Examining the Roles of Psychological Inflexibility and Distress Tolerance on Cigarette Dependence and Binge Drinking among Individuals who Co-use Cannabis for Therapeutic Purposes

Abstract The aims of this study were to examine associations between psychological inflexibility and (1) cigarette dependence among individuals who co-use cannabis and combustible cigarettes, and (2) binge drinking among individuals who co-use cannabis and alcohol. Adults attending a medical marijuana dispensary (N = 697) completed a survey examining cannabis use, cigarette smoking, binge drinking, psychological inflexibility, and distress tolerance. Psychological inflexibility was associated with greater cigarette dependence ( β = .325, p = .013) and binge drinking ( β = .303, p < .001). In linear but not zero-inflated negative binomial models, distress tolerance moderated the relationship between psychological inflexibility and binge drinking frequency ( β = .160, p = .003), though not the relationship between psychological inflexibility and cigarette dependence. Findings highlight the role of psychological inflexibility in the use of cigarettes and alcohol among people who co-use cannabis for therapeutic purposes. This population may benefit from interventions aimed at reducing psychological inflexibility and improving distress tolerance.