Multisubstance Use Among Treatment-Seeking Smokers: Synergistic Effects of Coping Motives for Cannabis and Alcohol Use and Social Anxiety/Depressive Symptoms

ABSTRACT

Objective: This study examined the impact of coping motives for cannabis and alcohol use on the relation between social anxiety/depressive symptoms and severity of substance use for alcohol, tobacco, and cannabis among treatment-seeking smokers who also use cannabis and alcohol. Methods: The sample included 197 daily cigarette smokers (M_Age 34.81 years, SD = 13.43) who reported using cannabis and alcohol. Results: Hierarchical multiple regression analyses were conducted wherein separate models were constructed for each dependent variable. Among individuals with higher social anxiety, alcohol coping motives were associated with heavier drinking, and this was more pronounced among those low in depressive symptoms. Similarly, those at greater risk for nicotine dependence were anxious individuals with lower depressive symptoms who endorse coping-oriented motives for using cannabis. Further, among those with higher social anxiety, cannabis coping motives were associated with marginally greater drinking, particularly for those high in depressive symptoms. Conclusions: The present findings support the perspective that among multisubstance users, the interplay between social anxiety, depressive symptoms, and coping-oriented motives for using one substance (e.g., cannabis or alcohol) may pose difficulties in refraining from other substances (e.g., tobacco). This observation highlights the importance of tailoring multisubstance treatments to specific needs of multiusers for whom single-substance interventions may be less effective. Findings also support previous work exploring the benefits of concurrently treating co-occurring substance use and lend credence to the perspective that motivation to use substances for coping reasons is of central theoretical and clinical relevance.

Keywords:

• Coping
• motives
• cannabis
• alcohol
• tobacco
• social anxiety
• depressive symptoms

Glossary

• Anxiety: A future-oriented mood state of inner turmoil and unease associated with preparing for possible negative events.

• Depressive symptoms: Depressed mood or loss of interest or pleasure in daily activities which can affect functioning in domains including social, educational, and occupational realms.

• Negative affect: Involving the experience of negative emotions including fear, anger, nervousness, and guilt.

• Substance-related motivation: Motivational models of substance use suggest that using substances to cope with psychological distress is related to higher levels of use.

Acknowledgments

Dawn Foster conducted statistical analyses and drafted the manuscript. Julie Buckner contributed to data analytic strategy and manuscript drafts. Michael Zvolensky and Norman Schmidt conceptualized the grant, oversaw data collection, and provided guidance and feedback to manuscript drafts. All authors contributed to and have approved the final manuscript.

Declaration of interest

The authors report no financial relationships with commercial interests, and have no additional income to declare. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This project was supported by National Institute of Mental Health grant R01 MH076629-01 (Drs. Zvolensky and Schmidt). Additionally, preparation of this manuscript was supported in part by National Institute on Drug Abuse grant K12-DA-000167 (Dr. Foster). NIMH and NIDA had no direct role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The contents of this manuscript do not necessarily represent the policy of the NIMH or NIDA, and as such, endorsement by the Federal Government should not be assumed.

Additional information

Notes on contributors

Dawn W. Foster

Dawn W. Foster is an Assistant Professor in the Psychiatry Department at Yale University's School of Medicine. Her work focuses on social psychological principles related to substance misuse and addictive behaviors.

Julia D. Buckner

Julia D. Buckner is an Associate Professor of Psychology at Louisiana State University. Her work focuses on understanding the nature and treatment of anxiety disorders, with a particular interest in the relations between anxiety and addictive behaviors.

Norman B. Schmidt

Norman B. Schmidt is Distinguished Research Professor and Director of the Anxiety and Behavioral Health Clinic in the Department of Psychology at Florida State University. His work focuses on the nature and treatment of anxiety and related disorders.

Michael J. Zvolensky

Michael J. Zvolensky is the Hugh Roy and Lillie Cranz Cullen Distinguished University Professor and Director of the Anxiety and Health Research Laboratory and Substance Use Treatment Clinic (AHRL-SUTC) at the University of Houston (UH) and a research Professor at MD Anderson Cancer Center at The University of Texas.