Reductions in cigarette and cannabis use during a randomized clinical trial for alcohol use disorder

Objectives Alcohol, tobacco, and cannabis are the most frequently used psychoactive substances in the United States and are commonly used concurrently. This study analyzed patterns of cigarette and cannabis use during a randomized controlled trial (RCT) for alcohol use disorder (AUD). Methods This secondary analysis of a 12-week RCT of ibudilast for AUD (N = 102; 61 M/41F) examined whether cigarette and cannabis use changed over the trial and whether changes in their use were associated with the observed reductions in alcohol consumption. Results Individuals significantly reduced their cigarette use over the trial (P = .002). Cannabis use significantly decreased during the early phase of the trial (P = .006) and subsequently increased during the remainder of the trial (P = .03). Changes in cigarette use and cannabis use were not significantly associated with changes in the primary drinking outcome, percent heavy drinking day (Ps ≥ .22). However, changes in the secondary drinking outcome, drinks per drinking day (DPDD), were positively associated with changes in cigarette use across the trial and negatively associated with changes in cannabis use during the early phase of the trial (Ps < .05). Conclusion Individuals enrolled in an RCT for AUD were able to reduce their cigarette and cannabis use without being prompted to, and these changes were significantly associated with changes in DPDD. These findings emphasize the importance of evaluating co-occurring substance use in AUD clinical trials, given that significant changes in cigarette and cannabis use behaviors may occur even when not directly targeted.