title: Impacts of Changing Marijuana Policies on Alcohol Use in the United States.
abstract: BACKGROUND
  Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol.
  
  
  METHODS
  The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and PsycINFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined.
  
  
  RESULTS
  The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States.
  
  
  CONCLUSIONS
  Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues.
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Katarina
authors.initials: K
authors.lastname: Guttmannova
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kilmer
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Fleming
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Isaac C
authors.initials: IC
authors.lastname: Rhew
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Rick
authors.initials: R
authors.lastname: Kosterman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Larimer
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology / Q000639:trends*; D006291:Health Policy; D006801:Humans; D007880:Legislation, Drug / Q000639:trends*; D008385:Marijuana Smoking / Q000331:legislation & jurisprudence*; D064086:Medical Marijuana; D011640:Public Policy; D014481:United States / Q000453:epidemiology
chemical_list: D064086:Medical Marijuana
keywords: Alcohol; Cannabis; Legalization; Marijuana; Policy