Background: Though marijuana use has previously been associated with risky alcohol use, studies often do not delineate between the effect of recreational versus therapeutic marijuana use, particularly among people living with HIV (PLWH). In this study, we examined the association between recreational versus therapeutic marijuana use to manage HIV symptoms (i.e., improve appetite/gain weight, induce sleep, relieve nausea/vomiting, relieve pain, relieve anxiety/depression/stress) on hazardous alcohol consumption and associated behavioral consequences among PLWH.

Methods: PLWH (N = 703) recruited from community health centers in Florida completed questionnaires assessing sociodemographics, marijuana use motives (i.e., recreational versus therapeutic), alcohol use, and alcohol-associated behavioral consequences. Hazardous alcohol use was defined as consuming 5 or more drinks on one occasion at least monthly or > 14 drinks per week for men, or 4 drinks on one occasion at least monthly or > 7 drinks per week for women over the past 12 months, while alcohol-associated behavioral consequences were assessed via the Short Inventory of Problems Revised (SIP-R). A one-way analysis of covariance (ANCOVA) assessed differences in average number of alcohol-associated behavioral consequences between recreational and therapeutic marijuana users, and non-users, while multivariate logistic regression analysis evaluated the association between reason for marijuana use and hazardous alcohol consumption.

Results: There was a significant effect of marijuana use group on SIP-R score after controlling for covariates [F (2, 579) = 3.04, p = 0.048], with post hoc analysis demonstrated significantly fewer alcohol-associated behavioral consequences among therapeutic marijuana users (1.27) compared to recreational users (3.35; p = 0.042). Compared to non-users, therapeutic marijuana users demonstrated significantly lower odds of hazardous drinking (AOR = 0.42, 95% CI = 0.18-0.96, p = 0.041), while recreational marijuana users were 64% more likely to report hazardous drinking (AOR = 1.64, 95% CI = 1.08-2.50, p = 0.019).

Conclusions: Findings from this study add to the literature by demonstrating how differing marijuana use motives are associated with hazardous alcohol consumption among PLWH. Given our findings showing greater risk of hazardous alcohol consumption among recreational marijuana users and lower risk among therapeutic marijuana users, results from this study may help inform interventions to reduce harmful alcohol consumption and associated adverse consequences among PLWH.