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Original Investigation
October 12, 2020

Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018

Author Affiliations
  • 1Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor
  • 2Institute for Research on Women and Gender, University of Michigan, Ann Arbor
  • 3Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
  • 4Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor
  • 5Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 6Department of Psychology, Iowa State University, Ames
  • 7Department of Sociology, University of Central Florida, Orlando
  • 8Department of Psychology, Texas State University, San Marcos
JAMA Pediatr. Published online October 12, 2020. doi:10.1001/jamapediatrics.2020.3352
Key Points

Question  Have rates of alcohol abstinence and marijuana abstinence, co-use, and use disorders changed in US young adults from 2002 to 2018 as a function of college status?

Findings  A nationally representative cross-sectional survey conducted annually of 182 722 US young adults found that alcohol abstinence, marijuana use, and co-use of alcohol and marijuana all increased between 2002 and 2018. These findings were apparent for both college students and non–college students.

Meaning  The findings of this study suggest that colleges and communities should create and maintain supportive resources in response to the recent changes in the US young adult substance use landscape, accounting for increases in alcohol abstinence, marijuana use, and co-use of alcohol and marijuana.

Abstract

Importance  Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited.

Objectives  To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018).

Design, Setting, and Participants  This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively.

Main Outcomes and Measures  Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

Results  The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non–college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse.

Conclusions and Relevance  The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

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