Polysubstance use in young people accessing residential and day‐treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion

Abstract

Background and Aims People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment. Design Cross‐sectional and prospective study using service and outcome data. Setting Substance use treatment services in Queensland and New South Wales, Australia. Participants De‐identified service and outcome measure data were extracted from the files of 744 clients aged 18–35 years (48% male) admitted into seven residential and four day‐treatment programmes. Measurements Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine‐type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post‐traumatic stress and psychotic symptoms, as well as QoL. Findings Latent class analysis identified three polysubstance use classes: wide‐ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11–1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50–3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day‐programmes had higher odds of completing treatment. Conclusions There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide‐ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.

Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis

“…Studies have used LCA within samples of people who use substances or diagnosed with a SUD to evaluate patterns of association with comorbid SUDs and clinically relevant variables (13,14). Previous studies examined nationally representative samples (15,16) and treatment-seeking populations (17)(18)(19). However, these types of study designs feature limited sample sizes for rare SUDs such as CoUD.…”

A Multi-Level Analysis of Biological, Social, and Psychological Determinants of Substance Use Disorder and Co-Occurring Mental Health Outcomes

“…Additionally, there is a notable prevalence of positive psychotic symptoms and schizophrenia. The connection between mental health and SUDs works both ways, with various mental health symptoms being linked to the use of different clusters of substances to achieve desired effects, such as intoxication, energy, or relief from distress [2].…”

“…The co-occurrence of substance use and psychopathology (dual diagnosis) can be explained by shared risk factors such as socioeconomic status and personality traits [30][31][32]. Many people with SUDs show psychiatric comorbidity, personality, mood, and anxiety disorders [12,[30][31][32][33], especially in cases of poly-drug use, where eating disorders, psychotic symptoms, schizophrenia [2], and PTSD (Post-Traumatic Stress Disorder) [4,34] can also be found; in some cases, the dual diagnosis of SUD and ASD (Autism Spectrum Disorder) is also found [35].…”

“…The substance use disorder spectrum includes both people who use one particular drug and individuals who use and/or abuse more than one, that is, "polysubstance users". Polysubstance use disorders are more difficult to treat than single SUDs and are associated with more serious substance use, mental health, and physical health outcomes [2]. People with wide-ranging polysubstance use are more likely to experience additional clinical complexities than single substance users, including psychosis [2].…”

“…Polysubstance use disorders are more difficult to treat than single SUDs and are associated with more serious substance use, mental health, and physical health outcomes [2]. People with wide-ranging polysubstance use are more likely to experience additional clinical complexities than single substance users, including psychosis [2].…”