Patterns of polysubstance use and clinical comorbidity among persons seeking substance use treatment: An observational study

Abstract

Introduction: Polysubstance use is common among individuals seeking treatment for substance use disorders (SUD). However, we know less about patterns and correlates of polysubstance use among treatment-seeking populations. The current study aimed to identify latent patterns of polysubstance use and associated risk factors in persons entering SUD treatment.

Methods: Patients (N = 28,526) being admitted for substance use treatment reported on their use of thirteen substances (e.g., alcohol, cannabis, cocaine, amphetamines, methamphetamines, other stimulants, heroin, other opioids, benzodiazepines, inhalants, synthetics, hallucinogens, and club drugs) in the month before treatment and prior to the month before treatment. Latent class analysis (LCA) determined the relationship between class membership and gender, age, employment status, unstable housing, self-harm, overdose, past treatment, depression, generalized anxiety disorder, and/or post-traumatic stress disorder (PTSD).

Results: Identified classes included: 1) Alcohol primary, 2) Moderate probability of past-month alcohol, cannabis, and/or opioid use; 3) Alcohol primary, Lifetime cannabis and cocaine use; 4) Opioid primary, Lifetime use of alcohol, cannabis, hallucinogens, club drugs, amphetamines, and cocaine; 5) Moderate probability of past-month alcohol, cannabis, and/or opioid use, Lifetime use of various substances; 6) Alcohol and cannabis primary, Lifetime use of various substances; and 7) High past-month polysubstance use. Individuals who engaged in past-month polysubstance use attended to face elevated risk of screening positive for recent unstable housing, unemployment, depression, anxiety, PTSD, self-harm, and overdose.

Conclusions: Current polysubstance use is associated with significant clinical complexity. Tailored treatments that reduce harms resulting from polysubstance use and related psychiatric comorbidity may improve treatment outcomes in this population.

Keywords: Comorbidity; Latent class analysis; PTSD; Polysubstance use; Self-harm.

Figure 1.. Stacked probabilities of substance use in each latent class.

In each class, there is a probability (between 0 and 1) of endorsing use of each substance (shown in Table 2). Probabilities of use in the past month are stacked in the upper portion of the figure. Probabilities of use prior to the past month are stacked in the lower portion of the figure. Class 1 = Alcohol primary; Class 2 = Moderate Probability of past-month alcohol, cannabis, and/or opioid use; Class 3 = Alcohol primary, Lifetime cannabis and cocaine use; Class 4= Opioid primary, Lifetime use of alcohol, cannabis, hallucinogens, club drugs, amphetamines, and cocaine, Class 5 = Moderate probability of past-month alcohol, cannabis, and/or opioid use, Lifetime use of various substances; Class 6 = Alcohol and cannabis primary, Lifetime use of various substances; Class 7 = High past-month polysubstance use.