Patterns of substance use and co-use by adolescents


Using in-depth interviews with 13 adolescents (16-19 years of age) who used alcohol and marijuana, this study examines the role that social and physical contexts play in adolescent decision-making about simultaneous use of alcohol and marijuana.

The research findings show that context matters in three ways:

context characteristics inform decisions about simultaneous use,context characteristics determine simultaneous use patterns such as the sequence in which substances were used, andsimultaneous alcohol and marijuana use occurred in both destination locations and transitional locations.

First, researchers found that adolescents described decisions about which substance to use—or both together—based on how the physiological effects of the substance would fit with the social, physical, and situational characteristics of the context.

For example, marijuana was named as a substance that could be used in situations during which youth had to maintain control or where they were likely to encounter authority figures.

Because, I don’t know, people usually get high because they like the way it enhances everything. .. [Of country clubs, school events, and malls] I would only smoke weed there, because the only substance I feel where I can fully act like myself and not be obvious would be weed. ‘Cause if it’s public, you know. Restaurant, same thing. I wouldn’t go drunk to a restaurant, but I would go high.” (Participant 5, Male, age 17).

Second, use of which drug was used—or both together—was related to how adolescents wanted to feel or behave in a particular context.

“Generally, the formula that I kind of go with is there will usually be a pregame. I’ll have a couple of shots of something. Usually it’s whatever we have on hand, if it’s vodka or if it’s whiskey. Then we’ll walk to the party…Usually at the party, I’ll drink mostly hard alcohol, ’cause that’s what there is. Then kind of as the night winds down, maybe if there’s beer, I’ll drink that…Then usually, at the end of the night, me and my friends will smoke [marijuana], because it helps kind of wind down and it’s supposed to make the hangover less bad.” (Participant 8, Male, age 18)

Finally, adolescents described simultaneous alcohol and marijuana use in two types of contexts: destination and transitional. Destination contexts were places where adolescents stayed for a long period of time. Transitional contexts were on the way to place, such as in a car.

The authors conclude that interventions designed to reduce simultaneous alcohol and marijuana use could benefit from paying attention to substance use contexts.