Transitions in polysubstance use patterns among US adults from 2016 to 2023: a latent transition analysis

Polysubstance use is a major public health concern in the U.S., yet longitudinal examination of patterns and transitions among adults remains limited. Understanding these transitions is important because it can reveal whether substance use patterns persist, escalate, or remit over time. This study aimed to examine polysubstance use patterns (i.e., concurrent use of multiple substances) and their transitions over time.

Data were drawn from Waves 4-7 (2016-2023) of the U.S. Population Assessment of Tobacco and Health Study (N = 10,433 adults). Participants reporting no substance use across all waves were excluded. Examined substance use behaviors included past 30-day cigarettes, e-cigarettes, binge drinking, cannabis, prescription drug misuse, and hard drug use. Latent class analysis identified substance use patterns at each wave, and latent transition analysis estimated transitions between classes over time.

Three latent classes were identified: predominant cigarette use (Class 1), primary binge drinking (Class 2), and polysubstance use (Class 3). Class membership was highly stable across waves, with high probabilities of remaining in same class over time (Class 1: 90.82 %-99.64 %; Class 2: 97.45 %-98.92 %; Class 3: 96.18 %-100.00 %). A notable transition was observed from Class 1 to Class 3 between Waves 5 and 6 (6.22 %), whereas transitions from Class 3 to other classes were infrequent (≤2.40 %).

The substantial stability of substance use patterns among adults suggests that these behaviors may persist once established, highlighting the need for early intervention. Transitions from predominant cigarette use to polysubstance use underscore cigarette use as a key intervention target.