The research team, led by Jessica S. Johnson of the Department of Psychiatry at the University of North Carolina at Chapel Hill, together with colleagues including Cynthia M. Bulik of the University of North Carolina and Karolinska Institutet, and Melissa A. Munn-Chernoff of Texas Tech University, analyzed data from the United States arm of the global Eating Disorders Genetics Initiative, known as EDGI. This initiative, funded by the National Institute of Mental Health, is one of the largest genetic studies of eating disorders ever undertaken and is registered as a clinical trial. From this resource, the investigators assembled a cohort of 6,128 participants, 95 percent of whom were female, with a mean age of 34.9 years.

What distinguished this study from prior work was its systematic comparison of nicotine use patterns across the full diagnostic spectrum of eating disorders. Participants fell into six groups based on lifetime diagnoses: anorexia nervosa only, which accounted for 37 percent of the sample; anorexia nervosa plus another eating disorder, at 21 percent; bulimia nervosa only, at 11 percent; bulimia nervosa combined with binge-eating disorder, at 14 percent; binge-eating disorder only, at 10 percent; and a comparison group of screened controls with no lifetime eating disorder diagnosis and no history of eating disorder behaviors, representing 7 percent of the cohort. This diagnostic granularity allowed the researchers to test not only whether eating disorders in general are linked to nicotine use, but whether specific diagnoses carry different risk profiles.

Each participant reported whether they had ever used nicotine, and the investigators classified them into four categories: never used nicotine, which comprised half the sample; vaped only, which accounted for 6 percent; smoked only, at 22 percent; and combined vaping plus smoking, which also represented 22 percent. Notably, nearly half of the cohort reported some form of lifetime nicotine use, a proportion that immediately stands out against the backdrop of declining smoking rates in the general population.

The statistical approach was carefully constructed to handle the large number of comparisons being made. The team used chi-square tests to examine categorical associations, analysis of variance to compare continuous measures across groups, and multinomial logistic regression to estimate the odds of belonging to each nicotine use category as a function of eating disorder diagnosis and symptom profile. Because the study tested many associations simultaneously, the researchers applied false discovery rate correction, a method that controls the expected proportion of false positives among statistically significant findings. Even under this stringent correction, the results were robust: lifetime nicotine use was significantly more common among every eating disorder group than among the screened controls, with corrected p values below 8.63 × 10⁻³.

The pattern of associations across diagnoses proved to be highly informative. Compared with participants whose only lifetime diagnosis was anorexia nervosa, those with bulimia nervosa only, anorexia nervosa plus another eating disorder, or bulimia nervosa combined with binge-eating disorder showed significantly higher odds of smoking, or of combined smoking and vaping, with corrected p values below 3.79 × 10⁻³. In other words, individuals whose illness included binge-eating episodes or features of more than one diagnostic category were the most likely to report cigarette smoking or dual use of both cigarettes and e-cigarettes. Vaping alone, however, told a somewhat different story: it was reported by only 6 percent of the sample, making it a less common pattern than smoking or dual use, yet still a meaningful one given the relative novelty of electronic cigarettes and the open question of whether they serve as an entry point to nicotine dependence among people vulnerable to eating disorders.

Perhaps the most clinically striking findings emerged when the researchers turned from diagnoses to specific behaviors. Eating disorder psychopathology is characterized by a set of recurrent behaviors, including binge eating and a range of compensatory actions intended to counteract perceived weight gain: self-induced vomiting, laxative misuse, diuretic misuse, diet pill use, fasting, and excessive exercise. The team examined how each of these behaviors related to nicotine use patterns. Binge eating and every compensatory behavior except excessive exercise were significantly associated with higher odds of lifetime smoking or dual use compared with never using nicotine, with corrected p values below 7.85 × 10⁻⁴. Purging, in particular, was linked to a greater likelihood of any lifetime nicotine use whatsoever, with a corrected p value below 0.017.

The selective exception of excessive exercise is noteworthy. Exercise is unique among eating disorder compensatory behaviors in that it does not involve the ingestion of any substance, and the finding suggests that the relationship between nicotine use and eating disorder pathology may be tied to behaviors that involve manipulating what enters the body, rather than to the overall severity of the illness. One plausible mechanism is appetite suppression. Nicotine is a well-documented anorectic agent that acts on central appetite-regulating circuits, and individuals who restrict their intake, binge, or purge may use nicotine, consciously or not, as a tool for weight and appetite control. The finding that purging was linked to any nicotine use, while binge eating and most compensatory behaviors were linked specifically to smoking and dual use, hints at a complex interplay between the pharmacological effects of nicotine and the behavioral repertoire of the eating disorder.

The study’s authors are careful to note that their data are cross-sectional, meaning that they capture associations at a single point in retrospective reporting and cannot establish whether nicotine use preceded, followed, or developed alongside the eating disorder. The cohort is also predominantly female, reflecting the demographic composition of the eating disorder patient population but limiting generalizability to male and gender-diverse individuals, who represent a significant and growing share of eating disorder cases. In addition, all data were self-reported, and participants were recruited through a genetics initiative, which may influence the representativeness of the sample. These limitations notwithstanding, the sheer size of the cohort and the rigor of the statistical corrections give the findings considerable weight.

The implications for clinical practice are direct and actionable. The authors conclude that clinicians working with patients who have or are at risk for eating disorders should routinely assess not only cigarette smoking but also vaping, and should consider how nicotine use is interrelated with eating disorder pathology rather than treating it as a separate, incidental habit. This matters because nicotine use is a modifiable risk factor, and because the health consequences of smoking and vaping compound the already serious medical complications of eating disorders, including cardiovascular strain, electrolyte disturbances, and bone density loss. For a patient using laxatives, inducing vomiting, or fasting while also vaping heavily, the cumulative physiological burden may be greater than either behavior alone would suggest.

The study also arrives at a moment when vaping among young people continues to be a major public health concern, and when the eating disorder field is increasingly attentive to the roles of substances, from alcohol to stimulants, in the initiation and maintenance of disordered eating. By showing that vaping is not merely a harmless social behavior in this population, but part of a broader pattern of lifetime nicotine use that clusters with bulimic presentations and purging behaviors, the research adds urgency to the call for integrated screening. As electronic cigarette use evolves and new nicotine products reach the market, understanding how these products intersect with psychiatric conditions such as eating disorders will be essential for protecting one of the most medically vulnerable populations in mental health care.

As the world grappled with the realities of COVID-19, many individuals turned to alcohol as a coping mechanism. According to the findings presented by Yaseen et al., the surge in alcohol-related hospitalizations is not merely a coincidence but rather a multifaceted consequence of the pandemic. The heightened levels of anxiety, financial strain, and social isolation compelled many individuals toward increased alcohol consumption. These factors converged, correlating with an alarming rise in emergency health interventions linked to alcohol misuse.

The study meticulously cataloged hospital records, drawing a clear line between the pandemic’s onset and the subsequent increase in alcohol-related health complications. Prior to the pandemic, the health system was already strained, and with the sudden influx of alcohol-related cases, it faced overwhelming challenges. The research demonstrated a definitive spike in admissions for alcohol intoxication, alcoholic liver disease, and other alcohol-related health issues. Such trends present a pressing call for healthcare systems to adapt and respond to these evolving needs.

Interestingly, the geographical variation in alcohol-related hospitalizations during the pandemic was notable. Certain regions experienced more pronounced effects, suggesting that local demographics, socioeconomic factors, and cultural attitudes toward alcohol may have played pivotal roles in these trends. This research not only illuminates the national struggle but also emphasizes the localized manifestations of a global health crisis. Understanding these regional differences is key to tailoring public health responses to minimize the impact of alcohol-related health issues.

In the context of healthcare strategies, this study raises significant questions about preventive measures and the role of telehealth services. As traditional methods of treatment were disrupted during the pandemic, many healthcare providers turned to digital avenues to offer support. The efficacy of telehealth in managing substance use disorders remains an area of intense research. However, the effectiveness of these services in addressing the unique challenges posed by the pandemic is yet another layer that the study brings to light.

Furthermore, the findings call attention to the importance of screening for alcohol use during regular health assessments. As alcohol-related issues surged, the study suggests that routine inquiries about alcohol consumption could play a critical role in early identification and intervention, potentially alleviating some of the strain on hospital systems. This proactive approach could foster a culture of awareness and responsiveness within communities, encouraging individuals to seek help before reaching a crisis point.

The implications of this research extend beyond the immediate confines of hospital walls. The societal normalization of alcohol use as a coping mechanism during stressful times raises substantial moral and ethical questions. Public awareness campaigns may be essential to shift perceptions around alcohol consumption and promote healthier coping strategies. This broader cultural discourse is necessary to mitigate the long-term health consequences associated with increased alcohol use spurred by the pandemic.

As public health stakeholders grapple with the data presented in this study, the importance of longitudinal research cannot be overstated. Analyzing these trends over time will provide deeper insights into the patterns of alcohol use and the efficacy of public health interventions. As healthcare organizations work to formulate effective responses, understanding the post-pandemic landscape is crucial for creating resilient health systems.

Moreover, it is essential to integrate findings from studies like this into policymaking. Data-driven decisions are vital for addressing the public health crisis stemming from increased alcohol-related issues. Policymakers must prioritize funding for mental health resources and addiction treatment programs, ensuring that comprehensive support systems are in place to address this epidemic. The research findings can serve as compelling evidence to advocate for necessary changes at the legislative level.

The intersection of COVID-19 and substance use illustrates a critical moment in public health. As the world begins to move toward recovery, addressing the hidden toll of alcohol-related health issues is paramount. The insights gleaned from this study offer a roadmap for future interventions and underscore the need for concerted action across various sectors of society. As healthcare providers, policymakers, and communities come together, the goal must be a holistic approach to health that encompasses both physical and mental well-being.

The urgency of this research is echoed not only in the data but also in the personal stories of those impacted by alcohol-related health crises. Behind the statistics lie real people facing serious consequences, vivid reminders of the pandemic’s profound effects. Each hospitalization serves as a testament to the need for empathy, understanding, and expanded resources in tackling alcohol misuse. Engaging communities to foster dialogues about substance use can pivot perceptions and promote healthier responses in the face of adversity.

Ultimately, Yaseen et al.’s study delivers a compelling narrative on the interconnectedness of societal challenges and health outcomes in the wake of a global pandemic. It posits that as we recover from this crisis, we must not overlook the nuances of public health dynamics. Instead, we should leverage this moment to foster resilience, enhance awareness, and equip our healthcare systems to effectively address the multifaceted challenges posed by alcohol use exacerbated by the pandemic. Only through understanding and collaboration can we pave the way for a healthier and more informed future.

Subject of Research: Alcohol-related hospitalizations during the COVID-19 pandemic.

Article Title: Severity of Alcohol-Related Hospitalizations Following the Onset of the COVID-19 Pandemic: A Population-Based Cohort Study.

Article References:
Yaseen, W., Zagorski, B., Li, P. et al. Severity of Alcohol-Related Hospitalizations Following the Onset of the COVID-19 Pandemic: A Population-Based Cohort Study.
J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-10059-x

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s11606-025-10059-x

Keywords: COVID-19, Alcohol-related hospitalizations, Substance use, Public health, Telehealth, Emergency health interventions, Health policy, Mental health, Addiction treatment, Longitudinal research, Community engagement, Health outcomes, Resilience.

The research, led by Associate Professor Jeffrey Wardell, director of York University’s Behavioural Alcohol and Cannabis Research Lab (BAC Lab), addresses an urgent public health concern emerging in the post-legalization era of cannabis in Canada. With cannabis use on the rise among young adults, understanding why these individuals often concurrently consume alcohol and cannabis—and how such behavior correlates with mental health—is increasingly essential for developing effective intervention strategies. Wardell emphasizes that while occasional combined use may seem innocuous, the data substantiate heightened risks associated with such patterns, especially among those grappling with adverse emotional states.

Underlying the study is a sophisticated longitudinal design employing intensive daily self-reports collected via mobile surveys administered in three 21-day bursts spaced six months apart. Participants documented their alcohol and cannabis intake and detailed any negative repercussions encountered. Complementing this, they reported on psychological symptomatology related to depression, anxiety, and stress alongside their motivations for combining substances. This multi-temporal approach enables a nuanced examination of the bidirectional relationships between internal states and co-use behaviors, a methodological advancement over cross-sectional analyses traditionally employed in substance use research.

Results compellingly demonstrate that young adults experiencing heightened internalizing symptoms are more prone to using alcohol and cannabis simultaneously, often with the explicit motive of intensifying psychoactive effects—“doubling up” to achieve a heightened state of intoxication. Wardell elaborates that this cyclical pattern appears driven primarily by attempts at emotional self-regulation, with participants indicating that combining substances momentarily alleviated negative feelings. However, this short-term relief paradoxically escalated the frequency of binge drinking episodes paired with cannabis use, leading to cascading adverse outcomes spanning physical health, psychological well-being, and socio-environmental domains.

Delving deeper into the neurodevelopmental context, the study situates these behavioral patterns within the prolonged maturation trajectory of the young adult brain, which continues refining executive functions and emotional regulation well into the mid-20s. Given that dependencies on substances such as alcohol and cannabis are disproportionately observed within this age group, the findings hold particular salience. Wardell notes that exposure to combined substances during this sensitive developmental window likely compounds the risk of maladaptive neural plasticity, exacerbating susceptibility to enduring substance use disorders and mental health challenges.

Beyond mechanistic insights, the study importantly underscores the long-term ramifications of the simultaneous use of alcohol and cannabis. While participants acknowledged the temporary mitigation of distress through substance use, Wardell cautions that these behaviors are linked to elevated incidences of negative life events, including academic, occupational, and interpersonal difficulties. Such outcomes reinforce the pressing need for early detection and intervention frameworks designed to address co-use behaviors, particularly when motivated by maladaptive coping strategies.

Highlighting the translational potential of these findings, Wardell advocates for a multi-pronged approach to prevention and treatment, centered on fostering healthier alternative coping mechanisms. Techniques such as mindfulness meditation, controlled breathing exercises, and physical activity can serve as effective adjuncts or substitutes for substance use in regulating distress. Peer support networks and professional counseling services further constitute vital resources. The study also draws attention to accessible online screening tools that can empower young adults to self-assess substance-related risks, especially those linked to reliance on psychoactive agents for emotional relief.

The study’s methodological rigor stems from its longitudinal survey approach, which enables the capture of temporal fluctuations in both affective symptoms and substance use motives. This design circumvents recall biases commonly encountered in retrospective surveys and illuminates dynamic within-person processes that inform intervention timing and targeting. The granular data reveal that the propensity to simultaneously consume alcohol and cannabis escalates notably during periods characterized by acute depressive or anxious states, emphasizing the episodic nature of risk.

In considering the broader epidemiological implications, Wardell situates the findings within the evolving landscape of cannabis legalization and shifting societal norms around substance use. The normalization of cannabis has potentiated its integration into casual and heavy alcohol consumption routines, raising complex questions about polysubstance interactions and public health messaging. The study’s emphasis on young adults is especially prescient, given that this cohort not only exhibits the highest rates of co-use but also stands at a critical juncture where preventive efforts can substantially alter life course trajectories.

A key contribution of the study lies in elucidating specific motivational pathways that connect internalizing symptoms to simultaneous substance use. Contrary to simplistic models which treat co-use as merely additive effects of alcohol and cannabis consumption, Wardell’s team delineates how psychological distress uniquely modulates usage patterns through motives framed around alleviating negative affect and enhancing intoxication. This distinction has profound implications for tailoring clinical assessments and interventions that attend to motivational underpinnings rather than solely behavioral manifestations.

Moreover, the research reveals an urgent necessity for integrating mental health assessments into substance use interventions for young adults. Traditional siloed approaches may overlook the intricacies of co-occurring internalizing disorders and polysubstance behaviors, thereby limiting their efficacy. By contrast, informed therapeutic paradigms that concurrently address mood disturbances and substance co-use could disrupt trajectories toward entrenched addiction and chronic psychological impairment.

Wardell’s findings also illuminate emerging challenges and opportunities within digital health, as the study leverages mobile technology to enable real-time data capture. This method not only enhances ecological validity but also opens avenues for just-in-time adaptive interventions (JITAI) that respond dynamically to fluctuations in psychological distress and substance use cues. Such innovations could revolutionize both research methodologies and clinical practices targeting young adult populations.

Ultimately, this landmark study from York University contributes compelling evidence that the psychological landscape of young adults profoundly shapes their substance use behaviors, especially in the context of simultaneous alcohol and cannabis consumption. As policymakers, clinicians, and educators grapple with the public health implications of shifting substance use paradigms, research such as this furnishes a critical foundation for nuanced, evidence-based responses—aimed at mitigating harms while respecting the developmental and psychosocial realities of emerging adulthood.

Subject of Research: People

Article Title: Internalizing symptoms are indirectly associated with simultaneous alcohol and cannabis use through specific motives for simultaneous use: A longitudinal study of young adults

News Publication Date: 9-Sep-2025

Web References:
https://onlinelibrary.wiley.com/doi/10.1111/acer.70147

References:
Wardell, J. et al., 2025. Internalizing symptoms are indirectly associated with simultaneous alcohol and cannabis use through specific motives for simultaneous use: A longitudinal study of young adults. Alcohol Clinical and Experimental Research. DOI: 10.1111/acer.70147

Keywords:
Cannabis, Alcohol abuse, Mental health

The research team, spearheaded by Mallory Stephenson, Ph.D., a postdoctoral fellow at the Virginia Institute for Psychiatric and Behavioral Genetics inside VCU’s School of Medicine, collaborated closely with Jessica E. Salvatore, Ph.D., currently an associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School. Their work, published in the influential journal Clinical Psychological Science on May 5, 2025, embarks on a sophisticated analysis of gene-environment interactions that had previously remained largely underexplored in the context of romantic partnerships and alcohol use behaviors.

Genetic factors are known to account for roughly 50% of an individual’s vulnerability to alcohol use disorder and other risky drinking behaviors. However, as the study emphasizes, this genetic influence does not manifest in isolation; rather, it is intricately modulated by the surrounding environmental context, including psychosocial stressors and interpersonal relationships. For example, Stephenson notes that exposure to traumatic life events can amplify the impact of genetic risk on drinking behavior, whereas individuals with high genetic predisposition but without concurrent environmental stressors might exhibit considerably lower risk.

Prevailing research led by VCU had already established a correlation between genetic predisposition to risky alcohol behavior and decreased drinking frequency and dependency symptoms among individuals engaged in romantic relationships. Building upon this foundation, the current study set out to identify whether specific characteristics of romantic partners could further influence the magnitude of genetic risk expression in alcohol consumption patterns.

To achieve this, the researchers utilized data from the FinnTwin16 longitudinal study, which tracks Finnish twins selected from Finland’s Central Population Registry. This robust dataset included 1,620 twins in their 30s, all in long-term romantic relationships and with documented histories of alcohol use. Alongside twin data, detailed survey responses were gathered concerning the drinking and cigarette smoking patterns, personality dimensions, and mental health indicators of both the twins and their partners, enabling a comprehensive exploration of potential gene-environment dynamics.

The utility of twin studies in elucidating genetic and environmental influences cannot be overstated. By comparing identical twins, who share 100% of their genetic material, with fraternal twins, who share approximately 50%, the researchers could disentangle the relative contributions of heredity and environmental mechanisms that govern alcohol consumption behaviors. This methodological rigor permitted profound insights into how partner characteristics uniquely interact with genetic risk factors.

One of the key observations reaffirmed complexities documented in prior literature: individuals in early midlife were significantly more prone to alcohol consumption and binge drinking if their romantic partners also engaged frequently in alcohol use or cigarette smoking. Intriguingly, when analyzing identical twin pairs specifically, data suggested that male twins’ alcohol use patterns were more susceptible to partner influences compared to female twins, indicating potential sex differences in responsiveness to environmental modulation.

Beyond these direct behavioral correlations, the researchers uncovered a more nuanced and unexpected interaction. The genetic risk for binge drinking was found to intensify in the presence of romantic partners who smoked more frequently, exhibited lower conscientiousness, were more extroverted, or displayed elevated neuroticism and psychological distress. These specific personality and mental health characteristics of partners seemingly exacerbate the penetrance of genetic vulnerability, underscoring the critical role of the social environment in genetic expression.

Conversely, one surprising finding was that genetic heritability of binge drinking appeared to exert less influence among individuals whose partners drank alcohol more regularly. This counterintuitive result prompted the research team to hypothesize that partner drinking behavior might constitute a stronger environmental factor overshadowing genetic predispositions. Stephenson elegantly illustrates this with the analogy of a pie chart, where the proportional impact of environmental and genetic factors can shift depending on the predominance of one over the other.

The implications of these findings transcend theoretical genetics and psychology—they emphasize the profound and multifaceted ways romantic partners shape health trajectories. From a clinical perspective, these insights encourage a paradigm shift in couples therapy and alcohol intervention programs. Traditional approaches often concentrate primarily on relationship dynamics but may overlook the significant influence of partner attributes such as substance use habits and psychological profiles. The study suggests that addressing these partner-specific factors could enhance therapeutic efficacy and reduce the burden of alcohol-related disorders.

Stephenson further articulates that even robust, healthy romantic relationships do not necessarily shield individuals from the impacts of partners’ substance use or psychological stressors. This awareness foregrounds the delicate balance in partnership dynamics where personal well-being becomes entwined with partner characteristics in complex ways, demanding more tailored and nuanced intervention strategies.

Looking forward, the research team acknowledges that the current findings open new avenues for exploration. They are delving into how broader relationship characteristics, including the transition to parenthood, may interact with genetic and environmental influences to shape drinking behaviors over time. Such longitudinal and multifocal approaches promise to refine our understanding of the biopsychosocial mechanisms underpinning substance use disorders.

Financial support for this pioneering work was provided by the National Institute on Alcohol Abuse and Alcoholism—an agency within the National Institutes of Health—and the Academy of Finland. Their backing underscores the significance and anticipated impact of this novel research at the intersection of genetics, psychology, and behavioral health.

In summary, this study compellingly demonstrates that the fabric of romantic relationships profoundly intertwines with genetic susceptibility to influence alcohol consumption. By elucidating the nuances of gene-environment interplay shaped by partners’ substance use, personality, and mental health, researchers have paved the way for innovative therapeutic models that move beyond the individual to embrace relational contexts. This multidimensional perspective holds promise for substantially mitigating risky drinking behaviors and advancing public health outcomes.

Subject of Research: Genetic and environmental influences on alcohol consumption and binge drinking, specifically the role of romantic partners’ characteristics in gene-environment interactions.

Article Title: Associations of Romantic Partners’ Characteristics With Alcohol Consumption and Binge Drinking: Examining Evidence for Gene–Environment Interaction

News Publication Date: 5-May-2025

Web References:

• Virginia Commonwealth University Researcher Profile – Mallory Stephenson, Ph.D.
• Virginia Institute for Psychiatric and Behavioral Genetics
• Journal Article DOI Link
• Previous VCU-led Study on Genetic Predisposition and Romantic Relationships
• Genetic Risk of Alcohol Use Disorder Reference

References:
Stephenson, M., Salvatore, J. E., et al. (2025). Associations of Romantic Partners’ Characteristics With Alcohol Consumption and Binge Drinking: Examining Evidence for Gene–Environment Interaction. Clinical Psychological Science. DOI: 10.1177/21677026251332931

Keywords: Alcohol abuse, substance abuse, behavioral psychology, genetic risk, gene-environment interaction, romantic relationships, binge drinking, mental health, personality traits, twin study, social psychology, human behavior