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Addictive Behaviors
The role of psychological inflexibility on cigarette dependence and binge drinking
Silvana Agterberg, Ph.D.
Clinical Psychology Postdoctoral Fellow
Montefiore Medical Center
New York, New York, United States
Mary Barna Bridgeman, Other
Clinical Professor
Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey
Piscataway, New Jersey, United States
Benjamin Billingsley, Ph.D.
Postdoctoral Fellow
The Concord Center
Boston, Massachusetts, United States
Rachel L. Rosen, Ph.D.
Postodoctoral Fellow
Massachusetts General Hospital
Boston, Massachusetts, United States
Marc L. Steinberg, Ph.D.
Professor
Rutgers University
New Brunswick, New Jersey, United States
Background and Objectives. The co-use of cannabis with cigarettes and alcohol is prevalent and associated with adverse physical and mental health effects, thus it is important to identify factors (e.g., psychological inflexibility, distress tolerance) that may relate to greater cigarette smoking and alcohol use among individuals who use cannabis. The primary aims of the current study were to examine the relationship between psychological flexibility and cigarette dependence and the relationship between psychological flexibility and binge drinking among individuals who use cannabis for therapeutic purposes (CTP).
Methods. This was a secondary analysis of cross-sectional data from individuals attending a medical cannabis dispensary (N= 697; 75.3% white; 60.0% male). Participants completed a survey examining cannabis use, cigarette smoking, binge drinking, psychological inflexibility, and distress tolerance.
Results. Psychological inflexibility was associated with greater cigarette dependence (β = .325, SE = .015) and greater binge drinking frequency (β = .303, SE = .019). Moreover, distress tolerance moderated the relationship between psychological flexibility and binge drinking frequency (β = .160, SE = .014), but not cigarette dependence.
Discussion and Conclusions. Findings from the current study highlight the role of psychological flexibility in the use of cigarettes and alcohol among people who use cannabis for therapeutic purposes. Individuals who use cannabis for therapeutic purposes may engage in cigarette and alcohol use to escape or avoid uncomfortable internal states and conditions for which they use cannabis (e.g., pain, anxiety). This may be particularly true among those with lower levels of distress tolerance.
Scientific Significance. Individuals who co-use CTP with other substances may benefit from substance use screening and interventions aimed at increasing psychological flexibility and improving distress tolerance.