Psychological Distress, Unmet Need for Mental Health, and Associated Simultaneous Alcohol and Cannabis Use, and Co-Occurring Disorders Among College Students.

BACKGROUND

Simultaneous alcohol and cannabis (SAC) use is a significant public health concern among college students. This study examined whether unmet need for mental health treatment mediates the associations between psychological distress and 1) past 30-day SAC use, and 2) past-year co-occurring alcohol and cannabis use disorders.

METHODS

College students aged 18-22 from the 2010-2019 National Survey on Drug Use and Health study (N = 44,865; weighted N = 103,006,994). Psychological distress (independent variable) was measured using the Kessler-6 scale. The mediator was past-year unmet need for mental health treatment (binary). Outcome variables were binary indicators of past 30-day SAC use and past-year co-occurring alcohol and cannabis use disorders. Weighted generalized structural equation modeling was conducted to examine associations.

RESULTS

Higher levels of psychological distress were associated with higher odds of SAC use and co-occurring alcohol and cannabis use disorders (total effect: ORs = 1.0038 [CI = 1.0032-1.0043]; 1.0030 [1.0027-1.0033]; respectively; both ps < 0.001). Unmet treatment need mediated these associations, explaining 23.59% and 13.11% of the effects, respectively (indirect effects: ORs = 1.0009 [CI = 1.0007-1.0011]; 1.0004 [CI = 0.0003-1.0005]; Sobel test both ps < 0.001).

CONCLUSIONS

These findings highlight the relevance of mental health care access in understanding the connection between psychological distress and SAC use and co-occurring alcohol and cannabis use disorders among college students.