Forty-five male, Sprague Dawley rats were used to determine if external stimuli could influence the length of a conditioned taste aversion. Animals were given a novel taste (sucrose), and then injected with one of three different substances, marihuana, LiCI, or saline. The animals were then placed into either a stimulation condition, a non-stimulation condition, or returned to the home cage. The stimulation condition contained aversive stimuli in the form of bright, flashing lights and loud noises. The other conditions had no aversive stimulation. It was expected that the animals receiving injections of marihuana would have an increase in their responsiveness to events in their environment, and thus be more sensitive to the aversive stimulation. By reacting to not only the internal toxicosis, but also the aversive external stimulation, it was hoped that the animals would undergo a more totally aversive experience in the stimulation condition. This increase in discomfort with the addition of external aversive stimuli was expected to be reflected in the development of longer conditioned aversions in animals receiving the marihuana and stimulation. The LiCI group was expected to show no reactiveness to the external aversive stimuli. Although taste aversions did develop in the marihuana and LiCI groups, no differences were found between treatment conditions nor between toxins. This study shows that external aversive stimuli do not play a role in an animal's conditioned aversion to sucrose after injection of a toxic drug such as marihuana or LiCI.

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Electronic nicotine delivery systems emerged during the 2010s as a novel way to consume (i.e., vape) nicotine. Public health authorities became concerned that vaping could cause nicotine-naïve youth to begin using tobacco products and that a new generation of youth could become tobacco-dependent. Though millions of youth have vaped, authorities' fears about a new generation of youth tobacco dependence has not materialized. A more recent concern is nicotine vaping’s potential effects on cannabis use and the use of other substances. An increase in cannabis use among some adolescent groups and young adults could be because of nicotine vaping’s rise. Additionally, cannabis can be vaped, so transitioning from nicotine vaping to cannabis vaping may be easier than transitioning from nicotine vaping to other forms of cannabis use. Furthermore, nicotine product use was historically associated with later use of cannabis and other substances; this trend may be renewed with the advent of nicotine vaping. To date, most studies on the associations between nicotine vaping and cannabis/other substance use are cross-sectional, so more longitudinal evidence is needed. If evidence suggests that nicotine vaping does affect the use of cannabis and other substances, specifying a mechanism would help with developing potential interventions and with testing the validity of total effects. The overarching goal of this dissertation is to advance evidence of nicotine vaping's potential harmful effects on youth and young adults, which could be used to support interventions aimed at reducing the burden of nicotine vaping's outcomes. First, I conducted a systematic review in which I examined the extent to which confounding, measurement errors, and loss to follow-up could alternatively explain reported longitudinal effects of nicotine vaping on cannabis use or other substance use. I also identified studies that tested effect modification and mediation. This systematic review revealed that nicotine vaping likely increases the risk of subsequent cannabis use and other substance use for up to 24 months. It also revealed that some studies evaluated effect measure modification, while no study assessed mechanisms. These observations suggest that future studies should assess long-term effects on initiation and evaluate potential mechanisms. Second, I evaluated whether nicotine vaping affected the initiation of cannabis and other substances over a six-year period among adolescents as they age into adulthood. Results suggested that nicotine vaping had harmful effects on both outcomes over the six-year period. I also found evidence that nicotine vaping's harmful effects in later years appeared stronger than in earlier years; the absence of age effects suggest the absence of cohort effects. Furthermore, I found that effects appeared stronger among individuals who had a history of non-vaping tobacco product use than among individuals without a history of non-vaping tobacco product use, suggesting that tobacco use is key to nicotine vaping's harms. Finally, I evaluated possible mechanisms of the effects based on a theory that I developed from prior empirical literature and behavioral theory. I posited that nicotine vaping caused deviant peer affiliation, which caused conduct problems and subsequently, the outcomes. I found no evidence that three conduct problems (considered together) were mechanisms of the effects. Future studies of mechanisms can reveal potential intervention targets, lead to studies of other potential mechanisms, and help test the validity of total effects. This dissertation achieved its goal of advancing evidence that nicotine vaping may harm youth and young adults. Public health bodies tasked with addressing potential public health concerns about nicotine vaping products should consider evidence from this dissertation.

Objective: Cocaine use is prevalent among patients in methadone maintenance and a risk factor for poor treatment outcomes. Contingency management (CM) decreases cocaine use in this population, but little is known about its efficacy when marijuana use is present prior to or during treatment. Method: Data from five randomized CM trials (N = 557) were used to evaluate whether: (a) marijuana frequency (none, low, or high) prior to or during treatment impacts cocaine use outcomes and (b) marijuana use differentially impacts cocaine outcomes with standard care (SC) + CM versus SC alone. Results: Relative to no marijuana use, low (β = .28, p < .01) and high marijuana use (β = .32, p < .05) during treatment were associated with roughly 1 week shorter duration of cocaine abstinence on average. Low marijuana use (β = .71, p < .05) during treatment was associated with a lower proportion of negative cocaine samples during treatment relative to no marijuana use. Treatment group by marijuana use (before or during treatment) interactions on duration and proportion of cocaine abstinence during treatment were not significant. For longer term outcomes, in SC + CM, marijuana use during treatment did not impact cocaine abstinence 6 months post-baseline. In SC, low (OR = .44, p < .05) and high (OR = .26, p < .001) marijuana use during treatment decreased odds of cocaine abstinence at 6 months post-baseline relative to no use. Conclusions: Findings highlight the benefits of SC + CM and abstaining from marijuana use during active treatment. At 6 months postbaseline, SC + CM evidenced similar cocaine abstinence regardless of marijuana use levels during treatment, while those with low and high marijuana use showed decreased abstinence rates in SC only. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The purpose of this study was to analyze the factors that affect the use of marijuana by juveniles and how outside influences such as peer pressure, race, parental influence, and prevention programs such as the Drug Abuse Resistance Education (D.A.R.E.) contribute to the use of marijuana by juveniles. All of the variables used in this study came from the Gang Resistance Education and Training (G.R.E.A.T.) data collected by Esbensen and Osgood (1999). The analysis indicated that juveniles are most influenced by their peers such as friends, that African American juveniles would be less likely than Whites and Hispanics to become regular users of marijuana, that juveniles living with both parents would be less likely to use marijuana compared to those with alternative living conditions, and that the programs such as the D.A.R.E. program would have little long-term effect on marijuana usage by juveniles.

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Background: Opioid maintenance therapy has been advocated by American College of Obstetrics and Gynecology (ACOG) along with American Society of Addiction Medicine (ASAM) for opioid use disorder in pregnancy. Marijuana use has been increasing with legalization of marijuana in many states along with reported benefit of antiemetic effect in pregnancy. Both have been independently implicated in adverse neonatal outcome but they haven't been studied for concurrent use in pregnancy. Objective: Objective of the study was to look in to the use of opioid and marijuana in pregnancy related with neonatal outcomes; birth weight, Apgar scores,low birth weight, preterm birth along with social determinant of opioid and marijuana use in pregnancy. Design/Methods: A retrospective chart review from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia was conducted to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen (UDS) for marijuana(THC) at the time of delivery. Inclusion criteria were UDS positive for THC at delivery and exposure to opioid during pregnancy.18730 births were identified during the study period, 2638 pregnancy were opioid exposed, and 2375 pregnancies met the inclusion criteria were included for analysis with 108 pregnancies positive for THC in UDS at the time of delivery. Maternal characteristics, delivery and perinatal outcome were studied. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables like parity, maternal status, tobacco, and benzodiazepine to find aOR for marijuana exposure for NAS diagnosis, premature birth, and low birth weight (LBW). Results: Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Conclusion(s): In view of ACOG and ASAM guidelines for continuing opioid for opioid use disorder during pregnancy, finding of increased prematurity along with LBW carries significance of advocating counseling against use of marijuana in pregnancy exposed to opioids.

The purpose of this study is to estimate the association between sibling drug use and adolescent alcohol, cigarette, and marijuana use. Research is conducted using survey data from a probability sample of 4,987 adolescents in grades 9–12 in Utah. To account for the limited frequency of drug use among respondents, Poisson regression is used to estimate models for each type of drug. In support of current literature, findings indicate that having a sibling who uses drugs increases the frequency of drug use substantially, even when peer influences are taken into account. Significant sibling associations with adolescent drug use found in this study support the assumptions of social learning theory. Findings suggest that sibling influence is largely due to social learning, as older sibling influences are demonstratively more significant than younger sibling influences.

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