"It Just Depends on the Environement": Decisions, Risks, and Patterns of Substance Co-Use By Adolescents (WITHDRAWN)

BACKGROUND & PURPOSE:  We know very little about the social and physical characteristics of the contexts where adolescent substance co-use occurs and the potential mechanisms linking the two. If we understand such processes, we can develop context-specific interventions to reduce adolescent substance co-use and problems. This study used rich qualitative data to better understand relationships between adolescent co-use and social and physical contexts.

METHODS:  Qualitative interviews were conducted with 13 adolescents (46% female). Participants were self-reported co-users of alcohol and another substance who were sampled from a larger quantitative study of adolescents living in mid-sized California cities.  The interviews were conducted either in-person or over the phone.  Participants were asked to describe their substance use and co-use behaviors in a variety of contexts (e.g. parking lot, friend’s home), discuss the perceived risks in their various co-use contexts, and explain how they made decisions about co-use in relation to their immediate social and physical context. Data were coded and analyzed using a phenomenological approach. 

RESULTS:  Some adolescents had established patterns of co-use that were informed by their social and physical context (e.g. drink alcohol at a large house party followed by smoking marijuana with a smaller group of friends at home). Decisions about substance use and co-use were generally guided by whether the expected effects of a substance or combination of substances fit into the planned social and physical context. For example, alcohol was described as best for “partylike” atmospheres, molly as best for raves or contexts with fast-paced live music, and marijuana as best for “kickbacks” or gatherings of small groups of intimate friends in a private place such as a home. Co-use of substances was typically described as proximal rather than simultaneous as adolescents generally described long substance use events with substance use occurring in multiple contexts both static and transitional (e.g. in a car on the way to a restaurant). While some adolescents described context specific risks of co-use (e.g. greater potential for parental or law enforcement sanctions at specific contexts), overall the severity of risk was viewed as low across contexts.

CONCLUSIONS & IMPLICATIONS:  These findings suggest that adolescent substance co-use is a moving target in the sense that youth use multiple substances in different contexts throughout a typical evening or use event. Interventions designed to address co-use in adolescents must pay attention to use at both static and transitional contexts.