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Participants repeated these procedures again\u00a06 months and 12 months postbaseline. Daily survey responses were used to calculate the number of simultaneous use days involving heavy drinking (4 or more drinks for females; 5 or more drinks for males) and light drinking at each wave for each participant. The total number of negative consequences reported across all simultaneous use days was also calculated for each participant at each wave.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multilevel mediation analyses revealed that within\u2010person increases in internalizing symptoms (a latent factor consisting of depression, anxiety, and stress indicators) at a given wave were indirectly associated with (a) a greater number of heavy drinking simultaneous use days (controlling for number of cannabis\u2010only days and heavy drinking alcohol\u2010only days) and (b) greater negative consequences on simultaneous use days (controlling for negative consequences on cannabis\u2010only and alcohol\u2010only days). These within\u2010person associations were mediated by increases in positive (i.e., reward\/enhancement) motives for simultaneous use. At the between\u2010person level, greater average internalizing symptoms (aggregated across waves) were indirectly associated with more light drinking simultaneous use days via coping motives, and with fewer heavy drinking simultaneous use days via conformity motives (controlling for frequency of single substance use).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Young adults may combine cannabis with heavy episodic drinking more frequently during periods when they experience elevations in internalizing symptoms, mediated by a desire to achieve the positive\/enhancing effects of simultaneous use. Findings may inform alcohol and cannabis harm reduction interventions tailored for young adults with internalizing symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70147","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T13:08:12Z","timestamp":1757423292000},"page":"2319-2333","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Internalizing symptoms are indirectly associated with simultaneous alcohol and cannabis use through specific motives for simultaneous use: A longitudinal study of young adults"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9792-280X","authenticated-orcid":false,"given":"Jeffrey D.","family":"Wardell","sequence":"first","affiliation":[{"name":"Department of Psychology York University  Toronto Ontario Canada"},{"name":"Institute for Mental Health Policy Research Centre for Addiction and Mental Health  Toronto Ontario 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