Dynamic Associations between Impulsivity, Craving, and Co-Use of Alcohol, Cannabis, and Nicotine among Young Adults

Rates of alcohol, cannabis, and nicotine peak in young adulthood and rates of dual- (e.g., alcohol and cannabis) and tri-use (alcohol, cannabis, and nicotine) of these substances is prevalent and growing. Dual-/tri-use is particularly concerning given associations with heavier substance use, substance use disorder, and acute alcohol-related harms (e.g., blacking out, acute physical effects). There is a pressing need to understand risk factors that contribute to dual-/tri-use to tailor intervention content to be more impactful. Guided by dual process and incentive salience theories, impulsivity and craving are critical risk factors for alcohol use at the person- and day level. Scant research, however, has considered how impulsiveness and craving may vary between and within specific types of substance use episodes. Understanding how craving and different impulsive facets relate to dual-/tri-use may highlight underlying mechanisms for use and points of intervention. Toward this end, this R21 application seeks to collect intensive, momentary data (5 timepoints/day across 17 days) from 250 young adults who report tri-use of alcohol, cannabis, and nicotine. We aim to examine the additive effects of cannabis and/or nicotine use on the association between impulsivity facets (UPPS-P) and craving relative to alcohol-only occasions. Using a complementary set of intensive longitudinal analytic methods, we will contrast levels of impulsivity and craving between alcohol-only, dual-use, and tri-use episodes and will examine the role of cannabis and nicotine on impulsivity and craving as it unfolds across an alcohol use occasion. Lastly, we will examine day-/moment-level (mood, peer factors, location, craving) and person-level (sex, racial-ethnic group, baseline measures of impulsivity [UPPS-P, impulsive action, impulsive choice]) moderators to determine when and for whom associations are strongest and most in need of timely intervention. Specifically, this R21 application has three aims. Aim 1 is to examine within-person associations between impulsivity facets and craving as predictors of dual-use (alcohol + cannabis, alcohol + nicotine) vs. alcohol-only use, tri-use (alcohol + cannabis + nicotine) vs. alcohol-only use, and tri-use vs. dual-use. Aim 2 will examine the dynamic nature of each impulsivity facet and craving and the role of cannabis and nicotine use across moments leading up to, during, and after alcohol use initiation. Aim 3 will explore (a) day- and person-level characteristics as moderators of Aim 1; and (b) the time-varying effect of moment- and person-level characteristics on Aim 2. Findings from the current R21 will have critical implications for developing just-in-time interventions focused on attenuating the relationships between impulsivity, craving, and higher-risk substance use.