Simultaneous use of Alcohol, Tobacco and Cannabis in Relation to Severity of Substance Dependence: A Study among Young Swiss Men

Abstract

Objective: This study investigated patterns of the simultaneous use of alcohol, tobacco and cannabis among young polydrug users, and whether use of one substance might be a cue for use of another and associations with the severity of substance dependence. Methods:The study focused on 3 subsamples from the ongoing Swiss Cohort Study on Substance Use Risk Factors (C-SURF, N=5,990). It used 12 months of data on alcohol/tobacco co-users, alcohol/cannabis co-users and tobacco/cannabis co-users (N=2,660, 1,755 and 1,460 respectively. Simultaneous use, numbers of symptoms of substance dependence, and hazardous use of alcohol, tobacco and cannabis were assessed. The effect of simultaneous polydrug use (SPU) on the numbers of symptoms of substance dependence was tested using analysis of variance.Results: Polydrug use was most common as SPU, and less common as non/occasional SPU. Moreover, when participants started to use one substance while using another, the severity of substance dependence was more strongly associated with the triggered substance than with cue. Conclusions:This study highlights the necessity to take SPU into account. First, SPU rather than separate drug use was the most common pattern for polydrug users. Second, frequent SPU was associated with increased numbers of symptoms of substance dependence compared to non/occasional SPU. Furthermore, SPU may reveal the severity of substance use dependence, when substance use is triggered by a cue substance. For these reasons, SPU should be a serious cause for concern for prevention and intervention purposes.

Comorbidity of Symptoms of Alcohol and Cannabis Use Disorders among a Population-Based Sample of Simultaneous Users. Insight from a Network Perspective

“…Focusing on simultaneous users seems crucial for future researches in the addiction field, in both population-based and clinical samples. Clinical trials designed to evaluate substance abuse treatment often exclude multiple drug users, and focus on a single-drug use type [8,41]. Since multiple drug use is common and harmful, it should not been seen as a hindrance in clinical trials [42].…”

“…Compared with the use of alcohol and cannabis separately, the use of both substances on a single occasion is associated with higher levels of substance use, engagement in risky or norm-violating behaviors, and more substance-related problems, such as educational, legal, relational, and health problems [3,4,5,6,7]. Simultaneous alcohol and cannabis use is also likely to increase the severity of alcohol and cannabis use disorders [6,8]. Therefore, simultaneous use should be an important public health concern.…”

“…Data-driven approaches of the comorbidity of alcohol and cannabis use are therefore needed to achieve a better understanding of their relationships and, ultimately, to provide guidance for treatment. Simultaneous users should be at special focus because this is a common pattern of substance use, and because disorders may be strongly interacting when both substances are used on the same occasion [2,8].…”

Does level of attention deficit-hyperactivity disorder symptoms predicts poor transition into adulthood?

“…Focusing on simultaneous users seems crucial for future researches in the addiction field, in both population-based and clinical samples. Clinical trials designed to evaluate substance abuse treatment often exclude multiple drug users and focus on a single-drug use type (8,42). Since multiple drug use is common and harmful, it should not been seen as a hindrance in clinical trials (43).…”

“…Compared with the use of alcohol and cannabis separately, the use of both substances on a single occasion is associated with higher levels of substance use, engagement in risky or normviolating behaviors, and more substance-related problems, such as educational, legal, relational, and health problems (3)(4)(5)(6)(7). Simultaneous alcohol and cannabis use is also likely to increase the severity of alcohol and cannabis use disorders (6,8). Therefore, simultaneous use should be an important public health concern.…”