Polysubstance use is extremely common worldwide, and yet many substance use studies or treatment interventions may only focus on one substance at a time. The use of both cannabis and tobacco, for example, is very common among adolescents and adults and represents a major public health concern.
Though cannabis and tobacco are frequently used together (either by the same person or within the same preparation), little is known about quit interest, treatment preferences, and drug substitution during past quit attempts among adult co-users. These data are critical to inform treatment strategies for cannabis and tobacco co-users.
In a recent study in Experimental and Clinical Psychopharmacology, McClure and colleagues collected and analyzed online survey data from adults (ages 18+) in the United States who used both cannabis and tobacco regularly (20+ days of use in the past 30). Survey respondents were recruited from Amazon's Mechanical Turk (MTurk), which is an online crowdsourcing service that has been used successfully to recruit substance use populations.
Participants who qualified for and completed this survey (N=282; Mean age=33.3 years old; 57% female, and 79% White) were asked about their cannabis and tobacco use, quit interest for both substances, treatment preferences, and perceived drug substitution during past quit attempts.
This study had several important findings.
First, on a 10-point scale (1=not at all interested; 10=extremely interested) measuring interest in quitting, mean quit interest for tobacco was 7.1 (out of 10), while mean interest in quitting cannabis was 2.4.
Second, 50% of survey respondents self-reported that their cannabis use increased during their last tobacco quit attempt and 62% self-reported a perceived increase in their tobacco use while trying to quit using cannabis.
Third, when asked about quitting both cannabis and tobacco, 71% reported that they would prefer to quit tobacco first, and then attempt to quit using cannabis.
While this survey had important limitations, results suggest that drug substitution may be occurring among a sub-set of cannabis and tobacco co-users. This is an important treatment concern that should be addressed in future studies and as part of treatment programs. Tobacco cessation should be provided to co-users, but interventions may need to consider a potential lack of interest in cannabis cessation.
There are currently no widely accepted or available treatment plans for both tobacco and cannabis co-use, though these results should be used to help shape future interventions for co-users. Better understanding of co-use is needed to guide the development of effective and acceptable treatment strategies for cannabis and tobacco co-users.
Citation
- McClure, E. A., Tomko, R. L., Salazar, C. A., Akbar, S. A., Squeglia, L. M., Herrmann, E., Carpenter, M. J., Peters, E. N. (2019). Tobacco and cannabis co-use: Drug substitution, quit interest, and cessation preferences. Experimental and Clinical Psychopharmacology, 27(3), 265–275. http://dx.doi.org/10.1037/pha0000244
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