Polysubstance use: diagnostic challenges, patterns of use and health

Patterns of substance use and associations with mental health and interpersonal violence among adolescents

Objective

To identify patterns of adolescent substance use and associated behavioral health characteristics among adolescents.

Methods

We conducted a cross-sectional study of 167,504 adolescents aged 13-17 who were screened for substance use, mental health symptoms, and interpersonal violence during well-check visits in a large healthcare system in California from 2021 to 2022. We conducted latent class analysis to identify patterns of substance use from four substance use behaviors (past-year alcohol, cannabis, other substance, and close friends' use). We calculated the prevalence of depressive symptoms, suicidal ideation, bullying, physical abuse by an adult, sexual violence, and intimate partner violence for each substance use class compared to those with no reported substance use behaviors and estimated adjusted prevalence ratios using modified Poisson regression.

Results

In total, 29,288 (17 %) adolescents reported ≥ 1 substance use characteristic. From those, we identified five latent classes with different patterns of substance use: substance use among close friends (37 %), alcohol use (21 %), polysubstance use (20 %), cannabis use and some polysubstance use (18 %), and other substance use (5 %). All classes had higher adjusted prevalence of mental health and interpersonal violence outcomes compared to those with no substance use characteristics, with the greatest differences being among the polysubstance use class.

Conclusions

The high prevalence of mental health and interpersonal violence outcomes among adolescents with substance use, even among those who only report close friends' substance use, highlights the need for routine screening during well-check visits. Comprehensive routine social and behavioral health screening among adolescents is vital for early identification and intervention.

Substance use disorders, severe mental illness and risk of reoffending among women released from prison: a national cohort study

Women with a clinical history of a severe mental illness (SMI) or multiple mental disorders involving substance use disorder (SUD) might be at increased risk of re-offending after release from prison. This retrospective cohort study merged data from the Norwegian prison release study (nPRIS) with other registry sources. All women released from a Norwegian prison between 2011-2019 were followed for two years after date of release. Adjusting for several known risk factors, we used logistic regression to estimate risk of violent (VR), drug-related (DR) or other reoffending (ORE) after release among women with a history of SUD and severe mental illness (SUD-SMI), SMI, SUD and other mental illness (SUD-OMI) or a history of multiple SUDs (POLY-SUD) in comparison to a reference population with no history of such disorders or combination of disorders. Relative to the reference population, after adjusting for other relevant risk factors, women with a history of SUD-SMI (ORVR 2.27, 95% CI 1.37-3.76; ORDR 2.10, 95% CI 1.49-2.95), SUD-OMI (ORVR 1.81, 95% CI 1.11-2.47; ORDR 1.53, 95% CI 1.11-2.10) or POLY-SUD (ORVR 1.87, 95% CI 1.04-3.31; ORDR 2.51, 95% CI 1.80-3.49) were at significantly greater risk of violent and drug-related reoffending. Women with a history of SMI were at significantly greater risk of other reoffending (ORORE 2.64, 95% CI 1.21-5.30). Women with a clinical history of a severe mental illness (SMI) or multiple mental disorders involving substance use disorder (SUD) have an elevated risk reoffending.

Polysubstance Use Profiles Among the General Adult Population, United States, 2022

Objectives. To characterize present-day polysubstance use patterns in the general adult population. Methods. From a 2022 nationally representative survey in the United States, we defined polysubstance use as last 12-month use of 2 or more drugs (n = 15 800). Latent class analyses included medical (as indicated) and nonmedical (not as directed) use of prescription opioids, stimulants, benzodiazepines, and antidepressants; recreational use of cannabis, psilocybin or mushrooms, other psychedelics, cocaine, methamphetamine, and illicit opioids; and concomitant use with alcohol, cannabis, prescriptions, or recreational drugs. Results. The national prevalence of polysubstance use was 20.9% (95% confidence interval = 20.5%, 21.3%), broken down into the following 4 latent classes: (1) medically guided polysubstance use (11.5% prevalence, 6.1% substance use disorder [SUD]): prescribed drug use, some cannabis, and no concomitant use; (2) principal cannabis use variety (4.0% prevalence, 31.9% SUD): high probability of cannabis use with various drugs concomitantly used; (3) self-guided polysubstance use (3.4% prevalence, 14.5% SUD): nonmedical use of prescriptions and concomitant use; and (4) indiscriminate coexposures (2.1% prevalence, 58.9% SUD): concomitant drug use with indiscriminate drug preference. Conclusions. Different polysubstance profiles show adults with untreated SUDs, and there are 2 previously unrecognized classes. Prevention and treatment strategies addressing polysubstance use should take a personalized perspective and tailor to individuals' use profile. (Am J Public Health. 2025;115(5):747-757. https://doi.org/10.2105/AJPH.2024.307979).

Using Latent Class Analysis to Examine Polysubstance Use Patterns in Adolescents Aged 10-18: A Systematic Review

PURPOSE

Over half of substance use disorder (SUD) cases develop from substance use during adolescence. Studies have used latent class analysis (LCA) to determine adolescent polysubstance use patterns. This systematic review aims to provide an updated characterization of studies that examine patterns of adolescent polysubstance use.

METHODS

This paper is part of a two-part systematic review examining patterns of polysubstance use. This review focuses on the adolescent literature, which includes study samples with mean age up to 18 years.

RESULTS

A majority of the N=54 studies were conducted in the United States. Sample sizes (N=98 to N=418,702), number of substances used as indicators (3 to 15), and number of latent classes extracted (2 to 6) varied per study. Analyses with larger sample sizes tended to extract a greater number of latent classes (Spearman's rho = .274, p = .022). The mean ages of samples (Spearman's rho = .255, p = .181) nor the utilization of more substances as indicators (Spearman's rho = 0.021, p = .861) were associated with the number of classes extracted. The Bayesian Information Criterion was the most used statistical fit index for the latent classes.

DISCUSSION

Substantial heterogeneity existed regarding study methodologies, LCA solutions, and statistical measures. Analyses focusing on niche population samples tended to highlight patterns involving less commonly used substances among adolescents. Future studies should expand on the types of substances used as indicators to explore how polysubstance use patterns are influenced by unique geographical communities.

Recreational Ketamine Use among Individuals with Opioid Use Disorder: Demographics, Motivations, and Polysubstance Use

BACKGROUND

Data show that recreational ketamine use appears to be increasing. This study aimed to understand how ketamine fits into broader polysubstance use in individuals with opioid use disorder (OUD).

METHODS

Survey data were collected from a sample of treatment-seeking individuals with OUD in March 2022.

RESULTS

Of 301 respondents, 28.6% reported lifetime ketamine use. Ketamine use was more frequently reported among males (61.9% vs. 37%; p < 0.001) and less frequently reported among individuals in rural locations (33.6% vs 15.7%; p < 0.002). Most respondents (70.9%) used ketamine to achieve a desired psychoactive effect, and 46.4% used to self-treat a physical or mental health problem, including mental distress symptoms and mitigating opioid withdrawal symptoms or cravings. Polysubstance use involving ketamine was prevalent (70.7%) and included marijuana (64.9%), alcohol (61.4%), cocaine (36.8%), MDMA (36.8%), hallucinogens (31.6%), prescription opioids (29.8%), and illicit opioids (29.8%). Negative experiences while using ketamine were reported by 32.1% and included central nervous system complications and mental distress.

CONCLUSIONS

Among this sample of individuals with OUD, motivations for ketamine use are varied and polysubstance use is common. Such behaviors, even when attempting to self-treat OUD or other health problems may place individuals at risk for psychiatric or physical health conditions, including overdose or death.

Association between early sexual initiation and forced sexual intercourse with polysubstance use among adolescents: Findings from a population-based study

Substance use among adolescents in the United States is a significant public health concern. Despite the use of single substances among adolescents being rare, existing literature focuses on single, rather than the more common polysubstance use (PSU). Furthermore, the relationship between early sexual initiation (ESI), forced sexual intercourse, and PSU is underexplored. This study addresses this gap in the literature by examining this intersection. Data for this study came from the 2021 Youth Risk Behavior Survey (YRBS) and the sample was comprised of 17,033 adolescents aged 14-18. Models were built sequentially using descriptive, bivariate, and finally complementary log-log models to evaluate these associations, while controlling for symptoms of depression, poor mental health during COVID-19, parental monitoring, and demographic characteristics. Of the 17,033 adolescents examined, 18.7 % engaged in PSU, 21.6 % engaged in ESI, and 8.5 % also reported experiencing forced sexual intercourse. In the final model, adolescents who engaged in ESI had more than fourfold higher odds of engaging in PSU when compared to their counterparts who did not engage in ESI (AOR = 4.24, p < .001, 95 % CI = 3.75-4.79). History of forced sexual intercourse was associated with 1.34 times higher odds of engaging in PSU. These results underscore that ESI is significantly associated with increased risk of forced sexual intercourse and PSU. This study highlights the need of future research to uncover the psychological pathways linking ESI, forced sexual intercourse, and PSU.

Exploring the Patterns of Recreational Polysubstance Use and Executive Functions in Indian Young Adults: A Cross-Sectional Study

Background

Substance use is a serious public health concern and young adults in India often use multiple substances, often together. There is a dearth of research examining this and its neuropsychological consequences. Polysubstance use (PSU) usually indicates higher chances of dependence and negative outcomes. This study aims to describe the patterns of PSU and associated executive function profiles in a sample of young adults in India.

Methods

Fifty-four participants aged 18-25 years filled out a self-report questionnaire on PSU, for lifetime and current use of seven classes of substances. Thirty-four participants also performed four executive functions (Flexibility, Inhibition, Working Memory, and Planning). A descriptive analysis was used to identify patterns of PSU and one-way analysis of variance (ANOVA) was conducted to compare the executive functions between three groups of substance users with nonusers.

Results

Three patterns of PSU were identified in our sample: simultaneous (16.3%), concurrent (37.2%), and mixed (46.5%) patterns of use. Simultaneous and concurrent users reported the most commonly used substance combinations (alcohol/nicotine/cannabis). Performance on executive function tasks was compared among the different groups of substance users and nonusers. Executive function assessments revealed deficits in simultaneous users for inhibition (most errors) and planning (most number of moves) compared to other groups. Concurrent users had the lowest accuracy for the two-back visual working memory.

Conclusions

The findings of this small sample study suggest executive function deficits are more common in simultaneous users and underscore the need for more research to examine the synergistic effects of substances on cognition and executive functions.

Trend analyses and comparison of characteristics of current-, former- and never-drinkers among young adults in France from 2000 to 2021

BACKGROUND

An overall decrease in alcohol consumption has recently been observed among a growing segment of the youth population in Western countries. Our study aimed to assess evolving trends in the rates of current-, former- and never- alcohol drinkers among 18-30-year-old French individuals between 2000 and 2021, and to compare their socio-economic characteristics, psychoactive substance use, and health-related parameters.

METHODS

We used cross-sectional survey data from the 2000, 2005, 2010, 2014, 2017 and 2021 editions of the French Health Barometer, and tested the existence of a linear trend in current-, former- and never-drinking among young adults aged 18 to 30 over time. We compared the characteristics of the three groups by conducting a multivariable logistic regression.

RESULTS

In total, 26,622 participants were included in our analyses. We found no significant changes in the trends of current-, former- and never-drinkers from 2000 to 2021. Post-hoc analyses found no significant changes in the trend of at-risk drinkers during the same period. Compared to current-drinkers, former- and never- drinkers were less likely to be male (OR: 0.75 [0.66; 0.85]); OR: 0.48 [0.43; 0.54]), and were more likely to have incomplete high school education (OR: 1.70 [1.47; 1.97]; OR: 1.72 [1.51; 1.96]), to be unemployed (OR: 1.58 [1.33; 1.89]; OR: 1.34 [1.15; 1.56]), to have a low income (OR: 1.88 [1.62; 2.19]; OR: 1.28 [1.13; 1.45]), to have a higher level of physical activity (OR: 2.57 [2.25; 2.95]; OR: 1.38 [1.24; 1.55]), and to practice a religion (OR: 17.16, 95CI [15.08; 19.53]; OR: 5.43 [4.88; 6.05]). Never-drinkers were less likely to have experimented with tobacco and cannabis, as well as other illicit drugs, while former-drinkers were less likely to report current tobacco use or past-year cannabis use.

CONCLUSIONS

In contrast to other countries, we found no clear trend indicating a shift in the patterns of alcohol use among young adults aged 18-30 in France from 2000 to 2021. Groups of current-, former- and never-drinkers differed in socio-economic, socio-demographic, health-related parameters and substance use characteristics.

Lived Experiences of Nonmedical Use of Tramadol Among Urban Slum-Dwelling Youth in Ghana: A Qualitative Study

The world is witnessing a pharmaceutical opioid crisis, and in Africa's version, the nonmedical use of Tramadol is prevalent in vulnerable populations. However, data on the factors promoting nonmedical use of Tramadol in slums is generally lacking. The study explored the factors that promote the nonmedical use of Tramadol among urban slum-dwelling youth in the Asokore Mampong Municipality, Ghana. This qualitative study recruited 20 nonmedical Tramadol users from Asawase and Aboabo in the Asokore Mampong Municipality as participants. Data were gathered through face-to-face, in-depth interviews via the snowball sampling technique. Data were analyzed using themes and direct quotations. The study observed that Tramadol was used in quantities exceeding what is medically acceptable many times daily and in combination with other substances with psychoactive properties. Tramadol use was informed by its efficacy in providing physical (reducing tiredness, pain relief, and sexual enhancement) and psychological (mood enhancement) benefits. Easy accessibility and affordability of Tramadol, coupled with lax measures in checking substance use, contribute to its nonmedical use with other substances. The extent of abuse of Tramadol in the study setting needs urgent attention. Educational programs on substance use, counseling interventions, and effective drug monitoring and surveillance are required to curb the menace.

Detection of serum alterations in polysubstance use patients by FT-Raman spectroscopy

Substance use disorders pose significant health risks and treatment challenges due to the diverse interactions between substances and their impact on physical and mental health. The chemical effects of multiple substance use on bodily fluids are not yet fully understood. Therefore, this study aimed to investigate the chemical changes induced by a combination of substances compared to a control group. Analysis of FT-Raman spectra revealed structural alterations in the amide III, I, and C = O functional groups of lipids in subjects treated with opioids, alcohol and cannabis (polysubstance group). These changes were evident in the form of peak shifts compared to the control group. Additionally, an imbalance in the amide-lipid ratio was observed, indicating perturbations in serum protein and lipid levels. Furthermore, a 2D plot of two-track two-dimensional correlation spectra (2T2D-COS) demonstrated a shift towards dominance of lipid vibrations in the polysubstance use groups, contrasting with the predominance of the amide fraction in the control group. This observation suggests distinct molecular changes induced by multiple substance use, potentially contributing to the pathophysiology of substance use disorders. Principal Component Analysis (PCA) was utilized to visualize the data structure and identify outliers. Subsequently, Partial Least Squares Discriminant Analysis (PLS-DA) was employed to classify the polysubstance use and control groups. The PLS-DA model demonstrated high classification accuracy, achieving 100.00 % in the training dataset and 94.74 % in the test dataset. Furthermore, receiver operating characteristic (ROC) analysis yielded perfect AUC values of 1.00 for both the training and test sets, underscoring the robustness of the classification model. This study highlights the quantitative and qualitative changes in serum protein and lipid levels induced by polysubstance use groups, as evidenced by FT-Raman spectroscopy. The findings underscore the importance of understanding the chemical effects of polysubstance use on bodily fluids for improved diagnosis and treatment of substance use disorders. Moreover, the successful classification of spectral data using machine learning techniques emphasizes the potential of these approaches in clinical applications for substance abuse monitoring and management.

Temporal stability and volatility in population-level high-risk illicit polysubstance use by gender and marital status in the United States, 2002-2019

Population-level patterns in determinants of risky polysubstance use receive little attention despite rising mortality. We use secondary data from the National Survey on Drug Use and Health, 2002-2019 (N = 706,891), and weighted logistic regression to test trends and associations between gender and marital status on the probability of high-risk polysubstance use (i.e., illicit use of pharmacologically-distinct overdose-associated drugs). Our results show that at the population-level about 0.7% of adults engaged in high-risk illicit polysubstance use in the past month. Our regression analyses reveal that polysubstance use was lowest among married women (pˆ = 0.27%) and highest among never married and previously married men (pˆ = 1.06%). When we predicted polysubstance use from 2002 to 2019, the estimates were remarkably stable for women and married adults, with no statistically significant differences for women across the span and few for married adults. Yet, polysubstance use among men had statistically significant variation (ranging from pˆ = 0.55 to pˆ = 0.96%), and the gender gap was larger and more consistently significant as illicit drugs became prominent later in the study period. This pattern suggests that use among men is shaped by drug contexts and availability. Our findings also highlight the important roles of family structure in shaping high-risk drug use. Rising polysubstance use mortality may not stem from rising rates of use or large changes in patterns among high-risk groups, but may be related to the growing share of non-married adults, especially men, who are high-risk relative to married adults and women.

Responding to location-based triggers of cravings to return to substance use: A qualitative study

INTRODUCTION

Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers.

METHODS

We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences.

RESULTS

We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified 'home' as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of 'home' while recovery was associated with limited travel and more time spent at home.

CONCLUSIONS

Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of 'home' as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.

Global screening of health behaviors: Introducing Lev-screening (Lev-s)-development and psychometric evaluation

Poor health behaviors have been identified as a critical factor for the burden on healthcare systems and individual suffering. However, comprehensive assessment of health behaviors is time-consuming and often neglected. To address this, we introduce the Lev-screening (Lev-s), a new, brief tool that covers multiple health behaviors. The Lev-s assesses ten health behaviors-physical activity, diet, alcohol use, tobacco use, illegal drug use, sleep, social relations, meaningful activities, sexual health, and screen health-using 33 items. This article details the development and psychometric evaluation of Lev-s with a sample of 2,279 participants aged 18-87. Test-retest reliability estimated as intra-class correlation coefficients for the different health behaviors ranged from .71 to .98 (n = 157), indicating moderate to excellent reliability. Lev-s showed associations with quality of life, demonstrated inter-correlations among included health behaviors, and detected group differences between individuals with and without neurodevelopmental conditions. The Lev-s exhibits satisfactory psychometric properties and holds promise as an efficient tool for screening of health behaviors.

Study protocol for a randomized controlled trial to adapt a posttraumatic stress disorder intervention of patients with opioid-stimulant polysubstance use receiving methadone maintenance treatment

BACKGROUND

The purpose of the Treatment for Harnessing Resiliency, Improving emotional regulation, and empowering indiViduals for a brighter future (THRIVE) study is to adapt an evidence-based posttraumatic stress disorder (PTSD) treatment for use among a polysubstance population receiving methadone maintenance treatment (MMT) at an opioid treatment program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This study will use eight study phases to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in sustained opioid-stimulant polysubstance use.

METHODS AND ANALYSIS

The intervention is an adapted version of the STAIR-NT protocol. The massed version created includes four 60-min sessions of skill building and two weeks of four 60-min sessions of narrative therapy. A preliminary randomized controlled trial (RCT) with 80 participants, randomized 1:1, will be conducted to assess the intervention's implementation and impact on primary short-term outcomes of polysubstance use and PTSD symptoms.

ETHICS AND DISSEMINATION

The results of this study will inform a fully-powered effectiveness trial for individuals with PTSD and polysubstance use receiving MMT. The findings are expected to provide valuable insights into improving both PTSD and substance use outcomes, and real-world implementation insights to integrating trauma-informed care in treatment settings for vulnerable populations.

REGISTRATION

This study is registered at ClinicalTrials.Gov as NCT06307340. Registration date 03/2024.

Latent Classes of Comorbid Substance Use and Internalizing and Externalizing Symptoms and Their Stability in U.S. Adults Over Time: Findings from the PATH Study Waves 1-3 (2013-2016)

The co-occurrence of mental disorder symptoms is common in people who use substances. It is unclear whether patterns of comorbidity in a population-based sample of adults are consistent with prior work. The study goal was to identify this comorbidity structure and evaluate its stability over time.

Using Waves 1, 2, and 3 of the Population Assessment of Tobacco and Health Study, this study applied latent class analysis to identify comorbid substance use, internalizing and externalizing mental disorder symptoms, and their stability over time.

A four-class solution was identified for Wave 1 as: (1) low symptom (N = 23,571, 72.9%), (2) internalizing (N = 4,098, 12.7%), (3) externalizing (N = 2,691, 8.3%), and (4) comorbid (N = 1,960, 6.1%). Similar latent profiles emerged across the three waves specifically where the low symptom class was largest (65.5% to 72.9%), and the comorbid class was smallest (6.1% to 8.2%). However, the composition of the classes changed in Wave 3 with low comorbid (N = 5,400, 20.6%) and substance use (N = 1,524, 5.8%) classes emerging. Overall, when individuals transitioned from preceding to subsequent wave, they typically transitioned into the low symptom class.

The comorbidity structure of substance use behaviors, including cigarette and e-cigarette use, and mental disorder symptoms in a population-based sample of U.S. adults was characterized by four classes. Psychiatric comorbidity may vary in severity within a population and by specific sociodemographic factors. When comparing the latent classes over three years of data, the results suggest that the comorbidity structure may change as participants age.

The Monitoring Illicit Substance Use Consortium: A Study Protocol

Objective

The global impact of substance use, including cannabis, amphetamine, cocaine, ecstasy, hallucinogens, and opioids, is increasing, although the overall prevalence is low. Australia and New Zealand are among the few regions of the world in which use (typically illicit) of these classes of substances remains within the top 10 causes of disease burden. The period of adolescence and young adulthood, during which substance use behaviors accelerate in prevalence, is associated with a particular risk for harm. However, the ability to study each substance class has been limited by their low population prevalence in single population-based cohort studies.

Method

The Monitoring Illicit Substance Use (MISUse) Consortium was established to address this problem by bringing together 4 mature prospective cohort studies across Australia and Zealand: Christchurch Health and Development Study (established 1977; 24 waves; N = 1,265), Australian Temperament Project (established 1983; 16 waves; N = 2,443), Victorian Adolescent Health Cohort Study (established 1992; 11 waves; N = 1,943), and International Youth Development Study (established 2002; 10 waves; N = 2,884).

Conclusion

The MISUse Consortium should enable well-powered studies of the natural history, developmental antecedents, and longer-term consequences of illicit substance use with a focus on identifying modifiable determinants of use that can be targeted in population-level policy and intervention responses.

Chronic disease diagnoses and health service use among people who died of illicit drug toxicity in British Columbia, Canada

BACKGROUND

Illicit drug toxicity (i.e., overdose) is the leading cause of death in British Columbia (BC) for people aged 10-59. Stimulants are increasingly detected among drug toxicity deaths. As stimulant use and detection in deaths rises, it is important to understand how people who die of stimulant toxicity differ from people who die of opioid toxicity.

METHODS

BC Coroners Service records were retrieved for all people who died of unintentional illicit drug toxicity (accidental or undetermined) between January 1, 2015, and December 31, 2019, whose coroner investigation had concluded and who had an opioid and/or stimulant detected in post-mortem toxicology and identified by the coroner as relevant to the death (N = 3788). BC Chronic Disease Registry definitions were used to identify people with chronic disease. Multinomial regression models were used to examine the relationship between chronic disease diagnoses and drug toxicity death type.

RESULTS

Of the 3788 deaths, 11.1% (N = 422) had stimulants but not opioids deemed relevant to the cause of death (stimulant group), 26.8% (N = 1014) had opioids but not stimulants deemed relevant (opioid group), and 62.1% (N = 2352) had both opioids and stimulants deemed relevant (opioid/stimulant group). People with ischemic heart disease (1.80 (1.14-2.85)) and people with heart failure (2.29 (1.25-4.20)) had approximately twice the odds of being in the stimulant group as compared to the opioid group.

CONCLUSIONS

Findings suggest that people with heart disease who use illicit stimulants face an elevated risk of drug toxicity death. Future research should explore this association and should identify opportunities for targeted interventions to reduce drug toxicity deaths among people with medical comorbidities.

Possible Potentiating Effects of Combined Administration of Alcohol, Caffeine, and Nicotine on In Vivo Dopamine Release in Addiction-Related Circuits Within the CNS of Rats

BACKGROUND

Studies that assess the effects of the interaction of psychoactive substances on dopamine release, the key neurotransmitter in the neurochemical and behavioral effects related to drug consumption, are crucial to understand both their roles and the dysfunctions they produce in the central nervous system.

OBJECTIVE

We evaluated the effects of individual and combined administration of the three most widely consumed psychoactive substances in the world, ethanol, caffeine, and nicotine, on dopaminergic neurotransmission in three brain regions of rats related to addiction: the prefrontal cortex (PFC), the nucleus accumbens (NAcc), and the dorsal striatum.

METHODS

The dopamine levels were measured in vivo by cerebral microdialysis associated with HPLC-ED.

RESULTS

We observed that local administration of a single concentration of caffeine (5 mM) or nicotine (5 mM) significantly increased the dopamine levels in all three areas studied, while ethanol (300 mM) increased them in the NAcc and striatum. Perfusion of nicotine + caffeine produced a synergistic effect in both the NAcc and striatum, with increases in the in vivo dopamine release greater than the sum of the effects of both substances. When administering the combination of nicotine + caffeine + ethanol, we observed an additive effect in the NAcc, while in the PFC we observed a synergistic effect.

CONCLUSIONS

Our results support the stimulating effects of caffeine, nicotine, and ethanol on the brain reward system. In addition, we also observed that the administration of different mixtures of these substances produces synergistic and additive effects on the release of dopamine in the mesocortical and nigrostriatal systems.

Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis

BACKGROUND

Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use.

OBJECTIVE

The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic.

METHODS

Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described.

RESULTS

Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time.

CONCLUSIONS

Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances-particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility.

Symptom Shifting From Nonsuicidal Self-Injury to Substance Use and Borderline Personality Pathology

Importance

A decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered.

Objective

To examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology.

Design, Setting, and Participants

This cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024.

Main Outcomes and Measures

The frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria.

Results

Overall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P < .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54]).

Conclusions and Relevance

In this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.

College students mandated to substance use courses: Age-of-onset as a predictor of contemporary polysubstance use

Objective: College campuses report alcohol and other drug policy violations as the most frequent reason students receive disciplinary referrals and, thus, are mandated to programming. This study sought to determine predictors of mandated students' alcohol use frequency, and the likelihood of early-onset alcohol using college students enrolled in mandated programming engaging in current polysubstance use. Methods and participants: Employing a purposive sampling method, n = 822 participants were recruited from a pool of students who violated their university's alcohol policy between October 2019 and July 2021. Results: Data analysis revealed early-onset alcohol use (p < .001), gender ID (p < .01), Greek Affiliation (p < .001), ethnicity (p < .05), and perceived norms (p < .001) significantly predicted alcohol frequency. Analysis also revealed engaging in early-onset alcohol use significantly predicted current participation in polysubstance use (p < 0.01), outside of controls. Conclusions: University programs should consider exploring polysubstance use targeted interventions to mitigate these harmful behaviors and associated negative consequences.

Simultaneous Substance Use With Alcohol in a Community-Based Sample of Young Adults

Objective: Simultaneous substance use is associated with worse outcomes than concurrent use. Further investigations into simultaneous use are warranted because there is limited knowledge about the co-use of substances other than alcohol and cannabis. Study aims were to examine: (1) the prevalence of simultaneous use of substances with alcohol, (2) the extent to which use patterns are related to key correlates (i.e., psychological functioning, sensation seeking), and (3) differences by college status. Methods: Participants were 623 young adult drinkers who were recruited online to complete a one-time survey. Results: Cannabis (54.3%), tobacco (53.7%), and stimulants (46.5%) were most frequently used with alcohol. Moderation analyses showed the positive association between simultaneous use and psychological distress was stronger for students whereas the positive association with sensation seeking was stronger for nonstudents. Conclusions: Results highlight the need for future research and intervention efforts that consider the link between simultaneous use and psychological wellbeing while acknowledging that educational attainment may differentially influence these factors.

Enhancing translation: A need to leverage complex preclinical models of addictive drugs to accelerate substance use treatment options

Preclinical models of addictive drugs have been developed for decades to model aspects of the clinical experience in substance use disorders (SUDs). These include passive exposure as well as volitional intake models across addictive drugs and have been utilized to also measure withdrawal symptomatology and potential neurobehavioral mechanisms underlying relapse to drug seeking or taking. There are a number of Food and Drug Administration (FDA)-approved medications for SUDs, however, many demonstrate low clinical efficacy as well as potential sex differences, and we also note gaps in the continuum of care for certain aspects of clinical experiences in individuals who use drugs. In this review, we provide a comprehensive update on both frequently utilized and novel behavioral models of addiction with a focus on translational value to the clinical experience and highlight the need for preclinical research to follow epidemiological trends in drug use patterns to stay abreast of clinical treatment needs. We then note areas in which models could be improved to enhance the medications development pipeline through efforts to enhance translation of preclinical models. Next, we describe neuroscience efforts that can be leveraged to identify novel biological mechanisms to enhance medications development efforts for SUDs, focusing specifically on advances in brain transcriptomics approaches that can provide comprehensive screening and identification of novel targets. Together, the confluence of this review demonstrates the need for careful selection of behavioral models and methodological parameters that better approximate the clinical experience combined with cutting edge neuroscience techniques to advance the medications development pipeline for SUDs.

Grade-Level Differences in the Profiles of Substance Use and Behavioral Health Problems: A Multi-Group Latent Class Analysis

We investigated associations between polysubstance use and behavioral problems among adolescents. Because substance use becomes more developmentally normative with age, we examined whether polysubstance use was less likely to co-occur with behavioral problems among older (vs. younger) adolescents. Using data from a nationally representative survey of US high school students, we compared the association between polysubstance use (i.e., use of alcohol, cannabis, tobacco/nicotine, and illicit drugs) and behavioral problems (i.e., suicide attempts, depressive symptoms, poor school performance, and sexual risk behaviors) by grade level. We conducted latent class analysis (LCA) to characterize patterns of polysubstance use, and multi-group LCA to estimate invariance by grade. Among the three latent classes that emerged, classes were distinguished by having low, moderate, and high probabilities for behavior problems and use of substances. Class I comprised 52% of the sample, whereas classes II and III comprised 35% and 12% of the sample, respectively. The multi-group LCA showed that younger adolescents had a higher relative probability of co-occurring problem behaviors and polysubstance use. Findings may be helpful in targeting screening and prevention efforts of high school students by grade. Specifically, our results provide evidence that associations between behavioral problems and alcohol/drug use are weaker in later high school grades, suggesting that substance use may not be a weaker marker of behavioral problems for students in higher grades.

Higher prevalence of polysubstance use among older lesbian, and gay US adults

Introduction

Polysubstance use (i.e., the use of more than one substance) is a major public health concern in the US that disproportionately hinders those from marginalized groups by sexual identity and age. Little research has examined this concern among lesbian, gay, and bisexual (LGB) older adults, and no study has measured past-30 day polysubstance use prevalence among these groups. The objective was to examine polysubstance use among older LGB adults compared to their heterosexual same-age peers and younger LGB counterparts.

Methods

We used the National Survey of Drug Use and Health 2021 and 2022 datasets with an analytic sample of 86,254 participants. Past-30 day polysubstance use prevalence was survey-weighted and adjusted by sociodemographic factors. We constructed Weighted multinomial models to compare polysubstance use between older LGB adults (65+ years old) with their same-age heterosexual and younger LGB counterparts.

Results

Older Gay/Lesbian adults had a significantly higher polysubstance use prevalence than their heterosexual counterparts (OR = 27.94; p <0.001) while heterosexual participants showed a decline in polysubstance use with age (OR = 0.27; p < 0.001). Polysubstance use among gay/lesbian (OR = 0.67; p = 0.491) and bisexual (OR = 1.04; p = 0.969) older adults did not significantly differ from their younger counterparts.

Conclusions

Polysubstance use is a public health concern for older gay/lesbian adults. Interventions are needed to address polysubstance use for older LGB adults, including early detection of polysubstance use and prevention strategies that are age and LGB inclusive.

Suicidal Thoughts and Behaviors Among US Adolescents: The Cumulative Effects of Polysubstance Use Behaviors

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide.

Polysubstance Use and Related Risk Behaviors among People Who Inject Drugs in Kenya Preparing for Hepatitis C Virus Treatment

Polysubstance use (PSU), injection drug use (IDU), and equipment sharing are associated with bloodborne infection (BBI) transmission risk, particularly Hepatitis C Virus (HCV), yet data on PSU in low- and middle-income countries (LMICs) is limited. We report on baseline PSU, medication-assisted treatment (MAT) engagement, and motivation to reduce IDU among 95 people who inject drugs (PWID) who accessed needle and syringe programs (NSP) in Nairobi and Coastal Kenya prior to HCV treatment. Bivariate and multivariate logistic regression were used to examine the associations between PSU and behaviors that confer HCV transmission and acquisition risks. Most participants (70.5%) reported PSU in the last 30 days, and one-third (35.8%) reported PSU exclusive to just heroin and cannabis use. Common combinations were heroin and cannabis (49.3%), and heroin, cannabis, and bugizi (flunitrazepam) (29.9%). Participants at baseline were receiving MAT (69.5%), already stopped or reduced IDU (30.5%), and were HIV-positive (40%). PSU was significantly associated with IDU (p = 0.008) and the number of times (p = 0.016) and days (p = 0.007) injected in the last 30 days. Participants reported high PSU and equipment sharing, despite high MAT engagement. While co-locating BBI treatment within existing harm reduction services is necessary to promote uptake and curb re-infection, tailored services may be needed to address PSU, particularly in LMICs.

Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study

OBJECTIVE

The aim of the study was to identify groups of young adults with distinct longitudinal patterns of use of treatment for substance use disorders and mental health (MH) problems and to investigate potential explanatory factors for different patterns of treatment use over time, including sociodemographic factors.

METHODS

The sample consisted of 447 young adults aged 16-29 years who entered long-term residential substance use disorder treatment facilities in Norway from 2011 to 2016. In this study, we obtained data collected by the Norwegian Patient Registry and Statistics Norway. These data were linked with the electronic health record data of the substance use disorder treatment facilities from which the participants were recruited. Growth mixture modeling was performed. The identified groups were further compared using analysis of variance or χ2 test.

RESULTS

Four groups of participants for total treatment use, substance use disorder treatment use, and MH treatment use were identified. Most participants from the overall sample were classified as members of a group characterized by a low and stable pattern of treatment use over time. A group with a high and stable pattern of treatment use was identified in total and MH treatment use. The proportion of participants with higher levels of substance use disorder treatment use at the end of the study period than at the beginning was larger (35%) than in the case of MH treatment use (14.2%). Younger age was associated with a decreasing pattern of MH treatment use and with an increasing pattern of substance use disorder treatment use over time. There were larger proportions of female participants in groups with a stable high use of MH treatment and in groups with an initially increasing trend of substance use disorder treatment use. Findings revealed that most participants across the identified groups were recipients of welfare benefits, had low educational attainment, and were not working.

CONCLUSIONS

Results demonstrated significant variation in trajectories of treatment use among young adults with substance use disorder. Differences in treatment use could indicate differences in symptom severity and complexity. In this study, treatment use was associated with socioeconomic factors, sex, and age. Integrative approaches, including interagency and interdisciplinary collaboration, will often be necessary to sufficiently address the multidimensionality of substance use disorder.

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

Importance

Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.

Objective

To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.

Design, Setting, and Participants

This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023.

Exposures

Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods.

Main Outcomes and Measures

Disclosure of recent intent, suicide note presence, and known psychotropic usage.

Results

Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]).

Conclusions and Relevance

This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

E-cigarettes in college: Associations between mental health and e-cigarette use with other substances

INTRODUCTION

College students are a priority population for substance use prevention, and other studies have reported associations between mental health and e-cigarette use. This study described the association of mental health to e-cigarette and other substance use (ECIG+ use) among US college students.

METHODS

We used Fall 2018 and Spring 2019 National College Health Assessment data among undergraduate students aged 18-24 years (n=55654) at 138 institutions. We characterized substance use patterns and used multinomial regression to model adjusted odds of past 30-day ECIG use type [no substance use (reference); sole e-cigarette use; e-cigarette use and other substance use (ECIG+ use); no e-cigarette use but other substance use] by mental health characteristics, past 12-month diagnosis/treatment and psychological distress, individual characteristics, and college characteristics.

RESULTS

Alcohol was the most prevalent substance (58%) used, followed by cannabis (23%) and e-cigarettes (15%). Nearly all (95%) students who used e-cigarettes reported using another substance. Adjusted odds of ECIG+ use (vs no substance use) were higher among students with past 12-month mental health diagnosis/treatment (AOR=1.5; 95% CI: 1.4-1.6) and higher psychological distress (AOR=1.1; 95% CI: 1.1-1.2). Other characteristics significantly associated with ECIG+ use included gender identity, sexual orientation, race and ethnicity, self-rated health, year in school, cumulative grade average, fraternity/sorority membership, and current residence.

CONCLUSIONS

Most students who used e-cigarettes also reported other substance use, and this pattern of use was associated with poorer mental health outcomes than no substance use. Clarifying the relationship between mental health and ECIG+ use may enhance health interventions for college students.

Independent and concurrent cannabis use with alcohol, cigarettes, and other substances among college students: Rates and consequences

Objective: The purpose of this study was to examine patterns of concurrent cannabis and other substance use and their differential associations with cannabis-related problems and academic outcomes in college students. Participants: Participants were undergraduate students (N = 263; M age = 19.1 years; 61.2% female) who were eligible if they used cannabis at least 3 days in the past month (M = 10.1 days). Method: Substance use, academic-related outcomes, and measures of Cannabis Use Disorder (CUD) severity and problems were obtained in an online survey. Results: The five groups evaluated were cannabis-only users (5.3%), cannabis and alcohol (47.1%), cannabis, alcohol and cigarettes (16.7%), cannabis, alcohol and other substances (14.8%), or all-substances (16%). Cannabis-only and all-substance users reported using cannabis most frequently (ps ≤ .034), but only the latter reported greater CUD severity, problems, and poorer academic outcomes. Discussion: College student polysubstance users may be at increased risk for poorer outcomes compared to cannabis-only users and other groups.

Substance use patterns, quantities, and associated risk factors in women with polysubstance misuse

Polysubstance use (PSU), the use of two or more substances proximally, is highly prevalent and has amplified the risk for morbidity and mortality. However, PSU patterns and associated risk factors are not well characterized. This may be especially relevant to women who are known to be vulnerable to stress/trauma, craving, pain, and anxious and depressive symptoms as associated risk factors for PSU. A cross-sectional observational study was conducted to characterize substance use patterns in women who regularly used cocaine, opioids, marijuana, alcohol, benzodiazepines and/or nicotine and were being assessed for a placebo-controlled study of guanfacine treatment (n = 94; ages 19-65). Data on stress/traumatic life events, drug cravings for each substance, pain ratings, and anxiety and depressive symptoms were also obtained using standardized well-validated surveys. High use per day of two or more drugs was observed (72.7% ± 33.3%) and opioid amounts were high relative to other drug amounts (p's < 0.001). Notably, higher stress/trauma events and higher cravings are each associated with cumulative PSU days, amounts and probability of an individual PSU day (p's < 0.02). This remained when PSU versus single substance use was compared. Pain, anxiety and depressive symptoms were not associated with PSU metrics. These findings characterize specific patterns of PSU in women and show that average drug craving and stress/trauma events are associated with PSU. Interventions that focus on stress/trauma and craving management could be of benefit in reducing PSU risk in women.

Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV?

Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.

The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping

Objective

Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping.

Method

College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used.

Results

Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC.

Conclusions

Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

BACKGROUND

This randomized controlled trial aimed to evaluate the effects of a two-month exercise intervention on the concurrent non-opiate substance use (alcohol, cocaine, cannabis, and benzodiazepines) in opioid users during their medication treatment.

METHODS

Ninety opioid users (41 females) in methadone and buprenorphine medication treatment were randomly divided into four groups: (a) buprenorphine experimental (BEX; n = 26, aged 41.9 ± 6.1 yrs); (b) buprenorphine control (BCON; n = 25, aged 41.9 ± 5.6 yrs); (c) methadone experimental (MEX; n = 20, aged 46.7 ± 6.6 yrs); and (d) methadone control (MCON; n = 19, aged 46.1 ± 7.5 yrs). The experimental groups (BEX and MEX) followed an aerobic exercise training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. Socio-demographic, anthropometric, and clinical characteristics, as well as non-opioid drug use in days and quantity per week, were assessed before and after the intervention period.

RESULTS

Following the exercise training, the weekly non-opioid substance consumption (days) decreased (p < 0.05) in both exercise groups and was lower in BEX compared to MEX, while no differences were observed (p > 0.05) between the control groups (BCON vs. MCON) or compared to their baseline levels. Similarly, the daily amount of non-opiate substance intake was reduced (p < 0.05) post-training in BEX and MEX, whereas it did not differ (p > 0.05) in BCON and MCON compared to the baseline.

CONCLUSIONS

The two-month exercise intervention reduced the non-opioid drug use in both the methadone and buprenorphine substitution groups compared to the controls, suggesting that aerobic exercise training may be an effective strategy for treating patients with OUDs.

Longitudinal polysubstance use patterns and non-fatal overdose: A repeated measures latent class analysis

BACKGROUND

Polysubstance use (PSU) is common among people who use opioids (PWUO) and has been associated with drug-related harms. We aimed to identify latent longitudinal PSU classes among a cohort of PWUO and characterize non-fatal overdose risks among different sub-classes over time.

METHODS

We used longitudinal data (2005-2018) from three ongoing prospective cohorts of people who use drugs in Vancouver, Canada. The primary outcome of interest was self-reported non-fatal overdose during the past six months. The primary exposure of interest was longitudinal PSU patterns among PWUO, obtained from repeated measures latent class analysis (RMLCA) of weekly substance use-related outcome indicators. Multivariable generalized estimating equations models were built to assess the association between latent PSU class membership and non-fatal overdose, adjusting for potential sociodemographic, behavioural, and structural confounders.

RESULTS

2627 PWUO were included in the analysis, and 1094 (41.6 %) had experienced at least one non-fatal overdose during the study period. RMLCA revealed five distinct latent longitudinal PSU classes, including low/infrequent use (Class 1; 30 %), primarily opioid and methamphetamine use (Class 2; 22 %), primarily cannabis use (Class 3; 15 %), primarily opioid and crack use (Class 4; 29 %), and frequent PSU (Class 5; 4 %). In comparison with Class 1 (low), membership in all latent PSU classes except Class 3 (cannabis) was associated with increased odds of non-fatal overdose: Class 2 (opioids + meth) vs. Class 1 (Adjusted odds ratios [aOR] = 2.20, 95 % confidence intervals [CI]: 1.51-3.22), Class 4 (opioids + crack) vs. Class 1 (aOR = 1.06, 95 % CI: 0.85-1.33), and Class 5 (frequent) vs. Class 1 (aOR = 2.39, 95 % CI: 1.92-2.97).

CONCLUSION

Our findings highlighted the heterogeneous characteristics of PWUO in terms of patterns of PSU and non-fatal overdose risk. The diverse nature of PWUO and the potential additive or multiplicative impact of using several substances on overdoses should be reflected across the substance use treatment continuum and care provision.

Do Peers, Neighborhood Disorder, Religiosity, Spirituality, and Family Support Influence Polysubstance Use Among Older Youth Transitioning from Foster Care?

PURPOSE

Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose.

METHOD

This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children's Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances.

RESULTS

Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p < .001), having deviant peers (RR = 1.15, p < .001), and living in a more disordered neighborhood (RR = 1.13, p < .05), increased the risk engaging in polysubstance use.

DISCUSSION

Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use.

CONCLUSION

Interventions should work to reduce deviant peer relationships among foster youth.

Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.

Changes in patterns of youth multiple tobacco and/or e-cigarette product use in the US between 2014 and 2020: a multiple-group latent class analysis

BACKGROUND

Multiple tobacco and e-cigarette product (MTEP) use, the concurrent use of two or more different types of tobacco and/or e-cigarettes products, is common among young people in the US. Changes in patterns of MTEP use among US youth between 2014 and 2020 were identified and the determinants of MTEP use were examined.

METHODS

Four years of repeated cross-sectional data from the US National Youth Tobacco Survey of middle and high school students from grade 6 to 12 (Ntotal=77 402). Multigroup latent class analysis (LCA) was applied to the data series to allow for simultaneous identification of MTEP use patterns between 2014 and 2020. Logistic regression was used to predict class membership on demographic and tobacco-related variables.

FINDINGS

Over the 7-year period, LCA identified three patterns: minimal/non-users (MNU: ~89.8%), mostly occasional e-cigarette and cigarette users (MOEC: ~9%) and polytobacco users (POLY: ~1.2%). From 2014 to 2020, MNU increased from 86.4% to 92% (p<0.05), while MOEC and POLY decreased from 11.2% to 7.9% and from 2.4% to 0.1%, respectively. The probability of regular e-cigarette use increased from 0 to 2.3% among MNU, 6% to 31.9% among MOEC and 29.6% to 67.6% among POLY (p<0.05). In binomial logistic regression, being male, in high school, non-heterosexual, living with someone who uses tobacco at home, having cognitive difficulties, having lower perceptions of tobacco's danger and exposure to tobacco marketing were associated with greater odds of MOEC and POLY than MNU.

CONCLUSIONS

There was an increase in regular e-cigarette use in all three classes, but a corresponding decrease in the proportion of MTEP use. Public health interventions to discourage uptake of e-cigarettes, such as tighter restrictions on marketing to minors, are warranted and there is a need to consider disparities in the determinants of MTEP use.

Polysubstance use and post-discharge mortality risk among hospitalized patients with opioid use disorder

Polysubstance use is becoming increasingly common and presents several harms. This study aimed to examine the association of comorbid cocaine, alcohol (binge drinking), and sedative use with mortality among hospitalized patients with opioid use disorder (OUD). A subsample of adult medical/surgical hospital patients with OUD who were seen by a hospital addiction consultation service in Baltimore City and enrolled in a randomized trial of a patient navigation intervention were included in this study (N = 314; 45 % female; 48 % White; mean age = 44). Death certificate data from the Maryland Division of Vital Records was used, covering 3.3-5.5 years post-discharge. Multivariable proportional hazards Cox regression and competing risks regression were used to estimate all-cause mortality and overdose mortality, respectively, as a function of concurrent use of cocaine, alcohol (binge drinking), and non-prescribed sedatives at baseline. In the 30 days prior to hospital admission, 230 (73 %) participants used cocaine, 64 (20 %) binge drank, and 45 (14 %) used non-prescribed sedatives. Nearly one-third (N = 98; 31 %) died during the observation period. Drug overdose caused 53 % (N = 52) of deaths. Older age (HR = 1.03 [1.01,1.05]; P = 0.001), less than high school education (HR = 0.36 [0.24,0.54]; P < 0.001), and past 30-day sedative use (HR = 2.05 [1.20,3.50]; P = 0.008) were significantly associated with all-cause mortality. The risk of overdose mortality was 62 % lower (HR = 0.38 [0.22,0.66]; P = 0.001) for those who completed high school. No other characteristics were significantly associated with overdose mortality. The concurrent use of opioids and sedatives increases the post-discharge mortality risk among hospitalized patients with OUD. Interventions are needed to prevent mortality among this high-risk population.

Association of electronic nicotine delivery system (ENDS) and cigarette solo and dual use with alcohol-related consequences among US adults

INTRODUCTION

Research reports a robust association between combustible cigarette use and alcohol use frequency and severity. Extension to the emerging landscape of electronic nicotine delivery system (ENDS) use is needed to inform prevention and treatment strategies.

METHOD

We evaluated data from the 2020 National Survey on Drug Use and Health (NSDUH). Respondents included adults reporting cigarettes or ENDS solo or dual use. Multivariable logistic regression models evaluated associations with alcohol use disorder (AUD) and alcohol-related risky behavior (i.e., heavy drinking, binge alcohol use, and driving after drinking) compared to never use controls and respondents with a history, but not current, use of cigarettes or ENDS.

RESULTS

Multivariable models showed greater odds of AUD for respondents with dual ENDS and cigarette use (AOR = 10.2), ENDS use (AOR = 6.27), cigarette use (AOR = 4.45), and a history, but not ongoing, use (AOR = 2.60) relative to respondents with no use history. Similarly, respondents with dual use (AOR = 3.94), ENDS use (AOR = 2.41), and cigarette use (AOR = 1.71) had greater odds of AUD relative to those with a history of, but not ongoing, use. The association between dual use and AUD was greater for adults ages 21-25 (AOR = 16.2) than for adults over 25 (AOR = 7.82). Cigarette and ENDS solo and dual-use were similarly associated with greater odds of alcohol-related risky behavior relative to control groups.

CONCLUSION

These findings demonstrate that nicotine use and dual use may be associated with indicators of problematic drinking. These results offer insight into emerging licit polysubstance profiles and call for mechanistic research to inform prevention and intervention efforts.

A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine

Methamphetamine use typically starts in adolescence, and early onset is associated with worse outcomes. Yet, health, functional, and cognitive outcomes associated with methamphetamine use in young people are not well understood. The aim of this study was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were included. The strongest association observed was with conduct disorder, with young people who use methamphetamine some 13 times more likely to meet conduct disorder criteria than controls. They were also more likely to have justice system involvement and to perpetrate violence against others. Educational problems were consistently associated with youth methamphetamine use. The cognitive domain most reliably implicated was inhibitory control. Key limitations in the literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited longitudinal evidence. Outcomes identified in the present review - suggesting complex and clinically significant behavioural issues in this population - are informative for the development of future research and targeted treatments.

Attention deficit hyperactivity disorder symptoms and lifetime use of psychoactive substances among French university students: A cross-sectional study

In a cross sectional study of 13,837 university students, we aimed to explore the association between attention deficit hyperactivity disorder (ADHD) symptoms and lifetime psychoactive substance use (LPSU) on a wide range of illicit substances. Logistic and Hurdel multivariable regressions were used. ADHD symptoms were significantly associated with the lifetime use of ketamine, magic mushrooms, poppers, and nine other psychoactive substances. There was an association between ADHD symptoms and both LPSU and truncated count of lifetime psychoactive substance use. High levels of ADHD symptoms are associated with the use of a large variety and multiple LPSU.

Longitudinal patterns of polysubstance use throughout adolescence: association with adult substance use and psychosocial outcomes controlling for preadolescent risk factors in a male cohort

PURPOSE

Inconsistent reports raise the question of the extent to which poor adult outcomes are associated with adolescent polysubstance use (PSU: alcohol, marijuana, other illicit drugs) above and beyond earlier risk factors.

METHODS

Early adulthood substance-related and psychosocial outcomes were examined in association with age 13 to 17 developmental patterns of PSU in boys from urban, low SES neighborhoods (N = 926). Three classes obtained by latent growth modeling described low/non-users (N = 565, 61.0%), lower risk PSU (later onset, occasional use, 2 ≤ substances; N = 223, 24.1%), and higher risk PSU (earlier onset, frequent use, 3 ≥ substances; N = 138, 14.9%). Preadolescent individual, familial and social predictors of adolescent PSU patterns were used as covariates.

RESULTS

Adolescent PSU contributed to both age-24 substance-related outcomes (frequency of alcohol, drug use, and getting drunk, risky behaviors under influence, and use-related problems) and psychosocial outcomes (no high school diploma, professional or financial strain, ASP symptoms, criminal record) over and above preadolescent risk factors. Controlling for preadolescent risk factors, adolescent PSU made a more important contribution to adult substance use outcomes (increasing the risk by about 110%) than to psychosocial outcomes (16.8% risk increase). PSU classes showed poorer adjustment for all age-24 substance use, and for various psychosocial outcomes than low/non-users. Higher risk polysubstance users also reported poorer outcomes than their lower risk peers for most substance use outcomes, and for professional or financial strain and criminal record.

CONCLUSION

Findings highlight the contribution of adolescent PSU in a dose-response fashion, over and above preadolescent risk factors, on both homotypic and heterotypic outcomes in early adulthood.

Risks of returning to opioid use at treatment entry and early in opioid use disorder treatment: Role of non-opioid substances

OBJECTIVE

Patients in treatment with medications for opioid use disorder (MOUD) often report use of other substances in addition to opioids. Few studies exist that examine the relationship between use at treatment entry and early non-opioid use in opioid treatment outcome.

METHODOLOGY

We combined and harmonized three randomized, controlled MOUD clinical trials from the National Institutes of Drug Abuse (NIDA) Clinical Trials Network (CTN) (N=2197) and investigated the association of non-opioid substance use at treatment entry and during early treatment with a return to opioid use. The trials compared MOUD treatment (buprenorphine, methadone, extended-release naltrexone) in populations with opioid use disorder (OUD). Non-opioid substances were identified through harmonizing self-reported use. The primary outcomes were markers of return to opioid use by 12 weeks.

RESULTS

When treatment cohorts were adjusted, no association between self-reported treatment entry use of non-opioid substances and week-12 opioid use was detected. During the first month of treatment, higher use of cocaine (OR 1.41 [1.18-1.69]) and amphetamine (OR 1.70 [1.27-2.26]) was found to be associated with higher likelihood of illicit opioid use by week 12. Exploratory analyses of potential treatment cohort-by-predictor interactions showed that those with heavier cocaine use had a lower rate of returning to opioid use in the extended-release naltrexone group than in the methadone group.

CONCLUSION

Substance use other than opioids at treatment entry is not associated with relapse. Use of cocaine or amphetamines during the first few weeks of MOUD treatment may signal a worse outcome, suggesting a need for additional interventions.

Longitudinal latent polysubstance use patterns among a cohort of people who use opioids in Vancouver, Canada

INTRODUCTION

Polysubstance use (PSU) practices are increasing among people who use opioids (PWUO). However, several aspects of longitudinal PSU patterns among PWUO remain understudied. This study aims to identify person-centred longitudinal patterns of PSU among a cohort of PWUO.

METHODS

Using longitudinal data (2005-2018) from three prospective cohort studies including people who use drugs in Vancouver, Canada, we used repeated measures latent class analysis to identify different PSU classes among PWUO. Multivariable generalised estimating equations models weighted by the respective posterior membership probabilities were applied to identify covariates of membership in different PSU classes over time.

RESULTS

Overall, 2627 PWUO (median age at baseline: 36 [quartile 1-3: 25-45]) were included between 2005 and 2018. We found five distinct PSU patterns, including low/infrequent probability of regular substance use (Class 1; 30%), primarily opioid and methamphetamine use (Class 2; 22%), primarily cannabis use (Class 3; 15%), primarily opioid and crack use (Class 4; 29%) and frequent PSU (Class 5; 4%). Membership in Class 2, 4 and 5 was positively associated with several behavioural and socio-structural adversities.

DISCUSSION AND CONCLUSIONS

Findings of this longitudinal study suggest PSU is the norm among PWUO and highlights the heterogeneous characteristics of PWUO. The diversities within the population of PWUO need to be recognised in addiction care and treatment as well as optimising resource allocation in the response to the overdose crisis.

Can severity of substance use be measured across drug classes? Estimating differential item functioning by drug class in two general measures of substance use severity

BACKGROUND

Substance use severity is frequently measured using generic (i.e., non-drug specific) items. Yet, the measurement properties of these items must be evaluated for measurement invariance across inidividuals who use differing substances to ensure total scores can be compared across groups.

METHOD

This study used data from two independent samples (n1 = 474; n2 = 5183) and two measures of general substance use severity with generic items, the Patient Reported Outcomes Measurement Information System (PROMIS) Severity of Substance Use and DAST-10, to examine for differential item functioning (DIF) across substances (i.e., sedatives, opioids, amphetamines, cocaine, and cannabis). We utilized moderated nonlinear factor analysis to estimate DIF. Finally, we compared factor scores across estimation methods with and without accounting for DIF to examine the impact of DIF.

RESULTS

A minority of items showed statistically significant DIF in each scale (Items with DIF: PROMIS Sample 1: 5/37; PROMIS Sample 2: 7/20; DAST-10 Sample 2: 3/10). Factor scores across scoring methods showed extremely high correlations (0.994 - 0.999), estimates of mean differences across substance groups did not vary considerably across scoring methods, but measurement differences were correlated with factor scores.

DISCUSSION

These findings suggest that these two measures of substance use severity can be used across individuals using different substances. Factor scores appear similar across scoring methods and mean differences do not appear to be substantially biases. Measures with generic items may offer a parsimonious alternative to measures with drug specific items but more research is needed to evaluate the robustness of these findings.

Trends and psychosocial correlates of same day polysubstance use among people who inject drugs in Australia, 2012-2022

BACKGROUND

Polysubstance use is associated with negative health and social outcomes among people who inject drugs. We aimed to describe trends in polysubstance use and identify psychosocial correlates and associated drug use risk behaviours. We defined polysubstance use as intentional same day use of more than one of three drug classes: opioids, other non-opioid depressants (hereafter 'depressants'), and stimulants.

METHODS

We used 10 years (2012-2022, excluding 2020) of data from annual surveys in Australian capital cities with people who inject drugs (N=5657) to construct five mutually exclusive polysubstance use profiles: opioid-depressant, opioid-stimulant, stimulant-depressant, opioid-stimulant-depressant, and single drug class use. We examined time trends using the Mann Kendall test and identified correlates using multinomial logistic regression.

RESULTS

Same day polysubstance use was relatively common among this sample (43.6%). Opioid-depressant use was the most frequent polysubstance use profile, but this decreased over the study period (32.6% to 13.3%, p<0.001). This aligned with observed decreases in use of pharmaceutical opioids (p<0.001), opioid agonist treatment (p=0.007), and benzodiazepines (p=0.001). There was no evidence for any trend in the other polysubstance use profiles, although single drug class use increased (51.9% to 64.7%, p=0.031). The different polysubstance use profiles were variously associated with psychosocial factors, including unstable housing and very high psychological distress, and other drug use risk behaviours, including non-fatal overdose, receptive and/or distributive needle sharing, and reusing one's own needles.

CONCLUSION

Same day polysubstance use has remained relatively common among this sample over time, although the typology has changed. Collectively, our findings point to diverse drug use patterns among people who inject drugs and reiterate the need for a range of harm reduction, treatment, and support options.

Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype?

BACKGROUND

Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG.

METHODS

This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood.

RESULTS

The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes.

CONCLUSIONS

Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.

Predictors of polysubstance vaping in emerging adults

BACKGROUND

Polysubstance use, which increases the risk for negative consequences of substance use, is common among emerging adults who regularly consume substances by vaping. Examining predictors of polysubstance vaping is crucial for understanding whether this novel form of substance consumption lends itself equally efficaciously to established forms of intervention for smoked substances.

OBJECTIVE

The current study aimed to examine whether modifiable cognitive risk factors for increased vaping in the form of attitudes, expectancies and norms can predict co-use of nicotine and cannabis among vapers over and above the effect of demographics, personality risk factors and anxiety, depression symptoms.

METHODS

Regular nicotine and cannabis vapers between 18 and 30 years were recruited online in Canada via a Qualtrics panel. Hierarchical binary logistic regression was used to predict membership in a polysubstance or a single substance vaping group. Demographics, personality risk factors, depression and anxiety symptoms were included as predictors in block 1; attitudes, expectancies and perceived norms of vaping were added in block 2.

RESULTS

Attitudes, expectancies and norms predicted polysubstance use over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. Positive expectancies played a uniquely significant role in the prediction of polysubstance vaping.

CONCLUSIONS

Cognitive interventions targeting attitudes, expectancies and norms may be effective in prevention of polysubstance vaping, although positive expectancies appear to be the main unique factor that has an influence above and beyond all other cognitive factors related to vaping. Treatment and prevention programs should put special focus on lowering positive expectancies.