter length for gestational age. The effect of PCE on brain growth may be sexually dimorphic. Future PCE studies should include sex as a biological variable and longitudinally evaluate long-term developmental and physiological outcomes.