Severity of stimulant use disorder by psychostimulant type and polystimulant use pattern

Psychostimulant misuse and use disorders are major drivers of morbidity and fatal overdose in the United States, but little is known about how differences in psychostimulant use patterns relate to Diagnostic and Statistical Manual, Diagnostic and Statistical Manual of Mental Disorders, 4th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) stimulant substance use disorder (SUD) profiles. We used nationally representative U.S. data to assess the links between polystimulant use patterns and stimulant SUD prevalence, symptom counts, and DSM-5 stimulant SUD severity. Data were from the 2015-2019 and 2020 National Survey on Drug Use and Health. Participants (n = 282,786) were grouped by past-year psychostimulant use patterns: (a) nonmedical use of prescription stimulants (NUPS) only; (b) cocaine-only; (c) methamphetamine-only; and (d) polystimulant use. Analyses comparing groups used logistic regressions for prevalence of past-year Diagnostic and Statistical Manual of Mental Disorders, 4th edition (2015-2019 and 2020) and DSM-5 (2020 only) stimulant SUD, negative binomial regressions for stimulant SUD symptom counts, and multinomial regressions for DSM-5 stimulant SUD severity. Those with past-year methamphetamine-only or polystimulant use had significantly higher Diagnostic and Statistical Manual of Mental Disorders, 4th edition and DSM-5 prevalence rates, symptom counts, and DSM-5 severities of stimulant SUD than those with NUPS or cocaine use only. Depending on Diagnostic and Statistical Manual of Mental Disorders version, 34%-47% of those engaged in polystimulant use and 48%-54% of those with methamphetamine use only met criteria for a stimulant SUD, versus 9%-17% for NUPS-only and 16%-24% for cocaine-only. For 2020, roughly two thirds of those with methamphetamine-only use had stimulant SUD symptoms. Individuals with methamphetamine and/or polystimulant use may have different service needs than those with NUPS or cocaine use only. (PsycInfo Database Record (c) 2025 APA, all rights reserved).