Psychological Flexibility Mediates the Relationships between Obsessive Passion and Substance Use-Related Consequences Among College Students Who Use Cannabis and Alcohol Simultaneously

Background and Purpose: Obsessive passion for substance use refers to a relationship with substance use that becomes so compelling that it often causes conflicts with other activities and personal values. Research has shown that psychological flexibility, defined as a set of psychological processes enabling individuals to regulate internal experiences in the face of external stressors and to engage in adaptive behaviors in ways aligned with their values and goals, plays a mediating role in the relationships between substance use behaviors and use-related consequences. This study aims to investigate whether psychological flexibility mediates the relationships between obsessive passion for substance use and substance use-related consequences among college students engaging in simultaneous co-use of alcohol and cannabis. Methods: This secondary analysis utilized baseline data from a longitudinal prospective cohort study of undergraduates at two U.S. Midwestern institutions who reported simultaneous co-use of alcohol and cannabis (N=339, M_age=20.57,SD=2.32; biological female=54.3%, heterosexual=74.6%, Non-Hispanic White=76.4%, reported a 3.0 or above GPA=79.9%, full-time enrollment=90.3%). Mediation analyses were conducted using the PROCESS v4.2 macro in SPSS, with obsessive passion for alcohol and cannabis use as independent variables, psychological flexibility as the mediator, and various substance use-related consequences as dependent variables (alcohol use disorder (AUD) symptoms, cannabis use disorder (CUD) symptoms, alcohol and cannabis use consequences, cannabis use frequency) while controlling for study site and DSM CUD criteria at screening (i.e., 2+ CUD symptoms vs. less than two CUD symptoms). Results: Results revealed a significant indirect effect of greater obsessive passion for alcohol use and increased AUD symptoms through decreased psychological flexibility (indirect effect = 0.1069, p<0.001, 95% CI = [0.0177, 0.2296]). Similarly, a significant indirect effect of greater obsessive passion for cannabis use and more cannabis use consequences through decreased psychological flexibility (indirect effect = 0.0630, p<0.001, 95% CI = [0.0022, 0.1512]) was observed. Additionally, increased psychological flexibility was found to mediate the relationship between greater obsessive passion for cannabis use and increased frequency of cannabis use in the past month (indirect effect = -0.4470, p<0.001, 95% CI = [-1.0527, -0.0189]). Conclusions and Implications: These findings suggest psychological flexibility is a key mediator between obsessive passion for substance use and use-related consequences among college students engaging in simultaneous co-use of alcohol and cannabis. Students with co-use issues and high levels of obsessive passion for substance use may be more vulnerable to negative substance use-related consequences due to their decreased psychological flexibility to adapt to external stressors. Interestingly, college students with greater psychological flexibility might also engage in increased frequency of cannabis use. These findings highlight the potential of examining obsessive passion in understanding college students’ substance use behaviors and use-related consequences within the context of psychological flexibility. Future studies are needed to explore whether intervening in obsessive passion and psychological flexibility could reduce future substance use or use-related consequences among this population.