Not of sound mind

Kevin Lewis

October 05, 2017

The Effects of Marijuana Liberalizations: Evidence from Monitoring the Future
Angela Dills, Sietse Goffard & Jeffrey Miron
NBER Working Paper, September 2017


By the end of 2016, 28 states had liberalized their marijuana laws: by decriminalizing possession, by legalizing for medical purposes, or by legalizing more broadly. More states are considering such policy changes even while supporters and opponents continue to debate their impacts. Yet evidence on these liberalizations remains scarce, in part due to data limitations. We use data from Monitoring the Future’s annual surveys of high school seniors to evaluate the impact of marijuana liberalizations on marijuana use, other substance use, alcohol consumption, attitudes surrounding substance use, youth health outcomes, crime rates, and traffic accidents. These data have several advantages over those used in prior analyses. We find that marijuana liberalizations have had minimal impact on the examined outcomes. Notably, many of the outcomes predicted by critics of liberalizations, such as increases in youth drug use and youth criminal behavior, have failed to materialize in the wake of marijuana liberalizations.

The Effects of Medical Marijuana Dispensaries on Adverse Opioid Outcomes
Rhet Smith
University of Georgia Working Paper, August 2017


As the U.S. opioid epidemic surges to unprecedented levels and individual states continue to enact laws liberalizing marijuana use, understanding the relationship between narcotics and marijuana consumption is growing increasingly important. This paper uses a unique marijuana dispensary dataset to exploit within- and across-state variation in dispensary openings to estimate the effect increased access to marijuana has on narcotic-related admissions to treatment facilities and drug-induced mortalities. I find that core-based statistical areas (CBSAs) with dispensary openings experience a 20 percentage point relative decrease in painkiller treatment admissions over the first two years of dispensary operations. The effect is strongest for non-Hispanic white males in their thirties, a demographic whose recent increase in morbidity and mortality rates diverge from prior trends and from those of other demographic groups over the same time period. Finally, I provide suggestive evidence that dispensary operations negatively affect drug-induced mortality rates. These results are confined to the areas directly exposed to dispensary openings suggesting a substitutability between the drug types while shedding light on the channel through which the negative relationship is being driven.

Alcohol use and the wage returns to education and work experience
Jeremy Bray, Jesse Hinde & Arnie Aldridge
Health Economics, forthcoming


Despite a widely held belief that alcohol use should negatively impact wages, much of the literature on the topic suggests a positive relationship between nonproblematic alcohol use and wages. Studies on the effect of alcohol use on educational attainment have also failed to find a consistent, negative effect of alcohol use on years of education. Thus, the connections between alcohol use, human capital, and wages remain a topic of debate in the literature. In this study, we use the 1997 cohort of the National Longitudinal Survey of Youth to estimate a theoretical model of wage determination that links alcohol use to wages via human capital. We find that nonbinge drinking is associated with lower wage returns to education whereas binge drinking is associated with increased wage returns to both education and work experience. We interpret these counterintuitive results as evidence that alcohol use affects wages through both the allocative and productive efficiency of human capital formation and that these effects operate in offsetting directions. We suggest that alcohol control policies should be more nuanced to target alcohol consumption in the contexts within which it causes harm.

The Effects of Graduation Requirements on Risky Health Behaviors of High School Students
Zhuang Hao & Benjamin Cowan
NBER Working Paper, September 2017


Previous studies have shown that years of formal schooling attained affects health behaviors, but little is known about how the stringency of academic programs affects such behaviors, especially among youth. Using national survey data from the Youth Risk Behavior Surveillance System (YRBS), we study the effects of mathematics and science high-school graduation requirements (HSGR) on high school students’ risky health behaviors -- specifically on drinking, smoking, and marijuana use. We find that an increase in mathematics and science HSGR has significant negative impacts on alcohol consumption among high-school students, especially males and non-white students. The effects of math and science HSGR on smoking and marijuana use are also negative but generally less precisely estimated. Our results suggest that curriculum design may have potential as a policy tool to curb youth drinking.

Should Flavors be Banned in E-cigarettes? Evidence on Adult Smokers and Recent Quitters from a Discrete Choice Experiment
John Buckell, Joachim Marti & Jody Sindelar
NBER Working Paper, September 2017


E-cigarettes are available in over 7,000 flavors, whereas all flavors but menthol are banned in combustible cigarettes. The FDA recently requested a ban on e-cigarette flavors, but was rejected. The FDA is again considering this ban and also a ban on menthol in combustible cigarettes, but there is little information on the impacts of alternative bans on the market for combustible and e-cigarettes. Our study provides these much-needed estimates. We conduct a discrete choice experiment on a nationally representative sample of 2,031 adult smokers and recent quitters that we collected. We estimate preferences for flavors and other attributes and use these preferences to predict the demand for each cigarette type and for “none of these.” We then predict the impact of alternative bans and compare results for the current treatment of flavors to results for the alternative bans. We find that the recently denied FDA ban would result in increased choice of combustible cigarettes, the most harmful alternative. However, a ban on menthol in combustibles would result in the greatest reduction in smoking of combustibles. Our results are timely and policy-relevant, suggesting which flavor bans are likely to be most effective in protecting public health.

Acute effects of smoked marijuana in marijuana smokers at clinical high-risk for psychosis: A preliminary study
Nehal Vadhan et al.
Psychiatry Research, November 2017, Pages 372-374


Marijuana use is associated with psychosis, but its effects are understudied in individuals with preexisting risk for psychotic disorders. This preliminary study examined the acute psychological and physiological effects of smoked marijuana (0.0% or 5.5% Δ9-THC) in marijuana users at clinical high-risk (CHR; n = 6) to develop a psychotic disorder, and those not at risk (n = 6), under controlled laboratory conditions. CHR marijuana users exhibited temporary increases in psychotic-like states and decreases in neurocognitive performance during marijuana intoxication but control marijuana smokers did not. These findings, if replicated, may support a psychotogenic role for marijuana in CHR individuals.

Preliminary evidence that reactivity to uncertain threat is an endophenotype for alcohol use disorder
Stephanie Gorka & Stewart Shankman
Drug and Alcohol Dependence, forthcoming

Background: Having an exaggerated reactivity to threats that are uncertain (U-threat) may facilitate the initiation and maintenance of excessive alcohol use in some individuals. This abnormality may not just be a concomitant for alcohol use disorder (AUD), but also an endophenotype for AUD.

Method: The aim of the current study was therefore to provide a preliminary test of whether U-threat is an endophenotype for AUD using several of the endophenotype criteria outlined by Gottesman and Gould (2003). Specifically, the study examined whether heightened U-threat reactivity is evidenced in those with: 1) current AUD; 2) remitted AUD (early and sustained remission examined separately); and 3) at-risk for AUD by virtue of having a positive family history of AUD. Participants (N = 147) completed a well-validated threat-of-shock task and startle eyeblink potentiation was collected as an index of aversive responding. Individuals and all available first-degree family members were diagnosed using structured clinical interviews.

Results: Individuals at-risk for AUD, with current AUD, and AUD in remission (both early and sustained) all displayed exaggerated reactivity to U-threat, but not predictable threat, compared with non-AUD controls. Moreover, there were no significant differences between the at-risk and any of the AUD groups indicating that exaggerated reactivity to U-threat is relatively state-independent and present regardless of current AUD disease status.

The Impact of State Medical Marijuana Laws on Social Security Disability Insurance and Workers' Compensation Benefit Claiming
Johanna Catherine Maclean, Keshar Ghimire & Lauren Hersch Nicholas
NBER Working Paper, September 2017


We study the effect of state medical marijuana laws (MMLs) on Social Security Disability Insurance (SSDI) and Workers' Compensation (WC) claiming. We use data on benefit claiming drawn from the 1990 to 2013 Current Population Survey coupled with a differences-in-differences design. We find that passage of an MML increases SSDI, but not WC, claiming on both the intensive and extensive margins. Post-MML the propensity to claim SSDI increases by 0.27 percentage points (9.9%) and SSDI benefits increase by 2.6%. We identify heterogeneity by age and the manner in which states regulate medical marijuana. Our findings suggest an unintended consequence of MMLs: increased reliance on costly social insurance programs among working age adults.

Does Cigarette Smuggling Prop Up Smoking Rates?
James Bishop
American Journal of Health Economics, forthcoming


A state cigarette tax increase may deter some residents from smoking, but other residents may avoid the higher tax by purchasing cigarettes from another state. Using U.S. health survey microdata from 1999 to 2012, this paper measures how border-crossing opportunities affect the smoking deterrence achieved by a cigarette tax increase. I estimate by two-way fixed effects regression that a $1 state cigarette tax increase decreases the smoking rate by an additional 0.64 percentage points for each dollar of cigarette tax in the nearest lower-tax state. However, each successive $1 tax increase decreases the smoking rate by 0.43 fewer percentage points than the last. I show that the signs of these terms can be theoretically derived without parametric assumptions. I observe that, as both home and nearest lower taxes rose from 1999 to 2012, the mean effectiveness of a home state tax increase remained roughly constant over the period. My results imply that the lowest-tax states are those with the greatest power to reduce the national smoking rate.

March Madness: NCAA Tournament Participation and College Alcohol Use
Dustin White, Benjamin Cowan & Jadrian Wooten
NBER Working Paper, September 2017


We examine the impact of the NCAA Men’s Basketball Tournament on college students’ drinking behavior using a nationally representative sample of American institutions. While success in intercollegiate athletics may augment the visibility of a university to prospective students and thereby benefit the school, it may also have a negative effect on the current student body by influencing risky behavior, especially the consumption of alcohol commonly associated with game day festivities. Using the Harvard School of Public Health College Alcohol Study (CAS), we find that a school’s participation in the NCAA Tournament is associated with a 30% increase in binge drinking and a 9% increase in self-reported drunk driving by male students at that school. The results suggest that this increase is not offset by less alcohol use before or after the tournament (intertemporal substitution) but instead seems to represent a net increase in the amount of alcohol consumed by students at participating schools.

A randomized controlled trial of a brief online intervention to reduce alcohol consumption in new university students: Combining self-affirmation, theory of planned behaviour messages, and implementation intentions
Paul Norman et al.
British Journal of Health Psychology, forthcoming

Objectives: Excessive alcohol consumption increases when students enter university. This study tests whether combining (1) messages that target key beliefs from the theory of planned behaviour (TPB) that underlie binge drinking, (2) a self-affirmation manipulation to reduce defensive processing, and (3) implementation intentions (if-then plans to avoid binge drinking) reduces alcohol consumption in the first 6 months at university.

Design: A 2 (self-affirmation) × 2 (TPB messages) × 2 (implementation intention) between-participants randomized controlled trial with 6-month follow-up.

Methods: Before starting university, students (N = 2,951) completed measures of alcohol consumption and were randomly assigned to condition in a full-factorial design. TPB cognitions about binge drinking were assessed immediately post-intervention (n = 2,682). Alcohol consumption was assessed after 1 week (n = 1,885), 1 month (n = 1,389), and 6 months (n = 892) at university. TPB cognitions were assessed again at 1 and 6 months.

Results: Participants who received the TPB messages had significantly less favourable cognitions about binge drinking (except perceived control), consumed fewer units of alcohol, engaged in binge drinking less frequently, and had less harmful patterns of alcohol consumption during their first 6 months at university. The other main effects were non-significant.

How Extensive is Inter-State Diversion of Recreational Marijuana?
Benjamin Hansen, Keaton Miller & Caroline Weber
NBER Working Paper, August 2017


Despite federal prohibition, recreational marijuana is available to 21% of the United States population. A chief concern among policy makers across multiple levels of government and political parties is inter-state diversion of marijuana from states with legal markets to others. We measure this diversion with a natural experiment. Oregon opened a recreational market on October 1, 2015 next to an existing market in Washington, which opened on July 8, 2014. Using comprehensive administrative data on the universe of Washington sales, we find Washington retailers along the Oregon border experienced a 41% decline in sales immediately following Oregon's market opening. Retailers along Washington's borders with Idaho and Canada experienced no such decline. The decline occurred equally across weekdays and weekends, and was largest among the largest transaction sizes, suggesting diversion, not drug tourism, was to blame. Our estimates suggest that 11.9% of the marijuana sold in Washington was diverted out of the state before Oregon legalized and 7.5% remains diverted today.

With a Little Help From Adults: Positive Emotion as an Excuse for Underage Drinking
Lubomir Lamy, Jacques Fischer-Lokou & Nicolas Guéguen
Basic and Applied Social Psychology, forthcoming


This study provides an empirical demonstration that people’s reaction to youth drinking are influenced by the alleged motive for drinking and that regulations can easily be violated as soon as the perceived motive for underage liquor drinking is a positive emotion. The study solicited 432 passersby (50% men) to buy hard liquor for a female confederate allegedly younger than the minimum legal drinking age in France. Results showed that participants complied more frequently with the request when the motive for drinking was related with positive emotion.

to your National Affairs subscriber account.

Already a subscriber? Activate your account.


Unlimited access to intelligent essays on the nation’s affairs.

Subscribe to National Affairs.