Smoking mull: a grounded theory model on the dynamics of combined tobacco and cannabis use among adult men
A. Banbury A G , A. Zask A B C , S. M. Carter D , E. van Beurden B , R. Tokley E , M. Passey C and J. Copeland F
+ Author Affiliations
- Author Affiliations
A Southern Cross University, Lismore, NSW 2480, Australia.
B Health Promotion, Northern New South Wales Local Health District (formerly North Coast Area Health Service), Lismore, NSW 2480, Australia.
C University Centre for Rural Health – North Coast, University of Sydney, Lismore, NSW 2480, Australia.
D Centre for Values, Ethics and the Law in Medicine, University of Sydney, NSW 2050, Australia.
E Health Promotion, Mid North Coast Local Health District (formerly North Coast Area Health Service), Coffs Harbour, NSW 2444, Australia.
F National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, NSW 2031, Australia.
G Corresponding author. Email: annie.banbury@scu.edu.au
Health Promotion Journal of Australia 24(2) 143-150 https://doi.org/10.1071/HE13037
Submitted: 7 May 2013 Accepted: 23 August 2013 Published: 30 October 2013
Abstract
Issue addressed: Australians’ use of cannabis has been increasing. Over a third of Australians (35.4%) have used cannabis at some time in their lives and 10.3% are recent users. Almost two-thirds of cannabis users combine cannabis with tobacco. The aim of this study was to understand the process of mulling – smoking tobacco and cannabis together – using a grounded theory approach.
Methods: Twenty-one in-depth semistructured interviews were conducted with men aged 25–34 and living on the North Coast of New South Wales. Interviews explored participants’ smoking practices, histories and cessation attempts.
Results: A model describing mulling behaviour and the dynamics of smoking cannabis and tobacco was developed. It provides an explanatory framework that demonstrates the flexibility in smoking practices, including substance substitution – participants changed the type of cannabis they smoked, the amount of tobacco they mixed with it and the devices they used to smoke according to the situations they were in and the effects sought.
Conclusion: Understanding these dynamic smoking practices and the importance of situations and effects, as well as the specific role of tobacco in mulling, may allow health workers to design more relevant and appropriate interventions.
So what?: Combining tobacco with cannabis is the most common way of smoking cannabis in Australia. However, tobacco cessation programmes rarely address cannabis use. Further research to develop evidence-based approaches for mull use would improve cessation outcomes.
Key words: concomitant use, marijuana, mulling, nicotine.
References
[1] Australian Institute of Health and Welfare. 2010 National drug strategy household survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW; 2011.[2] CDC Office on Smoking & Health. National Center for Chronic Disease Prevention & Health Promotion – CDC. The health consequences of smoking. A report of the Surgeon General. Atlanta, GA: CDC’s Office on Smoking & Health; 2004.
[3] Copeland J, Gerber S, Swift W. Evidence-based answers to cannabis questions: a review of the literature. Canberra: Australian National Council on Drugs; 2006.
[4] Australian Institute of Health and Welfare. 2007 National drug strategy household survey: detailed findings. Drug statistics series no. 22. Cat. no. PHE 107. Canberra: AIHW; 2008.
[5] Peters EN, Budney AJ, Carroll KM (2012) Clinical correlates of co-occurring cannabis and tobacco use: a systematic review. Addiction 107, 1404–17.
| Clinical correlates of co-occurring cannabis and tobacco use: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22340422PubMed |
[6] Clough AR (2005) Associations between tobacco and cannabis use in remote indigenous populations in northern Australia. Addiction 100, 346–53.
| Associations between tobacco and cannabis use in remote indigenous populations in northern Australia.Crossref | GoogleScholarGoogle Scholar | 15733248PubMed |
[7] Wu TC, Tashkin DP, Djahed B, Rose JE (1988) Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med 318, 347–51.
| Pulmonary hazards of smoking marijuana as compared with tobacco.Crossref | GoogleScholarGoogle Scholar | 3340105PubMed |
[8] Akre C, Michaud P, Berchtold A, Suris J-C (2010) Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents. Health Educ Res 25, 74–82.
| Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents.Crossref | GoogleScholarGoogle Scholar | 19515745PubMed |
[9] British Lung Foundation. A smoking gun? The impact of cannabis smoking on respiratory health. London: British Lung Foundation; 2003.
[10] Reid PT, MacLeod J, Robertson JR (2010) Cannabis and the lung. Journal of the Royal College of Physicians of Edinburgh. 40, 328–34.
| Cannabis and the lung.Crossref | GoogleScholarGoogle Scholar | 21132143PubMed |
[11] Amos A, Wiltshire S, Bostock Y, Haw S, McNeill A (2004) ‘You can’t go without a fag… you need it for your hash’ - a qualitative exploration of smoking, cannabis and young people. Addiction 99, 77–81.
| ‘You can’t go without a fag… you need it for your hash’ - a qualitative exploration of smoking, cannabis and young people.Crossref | GoogleScholarGoogle Scholar | 14678065PubMed |
[12] Okoli CTC, Richardson CG, Ratner PA, Johnson JL (2008) Adolescents’ self-defined tobacco use status, marijuana use, and tobacco dependence. Addict Behav 33, 1491–9.
| Adolescents’ self-defined tobacco use status, marijuana use, and tobacco dependence.Crossref | GoogleScholarGoogle Scholar |
[13] Tullis LM, Dupont R, Frost-Pineda K, Gold MS (2003) Marijuana and tobacco: a major connection? J Addict Dis 22, 51–62.
| Marijuana and tobacco: a major connection?Crossref | GoogleScholarGoogle Scholar | 14621344PubMed |
[14] van Beurden EK, Zask A, Passey M, Kia AM (2008) The mull hypothesis: is cannabis use contributing to high tobacco use prevalence among young North Coast males? N S W Public Health Bull 19, 72–4.
| The mull hypothesis: is cannabis use contributing to high tobacco use prevalence among young North Coast males?Crossref | GoogleScholarGoogle Scholar | 18507971PubMed |
[15] Zinberg N. Drug, set, and setting: the basis for controlled intoxicant use. New Haven, CT: Yale University Press; 1984.
[16] Grund J-P. Drug use as a social ritual: functionality, symbolism and determinants of self-regulation. Rotterdam: Instituut voor Verslavingsonderzoeck; 1993.
[17] Becker HS. Outsiders: studies in the sociology of deviance. New York: The Free Press; 1997.
[18] Decorte T (2001) Drug users’ perceptions of ‘controlled’ and ‘uncontrolled’ use. Int J Drug Policy 12, 297–320.
| Drug users’ perceptions of ‘controlled’ and ‘uncontrolled’ use.Crossref | GoogleScholarGoogle Scholar |
[19] Nasir S, Rosenthal D, Moore T (2011) The social context of controlled drug use amongst young people in a slum area in Makassar, Indonesia. Int J Drug Policy 22, 463–70.
| The social context of controlled drug use amongst young people in a slum area in Makassar, Indonesia.Crossref | GoogleScholarGoogle Scholar | 22104590PubMed |
[20] Humfleet GL, Haas AL (2004) Is marijuana use becoming a ‘gateway’ to nicotine dependence? Addiction 99, 5–6.
| Is marijuana use becoming a ‘gateway’ to nicotine dependence?Crossref | GoogleScholarGoogle Scholar | 14678052PubMed |
[21] Burns CB, Ivers RG, Lindorff KJ, Clough AR (2000) Cannabis: a Trojan horse for nicotine? Aust N Z J Public Health 24, 637
| Cannabis: a Trojan horse for nicotine?Crossref | GoogleScholarGoogle Scholar | 11215017PubMed |
[22] Agrawal A, Budney AJ, Lynskey MT (2012) The co-occurring use and misuse of cannabis and tobacco: a review. Addiction 107, 1221–33.
| The co-occurring use and misuse of cannabis and tobacco: a review.Crossref | GoogleScholarGoogle Scholar | 22300456PubMed |
[23] Didcott P, Reilly D, Swift W, Hall W. Long-term cannabis users on the New South Wales North Coast. Lismore: National Drug and Alcohol Research Centre Northern Rivers Area Health Service; 1997.
[24] Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE Publications Inc; 2006.
[25] International QSR. NVivo 8. Doncaster, Victoria: QSR International Pty Ltd; 2008.
[26] Highet G (2004) The role of cannabis in supporting young people’s cigarette smoking: a qualitative exploration. Health Educ Res 19, 635–43.
| The role of cannabis in supporting young people’s cigarette smoking: a qualitative exploration.Crossref | GoogleScholarGoogle Scholar | 15199002PubMed |
[27] Bélanger RE, Akre C, Kuntsche E, Gmel G, Suris J-C (2011) Adding tobacco to cannabis—its frequency and likely implications. Nicotine Tob Res 13, 746–50.
| Adding tobacco to cannabis—its frequency and likely implications.Crossref | GoogleScholarGoogle Scholar | 21454910PubMed |
[28] Boys A, Marsden J, Strang J (2001) Understanding reasons for drug use amongst young people: a functional perspective. Health Educ Res 16, 457–69.
| Understanding reasons for drug use amongst young people: a functional perspective.Crossref | GoogleScholarGoogle Scholar | 11525392PubMed |
[29] Vandrey RG, Budney AJ, Moore BM, Hughes JR (2005) A cross-study comparison of cannabis and tobacco withdrawal. Am J Addict 14, 54–63.
| A cross-study comparison of cannabis and tobacco withdrawal.Crossref | GoogleScholarGoogle Scholar | 15804877PubMed |
[30] Budney AJ, Vandrey RG, Hughes JR, Thostenson JD, Bursac Z (2008) Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse. J Subst Abuse Treat 35, 362–8.
| Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse.Crossref | GoogleScholarGoogle Scholar | 18342479PubMed |
[31] Vandrey RG, Budney AJ, Hughes JR, Liguori A (2008) A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend 92, 48–54.
| A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances.Crossref | GoogleScholarGoogle Scholar | 17643868PubMed |
[32] Ford DE, Vu HT, Anthony JC (2002) Marijuana use and cessation of tobacco smoking in adults from a community sample. Drug Alcohol Depend 67, 243–8.
| Marijuana use and cessation of tobacco smoking in adults from a community sample.Crossref | GoogleScholarGoogle Scholar | 12127195PubMed |
[33] Patton GC, Coffey C, Carlin JB, Sawyer SM, Lynskey M (2005) Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 100, 1518–25.
| Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence.Crossref | GoogleScholarGoogle Scholar | 16185213PubMed |
[34] Abrams DI, Vizoso HP, Shade SB, Jay C, Kelly ME, Benowitz ME (2007) Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 82, 572–8.
| Vaporization as a smokeless cannabis delivery system: a pilot study.Crossref | GoogleScholarGoogle Scholar | 17429350PubMed |
[35] Harling MR (2007) The place and meaning of ‘controlled’, illicit substance use in the private lives of a group of individuals. J Subst Use 12, 1–12.
| The place and meaning of ‘controlled’, illicit substance use in the private lives of a group of individuals.Crossref | GoogleScholarGoogle Scholar |
[36] Akre C, Belanger R, Mejia D, Suris J-C (2011) Addicted to the cannabis community? The socializing role of cannabis use. J Adolesc Health 48, s72
| Addicted to the cannabis community? The socializing role of cannabis use.Crossref | GoogleScholarGoogle Scholar |
[37] Hesse M, Tutenges S, Schliewe S (2010) The use of tobacco and cannabis at an international music festival. Eur Addict Res 16, 208–12.
| The use of tobacco and cannabis at an international music festival.Crossref | GoogleScholarGoogle Scholar | 20606446PubMed |
[38] Perez A, Ariza C, Sanchez-Martinez F, Nebot M (2010) Cannabis consumption initiation among adolescents: a longitudinal study. Addict Behav 35, 129–34.
| Cannabis consumption initiation among adolescents: a longitudinal study.Crossref | GoogleScholarGoogle Scholar | 19836900PubMed |
[39] United Nations Office of Drugs and Crime. 2006 World drug report. Volume 1: analysis. Vienna: United Nations Publications; 2006.
[40] Stafford J, Burns L. Australian drug trends 2010. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 55. Sydney: National Drug and Alcohol Research Centre, University of New South Wales; 2011.