Citation

John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu LT. Drug Alcohol Depend. 2018; 187: 79-87.

Affiliation

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC, 27705, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, 302 Towerview Road, Durham, NC, 27708, USA.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2018.01.035

PMID

29635217

Abstract

BACKGROUND: Addressing multiple substance use disorders (SUDs) in primary care-based screening and intervention may improve SUD treatment access, engagement, and outcomes. To inform such efforts, research is needed on the prevalence and patterns of multiple SUDs among primary care patients.

METHODS: Data were analyzed from a sample of 2000 adult (aged ≥ 18) primary care patients recruited for a multisite National Drug Abuse Treatment Clinical Trials Network (CTN) study (CTN-0059). Past-year DSM-5 SUDs (tobacco, alcohol, and drug) were assessed by the modified Composite International Diagnostic Interview. Prevalence and correlates of multiple versus single SUDs were examined. Latent class analysis (LCA) was used to explore patterns of multiple SUDs.

RESULTS: Multiple SUDs were found among the majority of participants with SUD for alcohol, cannabis, prescription opioids, cocaine, and heroin. Participants who were male, ages 26-34, less educated, and unemployed had increased odds of multiple SUDs compared to one SUD. Having multiple SUDs was associated with greater severity of tobacco or alcohol use disorder. LCA of the sample identified three classes: class 1 (83.7%) exhibited low prevalence of all SUDs; class 2 (12.0%) had high-moderate prevalence of SUDs for tobacco, alcohol, and cannabis; class 3 (4.3%) showed high prevalence of SUD for tobacco, opioids, and cocaine. LCA-defined classes were distinguished by sex, age, race, education, and employment status.

CONCLUSIONS: Findings suggest that primary care physicians should be aware of multiple SUDs when planning treatment, especially among adults who are male, younger, less educated, or unemployed. Interventions that target multiple SUDs warrant future investigation.

Copyright © 2018 Elsevier B.V. All rights reserved.

Language: en

Keywords

Cannabis use disorder; Comorbidity; Latent class analysis; Opioid use disorder; Polysubstance; Primary care; Substance use disorder