The Role of Life Events/Contextual Factors and Cannabis Use in Patterns of Other Drug Use Among Young Adult Cannabis Users in Los Angeles: A Qualitative Inquiry

• DOI: 10.1177/0022042619900205
• Date: 01 April 2020
• Published date: 01 April 2020
• Subject Matter: Articles

https://doi.org/10.1177/0022042619900205

Journal of Drug Issues

2020, Vol. 50(2) 157 –172

© The Author(s) 2020

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0022042619900205

journals.sagepub.com/home/jod

Article

The Role of Life Events/Contextual

Factors and Cannabis Use in

Patterns of Other Drug Use Among

Young Adult Cannabis Users in Los

Angeles: A Qualitative Inquiry

Ekaterina V. Fedorova1, Alexis M. Roth1,

Alice Cepeda2, Carolyn F. Wong2,3,

Ellen Iverson2,3, and Stephen E. Lankenau1

Abstract

This analysis examined the role of impactful life events/stressful contextual factors and cannabis

use in the patterns of illicit drug use. It utilized semi-structured qualitative interviews with

40 young adult medical cannabis patients and 22 non-patient users collected in Los Angeles

during 2014–2015. Three patterns of illicit drug use emerged based on participants’ narratives:

regular/problematic, recreational/occasional, and never users. Among regular/problematic

users, a common theme was the lasting impact of traumatic life events or stressful contextual

factors on transition to and away from problematic drug use, and using cannabis to cope with

negative after effects of drug use. In contrast, most recreational/occasional and never users,

who reported impactful life events or stressful contextual factors, used cannabis to cope with

those experiences. Family history of addiction and acceptance of cannabis use within a family as

protective factors against illicit drug use among some recreational/occasional and never users

was an unexpected finding.

Keywords

medical marijuana, medical cannabis, illicit drug use, prescription drug misuse, young adults,

traumatic events, positive life events, negative life events, contextual factors, substitution,

coping, self-medication

Introduction

Zinberg’s (1984) “Drug, Set & Setting” framework proposes that patterns of drug use are influ-

enced by three main factors: pharmaceutical properties of a specific drug, personal characteris-

tics of a user (the set), and the settings (social and physical) whose role is often underestimated.

1Drexel University, Philadelphia, PA, USA

2University of Southern California, Los Angeles, CA, USA

3Children’s Hospital Los Angeles, CA, USA

Corresponding Author:

Ekaterina V. Fedorova, Department of Community Health and Prevention, Dornsife School of Public Health, Drexel

University, 3215 Market Street, Philadelphia, PA 19104, USA.

Email: evf26@drexel.edu

900205JODXXX10.1177/0022042619900205Journal of Drug IssuesFedorova et al.

research-article2020

158 Journal of Drug Issues 50(2)

Furthermore, he argued that “controlled” drug use is possible through a learning process about

social sanctions and rituals as informal norms around acceptable use of a specific substance:

where, with whom, how, and how much to use (Zinberg, 1984). Therefore, it is important to dis-

tinguish controlled or recreational/occasional use, primarily driven by enhancement or social

motives, from regular/problematic patterns of drug use, which have been linked to coping motives

(Bahora et al., 2009; Boys et al., 1999; Cooper, 1994; Hides et al., 2008; Järvinen & Ravn, 2011;

Lankenau et al., 2008; Lloyd, 1998).

Role of Life Events/Contextual Factors in Continued Use and Transition to

Problematic Drug Use

Controlled forms of recreational drug use are influenced by social norms that support con-

sumption of drugs when it is limited to certain settings (e.g., as facilitators of social interac-

tions) and does not interfere with everyday functioning (e.g., school, work, health, and

relationships). For instance, in a study of young adult ecstasy users, most respondents

restricted their use to weekends and managed to maintain good academic standing, employ-

ment, and relationships with significant others (Bahora et al., 2009). Similarly, LSD (lysergic

acid diethylamide) use is infrequent and requires advance planning and very specific circum-

stances to ensure pleasurable experiences (Boys et al., 1999; Järvinen & Ravn, 2011). Finally,

prescription drug misuse is commonplace on college campuses, especially during periods of

high academic stress such as exam week, where prescription stimulants facilitate learning

process while prescription opioids or tranquilizers are often misused for fun and relaxation

(Bardhi et al., 2007; Daniulaityte et al., 2006; DeSantis et al., 2008; Lord et al., 2011; Quintero,

2009).

Transitions from recreational to regular/problematic use can be influenced by negative life

events (McCabe et al., 2016; McEwen, 2000), and family history of substance abuse and other

mental health disorders (Lankenau et al., 2012; Lloyd, 1998; Stone et al., 2012). Young adults

who misuse prescription opioids and transition to heroin oftentimes have diagnosed mental

health disorders, report drug abuse and other serious mental health issues among their parents or

siblings (Daniulaityte et al., 2006; Darke, 2011; Lankenau et al., 2012). In a qualitative study

with former and current methamphetamine users, dealing with stress and depression was among

the reasons for continued use while negative life events which involved relationships with sig-

nificant others, such as break up, death, or dating a drug dealer, played an important role in

relapse or escalation of use (Boeri et al., 2009).

Role of Life Events/Contextual Factors in Transition to Non-Use or

Non-Problematic Drug Use

In addition to the significant impact of social factors, including family background, peers, and

negative life events such as separation from loved ones, on initiation, escalation and continued

problematic drug use (Liebregts et al., 2013; McCabe et al., 2016), relationship with significant

others, and social institutions are among the most powerful motivators for remission or transition

to asymptomatic drug use (Granfield & Cloud, 2001; Teruya & Hser, 2010; Walters, 2000). For

instance, in a study on ecstasy use, almost all regular users switched back to occasional use once

their use started to interfere with school, work, and romantic relationships (Järvinen & Ravn,

2011). Positive life events, such as starting a new relationship, getting married, and becoming a

parent, were very common push factors for remission from heroin (Biernacki, 1986; Klingemann,

1992), methamphetamine (Boeri et al., 2009; Sexton et al., 2008), and other substances (Lankenau,

Jackson Bloom, & Shin, 2010; Stone et al., 2012).