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Peer-reviewedCC BY 4.0Addiction Biology

Neurophysiological and Behavioural Effects of Combined Cannabis Concentrates and Alcohol Among People Who Regularly Use Alcohol and Cannabis

  • Eleftherios M. Hetelekides1
  • Patricia L. Davies2,3
  • Mark A. Prince4
  • William J. Gavin3,5
  • Hollis C. Karoly6
6 affiliations
  1. 1Department of Psychology Colorado State University Fort Collins Colorado USA
  2. 2Department of Occupational Therapy Colorado State University Fort Collins Colorado USA
  3. 3Molecular, Cellular, and Integrative Neurosciences Program Colorado State University Fort Collins Colorado USA
  4. 4Department of Psychiatry and the Behavioral Sciences Keck School of Medicine Los Angeles California USA
  5. 5School of Music, Theatre, and Dance Colorado State University Fort Collins Colorado USA
  6. 6Department of Psychiatry, School of Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
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Abstract

Increasingly potent concentrated cannabis products containing high levels of Δ9‐tetrahydrocannabinol (THC) are being consumed with alcohol. This combination is known to acutely impair cognitive and psychomotor abilities, although few studies have evaluated alcohol and cannabis co‐use using neural measures. This naturalistic feasibility study explored the acute effects of co‐intoxication on behavioural performance and brain activity, measured via electroencephalography (EEG), during a performance monitoring task administered three times over a 4.5‐h period. Participants (N = 17, 65% male) were heavy drinking community members (age M = 31.7 years; SD = 10.27) who regularly use cannabis. EEG was recorded while participants completed a speeded visual‐flanker task at baseline (sober) before consuming a standardized dose of alcohol and a cannabis concentrate product, followed by EEG recordings 1‐h (intoxicated) and 4‐h post co‐consumption (recovery). Recordings were processed to obtain six event‐related potential components: the stimulus‐locked N1, P2, N2 and P3 and response‐locked error‐related negativity (ERN) and error positivity (Pe). Repeated measures ANOVAs revealed that behavioural measures at the intoxicated timepoint showed an increase in errors (p < 0.005; η 2

p = 0.35) and significant decrease in response time (RT) (p < 0.001; η 2

p = 0.50) compared to sober and recovery periods. Measures of brain activity also demonstrated significant change across time with largest amplitudes when sober, smaller amplitudes when intoxicated, then an increase in amplitude to near sober levels at recovery for stimulus‐locked (P2, N2 and P3) and response‐locked components (ERN and Pe). Thus, compared to sober and recovery periods, the behaviour at the intoxicated timepoint revealed significantly greater impulsivity (RT) leading to significantly higher error rates, while measures of cognitive processing (i.e., decision‐making, error detection, performance monitoring/adaptation) showed significantly diminished levels of brain activity. Performance and neurophysiology measures remained diminished at recovery compared to baseline. Understanding neurocognitive functioning during co‐intoxication may provide insights into specific cognitive processes that may impact function in everyday activities such as driving.

Trial Registration: NCT06259916

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Cite

BibTeXRIS
BibTeX
@article{hetelekides2026neurophysiological,
  title = {{Neurophysiological and Behavioural Effects of Combined Cannabis Concentrates and Alcohol Among People Who Regularly Use Alcohol and Cannabis}},
  author = {Eleftherios M. Hetelekides and Patricia L. Davies and Mark A. Prince and William J. Gavin and Hollis C. Karoly},
  journal = {Addiction Biology},
  year = {2026},
  month = oct,
  doi = {10.1111/adb.70194},
  url = {https://doi.org/10.1111/adb.70194},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Neurophysiological and Behavioural Effects of Combined Cannabis Concentrates and Alcohol Among People Who Regularly Use Alcohol and Cannabis
AU  - Eleftherios M. Hetelekides
AU  - Patricia L. Davies
AU  - Mark A. Prince
AU  - William J. Gavin
AU  - Hollis C. Karoly
PY  - 2026
DA  - 2026/10/27
JO  - Addiction Biology
DO  - 10.1111/adb.70194
UR  - https://doi.org/10.1111/adb.70194
AB  - Increasingly potent concentrated cannabis products containing high levels of Δ9‐tetrahydrocannabinol (THC) are being consumed with alcohol. This combination is known to acutely impair cognitive and psychomotor abilities, although few studies have evaluated alcohol and cannabis co‐use using neural measures. This naturalistic feasibility study explored the acute effects of co‐intoxication on behavioural performance and brain activity, measured via electroencephalography (EEG), during a performance monitoring task administered three times over a 4.5‐h period. Participants (N = 17, 65% male) were heavy drinking community members (age M = 31.7 years; SD = 10.27) who regularly use cannabis. EEG was recorded while participants completed a speeded visual‐flanker task at baseline (sober) before consuming a standardized dose of alcohol and a cannabis concentrate product, followed by EEG recordings 1‐h (intoxicated) and 4‐h post co‐consumption (recovery). Recordings were processed to obtain six event‐related potential components: the stimulus‐locked N1, P2, N2 and P3 and response‐locked error‐related negativity (ERN) and error positivity (Pe). Repeated measures ANOVAs revealed that behavioural measures at the intoxicated timepoint showed an increase in errors (p < 0.005; η 2  p = 0.35) and significant decrease in response time (RT) (p < 0.001; η 2  p = 0.50) compared to sober and recovery periods. Measures of brain activity also demonstrated significant change across time with largest amplitudes when sober, smaller amplitudes when intoxicated, then an increase in amplitude to near sober levels at recovery for stimulus‐locked (P2, N2 and P3) and response‐locked components (ERN and Pe). Thus, compared to sober and recovery periods, the behaviour at the intoxicated timepoint revealed significantly greater impulsivity (RT) leading to significantly higher error rates, while measures of cognitive processing (i.e., decision‐making, error detection, performance monitoring/adaptation) showed significantly diminished levels of brain activity. Performance and neurophysiology measures remained diminished at recovery compared to baseline. Understanding neurocognitive functioning during co‐intoxication may provide insights into specific cognitive processes that may impact function in everyday activities such as driving.  Trial Registration: NCT06259916
SN  - 1355-6215
SN  - 1369-1600
ER  -