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Substance use disorders involve a pattern of using drugs more extensively than intended and continuing use despite harmful consequences. This includes legal substances like alcohol and nicotine, as well as illegal drugs. These disorders often involve both physical and psychological dependence, reflecting compulsive use of substances that significantly alter thoughts, feelings, and behaviors, contributing to a major public health issue.
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Polysubstance use disorders among US adults.

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Polysubstance use disorders are common and linked to early substance initiation. Preventing use before age 21 significantly reduces the number of substance use disorders (SUDs).

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Area of Science:

  • Public Health
  • Epidemiology
  • Addiction Medicine

Background:

  • Polysubstance use disorders (≥2 substance use disorders [SUDs]) are a significant public health concern, associated with elevated morbidity and mortality.
  • Understanding the prevalence and risk factors for polysubstance use disorders is crucial for developing effective prevention and intervention strategies.

Purpose of the Study:

  • To estimate the past-year prevalence of polysubstance use disorders in US adults.
  • To examine the association between the age of substance use initiation and the number of SUDs.

Main Methods:

  • Analysis of data from 92,233 adult participants in the 2022-2023 US National Surveys on Drug Use and Health.
  • Utilized multivariable logistic regression and Poisson regression to assess prevalence and associations.
  • Examined age- and sex-adjusted prevalence rates and incidence density ratios (IDRs) for different substance use disorder combinations and initiation ages.

Main Results:

  • The prevalence of 2 SUDs was 19.2-44.9% among adults with any SUD. The prevalence of ≥3 SUDs varied by primary substance, ranging from 16.4% for cannabis use disorder to 48.2-72.0% for methamphetamine, cocaine, or hallucinogen use disorder.
  • Adults initiating substance use at age ≥21 had 73-83% fewer SUDs compared to those initiating before age 18.
  • Initiating alcohol or cannabis between ages 21-29 was associated with a 32% and 21% reduction in moderate-severe SUDs, respectively. Never initiating alcohol, cannabis, or nicotine before age 21 was associated with a 45-62% reduction in SUDs.

Conclusions:

  • Early initiation of substance use, particularly before age 18, is strongly associated with an increased number of polysubstance use disorders.
  • Preventing the initiation of alcohol, cannabis, and nicotine use before age 21 is a critical public health goal to reduce the burden of substance use disorders.
  • Evidence-based strategies targeting prevention of early substance use are essential to mitigate the long-term consequences of polysubstance use disorders.