Personal choices drive young adults' alcohol abstinence with cannabis as a common substitute

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Jun 24 2024

In a recent study published in the journal Alcohol Clinical & Experimental Research, researchers examined typical drinking motives in young adults and their associations with demographics, timings (weekday versus weekend), and alcohol use patterns. They used a questionnaire-based 14-day-long daily survey approach for their investigations to identify factors that could be used in future anti-alcohol abuse interventions. Study findings revealed that "wasn't interested in drinking" was the most common reason for alcohol abstinence (83.4%), followed by "didn't want to get drunk" (81.8%). In individuals who substituted a different drug in place of alcohol, cannabis was the most often cited (81.8%).

Together, these findings highlight that 'personal decisions' form the bulk of young adults' underlying reasons for alcohol abstinence and identify situational barriers (such as financial concerns) as crucial points that clinicians and policy-makers can tap into for future alcohol-centric interventions in this at-risk population.

Study: Prevalence and correlates of daily-level reasons not to drink among young adults who use alcohol. Image Credit: AndreyCherkasov / Shutterstock

Background

A study by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2022) identified alcohol as the most common substance abuse among young adults (ages 18-25). Alcohol is known to have a substantial negative impact on this vulnerable age group, contributing to surges in road-related accidents, physical and sexual assaults, and physiological trauma (e.g., liver cirrhosis).

Despite public health service interventions slowly reducing alcohol use (and its associated disorder), alcohol consumption by young people is still substantially higher than in most other age groups. As of 2022, reports by the National Institute on Alcohol Abuse and Alcoholism and others still find that 30.5% and 9.5% of young adults partake in binge- and high-intensity drinking (HID), respectively. Together, this literature highlights a need for understanding the underlying motivations for and against alcohol consumption as a preliminary step in curbing its global influence.

Decades-long research has hypothesized and tested the role of 'reasons and motives' (coping, social enhancement, and conformity) as proximal risk factors in substance abuse. Coping and conformity have been highlighted as often-referenced reasons to drink. Surprisingly, 'reasons not to drink' are often overlooked in the literature, especially in daily-level investigations. This leaves policy markers with little information on the population's perceived cons of drinking. Furthermore, the effects of confounding variables like demographics, alcohol-use patterns, and drinking timings remain understudied.

About the study

The present study aims to answer two main questions: 1. How often do regular young adult alcohol drinkers abstain from alcohol consumption, and what are their commonly endorsed reasons for doing so? 2. What is the role of confounding variables (demographics, timing, motives, and alcohol use behaviors) in altering the results of question 1?

The participant cohort was derived from the Young Adult Daily Life (YADL) study (Year 4 – 2022 dataset). Of the 14,502 participants who enrolled in the United States (US) nationally representative YADL study, 1,208 presented missing data, and 10,262 did not report past 30-day alcohol use (eligibility criteria) and were thus excluded from the current analyses. An additional 1,439 participants were lost during the four-year-long follow-up period. Data was collected via one baseline survey (30 minutes) and 14 daily questionnaire surveys (5-7 min), each comprising 12 questions about the participants' against alcohol consumption on that particular day.

For confounding data analyses, participants' drinking habits were categorized into regular drinking (<5 drinks in a row), binge drinking (5 or more drinks in a given day), and high-intensity drinking (HID; 10 or more drinks in a given day). The Drinking Motives Questionnaire (DMQ-R; 20 items) was used to evaluate participants' reasons/motives for binge- or HID. YADL demographic data was queried for participants' sex, ethnicity, and current college status (> or <4 years of college education). Statistical analyses included descriptive and multilevel logistic regression models to reveal day- and person-level predictors corrected for confounding variables.

Study findings

Of the 14,502 YADL participants initially included in the study and more than 2,000 screened at baseline, only 765 provided completed daily questionnaires and were included in the final analysis. Statistical evaluations revealed that "I wasn't interested in drinking" was the most listed reason to abstain from alcohol consumption (83.4% days), with an almost ubiquitous 97.2% of participants citing this reason at least once throughout the 14-day-long investigation. "I didn't want to get drunk," "I didn't want alcohol to interfere with school/work," and "I don't usually drink on weekdays" were other commonly referenced reasons for alcohol abstinence (81.8%, 58.4%, and 58.7% of days, respectively).

72.6% of participants, most of whom were female, highlighted the need for monetary prioritization over alcohol as a reason for choosing not to drink. Close to 1/3^rd of the participants (29.5%) reported substituting alcohol with a different drug, with cannabis (81.8%) comprising the most frequent substitute.

Demographic analyses revealed that women were more likely to refrain from alcohol consumption for monetary-, hangover-, or interest-based reasons than their male counterparts. Encouragingly, the duration of a college education was positively correlated with alcohol and drug abstinence, potentially due to the frequency of campus-based anti-substance-abuse intervention programs. Surprisingly, binge- and HID had almost no statistically significant association with reasons for or against drinking, with "I had a hangover recently" being the only exception.

…binge drinking (vs. moderate) and HID (vs. moderate) at the person level were associated with greater odds of endorsing "I had a hangover recently" and lower odds of endorsing "I do not drink alcohol". Those who endorsed more coping motives had greater odds of endorsing "I needed money for things other than alcohol" and "I upset my family/friends when I drink alcohol." Those who endorsed more enhancement motives had greater odds of endorsing "I used another drug instead of alcohol" and lower odds of endorsing "I do not drink alcohol." Those who endorsed more conformity motives had greater odds of endorsing "I didn't have anyone to drink with," "I upset my family/friends when I drink alcohol," and "I was quarantining or sick."

Conclusions

Findings from the present study help fill a persistent gap in the motivational model of alcohol use risk – reasons for use and avoidance. Study findings highlight that the motivation to abstain from drinking is a primarily personal decision influenced by monetary, coping, and conformity concerns. Encouragingly, comparisons between college-going and college-abstaining participants suggest that campus-based intervention programs may coax young adults to give up not only drinking but also other drug use. Together, these findings highlight the need for a surge in informed and personalized intervention programs that may help reduce young adult dependence on alcohol and its associated risky behaviors.