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Review
. 2018 Nov 1:192:16-28.
doi: 10.1016/j.drugalcdep.2018.07.025. Epub 2018 Sep 1.

The importance of considering polysubstance use: lessons from cocaine research

Yiyang Liu  1 , Victoria Guazzelli Williamson  2 , Barry Setlow  3 , Linda B Cottler  4 , Lori A Knackstedt  5
Affiliations
Review

The importance of considering polysubstance use: lessons from cocaine research

Yiyang Liu et al. Drug Alcohol Depend. .

Abstract

Background: Polysubstance use (PSU) is prevalent among individuals with substance use disorders, but the vast majority of preclinical substance use research has focused on individual substances in isolation. Cocaine has been prevalent in the repertoire of persons who use more than one illicit substance.

Methods: We conducted a meta-analysis combining results from literature searches and secondary data analyses to estimate the prevalence of simultaneous and concurrent cocaine + alcohol and cocaine + cannabis use among cocaine users. We next summarized the small body of literature on behavioral, cognitive and neurobiological consequences of cocaine PSU across species, with a focus on alcohol and cannabis. Finally, we used systematic literature searches to assess the extent to which human and animal studies on the neurobiological consequences of cocaine include PSU subjects.

Results: The estimated prevalence of simultaneous and concurrent alcohol use among human cocaine users was 74% and 77%, respectively. The estimated prevalence of simultaneous and concurrent cannabis use among cocaine users was 38% and 64%, respectively. Consumption of alcohol or cannabis with cocaine enhances subjective responses to cocaine, concomitant with changes in cocaine metabolism that increase blood cocaine levels, and, in the case of alcohol, produce the psychoactive metabolite cocaethylene. There is also consistent evidence for neurobiological effects of cocaine + alcohol combinations. However, animal PSU research with cocaine lags behind human research.

Conclusion: Based on the prevalence and known consequences of PSU, consideration of PSU in both human and animal research is vital for understanding patterns of substance use.

Keywords: Alcohol; Cannabis; Cocaethylene; Neurocognitive; Neuroimage.

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Conflict of interest statement

Conflict of interest

No conflict declared

Figures

Fig. 1.
Fig. 1.
Forest plots show the prevalence of simultaneous and concurrent alcohol/cannabis use among cocaine users. Vertical lines in forest plots show the pooled estimates of prevalence from the random effect models. I2 values greater than 50% indicate substantial heterogeneity between studies.
See this image and copyright information in PMC

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